Question

AT&T 8:25 PM Back Case Study 1.doc Case Study 1 A 58 year old man presents for the follow-up of gout. He has had multiple episodes of gouty arthritis, primarily in the great toe. Each episode has been successfully treated wit oral anti-inflammatory medications. He takes no medications regularly and has a normal physical examination today. Laboratory studies following his last episode showed an elevated uric acid level and normal renal function. The physician prescribes allopurinol daily in an effort to lower his uric acid level and prevent recurring gout episodes. I. Name 2 medications or 2 groups of medications that are used in the treatment of acute gout? (25 pts.) 2. Name 2 medications that are used in the treatment of chronic gout? (25pts.) 3. What is the mechanism of action of allopurinol? (25pts.) 4. Identify and define 3 significant adverse effects of allopurinol therapy.(25 pts.) Dashboard Calendar To Do Notifications Inbox

Answer 1

Ans) Gout: A form of arthritis characterised by severe pain, redness and tenderness in joints.

1) The goal of acute gout management is to control pain using drugs that limit joint inflammation.

Medications for acute gout:

-NSAIDS: indomethacin or COX-2 inhibitor is 1st line
-Corticosteroids or ACTH
-Cochine: no longer recommended
-DO NOT give alopurnol during acute gout-any change in uric acid worsens attacks.

2) The goal of chronic gout management is to acheive normal concentrations of plasma urate. Drugs used for the treatment of chronic gout either decrease synthesis of urate or increase excretion of urate.

Medications used to treatment of chronic gout:

- Xanthine-oxidase inhibitors
- Uricosuric durgs

3) Mechanism of action of Allopurinol:

- Allopurinol is a purine analog.

- It reduces the production of uric acid by competitively inhibiting the last two steps in uric acid biosynthesis that are catalyzed by xanthine oxidase.

4) Adverse effects of Allopurinol:

- Allopurinol may cause hypersensitivity reactions, especially skin rashes, are the most common adverse reactions, occurring in approximately 3 percent of patients.

- In rare instances, the rash may progress to Steven's Johnson syndrome.

- For this reason all patients who develop a cutaneous reaction to allopurinol should discontinue the drug.