February 7, 2023

You hello people in this video we wanted to get all of you purely non allopurinol so now where exactly are we you know where we are okay we will take you back and show you a recap we are in aunt pig out drugs pharmacology correct do you know what gout this hyperuricemia so here what happens these are you you eat that is uric acid crystals they go and deposit in

The joints and even in the kidney they also are going to deposit and subcutaneous tissue that i mean is called as toffee correct so this is goat gouty arthritis means when it deposits in the joints like this this is gouty arthritis the causes of this hyperuricemia are something like extra purine breakdown right when purine breakdown happens xanthine is released and

That will convert into uric acid uric acid has to be removed in urine right so what happens when excess breakdown is there excess uric acid gets produced and if there is some problem in the kidney where it is not able to remove this much uric acid when the excretion is low then uric acid will become more and here you can see how it it will go in deposit and all this

Joins etc the another cause for this hyperuricemia can be leukemia and some drugs that people are taking like the asura its furious amide which are diuretics rate they act on the kidney so all these causes can increase hyperuricemia now you know like if it is going in deposit in the joint then it’s called as gouty arthritis now coming to the drugs which are used

To treat gout remember acute gouty arthritis you should give only this anti-inflammatory like nsaids were about non-steroidal anti-inflammatory done drugs like diclofenac indomethacin so many other drugs that you can give for acute gouty arthritis na ca ds are the first choice then if they are not responding to any side ease you can give holschuh chief coach team

What it will do it is acting only against gout the inflammation so it will suppress only gout the inflammation and you can give steroids only after this all this comes to control right only after this acute episode comes to control only then you should give these drugs because these drugs are going to work on the uric acid levels and if you give them during acute

Episode them they can precipitate uric acid levels i really don’t know how but they are saying that during the county episode arthritis acute episode don’t give these drugs don’t try to solve the problem smokey both try to solve the uric acid problem first try to just to reduce the inflammation then we will see they see okay so this is how iron pig-out drugs work

Now when it comes to chronic gout that is where we are currently we want to cover a low purine on creek and up urinal is the first choice off and drug it is the first choice that should be written you first choice for this is the first choice for chronic gout first choice for chronic gout is allopurinol remember the first choice for acute gout is in the cid okay so

Allopurinol is what it inhibits the synthesis of this uric acid so it is a very good drug it is very well tolerated etcetera so synthesis inhibitor allopurinol is the first choice then you have this probenecid which is a yuriko slew rate control your course uric means actually they just increase the excretion okay they increased excretion of uric acid that’s all

I’m not sure you recall uric means what is there in some some hidden meaning in that will cause you rick i don’t know but it just says that it increases in excretion of uric acid anyways our focus in this video is allopurinol in the previous videos we have covered in this cid is called szczecin corticosteroids are probably i said everything we have covered now we

Are moving on to and appearing on okay you can just see what now we have covered a few doty arthritis nsaids indomethacin diclofenac pi roxy cam eatery cox it burn a pros sent everything we discussed so non-steroidal anti-inflammatory drugs layer cox inhibitors right they also stop the migration of leukocytes to the inflamed joint right so that’s how in is he ids

Work then we saw colchicine coal teaching is the fastest acting drug okay and it is how it works coaching it is a suppressing only gouty inflammation only for gout the information you can give it is going to bind it off liberal a protein that is tubulin and inhibit granulocyte migration this is the main action you should know this okay this called gene is excreted

In bile so this is coaching okay then we saw a small action or first steroids so basically they are given by intra-articular injections the nice thing here is the only unique thing that you have learnt here intra-articular injection of corticosteroids for treating of you to coffee arthritis this is a local root of drug administration directly into the joint mean

They will give the injection now coming to chronic gout this is where we are we have to we have already covered provenance it in the previous video basically probenecid what it does it makes sure that you it is blocking this organic acid transport so what it filled up as it blocks this uric acid cannot be reabsorbed right so it increases the excretion of uric acid

In okay so that’s all then it increases the level of penicillin and the other drugs okay it increases the level of rifampicin fancy everything it increases the drug levels of other drugs okay this is the main thing this is much if you remember for now it’s enough now we are coming to allopurinol this was the whole intention of this video allopurinol now allopurinol

Actually is a hypo xanthine and not analog so you know hypose on time we came van tine rate that is what we saw hold on so just look at this diagram see purines are broken down okay purines are broken down you get hypose and fine now hypo xanthine becomes an time then zanta in love with xanthine oxidase it becomes uric acid okay so they are saying this allopurinol

Is a hypo xanthine analog so if it is a hypo xanthine analog what it will do let’s see that it hi kozan fine analog is very small for you to see it’s a high pose and time analog it competitively inhibit xanthine oxidase so it will not allow this damn time to bind to xanthine oxidase right it is going to competitively inhibit this nothing so xanthine will not be

Able to go and bind to xanthine oxidase because this who will come and bind here and a purine on so allopurinol is only written here allopurinol inhibits xanthine oxidase is a competitive inhibitor of sanfran oxidase – yes it’s written here allopurinol inhibits xanthine oxidase so it is suicide inhibition that means it will give up itself it was it is a suicide

Inhibition allopurinol suicide inhibition okay hold on so here we saw that the it is a competitive inhibitor of xanthine oxidase it’s a suicide inhibitor that also if you want again remember suicide he pick up so it has short action of two hours but the thing is this has on allopurinol it becomes it becomes an act another metabolite which is a lose on time so there

Are two things here i hope you’re annoyed because i lose on time so when it becomes a lows on time this one has long acting girl it has long action and it’s a non-competitive inhibitor of xanthine oxidase so basically it has both the ways it is a competitive inhibitor also then it becomes a non-competitive inhibitor also but whatever it will inhibit xanthine oxidase

That’s all we want right now this drug will learn what in all it will do now if you look at this diagram of this lea will understand it will inhibit this xanthine oxidase right competitively non competitively whatever allopurinol competitively inhibit i love purine or competitively inhibit then you have a low xanthine allows xanthine will non competitively inhibit

So this one the allopurinol itself is a competitive inhibitor it’s a very strong thing it’s a competitive inhibitor then a low xanthine is going to be non-competitive inhibitor whatever they do finally they will inhibit the xanthine oxidase so no uric acid uric acid levels will come down but xanthine and hypose and ten levels will go up that much you understood rate

So this drug will reduce uric acid levels in the plasma in the plasma this obviously that was a whole point of giving allopurinol to the patient wake up if you are sleeping please wake up basically the whole point of giving allopurinol is to reduce the uric acid synthesis right so obviously the drug will reduce uric acid level in plasma but the hypose antonyms and

Ten levels will increase high presentin and xanthine lia’s are more soluble in so hence anyways they are easily removed with a urine so that is great so it’s a win-win situation in fitting is a win-win situation so basically hypose anion will increase van hien will increase uric acid will reduce these anyways are easily excreted in urine so whole problem solved and

When this level slightly increases in the blood also what will happen there will be a negative feedback and purine breakdown also will be reduced so it’s a win win win win situation with a urine okay then so this hypose anton and xanthine we said they are more soluble and they are easily removed in the urine correct so there is no precipitation of these also in

The urine now let us move on we come take a break take a deep breath okay so now let us continue you to increase the hypo xanthine negative feedback purine breakdown also is reduce this also we already told you orally allopurinol they are giving look at this and a pure and on is given orally look at this guy is taking the allopurinol orally with water law reporter

They should come just like probin a said lot of water should be taken with these drugs okay then what happens i hope urinal is taken orally it is not bound to plasma protein this is a very interesting thing you never i at least i never saw anything like this so far maybe a lot of drugs so that first time i am seeing this allopurinol is not bound to class for cooking

And it is a suicide inhibited inhibits its own metabolism it’s a suicide inhibitor it inhibits its own metabolism or something like that okay it is metabolized to a low sample that you only saw here it is metabolized to a low santa it it’s its own metabolism this is also interesting it inhibits its own metabolism so it’ll get whatever gets converted to understand

That it is fine but whatever remains that we get of excreted unchanged because it will inhibit its own metabolism okay so we are done with this slide of allopurinol we have to continue we have to continue we look at the interactions of an experiment okay how you fine are you okay what are we looking at today i love you love you are looking at and lo you ve not

Looking at allopurinol today good makeup if you’re sleeping now let us more interactions of a loop you know this is an anti gout drug basically what in all it will do it will increase the potentiates is six mercaptan as a theo prime it will potentiate the other drugs so it is giving more power to the other dress it also potentiates warfarin it put in shape sky

Of filing so it put in sheets everybody it put in sheets all these people okay then this province its shortens the behalf of anna’s on time so probenecid one second see everything it is potentiating here now allopurinol prolongs the behalf of provenance it obviously this allopurinol is another the sacrificing good person it will potentiate all these drugs that he

Prolong the tea half of prabha nice it obviously so allopurinol is like hey you only work i will sleep kind of a drug and a fury non will potentiate everybody else even provenience it it will prolong them i think mcrobbie nice it is not so good it will come ulta and make a noise on time be less see prabha nice it shortens the tea half of an angle or something but

Allopurinol is this allopurinol it so very good the person feeling potentiate everybody or not when you give with the even you give from this allopurinol with ampicillin right skin rash can occur skin rash when all of you are not given with ampicillin this have to add even in this side of it okay so in adverse effects to remember so hypersensitivity is the main

Thing okay allopurinol hypersensitivity allopurinol i love you renal hypersensitivity this you should remember because allopurinol hypersensitivity is the only thing that you can write okay others in all are very minor whenever hypersensitivity occurs in the space should he do i love urine on guys okay and now what happens he has hypersensitivity reaction in that

They don’t give allopurinol again don’t ever start it also again okay stop the allopurinol and don’t give him okay the skin rash can occur with a theory not when you are giving with ampicillin steven johnson syndrome that is again a skin condition right can occur with allopurinol all these are hypersensitivity only right look at this this is steven johnson syndrome

Some skin condition okay so i’ll look butanol you should remember all this the meaning you will write is there because anyways it’s given orally you will read gastric irritation nausea liver damage shown that you will read standard headache dizziness headache anyways feel right for all the trucks right headache dizziness mother so what adverse effects of allah p

Do not remember hypersensitivity main thing is hypersensitivity steven johnson syndrome don’t give allopurinol again stop it completely okay then what are the precautions and contraindications you should take when you should make you should make more talk when you’re giving an appearance all precautions is whenever you are giving a look you know you should tell

That person to take a lot of water right even like probie needs it they should take lot of water even an allopurinol contraindicated and hypersensitivity patients just now we told you i hope you read on hypersensitivity we don’t give again pregnancy and lactation don’t leave standard things right off okay what are the users of allopurinol very quickly we look at

The users of allopurinol not at all difficult guys don’t worry she’s the first choice and chronic out you on ready no this can be used in over producers of uric acid and under excreta sulfuric acid so people who make more use uric acid leave also you can give people who are not excreting uric acid is ugly from there so you can give you in a severe get soft ofi and

Nephropathy also you can give in fact the salafis you not can reverse this condition long-term imagine it can not only like control it can reverse the toffee and nephropathy trade then it can be used along with the yuriko’s urich’s when body load of eurex nuts that means you can combine it with the pro beliefs it if required not actually recommended the only if it

Is like very high load of you rate i think okay who am i to recommend anything guys see what it is written it’s if when body load of you rate is large salo purine all can be combined with this probie method probably needs it ok allopurinol can be given long term aren’t we happy so happy i love you on such a nice truck can be given long term even if the secondary

Hyper udc mia is there because of cancer because of drugs like tsi it’s a fluke furiosa might even in such reasons causes for hyper furious email you can give allopurinol you can you can also give it prophylactically so you are giving cancer therapy are you giving thea’s eyes and you think that this person can go into hyperuricemia then prophylactically also in

Prevention basics if you can give up for allopurinol you can use it to increase the action of all these anti-cancer drugs obviously this allopurinol is a such a cute cute drug it will increase the protein it will increase the action of the other drugs so to potentiate the other dress you can combine it with all these the anti-cancer drugs ok then lastly don’t use

An absolute attack of gout that you already know don’t you know this already how many people don’t know that you should not use these drugs in acute attack of code everybody knows because we have watched all the videos here watch this video all to be there from the beginning in the beginning we already mentioned drink in acute attack of gout you should give only

Anti-inflammatory drugs where is that thing here c r cubed roti arthritis you should not give these drugs should only give anti-inflammatory drugs okay that’s all guys we have covered allopurinol hope you’re happy allopurinol is the first choice of drug for chronic gout it is a synthesis inhibitors it will inhibit the synthesis of uric acid it is a hypo something

Analogue it will inhibit xanthine oxidase so yurika said willie sizeless hypose antonin son time will increase but however they will be excreted easily from the kidney so no problem everybody’s happy everybody’s happy doctors happy patient happy ok we’ll meet you in the next video guys take a break relax enjoy bye bye

Transcribed from video
Pharmacology 248 c Allopurinol Gout Gouty Arthritis Hyperurecemia Uric Xanthine By MBBS VPASS