Gout

Question 1

Gout is a disorder of ________ causing _______ to crystallize in joints and tendons.

Answer 1

Gout is a disorder of purine metabolism causing uric acid to crystallize in joints and tendons.

Question 2

What are the deposits of monosodium urate crystals called and where are they commonly found?

Answer 2

Tophi

Fingers, ear

Question 3

What are the uric acid promoting drugs?

Answer 3

Aspirin

Diuretics: thiazide, loop

Question 4

What dietary habits are gout associated with?

Answer 4

Alcohol
Fructose-sweetened drinks
Meat
Seafood

Question 5

What drugs are used to treat acute gout attacks?

Answer 5

NSAIDs
Steroids
Colchicine

Question 6

What drugs are used for prophylactic treatment?

Answer 6

Colchicine
Allopurinol
Probenecid

Question 7

What is the first line treatment for gout?

Answer 7

NSAIDs

Tx for 1-2 weeks

Question 8

Indomethacin
Cat:
Ind:
MOA:

Answer 8

Indomethacin
Cat: NSAID
Ind: Gout, arthritis, bursitis, migraine
MOA: COX-1 (affects mostly the mucosa in stomach) and COX-II inhibition

Question 9

Indomethacin/Indocin

SE

Answer 9

Bleeding, gastritis, PUD, exacerbate HTN or CHF

Question 10

Indomethacin/Indocin CI

Answer 10

Caution: preexisting renal/liver disease, pts with hx of asthma and nasal or sinus polyps

CI: Hx of allergy to NSAID,

Question 11

What is Samter’s triad?

Answer 11

Asthma, Aspirin and NSAID sensitivity and nasal/ethmoidal polyposis

Question 12

Cortisone injection
Cat:
Ind:
MOA:

Answer 12

Cortisone injection
Cat: Steroid
Ind: Short term pain relief, reduce swelling from inflammation
MOA: decreases inflammation by inhibiting pro-inflammatory proteins

Question 13

Cortisone SE

Answer 13

Hyperglycemia, insulin resistance, DM, Osteoporosis, anxiety, depression, amenorrhea, cataracts and glaucoma

Question 14

Colchicine
Cat:
Ind:
MOA:

Answer 14

Colchicine
Cat: Mitotic inhibitor
Ind: Gout (acute and prophylaxis)

Question 15

Colchicine

MOA

Answer 15

MOA: INHIBITS MICROTUBULE POLYMERIZATION BY BINDING TO TUBULIN (inhibits mitosis) also inhibits neutrophil motility and activity = antiinflammatory

Question 16

Colchicine

SE

Answer 16

PERIPHERAL NEUROPATHY
GI upset
anemia
neutropenia
hair loss

Overdose: vomiting, diarrhea, acute renal failure, hypovolemic shock

Question 17

Allopurinol/Zyloprim
Cat:
Ind:
MOA:

Answer 17

Allopurinol/Zyloprim
Cat: Purine analog
Ind: Hyperuricemia, gout, prophylaxis against tumor lysis syndrome
MOA: Xanthine oxidase inhibitor

Question 18

Allopurinol/Zyloprim

SE:

Answer 18

N/V
Rash
SJS (Stevens-Johnson Syndrome)
Hepatitis
Decreased renal function

Question 19

What are uricosurics?

Answer 19

Substances that increase the excretion of uric acid in the urine, reducing the concentration of uric acid in the plasma.

Question 20

Probenecid/Probalan
Cat:
Ind:

Answer 20

Probenecid/Probalan
Cat: Uricosuric
Ind: Hyperuricemia, gout

Question 21

Probenecid/Probalan MOA

Answer 21

Interfers with OAT (organic anion transporter) which reclaims uric acid from the urine and returns it to the plasma = increased urinary excretion of uric acid

Question 22

Probenecid/Probalan SE

Answer 22

GI upset, gastritis, N/V, anemia, leukopenia, hemolytic anemia (pts with G6PD def)

EXACERBATION OF GOUT FOLLOWING THERAPY

MAY CAUSE FORMATION OF URIC ACID RENAL STONES