GOUT. By Prof. Azza El- Medany Dr. Osama Yousf OBJECTIVES At the end of lectures students should :...
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Transcript of GOUT. By Prof. Azza El- Medany Dr. Osama Yousf OBJECTIVES At the end of lectures students should :...
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GOUT
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By
Prof. Azza El-Medany
Dr. Osama Yousf
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OBJECTIVESAt the end of lectures students should :Define gout Describe outlines of treatmentDescribe treatment of acute gouty arthritis Describe the mechanism of action , clinical
uses & side effects of drugs used in acute attacks
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OBJECTIVES ( continue)Classify drugs used in chronic
treatmentDefine each group of drugs Describe the mechanism of action,
clinical uses & side effects & drug interactions for drugs used in chronic treatment
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Breakdown
of product of the
body’s purin
e (nucleic acid) metabolism.
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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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What is the What is the treatment of treatment of
gout ?gout ?
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Non-pharmacologicTherapy
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Control….
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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 sulfinpyrazone3.inhibiting leukocyte entry into the affected joint with colchicine,4.administration of NSAIDs
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Aaarrrgg
hhh!!
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1. NSAIDs
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NSAIDsdrugs of choice for young, healthy
adults without any other serious medical condition
usually taken orally at their highest safe dosage as long as gout symptoms persist and for three or four days after
low doses of NSAIDs may be used to prevent gout attacks, including in patients who are starting anti-hyperuricemic therapies.
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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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Prevention of recurrent
attack
Inhibition of uric acid synthesis Allopurinol
Uricosuric drugs
- Probenacid
- Sulfinpyrazone
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Inhibition of uric acid synthesis
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Mechanism of action
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Pharmacokinetics
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Therapeutic UsesIt is drug of choice in patient with both gout & coronary artery disease
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Severe tophaceous deposits (uric acid deposits in tissues)
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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)
Prolong and exacerbationan 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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Hemic and Lymphatic: Thrombocytopenia Respiratory: Epistaxis
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Drug Interactions
With oral anticoagulant: warfarin
and dicumarol•inhibits their metabolism
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With anticancer :Reduce the metabolism of
6-mercaptopurineand azathioprine
•Requring reduction of•Dosage 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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Uricosuric drugs ( probenecid, sulfinpyrazone, large dose of aspirin)
block the active transport sites of the proximal tubules(middle segment , decrease the reabsorption of uric acid & increase the amount excreted
Mechanism of action
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Clinical usesChronic gout (urine volume should be
maintained at a high level,and urinary pH kept alkaline ).
Probenecid is used to prolong the action of some antibiotics e.g. penicillin.
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Side effectsExacerbation of acute attackRisk of uric acid stoneGIT upsetAllergic rash
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Contra-indication
Previous urinary tract stone
Impaired renal functionRecent acute goutCo-administration of low dose aspirin
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DRUG INTERACTIONS
Aspirin can prevent probenecid from being fully effective
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DRUG INTERACTIONS:
Sulfinpyrazone can aggravate peptic ulcer disease
Aspirin products can interfere with sulfinpyrazone's effects
Sulfinpyrazone can enhance the action of certain diabetes medicines
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SUMMARYGout is a form of arthritis that is
characterized by sudden , severe attacks of pain, redness and tenderness.
Gout is caused by deposits of uric acid crystals in a joint
Uric acid is a waste product formed from the breakdown of purines.
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SUMMARY ( continue)Treatment of gout includes :Treatment of acute attacks Prevention of future attacksTreatment of chronic gout
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SUMMARY (continue)Drugs used for acute attacks
includes :NSAIDs ( selective or non-selective)Colchicine interfere with the migration
of granulocytes to the site of inflammation & reduce the release and synthesis of leukotriens
Main adverse effects includes :
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SUMMARY ( continue)DiarrheaSkin rash Kidney, liver & CNS injuryDrugs used for chronic treatment
includes :Uricosuric drugs that increase urinary
excretion of uric acid
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SUMMARY ( continue)Probenecid & sulfinpyrazoneTheir main adverse effects includes :Gastrointestinal problemsSkin rashesLeukopeniaAnti-hyperuricemic drugs that reduce
the production of uric acid
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SUMMARY ( continue)Allopurinol is an oxidase inhibitorUsed in patients with elevated blood
uric acid levelOr in patients with tendency for renal
stone formationIts main adverse effects includes :Gastric problems
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SUMMARY ( continue)Skin rashesLeukopeniaThrombocytopeniaAllopurinol reduces the metabolism of
some drugs including azathioprime , this needs reduction of the doses of these drugs up to 75%