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 toethe crystals provoke an immune responsegranulocytes respond and their high metabolic activity produces lactic acid, reducing pH and causing more uric acid to precipitate

ACUTE

Reduce inflammation

Colchicine

MOA: inhibits activities of leukocytes (esp. granulocytes)

AE:

severe n/v, limits effectiveness

CHRONIC

Reduce uric acid synthesis

Allopurinol

MOA: inhibits xanthine oxidase80% bioavailabilityit is a xanthine isomer

AE:

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

Contraindications

acute gouty attack

Increase uric acid excretion

Probenecid (high doses)

@ high doses, inhibits secretion + reabsorbtion incr. excretion decr. plasma urate(what we want in a gout treatment -- whatever's in there just passes right thru)@ low doses, inhibits secretion not reabsorbtion decr. excretion incr. plasma uratedrug must be in filtrate to act on transporters on the apical surface

other uses

uncomplicated gonoccocal infxn

only takes one shotMOA: inhibits penicillin excretion via nonspecific OAT 1 & 3

AE:

GI disurbances

predisposes to kidney stone

b/c it decreases pH

complications

aspirin prevents its action

may use tylenol or naproxen instead

it antagonizes diuretics

Sulfinpyrazole

MOA same as probenecid

other uses:

antithrombic (like aspirin)

AE:

GI side effects

hypersensitivity not common