Gout

Question 1

Gout

Answer 1

inflammatory disorder characterized by

1) Hyper uricemia (high levels of blood urate)

2) Gout flares (severe joint pain episodes from crystal deposition)

Question 2

Hyperuricemia occurs from 2 things

Answer 2

1) Excessive production of uric avid

2) Impaired renal excretion of uric acid

Question 3

Acute Gout Flares (acute gout attacks)

Answer 3

Pain and swelling in a joint
- common at base of big toe

Question 4

Chronic hyperuricemia

Answer 4

large deposits (tophi) form in infected joint
- early detection can be arrested

Question 5

acute gout flare cause

Answer 5

neutrophil inside synovial joint,
phagocytosis monosodium urate crystals (MSU crystals)

Neutrophils break down and release destructive lysosomal enzymes

Question 6

2 ways gout drugs work

Answer 6

1) Short-term relief of gout flares

2) long-term to lower uric acid blood levels

Question 7

Drug for Acute Gout Flare-ups that occur less than 2x /year

Answer 7

NSAIDs first choice

Glucocorticoids

Question 8

Hyperuricemia (flareups more than 2x /year
3 types of drugs

Answer 8

1) decrease uric acid production

2) increase uric acid excretion

3) convert uric acid to allantoin

Question 9

Glucocorticoids pharmacokinetics

Answer 9

PO, IM
- highly effective at relieving gout flares (NSAIDs generally preferred)

• Used If patient is hypersensitive to NSAIDs
• gout that is unresponsive to NSAIDs

Question 10

Glucocorticoids drug

Answer 10

Colchicine

Question 11

Colchicine Therapeutic use

Answer 11

high doses provide dramatic relief of flares

Question 12

mechanism of colchicine

Answer 12

prevents microtubule assembly of inflammatory cells
= prevents cell division

prevents neutrophil migration

reduces inflammation by inhibiting neutrophils

Question 13

colchicine adverse effects (4)

Answer 13

1) hazardous to other cells undergoing cell division as it prevents microtubule assembly
2) GI effects
3) Myelosuppression: bone marrow suppression
4) Myopathy: skeletal muscle disorder

Question 14

Colchicine drug interaction

Answer 14

Statins - increase colchicine induced muscle injury

Drugs that inhibit P450 enzymes
= reduced metabolism colchicine
= increased microtubule effect

Question 15

Drugs for Hyperuricemia (flare-ups more than 2x/year)

3 types of drugs

Answer 15

1) decrease uric acid production: Allopurinol

2) Increase uric acid excretion: Probenecid

3)Convert uric acid to allantoin: Pegloticase

Question 16

Drug that blocks uric acid production

Answer 16

Allopurinol

Question 17

Allopurinol mech

Answer 17

XO: enzyme for uric acid formation

Allopurinol inhibits XO

Question 18

Allopurinol therapeutic uses

Answer 18

increase ULT
Increases joint function

Question 19

adverse effects allopurinol

Answer 19

• nausea, vomiting, headaches
• prolonged use (3 year) may cause cataracts
• serious effects: bone marrow suppression

Question 20

Allopurinol drug interaction

Answer 20

can inhibit P450

• delay inactivation of other drugs
• Warfarin is a major concern

Question 21

Drug converts uric acid to Allantoin

Answer 21

Pegloticase

Question 22

Pegloticase mechanism

Answer 22

drug recombinant form of urate oxidase
- an enzyme that catalyzes the conversion of uric acid into allantoin

Question 23

Pegloticase therapeutic use

Answer 23

IV for chronic gout that don’t respond to PO

Drug very expensive