Week 3 Endocrine Flashcards
T/F: Gout is more common in men than women?
True
Prevalence increases with age, >65
Gout considered a musculoskeletal disorder or metabolic disorder?
Both
Metabolic disorder b/c of purine metabolism
Musculoskeletal disorder b/c monosodium urate crystal deposition in and around joints.
What are some risk factors of Gout?
- Positive Family History
- Older Age
- Male
- Overweight
- Other chronic conditions (CKD, Hypothyroidism, Infections)
- Post-surgery
- Some Medications (E.g. Diuretics, low dose ASA)
- Alcohol
Etiology of Gout: Primary vs Secondary
Primary - High levels of uric acid result from either increased production or decreased excretion rates of uric acid
Secondary - Hyperuricemia results from primary disease processes such as HTN, HF, kidney disorders.
What medications can induce hyperuricaemia or gout?
Diurectics, ASA, ETOH, nicotinic acid, ethambul (anti-TB), pyrazinamide (anti-TB).
Drugs raise serum uric acid level by increasing uric acid reabsorption and/or decreasing uric acid secretion in gout.
Adequate hydration and routine uric acid level monitoring should be encouraged for drugs known to induce hyperuricaemia.
Drugs are FACT
- Furosemide
- Aspirin, alcohol
- Cyclosporin
- Diurectics (loop diuretics, thiazide diuretics and thiazide-like diuretics)
Pathophysiology of Gout
Uric acid can be obtained from the diet or made endogenously by xanthine oxidase, which converts xanthine to uric acid
An excess of uric acid results in hyperuricemia
Uric acid can deposit in the skin/subcutaneous tissues (tophi), synovium (microtophi), and kidney, where they can crystalize to form monosodium urate crystals that lead to gout
Uric acid crystals trigger an inflammatory response
Stages of Gout - initial phase:
Acute gouty arthritis
-sudden onset; maximal severity of the flare reached within 12-24 hours
-attack will subside spontaneously within 5-10 d; may recur
-red, hot, painful to touch, swollen
Stages of Gout - in between phase:
Intercritical gout (period without flares)
*pain free
Stages of Gout - chronic phase:
Chronic/tophaceous gout
*progression of gout has been inadequately treated resulting in urate crystal deposits (tophi) in the joints that can cause deformity and disability of the joint
Onset of gout flares at night or during the daytime?
night time
What joint is normally affected?
Base of great toe metatarsophalangeal joint or knee
*initial normally affects single joint (80%)
*polyarticular flares (20%) of initial flares with increased reoccurrence with untreated gout
What is the difference btwn gout flare and cellulitis?
limited mobility with gout
mobility is preserved with cellulitis unless infection over a joint
What connective tissues can urate crystals (tophi) be deposited?
cartilage, tendons, bursae, soft tissues, and synovial membranes
What are the common sites of urate deposits?
first MTP, ear helix, olecranon bursae, tendon insertions (common in Achilles tendon)
What are some medical complications that can arise from or be worsened by obesity?
DMT2, gallbladder disease, NAFLD, gout
Excess and ectopic body fat are important sources of adipocytokines and inflammatory mediators that can alter glucose and fat metabolism, leading to increased cardiometabolic and cancer risks, and thereby reducing disease-free duration and life expectancy by ____to _____ years.
6 to 14 years.
It is estimated that 20% of all cancers can be attributed to obesity, independent of diet.
Obesity increases the risk of the following cancers:
Colon (both sexes)
Kidney (both sexes)
Esophagus (both sexes)
Endometrium (women)
Postmenopausal breast (women)
People living with obesity experience something that contributes to increased morbidity and mortality, and it is independent of weight or BMI. What is it?
Pervasive weight bias and stigma.
What are the 5 A’s for obesity management in adults?
Ask - would it be alright if we discussed your weight?
Assess - Value-based goal that matters to the patient, obesity classification, adiposity-related complications, disease severity
Advise - discuss obesity risks, health benefits of obesity management
Agree - on realistic expectations, sustainable behavioural goals and health outcomes. Agree on a personalized action plan.
Assist - identify drivers and barriers, provide education and resources.
There are 4 medications approved for use in obesity management in Canada (as per Cdn guideline). What are they?
There are four medications indicated for long-term obesity management in Canada as adjuncts to health-behaviour changes:
liraglutide (Saxenda®),
naltrexone/bupropion (Contrave®) in a combination tablet,
orlistat (Xenical®) and
semaglutide (Wegovy®).
All four medications are effective in producing clinically significant weight loss and health benefits greater than placebo over a duration of at least one year.
Obesity medications are intended as part of a long-term treatment strategy. Clinical trials of pharmacotherapy for obesity management consistently demonstrate regain of weight when treatment is stopped.
True or false?
True!
According to the Cdn guideline, when should you consider treating obesity with pharm?
Pharmacotherapy for obesity management can be used for individuals with BMI ≥ 30 kg/m2 or BMI ≥ 27 kg/m2 with adiposity-related complications, in conjunction with medical nutrition therapy, physical activity and/or psychological interventions.
What is the recommended management approach if your patient has severe mental illness and is gaining significant weight assoc. with their anti-psychotic medications?
Metformin + psychological tx such as CBT
T/F: Vitamin C is recommended for prevention of acute gout attacks?
False. Not effective in lowering serum uric acid levels.