Gout P. 561 (ATI)
PATHO: Systemic Disease by PURINE metabolism in which URIC ACID crystals
deposited in joints and body tissue
↑URIC ACID
• INCREASED consumption of PURINES
o Shellfish
o Anchovies
o Red meat
o Organ meat
• INCREASED production of PURINES
o High fructose corn syrup beverages
• DECREASED clearance URIC ACID
o Dehydration
▪ Not enough water
▪ Alcohol consumption
RF
• Obesity
• CVD
• alcohol use
• DIURETIC use
• Chemotherapy
• CKD
S/S
• Severe joint pain (First metatarsal of BIG TOE)
o Painful, swollen when TOUCHED and MOVED
o Appearance of TOPHI (chronic gout)
DX/LABS
• Erythrocyte sedimentation rate (ESR) – ELEVATED (15-20 mm/hr)
• Serum uric acid - consistent↑ 6.5 mg/dL (2-6.6 mg/dl)
• Urinary uric acid – ELEVATED
• BUN/C – ELEVATED
TX
• ACUTE
o Antigout agent
▪ Colchicine (Colcyrus) (PO or parenteral)
• ↓pain and inflammation
1
, •SE: N/V, diarrhea, abdominal pain
•No grapefruit juice
•Take with food or milk to reduce GI distress
•NI: use CAUTIOUSLY w/ pt IMPAIRED kidney function
▪ NSAIDS (↓pain and
swelling)
• Indomethacin (Indocin)
o SE: Dizziness, tinnitus, N/V
• Ibuprofen (Motrin, Advil)
o Give on EMPTY stomach, may take with food/drink
if GI upset
o SE: heartburn, nausea, headache, GI bleeding
o NI: Monitor for GI bleeding, labs (HgB, LFT)
o Do not take aspirin, alcohol.
▪ Corticosteroid (treat inflammation)
• Prednisone
o Monitor for FLUID RETENTION, HTN,
impaired KIDNEY DYSFUNCTION
o DO NOT STOP abruptly
o TAKE with MEALS
o SE: N/V, muscle weakness, ↓K
o NI: BP, hypocalcemia
• CHRONIC o Do not take ASPIRIN or OTC
o Xanthine Oxidase Inhibitor
▪ Allopurinol ( Zyloprim)
• PROMOTE Uric Acid EXCRETION and ↓production
• NI
o ↑Fluid Intake
o Take AFTER meals w/ full glass of water
o Monitor for S/S acute gout first 6 weeks
o renal function
o serum uric acid
• SE: Hepatoxicity, N/V, H/A
• PE
o ↑FLUIDS
o Minimize eyes to ultrasound or sunlight→cataract
2
, ▪ Uricosuric (PROMOTE uric acid EXCRETION)
• Probenecid (Benemid)
o Given AFTER meals
o SE: H/A, N/V, anorexia, anemia,
respiratory depression
o INTERACTION: ↓clearance of
penicillin, cephalosporin, and NSAIDS,
Aspirin
NUTRITION o MONITOR uric acid levels
• LOW purine diet
o Low fat/fat free dairy
o Potatoes
o Fruits
o Broccoli
• NO organ meats
o Shellfish
o Anchovies
o RED MEAT
Systemic scleroderma (p. 1670 L)
PATHO: AKA Systemic sclerosis, collagen (protein) that gives normal skin its
strength and elasticity OVERPRODUCED. Disruption of the cell is followed by
platelet aggregation and fibrosis. Proliferate disrupts normal function of internal
organs, such as lungs, kidneys, heart, and GI tract.
2 TYPES
• Limited cutaneous disease (80%) –FACE AND
• Diffuse cutaneous disease –TRUNK AND
RF: All ethnic groups, AA > Caucasian, 30-50 y/o
S/S (C.R.E.S.T)
• Calcinosis – PAINFUL deposit of CALCIUM in SKIN
• aynaud’s phenomenon –ABNORMAL blood flow from COLD or STRESS
• Esophageal dysfunction – difficulty SWALLOWING
• Sclerodactyly – TIGHTENING of skin on FINGERS and TOES
• elangiecstacia –RED SPORTS on hands, forearms, palms, face, and lips
DX
• SCL-70 (30% w/diffuse disease)
3
PATHO: Systemic Disease by PURINE metabolism in which URIC ACID crystals
deposited in joints and body tissue
↑URIC ACID
• INCREASED consumption of PURINES
o Shellfish
o Anchovies
o Red meat
o Organ meat
• INCREASED production of PURINES
o High fructose corn syrup beverages
• DECREASED clearance URIC ACID
o Dehydration
▪ Not enough water
▪ Alcohol consumption
RF
• Obesity
• CVD
• alcohol use
• DIURETIC use
• Chemotherapy
• CKD
S/S
• Severe joint pain (First metatarsal of BIG TOE)
o Painful, swollen when TOUCHED and MOVED
o Appearance of TOPHI (chronic gout)
DX/LABS
• Erythrocyte sedimentation rate (ESR) – ELEVATED (15-20 mm/hr)
• Serum uric acid - consistent↑ 6.5 mg/dL (2-6.6 mg/dl)
• Urinary uric acid – ELEVATED
• BUN/C – ELEVATED
TX
• ACUTE
o Antigout agent
▪ Colchicine (Colcyrus) (PO or parenteral)
• ↓pain and inflammation
1
, •SE: N/V, diarrhea, abdominal pain
•No grapefruit juice
•Take with food or milk to reduce GI distress
•NI: use CAUTIOUSLY w/ pt IMPAIRED kidney function
▪ NSAIDS (↓pain and
swelling)
• Indomethacin (Indocin)
o SE: Dizziness, tinnitus, N/V
• Ibuprofen (Motrin, Advil)
o Give on EMPTY stomach, may take with food/drink
if GI upset
o SE: heartburn, nausea, headache, GI bleeding
o NI: Monitor for GI bleeding, labs (HgB, LFT)
o Do not take aspirin, alcohol.
▪ Corticosteroid (treat inflammation)
• Prednisone
o Monitor for FLUID RETENTION, HTN,
impaired KIDNEY DYSFUNCTION
o DO NOT STOP abruptly
o TAKE with MEALS
o SE: N/V, muscle weakness, ↓K
o NI: BP, hypocalcemia
• CHRONIC o Do not take ASPIRIN or OTC
o Xanthine Oxidase Inhibitor
▪ Allopurinol ( Zyloprim)
• PROMOTE Uric Acid EXCRETION and ↓production
• NI
o ↑Fluid Intake
o Take AFTER meals w/ full glass of water
o Monitor for S/S acute gout first 6 weeks
o renal function
o serum uric acid
• SE: Hepatoxicity, N/V, H/A
• PE
o ↑FLUIDS
o Minimize eyes to ultrasound or sunlight→cataract
2
, ▪ Uricosuric (PROMOTE uric acid EXCRETION)
• Probenecid (Benemid)
o Given AFTER meals
o SE: H/A, N/V, anorexia, anemia,
respiratory depression
o INTERACTION: ↓clearance of
penicillin, cephalosporin, and NSAIDS,
Aspirin
NUTRITION o MONITOR uric acid levels
• LOW purine diet
o Low fat/fat free dairy
o Potatoes
o Fruits
o Broccoli
• NO organ meats
o Shellfish
o Anchovies
o RED MEAT
Systemic scleroderma (p. 1670 L)
PATHO: AKA Systemic sclerosis, collagen (protein) that gives normal skin its
strength and elasticity OVERPRODUCED. Disruption of the cell is followed by
platelet aggregation and fibrosis. Proliferate disrupts normal function of internal
organs, such as lungs, kidneys, heart, and GI tract.
2 TYPES
• Limited cutaneous disease (80%) –FACE AND
• Diffuse cutaneous disease –TRUNK AND
RF: All ethnic groups, AA > Caucasian, 30-50 y/o
S/S (C.R.E.S.T)
• Calcinosis – PAINFUL deposit of CALCIUM in SKIN
• aynaud’s phenomenon –ABNORMAL blood flow from COLD or STRESS
• Esophageal dysfunction – difficulty SWALLOWING
• Sclerodactyly – TIGHTENING of skin on FINGERS and TOES
• elangiecstacia –RED SPORTS on hands, forearms, palms, face, and lips
DX
• SCL-70 (30% w/diffuse disease)
3
