1. Chapter 13 Agents Used to Treat Hyperuricemia and Gout

2. Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. 13 - 2 Gout 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.

3. Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. 13 - 3 Uric Acid Uric acid is formed from the breakdown of proteins. The accumulation of uric acid causes a problem in the joints and kidneys:  Kidney stones  Kidney failure  Gouty arthritis  Hyperuricemia

4. Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. 13 - 4 Acute Attacks Acute attacks of gout are treated with:  Nonsteroidal anti-inflammatory drugs (NSAIDs)  Corticosteroids  Colchicine: intravenously or orally

5. Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. 13 - 5 Agents Used Corticosteroids and NSAIDs actions  Produce anti-inflammatory effects  Produce analgesic effects Colchicine’s action is unclear  Reduces leukocyte production of lactic acid  Reduces phagocytic activity

6. Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. 13 - 6 Colchicine Not a first-line agent because of its adverse side effects (continues)

7. Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. 13 - 7 Colchicine Major adverse effects:  Nausea, vomiting, and diarrhea  Gastrointestinal bleeding  Neuritis  Myopathy  Alopecia  Bone marrow depression (continued)

8. Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. 13 - 8 Long-term Control Most commonly used agent for gout:  Allopurinol: prevents formation of uric acid  Adverse effects: hepatotoxicity and skin rash

9. Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. 13 - 9 Gouty Arthritis Most commonly used agent  NSAIDs  Indomethacin (Indocin)  Naproxen (Aleve)  Sulindac (Clinoril)

10. Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. 13 - 10 Uricosuric Agents Increase excretion of uric acid  Probenecid (Benemid)  Side effects Headaches Dizziness (continues)

11. Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. 13 - 11 Uricosuric Agents  Sulfinpyrazone (Anturane)  Side effects Nausea and vomiting Diarrhea (continued)

12. Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. 13 - 12 Therapeutic Effects Monitor for:  Decreased inflammation  Decreased pain  Ease of movement Monitor lab values of uric acid Monitor urine output