Following his third episode of gouty arthritis, a 50-year-old man sees you in the clinic. Each...

Following his third episode of gouty arthritis, a 50-year-old man sees you in the clinic. Each case was successfully treated acutely; however, your patient is interested in trying to prevent future episodes. He is not on regular medications and has a normal physical examination today. Blood work reveals an elevated serum uric acid level and otherwise normal renal function and electrolytes. A 24-hour urine collection for uric acid reveals that he is underexcreting uric acid. Suspecting that this is the cause of his recurrent gout, you place him on probenecid.

List a drug for which probenecid is used to improve patient outcome in clinical practice.

Solutions

Expert Solution

Client problem: Gouty arthritis due to underexcretion of uric acid.

Probenecid: It helps to pass out excess uric acid through the urine. It is used to treat Gouty arthritis. Sometimes it is used along with antibiotics( penicillin, ampicillin, nafcillin) or pain killers (colchicine, ibuprofen, indomethacin).

Mechanism of Action:It comes under the uricosuric drug, which inhibits the tubular reabsorption of filtered urate and increases urate excretion.

It is recommended if uric acid is less than 800mg in 24hr urine collection.

Dose: 250mg BD to a maximum of 3g/day.

Allopurinol: It is a hyperuricemic agent.

Mechanism of action: The metabolite compound is oxypurinol which inhibits the enzyme Xanthine oxidase.

Recommendations: the patient with uric acid is greater than 800mg in 24hr urine collection. And also patients with risk of uric acid nephropathy, nephrolithiasis, renal insufficiency.

Dose: 200-300mg/day.

Febuxostat: FDA approved the drug for treating of hyperuricemia.

Mechanism of Action: It inhibits the Xanthine oxidase.

Recommendations: serum urate level is greater than or equal to 8mg/dL.

Dose: 40mg/daily.

Lesinurad: It is a selective inhibitor.

Mechanism of Action: It inhibits the urate transporter which makes major reabsorption of uric acid and also anion transporter 4 in diuretic-induced hyperuricemia.

Recommendations: patients in need of targeted serum uric acid levels.

Dose: 200mg PO/day.

Pegloticase: It is used to treat chronic gout.

Mechanism of action: It catalyzes the oxidation of uric acid into allantoin and thereby excretes the urate.

Recommendation: for the patient with the uric acid-specific enzyme in chronic gout.

Dose: IV 8mg every 2 weeks.

Rasburicase: It is urate oxidase used to prevent the complications of hyperuricemia.

Mechanism of Action: It converts urate into allantoin.

Recommendation: the patient with risk of tumor lysis syndrome.

Dose: 600mg /daily.

Nightingale answered 1 year ago

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