gout-causes and treatment modalities.pptx

gout pharmacology

1. Dr : aya keshk Gout therapy

2. Definition A form of inflammatory arthritis due to deposition of monosodium urate crystals in the joint especially big toe.

3. Causes of hyperuricemia : Uric acid is an end product of purine metabolism hyperuricemia is an imbalance between overproduction of uric acid and/or the inability of the patient to excrete it via renal elimination. It may be due to: 1. High purine diet. 2. During treatment of leukemia due to increase tissue destruction. 3. Drugs: Thiazides, cytotoxic drugs, salicylates in low doses, cyclosporine.

4. Clinical picture Acute gout attacks are characterized by rapid onset of pain, swelling, and inflammation of the big toe and then, in order of frequency ankles, heels, knees, wrists, fingers, and elbows.

5. Treatment Goals of treatment Non pharmacological treatment Pharmacological treatment

6. Goals of treatment: Terminate the acute attack prevent recurrent attacks prevent complications associated with chronic deposition of urate crystals in tissues.

7. Non pharmacological treatment: Avoid high protein diet: Organ meats, meat extracts, shell fish, herrings, mackerel, sardines, goose, yeast, vegetables ( cauliflower, spinach and mushrooms). Avoid drugs that precipitate gout.

8. Pharmacological treatment

9. Pharmacological treatment: Acute gout: Anti-inflammatory drugs: 1- NSAIDs. 2-Colchicine. 3- Corticosteroids. Chronic gout: hypouricemic drugs: 1- Decrease uric acid synthesis: Allopurinol, Febuxostat . 2- Uricosuric drugs: Probenecid , Sulphinpyrazone

10. Colchicine Used in acute attack treatment. MOA:

11. Side effects: diarrhea and gastrointestinal pain. hematuria, alopecia, bone marrow depression, gastritis, and peripheral neuropathy. “long use”

12. Allopurinol uril MOA:

13. - Uses : Hyperuricemia & Chronic Gout. - Side effects: * Hypersensitivity reactions as skin rash. * GIT disturbances, hepatomegaly, headache, Leucopenia. * Acute attacks of gout occur early in treatment .

14. Uricosuric drugs Probenecid Sulphinpyrazone

15. Probenecid MOA: Uric acid is freely filtered by the glomerulus, secreted & normally 90% is reabsorbed by anionic active transport sites in the proximal tubule . Probenecid   inhibit the active transport sites that cause net reabsorption of uric acid in the proximal tubule of the kidney

16. Probenecid Uses: 1. Treatment of chronic gout. 2. To maintain high blood levels of penicillin, cephalosporinas it inhibits their renal secretion.

17. Side effects: Rashes, allergic dermatitis. upper GIT irritation , dyspepsia, drowsiness hemolytic anemia in G6PD deficiency. CI: Renal calculi.

18. Precautions for use of uricosuric drugs: Use a sufficient dose of probenecid . Begin therapy with the administration of colchicine or NSAIDs before adding a uricosuric drug . Maintain a high volume of urine by sufficient increase in fluid intake and render the urine alkaline.