gouty attack!!

nk cter sal gout neh...
br je pas pbl....
apekah pbl???
program based learning-
lecturer akan bg satu kes.....
1 patient and prescription for the patient...
tugas kami sbgai pharmacist kononnyer,,,,kene la bincng sal drug 2
their interaction with other drugs,,,patient counselling,,adverse effect,,,dosing,,,mechanism of action,,,n mcm2 lg...
okey,,,stop membebel...


DRUG INFO:Gouty attack


Pathogenesis

• elevation of the serum uric acid levels.Uric acid is the end product of purine metabolism
• Gout is characterized by initial intermittent attack of mono or polyarticular arthritis in the setting of prolonged hyperuricemia
• Marked fluctuation in serum urate levels increase the risk of gout

Factors that increase serum urate

• overproduction of purines.so purines will metabolized to uric acid
  
• reduction in glomerular filtration rate.less uric acid will secrete from blood cause accumulation of uric acid crystal
• lactic acid may competitively inhibit the renal tubular secretion of uric acid..conditions which these will lead to hyperuricemia
• drug induced hyperuricemia.eg;cytotoxic drugs,anhypertensive such as chlorothiazide,diuretics drugs

How gout occurs??

• Monosodium urate crystal(uric acid) precipitate in the joint and initiate an inflammation process
• The realeased crystal are chemotactic to leukocytes and also activate complement leading to inflammation and destructive changes to cartilage and subchondral bone

Guide line to treat Acute Gout Attack

• First line-teratment shoulb be pain relief-NSAIDS-such as indomethacin(not over the counter drugs due to the serious side effect), diclofenac, naproxen and voltaren.Be aware!!!although Aspirin includes under Nsaids, aspirin should not be used as it can worsen the condition.this is because aspirin inhibit uric acid secretion even at low dose.Aspirin also reduces vasodilation due to the inhibition of prostaglandin.
• Second line-Colchicine is given for those unable to tolerate Nsaids .Colchicine inhibits the inflammatory responseand is generally given by mouth but can also be given intravenously.Monitoring the levels of colchicines is necessary due to the narrow theraputic index.
• Third line-Glucocorticoids such as prednisolone.Introduction of these third line drugs must never be during the actual acute attack as they will potentially aggravate the acute episode and prolong it

Antigout

• Allopurinol(inhibit uric acid synthesis)
• Uricosuric agents(incerase uric acis secretion)
• Colchicine(inhibit neutrophil migrate into the joint
• NSAIDS(analgesics and antiinflammatory)

Mechanism of action of allopurinol




-Allopurinol will inhibit the metabolism of purines by inhibiting xanthine oxidase.Hypoxanthine analoque of allopurinol.Allopurinol converted to alloxanthine by xanthine oxidase..Allopurinol and alloxanthine will inhibit xanthine oxidase.So no metabolism of purine

Mechanism of action of Uricosuric agents

-Uricosuric agent will increase the excretion by inhibiting its reabsoption into the proximal tubule

Mechanism of action of Colchicine

-Colchicine inhibits microtubul polymerization by binding to tubulin and preventing its addition to the +ve ends.This binding causes depolymerisation od microtubules so will decreses cell motility and prevent migration of neurophils


Non-pharmacological counseling

• patients must avoid from taking any alcohol while medication because alcohol will reduced the effectiveness of the drugs
• try avaoid from taking high purine diet such as sardine,soya bean,meat,asparagus.

GOUT!!!