4 - Gout

Question 1

What is gout?

Answer 1

A form of arthritis which is caused by the accumulation of uric acid crystals in joints

Question 2

What can chronic gout cause?

Answer 2

• joint destruction
• decreased kidney function

Question 3

What is uric acid from?

Answer 3

It’s a breakdown product of purines

Question 4

What is asymptomatic hyperuricemia?

Answer 4

A state of elevated levels of uric acid in the blood without symptoms

**Precursor to developing gout

Question 5

What are the 2 types of gout?

Answer 5

1. excessive production of uric acid
2. reduced excretion of uric acid

Question 6

What are some purine-rich foods?

Answer 6

• Shellfish
• Organ meats - liver, brains, kidneys
• Sweetbreads

Question 7

What’s a tophi?

Answer 7

Uric acid crystal deposit - usually in other tissues (helix of ear)

Question 8

What are the 4 distinct stages of gout?

Answer 8

1. Asymptomatic
2. Acute
3. Intercritical - no pain or swelling, relatively symptom free
4. Chronic - tophi, polyarticular attacks

Question 9

What drug treats gout by inhibition of neutrophil migration and phagocytic activity in inflamed joints?

Answer 9

colchicine (Colcrys)

Question 10

What is the only indication for colchicine?

Answer 10

Acute attack of gout

Question 11

What is a side effect of colchicine?

Answer 11

GI toxicity

Question 12

What gout medication inhibits xanthine oxidase, that inhibits the synthesis of uric acid?

Answer 12

allopurinol (Zyloprim)

Question 13

What are the indications of allopurinol (Zyloprim)?

Answer 13

• Chronic gout
• Chemotherapy and radiation

Question 14

What are the side effects of allopurinol (Zyloprim)?

Answer 14

• hepatotoxic
• pruritic rash
• allergic skin and blood reactions

Question 15

What gout medication increases the excretion of uric acid = “uricosuric agent”?

Answer 15

probenecid (Benemid)

Question 16

What are the indications for probenecid (Benemid)?

Answer 16

• Chronic gout
• When acute gout attacks increase in frequency and severity

Question 17

What are 2 common problems with drug-to-drug interactions with probenecid (Benemid)?

Answer 17

• Low dose aspirin - interferes with the uricosuric action of probenecid
• Increases plasma level of penicillin

Question 18

Why are NSAIDS used to help manage acute arthritis pain and inflammation of gout?

Answer 18

• Relieve pain, tenderness and swelling of affected joints - no mechanism against gout itself