Gout Treatment

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Gout Treatment

dz produced by the formation of uric acid crystals (tophi) in joints (b/c there's low fluid there), especially in the big toe

the crystals provoke an immune response

granulocytes respond and their high metabolic activity produces lactic acid, reducing pH and causing more uric acid to precipitate

CHRONIC

Increase uric acid excretion

Sulfinpyrazole

MOA same as probenecid

hypersensitivity not common

GI side effects

other uses:

antithrombic (like aspirin)

Probenecid (high doses)

@ high doses, inhibits secretion + reabsorbtion

(what we want in a gout treatment -- whatever's in there just passes right thru)

@ low doses, inhibits secretion not reabsorbtion

drug must be in filtrate to act on transporters on the apical surface

complications

it antagonizes diuretics

aspirin prevents its action

predisposes to kidney stone

GI disurbances

other uses

uncomplicated gonoccocal infxn

Reduce uric acid synthesis

Allopurinol

MOA: inhibits xanthine oxidase

Contraindications

acute gouty attack

may worsen an acute gouty attack if used as 1st tx

ACUTE

Reduce inflammation

Colchicine

MOA: inhibits activities of leukocytes (esp. granulocytes)

AE:

severe n/v, limits effectiveness