GOUT

Gouty arthritis- inflammation of joints. Increased deposition of uric acid into the joints.

○Food Sources of Uric acid

● Beans
● liver (laman loob)
● bagoong, anchovies
● Mackerel
● fish (galunggong, tambakol)
● mabuto (lansones, rambutan)

○Uric acid is from Purines/ end product of metabolism of purine

○Purines- xanthine alkaloid ( when the enzyme xanthine oxidase acts, it will be converted to
uric acid)

○Allopurinol- xanthine oxidase inhibitor (enzyme inhibitor)

Examples of xanthine alkaloids (sources of uric acid)

● ○Theobromine- from chocolates
● ○Theophylline- from tea
● ○Caffeine- from coffee

Causes of Gout
○Lesch-nyhan syndrome- HGPRT (hypoxanthine-guanine phosphoribosyltransferase)
deficiency. Young age, there is a problem in the metabolism of purines. Manu uric acid is
deposited in the joints.

○Uricase- enzyme responsible for the digestion of uric acid. If uricase has low levels, it will be
deposited in the joints.

Examples of drugs that can decrease clearance of uric acid (HYPERURICEMIA-

INCREASEDURIC ACID IN THE BODY)
● diuretics [thiazide, loop, that can cause hyperuricemia]
● Salicylates
● Pyrazinamide
● Ethambutol
● ethanol [OH]).

SPECTRUM
○Tophi- uric acid deposits into the joints.
○Podagra- swelling of the big toe
○Nephrolithiasis- crystal formation in the kidneys

DRUGS FOR ACUTE GOUTY ATTACKS.

1. ○INDOMETHACIN
● NSAID
● COX inhibitor
● inhibits prostaglandin synthesis
● inhibits inflammation
● ○INFLAMMATION= (Arachidonic acid [precursor], COX enzyme will convert it to
prostaglandin (responsible for inflammation).
2. ○COLCHICINE
● an alkaloid
● microtubule synthesis inhibitor
● Inhibition of inflammatory genes and interfere with the formation of inflammatory
genes
● Phagocytosis- Engulf substances that can cause inflammation
● ADR -bloody diarrhea
3. ○CORTICOSTEROIDS
● acts into type 4 receptor
● TYPE IV- gene transcription linked receptor
● Two actions..
○ (1) activation of transcription of anti-inflammatory genes
○ (2) inhibition of transcription of anti-inflammatory genes

DRUGS FOR CHRONIC ATTACKS OF GOUT

1. ALLOPURINOL
● enzyme inhibitor
● Inhibit synthesis and formation of uric acid
● Inhibit conversion of xanthine to uric acid
● Matagal ang effect, utilize the available uric acid in the circulation. When it is
utilized completely, the drug will notice that there is no uric acid produced.
●
2. URICOSURIC AGENTS
● inhibit tubular reabsorption of uric acid
● Its purpose is not to reabsorb uric acid, but instead to excrete uric acid.
● (e.g, probenecid, sulfinpyrazone)
● COMMON DRUG INTERACTION..
○ probenecid + penicillin(acid) = probenecid-increase excretion of uric acid
/penicillin will be retained, penicillin will be reabsorbed (prolonged half life
of penicillin)
○NORMAL- Kidneys, Nephron, filter, reabsorb, excrete. Uric acid can be absorbed.