Gout Flashcards
Pathophysiology of Gout?
Caused by a buildup of uric acid crystals in the joint. Uric acid is the end product of purine metabolism which is present in many food and is a building block of DNA
What is the normal serum concentration of uric acid?
2 - 6.5 mg/dL in females
3.5 - 7.3 mg/dL in males
Where does Gout usually occur?
Typically in 1 joint, most often in big toe (metatarsophalangeal joint)
How can you diagnose Gout?
Serum level
A sample of synovial joint fruit to look for uric acid contains
What are some foods to avoid in Gout patients?
Organ meats
High-fructose corn syrup
Alcohol
At what point is drug treatment appropriate in Gout patients?
Symptomatic
UA level > 6mg/dL
What drugs are used in the treatment of acute Gout pain?
Colchicine
NSAID
Steroids
What are some drugs which can increase the occurrence of Gout attacks?
- Aspirin
- Diuretics (loop and thiazides)
- Niacin
- Pyrazinamide
- Calcineurin inhibitors (tacrolimus and cycloporine)
- Chemo drugs
- Select pancreatic enzyme products
Which NSAIDS can be used in the treatment of Gout?
Indomethacin
Naproxen
Sulindac
Colchicine sig
Treatment dose:
1.2mg (two 0.6mg tabs) PO followed by 0.6mg (one tab) in 1 hour
max: 1.8mg in one hour or 2.4mg/day
Prophylaxis dose:
0.6mg once or twice daily
Which Steroids can be used in the treatment of Gout?
Prednisone
Methylprednisolone
What are prophylactic drugs in the treatment of Gout?
Xanthine oxidase inhibitors (XOIs)
- Allopurinol
- Febuxostat
Colchicine ADE
Diarrhea Nausea Myelosuppression Myophathy Neuropathy
True or False: If patient has experienced 1 episode of Gout pain, prophylactic drugs should be started.
True
If Xanthine oxidase inhibitors (XOIs) are not tolerated, what other agent can be used for prophylactic treatment of Gout?
Probenecid
What drugs should also be used when starting prophylactic treatment of Gout?
Colchicine or NSAID should be used for the first 3 to 6 months due to high rate of gout attack when beginning prophylactic treatment
Xanthine oxidase inhibitors (XOIs) warning, ADE
Hypersensitive reaction (rash like SJS/TEN) Hepatotoxicity
Nausea
How can Tumor Lysis Syndrome can cause an acute Gout attack?
Tumor Lysis Syndrome is an acute, potentially life threatening complication of some types of chemotherapy.
It causes the breakdown of purines and therefore the increase in uric acid.
