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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

loss of appetite. juvenile rheumatoid arthritis. confusion. nausea. fever y Other: Blushing Dizziness Side Effect: y Headache. important mediators of inflammation. fever. vomiting. tinnitus. Aspirin Mechanism of Action: Inhibit the synthesis of prostaglandins. renal toxicity. hemostatic defects y Anaphylactoid reactions to anaphylactic schock y Salicylism: Dizziness. Black Box Warning: y Discontinue drug at first sign of toxicity: Severe bone marrow suppression. osteoarthritis. loss of appetite d. easy bruising. diarrhea. vomiting. asterixis.MI therapy to decrease incidence of sudden death. Indication: y Inflammatory conditions: rheumatic fever. b. Adverse effect: y Dermatologic: rash y GI: Upper GI disturbances y GU:Exacerbation of gout and uric acid stonrs. hyperpnea. Aurothioglucose . dyspepsia. c. pruritus. hemorrhage. epigastric discomfort. seizures. nausea. metabolic acidosis. tachypnea. anorexia. in rheumatic mitral stenosis to decrease the frequency of systemic embolism. which prevents patelet aggregation. vomiting. decreasing serum uric acid levels. dermatitis. CV collapse. rhinitis y GI: Nausea. gum bleeding. Sulfinpyrazone Mechanism of Action: Inhibits the renal tubular reabsorption of urate. and diarrhea are possible. nausea. excitement. mental confusion. Inhibits prostaglandin synthesis. Auranofin Indication: y Management of adults with active classic or definite rheumatoid arthritis who have insufficient response to or intolerance to NSAIDs. renal failure y Hematologic: Blood dyscrasias Side Effect: y Exacerbation of gouty attack or renal stones. lassitude Side Effect: y Nausea. increasing the urinary excretion of uric acid. exacerbation of gouty attack or renal stones. and promoting resorption of urate deposits. dizziness. rheumatoid arthritis. ANTI RHEUMATICS a. Indication: y Chronic gouty arthritis y Intermittent gouty arthritis y Unlabeled uses: Post. coma. hepatoxicity y Hematologic: Occult blood loss. renal and respiratory failure. retarding urate deposition.y Hypersensitivity: Reactions including anaphylaxis. but lacks analgesic and anti inflammatory activity. spondyloarthropaties Adverse effect: y Acute aspirin toxicity: Respiratory alkalosis. y Aspirin intolerance: Exacerbation of bronchospasms. tetany. difficulty hearing. pulomonary edema. heartburn. heartburn. GI upset.

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