gout Flashcards
gout (gout is pure crystal)
Gout : is a disorder of purine metabolism that is characterized by the deposition of sodium urate crystals in articular, periarticular (tissues around the joint) and subq tissue.
GOUT: CLASSIFICATION - primary (Men vs. women, age, and history?)
Primary:
Most common gout
Middle aged men – 90%
25% have (+) family history
In women onset is post-menopausal
GOUT: CLASSIFICATION - secondary (and age groups?) (gout knows no boundaries)
Related to other disorders or meds
Affects people of all ages
PRIMARY GOUT: ETIOLOGY
Problem with purine metabolism
End product of purine metabolism is uric acid
Uric Acid accumulates in the blood and deposits in synovium and other tissues.
↑ serum uric acid levels = Hyperuricemia
HYPERURICEMIA - what causes it? (too much, can’t get it out, food)
is a biochemical abnormality that could be due:
Impaired renal excretion of uric acid
Over production /biosynthesis of uric acid
“over- consumption of food rich in purine”?
All patients with gout have hyperuricemia.
ACUTE GOUT: CLINICAL MANIFESTATION - when does it peak?
Acute onset of swelling and pain in affected joints.
Peaks in several hours
CHRONIC GOUT - tophi in what % of pts?
Tophi in 30% of pt’s
GOUT: DIAGNOSTICS - are uric acid levels usually high?
Single uric acid levels are normal in 25% -50% of acute gout attacks.
GOUT: MEDICAL MANAGEMENT - no what?
Anti-Inflammatory meds:
NSAIDS (Indocin, Motrin) Tx of choice. Anti-inflammatory medication & Analgesic
NO Aspirin-inhibits uric acid secretion
HOW TO PREVENT FUTURE GOUTY ATTACKS - what foods?
Avoid foods that are high purine that can precipitate a gout attack:
.
ETOH (beer, alcohol)
All meats and seafood
\
Probenicid - MOA
Can increase uric acid excretion
Allopurinol (Zyloprim) (Block ALL uric acid)
blocks the production of uric acid
can control serum levels to prevent renal stones.
Febuxostat - (Ted is Flumoxed)
New drug
xanthine oxidase inhibitor approved by the FDA in 2009
Reduces serum uric acid levels
second-line therapy
New research (Phase 3Trials)
secondary gout - causes (Ted - door)
DM
ETOH
HTN
Cancer
Sickle cell
chemotherapeutic agents
The higher the uric acid level, the earlier the appearance of
tophi