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Skeletal Muscle > Gout PCOL Sharpe > Flashcards

Gout PCOL Sharpe Flashcards

1
Q

Which patients have a greater incidence of gout? (select all)

A. Obese patients

B. Male gender patients

C. Older patients

D. Female gender patients

E. Patients with decreased levels of serum urate

A

A, B, C

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2
Q

What foods or beverage will potentially increase incidence of gout? (Select All)

A. Rice

B. Alcohol

C. Fish

D. Vegetables

E. Meat

A

B, C, E

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3
Q

All of these factors lead to overproduction of Uric Acid except

A. Purine metabolization

B. Increased breakdown of tissue nucleic acids

C. Excessive dietary purines

D. Enzyme abnormalities

E. Decreased kidney function

A

E

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4
Q

What does the term “Denovo” mean in terms of uric acid in the body?

A. Refers to the consumption of urates that lead to increased levels in the blood stream.

B. Referse to the production of uric acid within the body.

A

B

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5
Q

Which of these can cause an increase in breakdown of tissue nucleic acids?

A. Myeloprloiferative disorders

B. Lymphoproliferative disorders

C. Cytotoxic drugs

D. All of the above

A

D

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6
Q

Which of the following factors leads to hyperuricemia? (select all)

A. Endogenous purine synthesis

B. Tissue nucleic acid breakdown

C. Over-excretion of uric acid

D. Dietary purines

E. Underexcretion of uric acid

A

A, B, D, E

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7
Q

What other clinical manifestations can be present in Gout? (Select All)

A. Tophi deposits

B. Constipation

C. Nephrolithiasis

D. Chronic Urate Nephropathy

E. Acute arthritis

A

A, C, D, E

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8
Q

How are Tophi deposits caused?

A. An inflammation of the joint due to pannus formation

B. Uric acid crystalize and deposit in the joints and causes damage, deformity to surrounding tissue.

C. Worn cartilage causes inflammation and attracts uric acid

D. None of the above

A

B

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9
Q

What are some non-pharmacologic treatments of gout? (Select All)

A. Diet higher in proteins

B. Diet consisting of liver and sweet breads.

C. Diet lower in sweetbreads and liver

D. Decreased alcohol consumption

E. Physlical activity, wegith loss, rest

A

C, D, E

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10
Q

Which medications for gout treatment are used to Terminate Acute Attacks? (Select All)

A. Xanthine Oxidase inhibitors

B. Corticosteroids

C. Uricosurics

D. Colchicine

E. NSAIDs

A

B, D, E

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11
Q

T/F Gout is a type of arthritis that is associated with hyperuricemia

A

T

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12
Q

Metabolism of ____ bases will lead to the formation of uric acid in the blood and increase the incidence of gout.

A. Purine

B. Pyrimidne

A

A

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13
Q

T/F Purine bases can come from cell breakdown and dietary intake

A

T

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14
Q

Based on the picture provided lable the boxes in the appropriate order from top to bottom:

I. Purine base

II. Xanthine

III. Hypoxanthine

IV. uric Acid

A. I, II, III, IV

B. I, III, II, IV

C. I, IV, III, II

D. II, I, III, IV

A

B

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15
Q

What enzyme is responsible for converting Hypoxanthine to Xanthine and Xanthine to Uric Acid?

A. MAO

B. CYP2C19

C. Xanthine Oxidase

D. UGT

A

C

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16
Q

Why do cancer patients have an increased chance of developing hyperuricemia?

A. Cytotoxic medications (chemo) that kills cells in the body

B. Increased Xanthine oxidase sensitivity

C. Higher levels of dietary intake of purines

D. Cancer naturally produces more uric acid than normal patients

A

A

Cytotoxic drugs destroy cells and cause them to break down. Cancer patients taking these medications or undergoing therapies will have more cell destruction and lead to more purines in the body.

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17
Q

Which of the following statements is true regarding Uric Acid solubility?

A. A drop in body temperature will lead to a decreased solubility.

B. An increase in pH will cause a decrease in solubility of uric acid.

C. An increase in body temperature will increase uric acid solubility.

D. A decrease pH will decrease solubility of uric acid

A

A,C, D

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18
Q

T/F Areas such as the big toe and ear are at an increased risk of developing uric acid crystalization due to lower body temperatures in those areas

A

T

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19
Q

What is the purpose of URTA1 transporters in the kidney?

A. Reabsorption of Uric acid back into the blood

B. Excretion of uric acid in the urine

C. Chemically eliminates uric acid from the body

D. Allows crystallized uric acid to pass through the tubules and into the urine.

A

A

20
Q

Hyperuricemia will lead to crystal deposition in the organs of the body and cause inflammation. The inflammation is caused by all of the following except:

A. Cytokine Release

B. Vasodilation

C. Influx of Polymorphonuclear

D. Vasoconstriction

A

D

21
Q

What are risk factors of gout (Sharpe)? (Select All)

A. Age

B. Female gender

C. Hyperuricemia

D. Obesity and Insulin resistance

E. Male gender

A

A, C, D, E

22
Q

Which of these risk factors could possibly bring about a gout attack?

A. Stress and trauma

B. Consumption of high purine foods

C. Aspirin and alcohol

D. Cytotoxic drugs and diuretics

E. All of the above

A

E

23
Q

(Short Answer) How does alcohol cause an increased risk of gout?

A

Dehydration: Alcohol causes dehydaration and decreases blood volume. This increases the concentration of uric acid in the blood and it will crystalize more easily as a result.

Elimination: Will impair elimination of uric acid from the body.

24
Q

Patients are at a higher risk of uric acid nephrolithiasis if their urine is at a ____ pH

A. Higher

B. Lower

A

B

25
Q

Gouty Nephropathy is often co-morbid with which of these health conditions? (Select All)

A. Hypertension

B. Diabetes

C. Parkinsons

D. Chrone’s disease

E. Atherosclerosis

A

A, B, E

26
Q

Which NSAID is not used in the treatment of gout?

A. Ibuprofen

B. Naproxen

C. Indomethacin

D. Aspirin

A

D

27
Q

What is the MOA of corticosteroids in the treatment of gout. (Select All)

A. Decreases production of uric acid

B. Decreases PMN migration and vasodilation

C. Inhibition of COX-2 and PGA2

D. Immune suppression

E. Decreases monocytes and TNF-a and IL-1

A

B, C, D, E

28
Q

All of the following are side effects of corticosteroids EXCEPT:

A. Adrenal insufficiencey with abrupt discontinuation of drug

B. Hyperglycemia

C. Anemia

D. Increased energy/insomnia

A

C

29
Q

All of the following statments are true regarding colchicine except:

A. Does not have any analgesic or uric acid production effects

B. Decreases IL-1B production

C. Has a large therapeutic window

D. Narrow therapeutic window

E. Must initiate within 24 hours of 1st symptoms.

A

C

30
Q

T/F Colchicine therapy can be continued during slight toxcicities such as signs of GI side effects.

A

F

Colchicine should be discontinued at first signs of any GI side effects

31
Q

Which of these medications is used to lower circulating Uric acid for prevention?

A. Corticosteroids

B. NSAIDs

C. Allopurinol

D. Probenecid

E. Febuxostat

A

C, D, E

32
Q

T/F Drugs that lower uric acid levels and prevent future gout flare-ups are also meant to provide pain relief.

A

F

They are only meant to maintain and are not meant to relieve pain. They are also not meant to stop an acute gout attack

33
Q

Which of the following medications will stop an acute gout attack? (Select All)

A. Colchicine

B. Allopurinol

C. NSAIDs

D. Corticosteroids

E. Febuxostat

A

A, C, D

34
Q

What is the MOA of allopurinol?

A. Decreases inflammation of the affected joint

B. Competitive inhibitor of Xanthine Oxidase (acts as an alternative substrate).

C. Serves as a powerful antipyretic for severe pain associated with gout flare-ups

D. MOA is unknown

A

B

35
Q

T/F Febuxostat is less of a concern in patients with kidney problems in comparison to patients on Allopurinol

A

T

Allopurinol creates a metabolite called Oxypurinol that can accumulate in the kidneys and become toxic.

36
Q

Which of the following statements is true regarding allopurinol?

A. Creates a metabolite called Oxypurinol

B. Metabolite can cause toxicity as it accumulates in the kidneys

C. Must be renally adjusted in patients with renal impairment and dysfunction

D. All of the above

A

D

37
Q

Which of these drugs can you not use with allopurinol? (Select All)

A. Indomethacin

B. Mercaptopurine

C. Azathioprine

D. Colchicine

E. Theophylline

A

B, C, E

The reason why is because those drugs are metabolized by xanthine oxidase and so is allopurinol. If they are metabolized by xanthine oxidase then they will be metabolized as well and keep the allopurinol levels elevated in the blood, causing toxicity.

38
Q

What are the side effects of Xanthine Oxidase inhibitors?

A. Skin rash (Stevens-Johnson)

B. HTN

C. Nausea

D. Hepatotoxicity

E. Stroke

A

A, C, D

39
Q

What is the MOA of Probenicid?

A. Competitively inhibits the reabosorption of uric acid at the Proximal Convoluted Tubule by blocking URAT1

B. Competitively inhibits xanthine oxidase

C. Reduces inflammation

D. Inhibits chemotaxis of monocytes

A

A

40
Q

(Short Answer) How does probenecid increase the risk of developing nephrolithiasis?

A

The drug doesn’t allow uric acid to be reabsorbed because it inhibits the

41
Q

What are the adverse effects of probenecid? (Select All)

A. GI irritation

B. Blurry vision

C. Hypersensitivity reactions (rash)

D. Increased risk of nephrolithiasis

A

A, C, D

42
Q

Which of the following statements is true regarding probenecid?

A. Aspirin can reduce probenecid efficacy

B. Can inhibit renal secretion of drugs

C. Contraindicated in patients with history of nephrolithiasis and existing renal disease

D. All of the above

A

D

43
Q

What is the mechanism of action of Pegloticase?

A. Inhibits Xanthine Oxidase

B. Converts Uric acid to Allantoin in order increase solubility and prevent crystallization

C. Inhibits URAT1 in the kidneys

D. Decreases inflammation by reducing chemotaxis

A

B

44
Q

T/F Patients must be premedicated with antihistamines or corticosteroids before administering Pegloticase.

A
45
Q

T/F Gout flare-ups are likely to occur when you first use Pegloticase so it is recommended to use it in conjunction with NSAIDs or Colchicine

A

T

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