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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. What is the treatment for gout ?

  7. 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, large doses of aspirin inhibiting leukocyte entry into the affected joint with colchicine, administration of NSAIDs

  8. Aaarrrgghhh!!

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

  10. ACUTE STAGE

  11. 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.

  12. CHRONIC STAGE

  13. Non-pharmacologicTherapy

  14. Control….

  15. 1. NSAIDs

  16. NSAIDs (Selective or non- selective ) • Inhibit pain & inflammation. • Inhibit urate crystal phagocytosis by decreasing the migration of granulocytes into the inflammatory area. • They are commonly used now& may replace colchicine . • ( Except aspirin & paracetamol)

  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.

  24. Acute intoxication • Burning throat pain. • Bloody diarrhea. • Shock. • Hematuria. • C.N.S.depression.

  25. Contraindication & Precaution • Contraindicated in pregnancy • Should be used with caution in hepatic , renal or cardiovascular diseases.

  26. 3. Corticosteroids

  27. Prevention of recurrent attack Inhibition of uric acid synthesis Allopurinol • Uricosuric drugs • - Probenacid • Sulfinpyrazone • Large doses of aspirin

  28. Inhibition of uric acid synthesis

  29. Mechanism of action

  30. Pharmacokinetics • 80% absorbed after oral administration. • Metabolized in the liver to active metabolite alloxanthine. • Given once daily. • Drug & its metabolite are excreted in the feces & urine.

  31. Pharmacokinetics

  32. Therapeutic Uses • It is effective in the treatment of primary hyperuricemia

  33. Hyperuricemia secondary to other conditions such as :

  34. Impaired renal functions.

  35. uric acid stones or nephropathy.

  36. In patients receiving cancer chemotherapy

  37. ALLOPURINOL(SIDE EFFECTS AND DRUG INTERACTIONS)

  38. Side Effects (most common) exacerbation of an acute attack of gout

  39. Maculopopular skin rash

  40. nausea, diarrhea

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