Chapter 13 Agents Used to Treat Hyperuricemia and

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Chapter 13 Agents Used to Treat Hyperuricemia and Gout

Chapter 13 Agents Used to Treat Hyperuricemia and Gout

Gout is a metabolic disease associated with the development of high uric acid in

Gout is a metabolic disease associated with the development of high uric acid in the blood. It is a metabolic defect and is not caused by excessive intake of meat and alcohol. l l 2 Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved.

Uric Acid Uric acid is formed from the breakdown of proteins. The accumulation of

Uric Acid Uric acid is formed from the breakdown of proteins. The accumulation of uric acid causes a problem in the joints and kidneys: l l £ £ Kidney stones Kidney failure Gouty arthritis Hyperuricemia 3 Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved.

Acute Attacks Acute attacks of gout are treated with: l £ £ £ Nonsteroidal

Acute Attacks Acute attacks of gout are treated with: l £ £ £ Nonsteroidal anti-inflammatory drugs (NSAIDs) Corticosteroids Colchicine: intravenously or orally 4 Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved.

Agents Used Corticosteroids and NSAIDs actions l £ £ Produce anti-inflammatory effects Produce analgesic

Agents Used Corticosteroids and NSAIDs actions l £ £ Produce anti-inflammatory effects Produce analgesic effects Colchicine’s action is unclear l £ £ Reduces leukocyte production of lactic acid Reduces phagocytic activity 5 Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved.

Colchicine Not a first-line agent because of its adverse side effects l 6 (continues)

Colchicine Not a first-line agent because of its adverse side effects l 6 (continues) Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved.

(continued) Colchicine Major adverse effects: l £ £ £ Nausea, vomiting, and diarrhea Gastrointestinal

(continued) Colchicine Major adverse effects: l £ £ £ Nausea, vomiting, and diarrhea Gastrointestinal bleeding Neuritis Myopathy Alopecia Bone marrow depression 7 Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved.

Long-term Control Most commonly used agent for gout: l £ Allopurinol: prevents formation of

Long-term Control Most commonly used agent for gout: l £ Allopurinol: prevents formation of uric acid u Adverse effects: hepatotoxicity and skin rash 8 Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved.

Gouty Arthritis Most commonly used agent l £ NSAIDs u u u Indomethacin (Indocin)

Gouty Arthritis Most commonly used agent l £ NSAIDs u u u Indomethacin (Indocin) Naproxen (Aleve) Sulindac (Clinoril) 9 Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved.

Uricosuric Agents Increase excretion of uric acid l £ Probenecid (Benemid) u Side effects

Uricosuric Agents Increase excretion of uric acid l £ Probenecid (Benemid) u Side effects • • 10 Headaches Dizziness (continues) Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved.

(continued) Uricosuric Agents £ Sulfinpyrazone (Anturane) u Side effects • • Nausea and vomiting

(continued) Uricosuric Agents £ Sulfinpyrazone (Anturane) u Side effects • • Nausea and vomiting Diarrhea 11 Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved.

Therapeutic Effects Monitor for: l £ £ £ Decreased inflammation Decreased pain Ease of

Therapeutic Effects Monitor for: l £ £ £ Decreased inflammation Decreased pain Ease of movement Monitor lab values of uric acid Monitor urine output l l 12 Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved.