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D5E2: Gout
castner
| Question | Answer |
|---|---|
| Gout is _____ ___ crystal deposition disease involving hyper____ which leads to formation of ___ crystals deposited in the tissue. | monosodium urate, uricemia, urate. |
| Hyperuricemia pts produce ____ amount of urate. | too much OR too little. |
| Uric acid is made from _____ molecules which comes from ___, ____, or ___. | purine, diet, de novo synthesis, tissue nucleic acid degraded to nucleotides. |
| Purines normally metab to either ___ or ____ then are excreted out. | nucleic acid, uric acid. |
| Peeps who make too much uric acid may do so because of ____ abnormalities (like increased ____ synthetase or decreased ____ transferase), increased ____ breakdown, excessive ____ synthesis, or excessive cell ___ (due to cytotoxic mediators). | enzyme, PRPP (phosphoribosyl pyrophosphate), HGPRT (hypoxanthine guanine phosphoribosyl), tissue, cell, lysis. |
| peeps who can't make enough uric acid may do so because of decreased ____ of it (85% of pts). | excretion. |
| Uric acid is excreted mostly in ___ but also through GI tract after _____ degrade it in large intestine. | urine, bacteria. |
| What are the four steps to renal urate transport? | glom filtration, reabsorption of almost all, secretion of almost all the rest, reabsorption again at proximal tubule of the rest. |
| Gout comorbidities: _____ which is directly related to urate levels, ____ where high levels of insulin can reduce urate _____ at the ____ channel, and ____ which can effect GFR. | Obesity, Insulin resistance, excretion, URAT1, HTN. |
| Drugs that induce urate overproduction thereby causing gout include what 3 agents? | cytotoxic drugs, alcohol, and vitamin B12. |
| Gout Attack begins by ___ crystals stimulating the synthesis and release of _____ inflam mediators which interact directly w the __. MSU gets eaten by the cells (__) which continues the inflam process. | MSU, humoral and cellular, cell membrane. Phagocytosis. |
| Early Gout Attack involves ______ and ___ cells of the inflam response. | monocytes & mast cells |
| Late Gout Attack involves ______ cells of the inflam response. This is important to note because ____. | Neutrophils, it is the HALLMARK of ACUTE gout attack. |
| What type of cell lines causes the resolution of a gout attack? | well differentiated cell lines. |
| When certain cell lines resolve a gout attack, they ____ the crystals, ____ apoptosis occurs, inflam mediators are activated, and vascular walls become ____. | coat and clear, neutrophil, permeable. |
| Although the cell lines can resolve an acute gout attack, the area is left with a ____ level of inflam which is caused by the crystals and the ____ interactions (inflammation!) which causes damage long-term. | low, chondrocytes. |
| Gout shows as "gouty arthritis" which as it worsens it goes from asymptomatic tissue _____, acute ____, intercritical ____, then eventually chronic gout. | deposition, flare, segment. |
| Sx of gout include intense pain, warmth, fever, swelling, erythema, inflam of joint which all show mostly when? | at night |
| Exacerbating gout factors include infection, rapid _____ of SrUrate, alcohol, trauma. | lowering |
| Tophi is a term used to describe _____ and usually shows up in the ____ phase of gout. It can be located at ____ or ____. | uric acid deposits, late, joints or BEYOND |
| Tophi occurs as either ____ or ___ tophi and can turn into an infection, joint ____, or nerve ____. | subcutaneous or intraarticular, deformity, compression. |
| To dx gout presumptively you do not need to see _____ | crystals in aspirtate |
| Dx definitively:MSU crystals in_OR_in crystalsOR6/11:1._swelling in joint on xray2._on joint3.first_joint tender/swollen4.first_joint unilateral attack5._joint unilateral attack6.hyper_7.max inflam@_8._acute attack9._cysts10._tophi11._during an attack | synovial fluid, tophi, asymmetric, redness, MTP, MTP, tarsal, uricemia, 1d, 2, subcortical, suspected, synovial fluid cx (-). |
| Nonpharm gout trx includes wt __, inc low fat __ foods, dec __&__food, avoid __, trx/maintain __ risk factors. | loss, dairy, red meat & seafood, alcohol, cardiovascular. |
| Gout trx includes decreasing underlying inflammation with ___ or __ and trx the crystal depositions (hyperuricemia) with __, __, or __ | nsaids or corticosteroids; colchicine, xanthine oxidase inhibitors (allopurinol, febuxostat), or uricolytics (probenecid, pegloticase). |
| What three NSAIDs are fda approved to trx AcuteGoutyAttacks? | indomethacin, naproxen, sulindac. |
| What does of NSAIDs should u use for trx of Acute Gouty Attacks? | MAX dose! |
| Which NSAIDs are used orally (1) and Intraarticular Injections (3) for Gout? | Oral Prednisone, IA Triamcinolone, Methylprenisolone, or Bethamethasone. |
| Colchicine is a anti___ agent that targets ___ during an attack. Its used as 2nd Line bc its slower to onset and has inc Ae. Also you must use it within __ of sx or else it wont work. | mitotic, neutrophils, 1d. |
| Colchicine Ae include ___, ___suppression, ___probs, or muscle ___. | n/v/d/abdom pain, mylosuppresion, neuro probs, muscle rhabdomyolysis. |
| XOi are initiated ___ in time from an attack. 6-8w AFTER an acute attack. | |
| XOi MUST be admined in combo w prophylactic ___ for gout attack. | Colchicine |
| Allopurinol is a ___ class of drug. Goal SrUrate of under ___mg/dL. Efficacy is __ dependent. | XOi, 6, dose |
| ____ is the most commonly prescribed drug for gout management. | Allopurinol |
| Allopurinol Ae include skin___, __ sx, ha, ___ syndrome which causes death | rash, GI, hypersensitivity |
| Febuxostat is a __class of drug. Goal SrUrate of under __ mg/dL. Adjust for kidney problems of CrCl < __mL/min. Adjust for liver problems of ____. | XOi, 6, 30, NONE! |
| Febuxostat contraindicated with DDI: __,__,__ | theophylline, mercaptopurine, azathioprine |
| Probenecid is a __class of drug that works by inhibiting the ____ of uric acid in the ____ part of the kidney to promote its excretion. | Uricolytic, reabsorption, proximal tubule. |
| Probenecid Ae include Nephro____. This can be avoided by ____ the dose, increase ___ intake. | nephrolithiasis, water. |
| Pegloticase is a ___class of drug. BlackBox: ____ and _____. | Uricolytic, anaphalactic shock & infusion site rxn. |
| Drugs that decrease your urate levels include what 5 that cis-inhibit URAT1 | Probenecid, Sulfinpyrazone, Benzbromarone, Losartan, Salicylate |
| Drugs that decrease your urate levels include what 1 that increases your kidney excretion of urate? | Amlodipine |
| Drugs that decrease your urate levels include what 2 that inhibit xanthine oxidase? | Allopurinol, febuxostat |
| Drugs that decrease your urate levels include what 1 that oxidizes urate-->allantoin? | Uricase |
Created by:
tarameesu