Week 10 - Gout Flashcards
what is gout
- disorder caused by accumulation of uric acid crystals in one or more joints
what are 3 causes of gout
- increased uric acid production
- underexcretion of uric acid by the kidneys
- increased intake of foods containing purines, which are metabolized to uric acid in the body
what 2 things can cause decreased excretion of uric acid
- prolonged fasting
- excessive alcohol
bc of increased production of keto acids which inhibit uric acid excretion
what is a type of food that is purine rich
- red meats
what are risk factors for gout (7)
- male
- genetic
- middle age
- obesity
- HTN, diuretic use
- excessive alcohol consumption
- diet high in purine rich foods
what is primary gout
- a hereditary error of purine metabolism = overproduction or retention of uric acid
what is secondary gout
- may be related to another acquired disorder
what is uric acid the major end project of
- purine catabolism
how is uric acid primarly excreted
- by the kidneys
symptoms of gout follow what type of pattern
- long periods of remiision
- then sudden flare ups
what part of the body is gout commonly found in
the big toe
- small joints
what is the acute phase of gout characterized by
- gouty arthritis (painful, inflamed joints) that may occur in one or more joints, but usually less than 4
describe the duration of acute gout attackd
- peak at 12-24 hrs after onset
- then begin to resolve
what is chronic gout characterized by
- multiple joint involvement
- visible deposits of sodium urate crystals called tophi
what is chronic relapsing gout attacks termed
chronic tophaceous gout
what are tophi? what do they cause
- visible deposits of sodium urate crystals
- significant joint deformity & destruction
what is a risk associated w large and unsightly tophaceous deposits
- can perforate overlying skin
= draining sinuses that become secondarly infected
what are 4 types of treatment for gout
- drug therapy
- weight reduction
- avoidance of alcohol & foods high in purine
- prevention of uric acid kidney stones & associated conditions like HTN and hypertriglyceridemia
what is one class of meds used for gout
- xanthine oxidase inhibitor
what is a type of xanthine oxidase inhibitor
- allopurinol
what is the drug of choice for chronic thopaceous gout
- allopurinol
what is the MOA of allopurinol
- inhibits the enzyme xanthine oxidase (which is required to form uric acid)
= uric acid not made
what is the effect of allopurinol
- reduced uric acid blooc lvls
= can prevent new tophi from forming & reduce the size of current tophi
what are the side effects of allopurinol (2)
- well tolerated w few side effects
- may initially cause more gout attacks
what should pts be taught regarding therapy w allopurinol
- stay on therapy
- may take NSAIDs to prevent or treat attacks
