ANTI GOUT a.

Allopurinol Mechanism of Action: Inhibits the enzyme responsible for the conversion of purines to uric acid, this reducing the production of uric acid with a decrease in serum and sometimes in urinary uric acid levels, relieving the sign and symptoms of gout. Indication: y Management of the signs and symptoms of primary and secondary gout. y Management of patients with leukemia, lymphoma, and malignancies that result in elevations of serum and urinary uric acid. y Orphan drug use: Treatment of Chaga s disease, cutaneous and visceral leishmaniasis Adverse effect: y CNS: Headache, drowsiness, peripheral neuropathy, neuritis, paresthesias y Dermatologic: Rashes- maculopapular, scaly or exfoliative- sometimes fatal y GI: Nausea, vomiting, diarrhea, abdominal pain, gastritis, hepatomegaly, hyperbilirubinemia, cholestatic jaundice y GU: Exacerbation of gout and renal calculi, renal failure Side Effect: y Exacerbation of gouty attack or renal stones; nausea, vomiting, loss of appetite; drowsiness b. Colchicine Mechanism of Action: Exact mechanism unknown; decreases deposition of uric acid; inhibits kinin formation and phagocytosis and decreases inflammatory reaction to urate crystal deposition. Indication: y Pain relief of acute gout attack; also used between attacks as prophylaxis y Orphan drug use: Arrest progression of neurologic disability caused by chronic progressive MS y Unlabeled uses: hepatic cirrhosis, familial Mediterranean fever, skin manifestations of scleroderma; Sweet s syndrome; treatment of Behcet s disease Adverse effect y CNS: Peripheral neuritis, myopathy y Dermatologic: Dermatoses, alopecia, purpura y GI: Diarrhea, vomiting, abdominal pain, nausea y GU: Azoospermia (reversible) y Hematologic: Bone marrow depression; elevated alkaline phosphate, AST levels with agranulocytosis, aplastic anemia; or thrombocytopenia Side Effect: y Nausea, vomiting, loss of appetite, loss of fertility, loss of hair. c. Probenecid Mechanism of Action: Inhibits the renal tubular reabsorption of urate, increasing the urinary excretion of uric acid, decreasing serum uric acid levels, retarding urate deposition, and promoting resorption of urate deposits; also inhibits the renal tubular reabsorption of most penicillins and cephalosporins. Indication: y Treatment of hyperuricemia associated with gout and and gouty arthritis y Adjuvant to therapy with penicillins or cephalosporins, for elevation and prolongation of plasma levels of antibiotic Adverse effect: y CNS: Headache y GI: Nausea, vomiting, anorexia, sore gums y GU: Urinary frequency, exacerbation of gout and and uric acid stones y Hematologic: Anemia, hemolytic anemia

y Hypersensitivity: Reactions including anaphylaxis, dermatitis, pruritus, fever y Other: Blushing Dizziness Side Effect: y Headache, dizziness, exacerbation of gouty attack or renal stones; nausea, vomiting, loss of appetite d. Sulfinpyrazone Mechanism of Action: Inhibits the renal tubular reabsorption of urate, increasing the urinary excretion of uric acid, decreasing serum uric acid levels, retarding urate deposition, and promoting resorption of urate deposits. Inhibits prostaglandin synthesis, which prevents patelet aggregation, but lacks analgesic and anti inflammatory activity. Indication: y Chronic gouty arthritis y Intermittent gouty arthritis y Unlabeled uses: Post- MI therapy to decrease incidence of sudden death; in rheumatic mitral stenosis to decrease the frequency of systemic embolism. Adverse effect: y Dermatologic: rash y GI: Upper GI disturbances y GU:Exacerbation of gout and uric acid stonrs, renal failure y Hematologic: Blood dyscrasias Side Effect: y Exacerbation of gouty attack or renal stones, nausea, vomiting, loss of appetite.

ANTI RHEUMATICS a. Aspirin Mechanism of Action: Inhibit the synthesis of prostaglandins, important mediators of inflammation. Indication: y Inflammatory conditions: rheumatic fever, rheumatoid arthritis, osteoarthritis, juvenile rheumatoid arthritis, spondyloarthropaties Adverse effect: y Acute aspirin toxicity: Respiratory alkalosis, hyperpnea, tachypnea, hemorrhage, excitement, confusion, asterixis, pulomonary edema, seizures, tetany, metabolic acidosis, fever, coma, CV collapse, renal and respiratory failure. y Aspirin intolerance: Exacerbation of bronchospasms, rhinitis y GI: Nausea, dyspepsia, heartburn, epigastric discomfort, anorexia, hepatoxicity y Hematologic: Occult blood loss, hemostatic defects y Anaphylactoid reactions to anaphylactic schock y Salicylism: Dizziness, tinnitus, difficulty hearing, nausea, vomiting, diarrhea, mental confusion, lassitude Side Effect: y Nausea, GI upset, heartburn, easy bruising, gum bleeding. b. Auranofin Indication: y Management of adults with active classic or definite rheumatoid arthritis who have insufficient response to or intolerance to NSAIDs. Black Box Warning: y Discontinue drug at first sign of toxicity: Severe bone marrow suppression, renal toxicity, and diarrhea are possible. c. Aurothioglucose

Indication: y Treatment of selected, early cases of adult and juvenile rheumatoid arthritis. Black Box Warning: y Discontinue drug at first sign of toxicity: Severe bone marrow suppression, renal toxicity, and diarrhea are possible. d. Gold Soduim Thiomalate Indication: y Treatment of selected, early cases of adult and juvenile rheumatoid arthritis. Black Box Warning: y Monitor lung, renal function and blood counts; discontinue at first sign of toxicity. e. Methotrexate Mechanism of Action: Inhibits dihydrofolic acid reductase, leading to inhibition of DNA synthesis and inhibition of cellular replication; selectively affects the most rapidly dividing cells. Indication: y Management of severe, active, classical or definite rheumatoid arthritis. y Management of polyarticular course juvenile rheumatoid arthritis. Adverse effect: y CNS: Headcahe, drowsiness, blurred vision, aphasia, hemiparesis, paresis, seizures, fatigue, malaise, dizziness y Dermatologic: Erythematous rashes, pruritus, urticaria, photosensitivity, depigmentation, alopecia, ecchymosis, acne, furunculosis y GI: Ulcerative stomatitis, pharyngitis, anorexia, nausea, vomiting, diarrhea, hematemesis, melena y GU: Renal failure, effects on fertility y Hematologic: Severe bone marrow depression, increased susceptibility to infection y Hypersensitivity: Anaphylaxis, sudden death y Respratory; Interstitila pneumonitis, chronic interstitial obstructive puloonary disease y Others: Chills and fever, metabolic changes, cancer Side Effect: y Nausea, vomiting, numbness, tingling, dizziness, drowsiness, blurred vision, difficulty speaking, mouth sores, infertility, loss of hair, rash, sensitivity to sun and ultraviolet light. f. Penicillamine Indication: Treatment of severe, acute rheumatoid arthritis when other therapies fail, Wilson s disease, cystinuria when other measures fail. g. Salsalate Mechanism of Action: Inhibit the synthesis of prostaglandins, important mediators of inflammation. Indication: y Relief of mild to moderate pain y Reduction of fever y Relief symptoms of various inflammatory conditions - rheumatic fever, rheumatoid arthritis, osteoarthritis. Adverse effect: y Acute salicylate toxicity: Respiratory alkalosis, hyperpnea, tachypnea, hemorrhage, excitement, confusion, asterixis, pulomonary edema, seizures, tetany, metabolic acidosis, fever, coma, CV collapse, renal and respiratory failure. y GI: Nausea, dyspepsia, GI pain, diarrhea, vomiting, constipation, flatulence y Salicylism: Dizziness, tinnitus, difficulty hearing, nausea, vomiting, diarrhea, mental confusion, lassitude