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Medicine

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Rheumatology

Question
16 out of 20
 

Rasburicase is used in the treatment of which condition? (LQ)



A Gout
B Pseudogout

C PAN
D Churg Strauss disease

Ans. A Gout

Treatment (Ref: H-18th edition, Pg-2838)

A. Acute attack

i. NSAID usually indomethacin. But aspirin is contraindicated because it raises the uric acid level.

ii. Colchicine: it inhibits granulocyte migration but can cause diarrhea

B. Prophylaxis

Allopurinol: It is a xanthine oxidase inhibitor

Extra Edge:: Allopurinol is not used in a acute attack

C: Uricosuricdrugs :Probenecid, sulphinpyrazone.

Recent Advances: Losartan, fenofibrate, and amlodipine have some mild uricosuric effects.

Recent Advances - New Drugs (Ref: H-18th edition, Pg-2838)

1. Febuxostat =Xanthine oxidase inhibitor drug

2. Benzbromarone It is new uricosuric drug

3. Rasburicase: It converts purine to allantois which is a water soluble compound.

Basic Biochemistry: Purin pathway. Allopurinol blocks the conversion of xanthine to uric acid. The urate oxidase rasburicase catalyses the oxidation of uric acid to allantoin, a highly water-soluble metabolite readily excreted

by the kidney

Extra Edge: All the diuretics are contraindicated in Gout because they cause hyperuricemia.

The only diuretic which has uricosuric effects so can be given in Gout is TIENELIC ACID!!!

Extra Edge: Pharmacotherapy

a. Modulation of purine metabolism has pharmacotherapeutic value.

b. Purine synthesis inhibitors inhibit the proliferation of cells, especially leukocytes.

c. The inhibitors are

i. Azathioprine, an immunosuppressant used in organ transplantation, autoimmune disease such as rheumatoid arthritis or inflammatory bowel disease.

ii. Mycophenolatemofetil is an immunosuppressant drug used to prevent rejection in organ transplantation; it inhibits purine synthesis by blocking inositol monophsophate dehydrogenase.

iii. Methotrexate indirectly inhibits purine synthesis by blocking the metabolism of folic acid (it is an inhibitor of the Dihydrofolatereductase).

iv. Allopurinol is a drug that inhibits the enzyme xanthine oxidase and, thus, lowers the level of uric acid in the body. So it is useful in the treatment of gout.

Rheumatology Flashcard List

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