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PHRM 825 > PHRM 825: Gout - Hazbun > Flashcards

PHRM 825: Gout - Hazbun Flashcards

1
Q

What is strongly correlated with gout?

A

Hyperuricemia

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2
Q

Why is there a limit of urate solubility in the blood of humans?

A

Humans lack the enzyme uricase

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3
Q

What serum urate level constitutes hyperuricemia?

A

> or = 6.8 mg/dL

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4
Q

What gets deposited and where is it deposited in someone that has gout?

A

Monosodium urate crystals in synovial fluid or tissue

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5
Q

How does uric acid solubility compare to hypoxanthine or xanthine?

A

Uric acid is ~35 times less soluble than hypoxanthine and ~25 times less soluble than xanthine

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6
Q

What does an increase in PRPP synthetase activity result in?

A

An increase in De Novo synthesis of Purines

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7
Q

What molecules inhibit De Novo synthesis of purines?

A

AMP, IMP, and GMP

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8
Q

What enzyme catalyzes the Purine Salvage Pathway

A

Hypoxanthine-guanine phosphoribosyltransferase (HGPRTase)

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9
Q

What happens with decreased HGPRTase activity?

A
  • Increased hypoxanthine oxidation to uric acid

- Stimulates De Novo synthesis through accumulated PRPP

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10
Q

What is primary gout?

A

Overproduction or decreased secretion of uric acid

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11
Q

What is secondary gout?

A

Uric acid increases due to cell death and lysis, releasing nucleic acid

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12
Q

What causes primary gout?

A
  • Ethanol
  • Foods high in purines
  • Obesity
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13
Q

What causes secondary gout?

A
  • Chemotherapeutic agents
  • Myelo-and lymphoproliferative disorders
  • Polycythemia vera and anemia
  • Psoriasis
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14
Q

What joint is commonly involved in gout?

A

First metatarsophalangeal joint

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15
Q

What is podagra?

A

Gout involving first metatarsophalangeal joint; ‘the great toe’

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16
Q

When does gouty arthritis occur?

A

When aggregation of MSU crystals (tophi) over several years of recurrent acute attacks

17
Q

What is tophi?

A

Deposits of monosodium urate in cartilage, tendons, synovial membranes, and elsewhere

18
Q

What is the gold standard for diagnosing gout?

A

VIsualization of urate crystals from the joint or tophi through aspiration

19
Q

What is uric acid nephrolithiasis?

A
  • Acidic urine, uric acid is less soluble and risk of stone formation
  • 10-25% of patients with gout
  • More common when urine pH < 6
  • Long-term complication of gout
20
Q

What is tophaceous gout?

A
  • Late complication of gout
  • Base of great toe, helix of ear, bursae, achilles, knee, wrists, and hands
  • Joint destruction, pain, and nerve compression syndrome
  • Long-term complication of gout
21
Q

What is acute gouty nephropathy?

A
  • Urine flow is blocked by precipitation of uric acid crystals in collecting ducts and ureters
  • Acute renal failure can ensue
  • Common with ALL, CLL, and CML patients
22
Q

What is chronic gouty nephropathy?

A
  • Long-term deposition of urate crystals within the renal system
  • Proteinuria may occur
  • Often associated with HTN, DM, and atherosclerosis
23
Q

What 3 immunosuppressants are used to treat gout?

A
  • Colchicine
  • NSAIDs
  • Corticosteroids
24
Q

What medications treat gout by reducing serum urate levels?

A
  • Uricosuric agents

- Xanthine oxidase inhibitors

25
Q

What is the MOA of allopurinol?

A

Inhibits the synthesis of uric acid by inhibition of xanthine oxidase

26
Q

What is allopurinol an isomer of?

A

Hypoxanthine

27
Q

When is Feboxustat advantageous?

A
  • Patients with allopurinol hypersensitivity
  • Patients with reduced kidney function
  • Patients not responding to high doses of allopurinol
28
Q

What is the MOA of Febuxostat?

A

Non-purine inhibitor of Xanthine Oxidase

29
Q

When is Pegloticase contraindicated?

A

In patients with G-6-P dehydrogenase deficiency

30
Q

What is the MOA of Pegloticase?

A

Uricase oxidizes uric acid to allantoin (soluble and more easily excreted)

31
Q

What is the MOA of Rasburicase?

A

Enzyme that catalyzes oxidation of uric acid to allantoin (soluble and more easily excreted)

32
Q

What is the MOA of Lesinurad?

A

Selective uric acid reabsorption inhibitor that blocks the URAT1 transporter

33
Q

What is the target serum uric acid concentration when gout is treated?

A

< 6 mg/dL

PHRM 825 (36 decks)

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