Rheumatology Case No 3.Gout

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Rheumatology Case No 3.Gout

Gout এর পেশেন্ট এর CKD থাকলে তাকে acute condition এ NSAID দেওয়া যাবেনা,

তখন Drug of choice.

Colchicine

NSAID এর চেয়েও দ্রুত পেইন কমায়

Tab1: colimax 0.6 mg 2 tab stat As a Colchicine Drugs used in Gout.

Indications Of Tab: colimax 0.6 mg As a Colchicine Drugs used in Gout.

Colimax are indicated for treatment of acute gout flares. And also indicated in Familial Mediterranean fever (FMF) in adults and children 4 years or older.

Pharmacology Of Tab: colimax 0.6 mg As a Colchicine Drugs used in Gout.

An acute attack of gout apparently occurs as a result of an inflammatory reaction to crystals of monosodium urate that are deposited in the joint tissue from hyperuric body fluids; the reaction is aggravated as more urate crystals accumulate. Leukocytes migrate to the sites where urate crystals have been deposited and try to engulf the crystals by phagocytosis. As a result lactic acid and proinflammatory enzymes are released which cause inflammation with severe pain, redness, and swelling of the affected joint. Lactic acid favors a local decrease in pH that enhances uric acid deposition. Colchicine inhibits the phagocytosis of uric acid by leukocytes & also diminishes the lactic acid production directly. Thus interrupts the cycle of urate crystal deposition and inflammatory response that sustains the acute attack of gout.

Colchicine is absorbed when given orally, reaching a mean Cmax of 2.5 ng/mL (range 1.1 to 4.4 ng/mL) in 1 to 2 hours after a single dose administered under fasting conditions. The mean apparent volume of distribution is approximately 5 to 8 L/kg. Colchicine binding to serum protein is low (39 ± 5%), primarily to albumin regardless of concentration. CYP3A4 is involved in the metabolism of Colchicine to 2-O-demethylcolchicine and 3-O-demethylcolchicine. Plasma levels of these metabolites are minimal (less than 5% of parent drug). Following multiple oral doses (0.6 mg twice daily), the mean elimination half-life is 26.6 to 31.2 hours.

Side Effects Of Tab: colimax 0.6 mg As a Colchicine Drugs used in Gout.

Blood dyscrasias: Myelosuppression, leukopenia, granulocytopenia, thrombocytopenia, and aplastic anemia have been reported. Diarrhea and pharyngolaryngeal pain may occur.

Then 1 tab 12 hourly

.Gout এর একটা পেশেন্ট যদি clinical sign symptoms নিয়ে আসে, serum uric acid করে কোনো লাভ নাই, Diagnosis এর জন্য Joint fluid aspirations and microscopy করতে হবে।

acute attack এর প্রথম ৭-১৪ দিন পর্যন্ত Uric acid normal আসবে

তাই Uric acid normal দেখে Gout নাই বলা যাবেনা।

allopurinol : acute attack er ১৪ দিন পরে শুরু হবে।

acute attack এর সাথে সাথে শুরু করলে Gout flare করবে।

এখন Gout এ ২ টা ঔষধ পাওয়া যায়,

Tablet2:-Esloric 100mg As a Allopurinol Drugs used in Gout.

Indications Of Tablet:-Esloric 100mg As a Allopurinol Drugs used in Gout.

Esloric is indicated for reducing urate/uric acid formation in conditions where urate/uric acid deposition has already occurred (e.g. gouty arthritis, skin tophi, nephrolithiasis). Esloric is indicated for management of 2,8-dihydroxyadenine (2,8-DHA) renal stones related to deficient activity of adenine phospho ribosyltransferase. Esloric is indicated for the management of recurrent mixed calcium oxalate renal stones in the presence of hyperuricosuria, when fluid, dietary and similar measures have failed.

Pharmacology Of Tablet:-Esloric 100mg As a Allopurinol Drugs used in Gout.

Allopurinol is a xanthine oxidase inhibitor which is administered orally. It acts on purine catabolism without disrupting the biosynthesis of purines. It reduces the production of uric acid by inhibiting the biochemical reactions immediately preceding its formation. Allopurinol is a structural analogue of the natural purine base, hypoxanthine. It is an inhibitor of xanthine oxidase, the enzyme responsible for the conversion of hypoxanthine to xanthine and xanthine to uric acid, the end product of purine metabolism. Allopurinol is approximately 90% absorbed from the GI tract. Peak plasma levels generally occur at 1.5 hours to 4.5 hours. It has a plasma half life of about 1 to 2 hours. Approximately 20% of the ingested Allopurinol is excreted in the faeces.

Side Effects Of Tablet:-Esloric 100mg As a Allopurinol Drugs used in Gout.

Rashes, gastro intestinal disorder’s, rearly malaise, headache, vertigo, drowsiness, visual and test disturbances, hypertension, alopecia, hepatotoxicity, neuropathy, gynaeconastia and blood disorders.

allopurinol, febuxostat

Tablet 3: Febustat 80 Mg As a Febuxostat As a Drugs used in Gout.

Indications Of Tablet :- Febustat 80 Mg As a Febuxostat As a Drugs used in Gout.

Febustat tablets are indicated for the chronic management of hyperuricemia in patients with gout. Febustat tablets are not recommended for the treatment of asymptomatic hyperuricemia.

Pharmacology Of Tablet :- Febustat 80 Mg As a Febuxostat As a Drugs used in Gout.

Febuxostat is a non-purine, selective xanthine oxidase (XO) inhibitor. It decreases serum uric acid level by inhibiting xanthine oxidase, which is responsible for uric acid production. Xanthine oxidase breaks down hypoxanthine to xanthine and thus to uric acid. Febuxostat is not expected to inhibit other enzymes involved in purine and pyrimidine synthesis and metabolism at therapeutic concentrations.

Side Effects Of Tablet :- Febustat 80 Mg As a Febuxostat As a Drugs used in Gout.

The most commonly reported adverse reactions are gout flares, liver function abnormalities, diarrhoea, nausea, headache, rash and oedema. These adverse reactions were mostly mild or moderate in severity. Rare serious hypersensitivity reactions to Febustat have observed.

অবশ্যই প্রথমে allopurinol দিয়ে শুরু করবে।

কাজ না হলে Febuxostat.

Raiyyan Tahsan Date:-23-12-2024 Tuesday Time:-2-22-37 Pm.

Raiyyan Tahsan

Raiyyan Tahsan