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THe GOUT
Pharmacotherapy Fall 2013 Exam 1
52
Pharmacology
Professional
09/11/2013

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Cards

Term
uric acid
Definition
end product of purine degradation
Term
xanthine oxidase
Definition
enzyme involved in purine metabolism
Term
normal urate levels
Definition
near the limits of solubility
Term
men
Definition
1200 mg accumulated uric acid
Term
women
Definition
600 mg accumulated uric acid
Term
patients with gout
Definition
urate pool is increased several fold
Term
uric acid (keto form) goes to uric acid (enol form)
Definition
hydrogen removed to form URATE
Term
uric acid
Definition
forms crystal and precipitates at LOW pH
Term
monosodium urate
Definition
forms crystal and precipitates at physiologic or HIGH pH
Term
increased prevalence due to
Definition
dietary habits, increasing logevity, increasing prevalence of obesity and metabolic syndrome
Term
gout typically occurs
Definition
during middle age and is uncommon before 30 years of age
Term
mostly occurs in
Definition
men (3-4 times more)
Term
80-90%
Definition
underexcreters
Term
65-75%
Definition
of uric acid is excreted by the kidneys, the rest excreted by GI tract
Term
uric acid is filtered through
Definition
glomeruli, then reabsorbed in the proximal tubule and secreted distally
Term
5 year cumulative risk of gout
Definition
0.6% with serum urate <7mg/dl, 30.5% with serum urate >10mg/dl
Term
increased risk
Definition
in ages 30-50 years
Term
it is more rare for patients
Definition
40-44years and even less so for ages 50-64 years
Term
tends to be
Definition
hereditary
Term
normal production considered to be
Definition
600 mg/day
Term
overproduction
Definition
may result in an abnormality in the enzymes that regulate purine metabolism
Term
patient on a regular diet who excrets more than 800 mg of uric acid in 24 hours is considered
Definition
overproducer
Term
increased risk in those with a diet of high
Definition
intake of purines, alcohol, sofdrinks and fructose
Term
decreased risk in those with a large consumption of
Definition
coffee, dairy products, and vitamin C
Term
increased risk with those who are taking
Definition
thiazide diuretics, low does aspirin, cyclosporin
Term
increased risk in those who have
Definition
insulin resistance, metabolic syndroe, obesity, renal insufficiency and HTN
Term
Gouty Arthritis
Definition
Recurrent attacks of acute arthritis associated with monosodium urate crystals in synovial fluid.
Term
initial attacks
Definition
usually monoarthic (in one joint)
Term
polyarthric attack
Definition
can also occur
Term
over 50% of initial attacks occur in
Definition
great toe (Podagra)
Term
acute gouty arthritis resolves without intervention
Definition
7-14 days
Term
crystals of _______ are deposited in and around synovial fluid
Definition
monosodium urate crystals
Term
phagocytes
Definition
ingest crystals and release vesicals leading to inflammation of the joind
Term
changes in serum uric acid concentration
Definition
may provoke an attack
Term
attacks usually occur at night due to
Definition
not exercising joints and not getting fresh synovial effusions
Term
attacks often occur in lower extremities
Definition
lower temp and decreased urate solubility
Term
interval gout
Definition
Time after acute attack has resolved or time between attacks
Term
tophaceous gout
Definition
late complication of hyperuricemia (about 12 years after initial attack
Term
trophi
Definition
nodular deposits of monosodium urate crystals in the tissues in and around the joints
Term
occur on the great toe, fingers, knees and other places
Definition
trophi that lead to soft tissue damage, deformity, joint destruction and nerve compression
Term
treatment goal for acute gouty arthritis
Definition
terminate acute attack, prevent terminate recurrent attacks, prevent complications associate with urate crystal deposition
Term
treatment option for acute gouty arthritis
Definition
nonpharmacologic, NSAIDs, Colchicine, steroids
Term
nonpharmacologic
Definition
reduce intake of saturated fats, meats high in protein, salt and increase fluid intake, rest joints for 1-2 days, ice (NO HEAT), weight loss, avoid thiazide diuretics
Term
recurrent gouty arthritis
Definition
treat if suffering from 2 or more attacks per year
Term
goal for uric acid level
Definition
less than 6mg/dL
Term
drug of choice for recurrent gouty arthritis
Definition
allopurinol; do not initiate during acute attacks, wait 2-4 weeks
Term
uric acid nephrolithiasis
Definition
kidney stones caused by uric acid deposits; Solubility of uric acid decreases in acidic environments – stones can form.
Term
acute gouty nephropathy
Definition
The blockage of urine flow from nephrolithiasis (the kidney stones) in the collecting ducts and ureters can lead to acute renal failure
Term
chronic gouty nephropathy
Definition
Long-term deposition of crystals in the nephron; Microtophi cause cell inflammation
Term
rapid lowering of urate levels
Definition
associated with gout flares; possibly due to urate stores mobilized when levels fall
Term
gout flare prophylaxis (without trophus)
Definition
colchicine 0.6mg BID or QD if no diarrhea for 6 months
Term
gout flare prophylaxis (with trophi)
Definition
colchicine 0.6mg BID or QD if no diarrhea for 6 months or until tophus resolves
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