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Published byAllison McCormick Modified over 9 years ago
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Prepared by : Tamara Odeh Diana Jawhari Supervised by : Dr. Ola Ayesh
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DNA Adenine Guanine Purine group Cytosine Thymine Pyrimidine group
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Adenine&Guanine (Purines) HypoxanthineXanthineUric acid Xanthine Oxidese Xanthene Oxidase
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Uric acid in blood Monosodium Urate Crystals deposition in joints and may be also in soft tissues Inflammatory response to the crystals Gout, Uric acid stones in kidney
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Causes of blood uric acid Excretion Excretory defect in kidney Drugs Ex ; thiazide diuretics Production Idiopathic (mutations ) Cell turn over (chemotherapy) Consuming ethanol,types of food
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1)Nonpharmacological Reduce intake of foods with high purines Exp: organ meats Avoid alcohol Loose Wt if obese 2)Pharmacological Using drugs for acute & chronic gout
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Drugs used in gout Acute NSAIDs (Indomethacin ) Corticosteroids Colchicine Chronic Xanthine oxidase inh. Allopurinol Uricosurics Ex; Probenecid Sulfonpyrazone
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Target : Inflammation & pain Drugs : NSAIDs inflammatory Corticosteroids mediators Colchicine neutrophils movement to the affected area
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Drug of choice if there is no C/I Exp: Indomethacin It is as effective as colchicine but it is preferred because it has less GIT toxicity Begin with dose (Exp: 75mg ) First 24-48hr Then 50mg/6hr for 1day, then 50mg/8hr for 1-2days. NSAIDs
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S/E : headache, dizziness. Use in caution in pt with : Peptic ulcer HF Chronic kidney disease Coronary artery disease
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PO dose 1mg initially, then 0.5mg/2hr S/E of PO colchicine is GIT toxicity so IV dose is used 2mg initially, if no relief then additional 1mg/6-12hr to total dose of 4mg. S/E of Iv colchicine: inflammation and necrosis of surrounding tissue. Colchicine Colchicine should be diluted with 20ml normal saline to minimize sclerosis of vein.
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C/I Of IV colchicine : Neutropenia Sever renal impairment Combined renal and hepatic insufficiency Colchicine should be discontinued within 7days after Iv or PO therapy to reduce the risk of bone marrow toxicity
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Used for resistant cases or Pt with C/I to NSAIDs & colchicine For multiple joint involvement: 1) Prednisone 30-60mg PO once daily for 3-5 days Corticosteroids The dose should be decreased gradually to prevent rebound attacks
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2) Adrenocorticotropic hormone (ASTH) gel 40-80 USP units given IM/6-8hr for2-3 days. For limited 1-2 joint involvement ; Triamcinolone hexacetonide 20-40mg given intra-articularly.
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Target : Treat the cause Drugs : 1) Colchicine 2) Uricosurics : Probenecid Uric acid Sulfinopyrazone excretion
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2) Xanthene oxidase Inh. : Allopurinol : converted to Oxypurinol Febuxostat Allopurinol Febuxostat Inh. Xanthine oxidase Inh. Uric acid production
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PO 0.5mg twice daily during the first 6-12 months of uric acid lowering therapy to minimize the risk of acute attacks that may occur during initiation of this therapy. Colchicine
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Probenecid 250mg twice daily for 1-2weeks then 500mg twice daily for 2 weeks, then increase until control is achieved or a maximum dose of 2g/day is reached. Sulfinpyrazone 50mg twice daily for 3-4 days then100mg twice daily,increasing the daily dose by 100mg each week up to 800mg/day. Uricosurics
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S/E : GI Irritation Rash & hypersensitivity Precipitation of acute gouty arthritis Stone formation
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C/I : Pt allergic to these drugs. Impaired renal function. History of renal calculi. Over producers of uric acid.
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Allopurinol is converted to oxypurinol It has long half –life so given once daily Po daily dose is usually 300mg 600-800mg/day may be necessary Xanthine oxidase inh.
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Allopurinol is DOC in Pt with : History of urinary stones Impaired renal function Over producers of uric acid Before initiation of cytotoxic therapy pretreatment with allopurinol is needed to prevent acute uric acid nephropathy.
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1) Skin rash. 2) Leukopenia. 3) GI toxicity. 4) Increase frequency of gouty attacks with the initiation of therapy. 5) Allopurinol hypersensitivity syndrom: Fever. Dermatitis. Vasculitis. Renal & hepatic dysfunction.
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Company : Takeda Approval Status : Approved February 2009 Treatment for : hyperuricemia
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Once-daily oral medication. Available in : 40-mg and 80-mg tablets. It is the first new treatment option for hyperuricemia in patients with gout.
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Recommended initial dose 40 mg once daily. For patients who do not achieve a serum uric acid less than 6 mg per dL after 2 weeks with 40 mg 80 mg is recommended
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Adenine&Guanine (Purines) HypoxanthineXanthineUric acid Xanthine Oxidese Xanthene Oxidase
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ULORIC was studied and evaluated in multiple clinical trials CONFIRMS which was the largest phase 3 clinical trial shows that ULORIC 80 mg was better than ULORIC 40 mg and allopurinol 300/200 mg at achieving serum uric acid levels of less than 6.0 mg/dL
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Uloric Allopurinol 0.60 per 100 Pt every year 0.60 per 100 Pt every year 0.74 per 100 Pt every year 0.74 per 100 Pt every year
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Nausea Arthralgia Rash Dizziness
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ULORIC is contraindicated in patients being treated with : Azathioprine Mercaptopurine Theophylline
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