Term
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Definition
| serum urate level > or = 6.8 mg/dL, the saturation pt of urate in body fluid; caused by overproduction --> dietary, metabolism of nucleic acid (multiple myeloma, leukemias, lymphomas, Hodgkins dx), de novo synthesis; Abnormalities of regulating enzyme (PRPP & HGPRT); also caused by UNDEREXCRETION --> < or = 750 mg/24 hrs in 24 hr urine collection, drugs that decrease renal clearance of uric acid |
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Term
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Definition
| caused by monosodium urate crystal deposits in & around joints; most common forms of inflammatory arthritis |
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Term
| Drugs the decrease renal clearance of Uric Acid |
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Definition
| diuretics (thiazides), nicotinic acid, ethanol, salicylates, cytotoxic drugs, ethambutol, pyrazinamide, levodopa, cyclosporine |
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Term
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Definition
| sudden onset of severe pain, swelling, inflammation, erythema, & warmth; occurs monoarticularly --> 1st metatarsophalangeal joint (great toe) most commone, also in ankles, heels, knees, wrists, fingers, elbows; typically occurs at night, causes waking up in unbearable pain; inflammation; untreated may last 3-14 days; as time progresses, attacks occur more often & for longer duration |
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Term
| Precipitating Factors for Acute Gout Attack |
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Definition
| can occur without one; trauma; excessive alcohol intake; initiation of hypouricemic therapy; physical stress/exercise; infection; surgery |
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Term
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Definition
| late complication of hyperuricemia; accumulation of urate crystals into hard white nodules called TOPHI deposited at base of great toe, ear, and elbow; loss of range of motion; joint persistently swollen & uncomfortable with no pain-free periods; acute flares continue with less severity; if left untreated, urate deposits in renal tubules --> renal calculi |
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Term
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Definition
| Immediate goal: relieve pain & inflammation; Non-pharm: rest joints, use ice (NOT HEAT) to reduce discomfort; PHarm: NSAIDs (drug of choice) - indomethacin, ibuprofen, naproxen --> well tolerated, significant pain relief; Colchicine: specific gout agent, decreases symptoms by blocking accumulation; Glucocorticoids (prednisone) - for pts that cannot use NSAIDs or colchicine |
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Term
| NSAIDs - indomethacin, ibuprofen, naproxen |
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Definition
| drugs of choice fot tx of acute gout attacks; well tolerated; signficant pain relief within 24 hrs; SEs: GI upset, nausea, HA, dizziness; Administer w/ food; Use caution in pts w/ renal dx, PUD, liver dx |
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Term
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Definition
| specific to gout, useful in diagnosis; MoA: inhibits uric acid formation by blocking accumulation; Serious GI Side Effects: abdominal cramping, N/V, diarrhea; Most effective when taken within 1st 12-24 hrs of acute attack; D/C after 7 days following attack due to risk of bone marrow suppression |
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Term
| Dosing for Colchicine (Colcrys) |
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Definition
| PO 1.2 mg initially, 0.6 mg single dose in 1 hr, MAX total dose = 1.8 mg in 1 hr; ADRs: N/V, diarrhea, abdominal cramps; Other: 50% dose reduction in pts w/ CrCl 10-50 mL/min; Use w/ caution in elderly pts |
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Term
| Dosing for indomethacin (Indocin) |
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Definition
| PO 50 mg TID until pain is tolerable; 75 mg may initially be given; ADRs: GI upset, nausea, HA, dizziness; Administer with food; Use with caution in pts w/ renal dx, PUD, or liver dx |
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Term
| Glucocorticoids - prednisone |
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Definition
| used for accute attacks in pts that cannot use NSAIDs or colchicine; use intra-articular injection when only 1 joint is involved; Use ORAL when multiple joints are involved; Taper dose to prevent rebound attacks |
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Term
| Goals of Tx of Chronic Gout |
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Definition
| prevent further attacks; reduce presence of tophi; lower risk of renal involvement |
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Term
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Definition
| low-dose to prevent recurrence of acute attacks; Dose: 0.6 mg BID; better tolerated than tx dose; Used in pts without visible tophi & normal/slightly elevated serum urate conc.; D/C if serum uric acid <6 mg/dL & is symptom free for 1 yr |
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Term
| allopurinol (Xyloprim), febuxostat |
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Definition
| xanthine oxidase inhibitors that inhibit uric acid production; effective for preventing acute attacks & tophi formation & promoting regression of existing tophi; also can lower PRPP synthetase conc.; can exacerbate gout symptoms during first 6 wks; initiate slowly; D-D Interactoin: decrease dose of azathioprine to 1/4 or 1/3 recommended dose |
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Term
| dosing of Allopurinol (Xyloprim) |
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Definition
| 100 mg PO daily x 2 wks then 200-300 mg PO daily in mild dx or 400-600 mg PO daily if required; ADRs: skin rash, leukopenia, GI intolerance, hypersensitivity syndrome is rare but serious & characterized by fever, eosinophilia, dermatitis, & renal and hepatic dysfunction; Drugs of Choice in pts with hx of urinary stones, imparied renal fcn; Administer after meals & with plenty of water |
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Term
| uricosuric agents - probenecid, sulfinpyrazone |
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Definition
| increase rate of excretion of uric acid by blocking reabsorption in kidneys; effective at promoting regression of tophi; smaller initial doses to reduce risk of uric acid stone formation from excretion of large amounts of urate; |
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Term
| Non-pharm Therapy for Gout Attacks |
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Definition
| diet; avoid beverages with high purine content (alcohol [beer>wine], soft drinks w/ high fructose); Balance foods with high purine content recommended between atacks & should be limited during an acute attack (red meat, bacon, turkey, liver, chicken, shrimp, lobster); Vitamin C intake decreases gout risk; Maintain desirable body weight; Drink 8-16 cups of fluid/day |
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