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GOUT

GOUT. By. Prof. Azza El- Medany. Dr. Osama Yousf. OBJECTIVES. At the end of lectures students should : Define gout Describe outlines of treatment Describe treatment of acute gouty arthritis Describe the mechanism of action , clinical uses & side effects of drugs used in acute attacks.

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GOUT

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  1. GOUT

  2. By • Prof. Azza El-Medany • Dr. Osama Yousf

  3. OBJECTIVES • At the end of lectures students should : • Define gout • Describe outlines of treatment • Describe treatment of acute gouty arthritis • Describe the mechanism of action , clinical uses & side effects of drugs used in acute attacks

  4. OBJECTIVES ( continue) • Classify drugs used in chronic treatment • Define each group of drugs • Describe the mechanism of action, clinical uses & side effects & drug interactions for drugs used in chronic treatment

  5. What is gout? Breakdown of product of the body’s purine (nucleic acid) metabolism.

  6. ASYMPTOMATIC STAGE • urate levels rise in the blood, but produces no symptoms

  7. ACUTE STAGE

  8. INTERCRITICAL STAGE • 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.

  9. CHRONIC STAGE

  10. What is the treatment of gout ?

  11. Non-pharmacologicTherapy

  12. Control….

  13. 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: interfering with uric acid synthesis with allopurinol increasing uric acid excretion with probenecidor sulfinpyrazone inhibiting leukocyte entry into the affected joint with colchicine, administration of NSAIDs

  14. Aaarrrgghhh!!

  15. 1. NSAIDs

  16. NSAIDs • drugs 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.

  17. 2. Colchicine

  18. Basyir Bin Kamaruzaman (15)

  19. OVERVIEW

  20. MECHANISM OF ACTIONS

  21. PHAPHARMACOKINETICS PHARMACOKINETICS

  22. THERAPEUTIC USES

  23. Adverse effects • Diarrhea 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

  24. Quiz? Colchicine is especially useful in treating an acute attack of gout because it achieves which of the following?

  25. Prevention of recurrent attack Inhibition of uric acid synthesis Allopurinol Uricosuric drugs - Probenacid - Sulfinpyrazone

  26. Inhibition of uric acid synthesis

  27. Mechanism of action

  28. Pharmacokinetics

  29. Therapeutic Uses • It is drug of choice in patient with both gout & coronary artery disease

  30. Severe tophaceous deposits (uric acid deposits in tissues)

  31. High serum uric acid in patients with impaired renal functions.

  32. uric acid stones or nephropathy.

  33. used to prevent increased uric acid levels in patients receiving cancer chemotherapy

  34. ALLOPURINOL(SIDE EFFECTS AND DRUG INTERACTIONS)

  35. Side Effects (most common) Prolong and exacerbation an acute attack of gout

  36. Maculopopular skin rash

  37. Quiz? A 44-year-old man is suffering from recurrent gouty arthritis. His serum uric acid level is elevated, and you prescribe allopurinol. Within 1 week of the allopurinol, he develops a painful episode that "feels like gout." Which of the following is the best explanation? A. The patient is resistant to the allopurinol and should be placed on another medication. B. The patient likely has an arthritis syndrome produced by allopurinol and should have an antinuclear antibody (ANA) drawn. C. The patient likely developed acute gout as a result of mobilization of the urate from joints and tissue. D. This likely represents a drug-drug interaction, and so the allopurinol should be discontinued

  38. nausea, diarrhea

  39. Side Effects(less common) Body : fever, headache CVS : vasculitis

  40. Hemic and Lymphatic: Thrombocytopenia Respiratory:Epistaxis

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