- Acute gout is treated with
- nonsalicylate NSAIDs – Indomethacin
- Chronic gout is treated with the
- uricosuric agent – which increases the elimination of uric acid
- drug that inhibits uric acid production.
- alkaloid with anti-inflammatory properties
- used for relief of inflammation and pain in acute gouty arthritis.
- Onset of action within 12–24 hours after oral administration.
- prevents polymerization of tubu- lin into microtubules
- inhibits leukocyte migration and phagocytosis
- inhibits cell mitosis.
- Adverse effects after oral administration
- occur in 80% of patients
- nausea, vomiting, abdominal pain
- particularly diarrhea (MCQ)
- IV administration
- reduces the risk of GI disturbances
- provides faster relief (6–12 h)
- increases the risk of sloughing skin and subcutaneous tissue.
- Higher doses may (rarely) result in liver damage and blood dyscrasias.
- indomethacin has been the NSAID most often used to treat acute gout attacks; the use of naproxen and sulindac is increasing.
- NSAIDs are preferred to the more disease-specific colchicine because of the diarrhea associated with the use of colchicine. (MCQ)
- Uricosuric agents
- organic acid that reduces urate levels
- act at the anionic transport site in the renal tubule to prevent reabsorption of uric acid. (MCQ)
- Used for chronic gout,often in combination with colchicine.
- Uricosuric agent undergo rapid oral absorption.
- inhibit the excretion of other drugs that are actively secreted by renal tubules
- penicillin, NSAIDs, cephalosporins, and methotrexate (MCQ)
- Dose reduction of these drugs may be warranted.
- Increased urinary concentration of uric acid may result in the formation of urate stones (urolithiasis). (MCQ)
- This risk is decreased with the
- ingestion of large volumes of fluid
- alkalinization of urine with potassium citrate.
- Low doses of uricosuric agents and salicylates inhibit uric acid secretion
- Aspirin is contraindicated in gout. (MCQ)
- Common adverse effects
- GI disturbances
- blood dyscrasias.
- used to treat chronic, tophaceous gout
- because it reduces the size of the established tophi (MCQ)
- colchicine is administered concomitantly during the first week of therapy to prevent gouty arthritis.
- inhibits the synthesis of uric acid by inhibiting xanthine oxidase (MCQ)
- xanthine oxidase converts hypoxanthine to xanthine and xanthine to uric acid.
- Allopurinol is metabolized by xanthine oxidase to alloxanthine, which also inhibits xanthine oxidase.
- Allopurinol also inhibits de novo purine synthesis.
- Adverse effects
- Commonly produces GI disturbances and dermatitis.
- Rarely causes hypersensitivity, including fever, hepatic dysfunction, and blood dyscrasias.
- Allopurinol should be used with caution in patients with liver disease or bone marrow depression. (MCQ)
- a new xanthine oxidase inhibitor. (MCQ)
- Although it is structurally unrelated to allopurinol, it has the same indications as those of allopurinol. (MCQ)
- The same drug interactions with 6-mercaptopurine, azathioprine, and theophylline apply
- Its adverse effect profile is similar to that of allopurinol.
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