Gout

Question 1

gout is the deposition of what ind of crystals in the joints? when these crystals are deposited into the connective tissue, what is the disorder called?

Answer 1

monosodium urate; tophi

Question 2

what are the two pt demographics in which gout is most common?

Answer 2

elderly men and post menopausal women

Question 3

True or False: hypercholesterolemia is a risk factor for gout.

Answer 3

true – the others include obesity, HTN, renal dysfunction; alcohol excess and dehydration and drugs

Question 4

which two drugs commonly taken are known to be risk factors for gout?

Answer 4

salicylates and diuretics

Question 5

the ddx for gout includes pseudo gout - one difference is in the crystals - what are they made out of with pseudo gout?

Answer 5

calcium pyrophosphate dihydrate

Question 6

an increase is what type of foods can lead to the development of gout?

Answer 6

increased intake of purine rich food

Question 7

true of false: a majority of hyper-uremic patients will eventually develop gout?

Answer 7

false

Question 8

true or false: typically multiple joints are involved in the first episode of gout.

Answer 8

false; it’s typically only one joint that is involved

Question 9

in elderly pple with advanced disease, the fingers may be involved in early manifestations of gout - what are bouchard’s nodules? who is their parter in crime?

Answer 9

B - nodes on the distal joints vs. Heberden’s nodes which are nodes on the proximal joints

Question 10

the first attack of gout can present as warm, red and tender - this often makes it easy to confuse with what?

Answer 10

cellulitis

Question 11

a medical term for a tiny collection of immune cells known as macrophages.

Answer 11

granuloma - form when the immune system attempts to wall off substances that it perceives as foreign but is unable to eliminate.

Question 12

what is chronic tophaceous gout often confused with?

Answer 12

RA

Question 13

true or false: uric acid levels may be low or normal during an acute attack of gout

Answer 13

True

Question 14

+ or - birefringement fo gout?

Answer 14

negative

Question 15

what is the DOC for treatment of acute phase of gout? what is recommended as a safer CVS profile?

Answer 15

indomethacin; naproxen

Question 16

what is the recommended dosage for indomethacin?

Answer 16

25-50 mg POx3/day

Question 17

what is the gout drug that must be tapered in use and is safe for patients with peptic ulcer disease?

Answer 17

colchicine

Question 18

what is the recommended dosage for colchicine?

Answer 18

.6 mg PO every 8 hours

Question 19

what is the recommended dosage for prednisone for gout patients?

Answer 19

26-50 mg PO

Question 20

what is the drug used to treat gout in patients who are under-excreters? what class of gout drug is it?

Answer 20

probenecid (uricosuric agent)

Question 21

what is the one caveat patients must adhere to when taking the medication probenecid?

Answer 21

must maintain urine volume by ingesting 1500 ml of water daily

Question 22

what is the xanthine oxidase inhibitor that is used to treat gout?

Answer 22

allopurinol

Question 23

what type of patients is the drug allopurinol best to treat?

Answer 23

overproducers of uric acid

Question 24

what is the recommended dose of allopurinol?

Answer 24

100 to 300 mg PO

Question 25

a rare, life-threatening skin condition that is usually caused by a reaction to drugs. The top layer of skin (the epidermis) detaches from the lower layers of the skin (the dermis) all over the body.

Answer 25

TEN (toxic epidermal necrolysis) - associated with allopurinol toxicity

Question 26

which anti HTN med is contraindicated with allopurinol? why?

Answer 26

thiazides b/c they lead to hyperuricemia (b/c they compete for the same secretion transporter on uric acid) and also contribute to allopurinol toxicity.