Gout Familial metabolic disease characterized by : Acute arthritis Uric acid stones in the kidneys...
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Transcript of Gout Familial metabolic disease characterized by : Acute arthritis Uric acid stones in the kidneys...
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GoutFamilial metabolic disease
characterized by : Acute arthritisUric acid stones in the kidneysHyperuricemia
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Breakdown
of product of the
body’s purin
e (nucleic acid) metabolism.
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What is the What is the treatment for gout treatment for gout
??
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DRUGS USED IN TEATMENT OF GOUT
Most therapeutic strategies for gout involve lowering the uric acid level below the saturation point (<6 mg/dL), thus preventing the deposition of urate crystals. This can be accomplished by: 1.interfering with uric acid synthesis with allopurinol2.increasing uric acid excretion with probenecid or sulfinpyrazone, large doses of aspirin3.inhibiting leukocyte entry into the affected joint with colchicine,4.administration of NSAIDs
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Aaarrrgg
hhh!!
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urate levels rise in the blood, but produces no symptoms
ASYMPTOMATIC STAGE
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ACUTE STAGE
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symptom-free intervals between gout episodes. Most people have a second attack from six months to two years, while others are symptom-free for five to 10 years.
INTERCRITICAL STAGE
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CHRONIC STAGE
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Non-pharmacologicTherapy
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Control….
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1. NSAIDs
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Inhibits pain & inflammation.Inhibits urate crystal phagocytosis by
decreasing the migration of granulocytes into the inflammatory area.
( Indomethacin is commonly used & it may replace colchicine .
Aspirin in therapeutic doses is contraindicated as it compete with uric acid secretion in proximal tubule.
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2. Colchicine
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Basyir Bin Kamaruzaman (15)
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OVERVIEW
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MECHANISM OF ACTIONS
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PHARMACOKINETICSPHAPHARMACOKINETICS
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THERAPEUTIC USES
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Adverse effectsDiarrhea is a common adverse effect. May cause nausea,vomiting ,abdominal cramps.
Chronic use may cause, alopecia, bone marrow depression, peripheral neuritis, myopathy.
Also,affect fertility
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Acute intoxicationBurning throat pain.Bloody diarrhea.Shock.Hematuria.C.N.S.depression.
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Contraindication & Precaution
Contraindicated in pregnancy
Should be used with caution in hepatic , renal or cardiovascular diseases.
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3. Corticosteroids
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Prevention of recurrent
attack
Inhibition of uric acid synthesis Allopurinol
Uricosuric drugs
- Probenacid
-Sulfinpyrazone
-Large doses of aspirin
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Inhibition of uric acid synthesis
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Mechanism of action
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Pharmacokinetics80% absorbed after oral administration.
Metabolized to active metabolite alloxanthine.
Given once daily.Drug & its metabolite are excreted in the feces & urine.
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Pharmacokinetics
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Therapeutic Uses
It is drug of choice in patient with:
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Chronic tophaceous deposits (reabsorption is more rapid)
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High serum uric acid in patients with impaired renal functions.
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uric acid stones or nephropathy.
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used to prevent increased uric acid levels in patients receiving cancer chemotherapy
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ALLOPURINOL(SIDE EFFECTS AND
DRUG INTERACTIONS)
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Side Effects (most common)
exacerbation ofan acute attack of gout
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Maculopopular skin rash
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nausea, diarrhea
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Side Effects (less common)
Body : fever, headache CVS : vasculitis
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Thrombocytopenia Epistaxis
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Drug Interactions
With oral anticoagulant:Potentiates warfarin
and dicumarol•inhibits their metabolism
in liver
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With anticancer :6-mercaptopurineand azathioprine
• inhibits their metabolism (doses are reduced up to 75%
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With ampicillin :Increases frequency
of skin rash
Prolongs half life ofChlorpropamide
• both compete for excretion in renal tubule
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Uricosuric drugs
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Probenecid is a uricosuric drug that increases uric acid excretion in the urine
primarily used in treating gout
Probenecid
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Sulfinpyrazone
Sulfinpyrazone is a metabolite of phenylbutazone
Metabolized into an active metabolite in the liver.
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Mechanism of actionUricosuric drugs ( probenecid, sulfinpyrazone, large dose of aspirin) block the active transport sites of the proximal tubules(middle segment ) the
reabsorption of uric acid is decreased.
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Clinical usesShould not be started until 2-3 weeks after an acute attack.
In chronic gout when :Evidence of tophi appearsPlasma levels of uric acid are so high that may cause tissue damage
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Clinical uses ( continue)Urine volume should be maintained at a high level, and urinary pH kept alkaline .
Probenecid is a general inhibitor of the tubular secretion of organic acids , so it is used to prolong action of other weak organic acids as some antibiotics e.g. penicillin.
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DRUG INTERACTIONS
Probenecid prolong the action of some antibiotics as: penicillin and cephalosporins
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Side effectsAcute attack of goutRisk of uric acid stoneGIT upset Allergic rash
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Adverse effects ( continue)Nephrotic syndrome ( probenecid)
Aplastic anemia ( not common )
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Contra-indications
History of urinary tract stone
Impaired renal functionRecent acute gouty attackAdministration of low doses of aspirin
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THANK YOU