Week 10 - Gout

Question 1

what is gout

Answer 1

• disorder caused by accumulation of uric acid crystals in one or more joints

Question 2

what are 3 causes of gout

Answer 2

• 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

Question 3

what 2 things can cause decreased excretion of uric acid

Answer 3

• prolonged fasting
• excessive alcohol

bc of increased production of keto acids which inhibit uric acid excretion

Question 4

what is a type of food that is purine rich

Answer 4

• red meats

Question 5

what are risk factors for gout (7)

Answer 5

• male
• genetic
• middle age
• obesity
• HTN, diuretic use
• excessive alcohol consumption
• diet high in purine rich foods

Question 6

what is primary gout

Answer 6

• a hereditary error of purine metabolism = overproduction or retention of uric acid

Question 7

what is secondary gout

Answer 7

• may be related to another acquired disorder

Question 8

what is uric acid the major end project of

Answer 8

• purine catabolism

Question 9

how is uric acid primarly excreted

Answer 9

• by the kidneys

Question 10

symptoms of gout follow what type of pattern

Answer 10

• long periods of remiision

- then sudden flare ups

Question 11

what part of the body is gout commonly found in

Answer 11

the big toe

- small joints

Question 12

what is the acute phase of gout characterized by

Answer 12

• gouty arthritis (painful, inflamed joints) that may occur in one or more joints, but usually less than 4

Question 13

describe the duration of acute gout attackd

Answer 13

• peak at 12-24 hrs after onset

- then begin to resolve

Question 14

what is chronic gout characterized by

Answer 14

• multiple joint involvement

- visible deposits of sodium urate crystals called tophi

Question 15

what is chronic relapsing gout attacks termed

Answer 15

chronic tophaceous gout

Question 16

what are tophi? what do they cause

Answer 16

• visible deposits of sodium urate crystals

- significant joint deformity & destruction

Question 17

what is a risk associated w large and unsightly tophaceous deposits

Answer 17

• can perforate overlying skin

= draining sinuses that become secondarly infected

Question 18

what are 4 types of treatment for gout

Answer 18

• drug therapy
• weight reduction
• avoidance of alcohol & foods high in purine
• prevention of uric acid kidney stones & associated conditions like HTN and hypertriglyceridemia

Question 19

what is one class of meds used for gout

Answer 19

• xanthine oxidase inhibitor

Question 20

what is a type of xanthine oxidase inhibitor

Answer 20

• allopurinol

Question 21

what is the drug of choice for chronic thopaceous gout

Answer 21

• allopurinol

Question 22

what is the MOA of allopurinol

Answer 22

• inhibits the enzyme xanthine oxidase (which is required to form uric acid)
  = uric acid not made

Question 23

what is the effect of allopurinol

Answer 23

• reduced uric acid blooc lvls

= can prevent new tophi from forming & reduce the size of current tophi

Question 24

what are the side effects of allopurinol (2)

Answer 24

• well tolerated w few side effects

- may initially cause more gout attacks

Question 25

what should pts be taught regarding therapy w allopurinol

Answer 25

• stay on therapy

- may take NSAIDs to prevent or treat attacks