Drugs for Gout and Migraine

Aspirin
Acetominophen (Tylenol)
Codeine

Propoxyphene is widely used but ineffective and toxic

Inhibits microtubule formation --> inhibiting LTE migration and phagocytosis

*Used to treat acute gout attacks*

Takes 24 hrs for effect to begin

*NO analgesic effect, COX inhibition, or effect on excretion*

DIARRHEA is SE

Diarrhea* like Quinidine as well

Indomethacin and Naproxen as they are potent

*used for acute gouty arthritis, often combined with colchicine*

Contraindicated - ASA is an acid and competes with uric acid for excretion - as do many other acidic drugs

Uricosuric Agent: Blocks active reabosrbtion of uric acid in S2 of Proximal Tubule

*Tx for CHRONIC gout*

initially triggers acute gouty attack, administer with colchicine

May trigger STONE FORMATION

*Also decreases excretion of acidic drugs, usually increasing their potency

Xanthine Oxidase Inhibitor --> Inhibits Uric Acid Synthesis

Effective in both Primary and Secondary Gout - may promote gouty attack, administer with colchicine

*Serious SE: VASCULITIS, agranulocytosis, hypersensitivity

Chemotherapy drug interactions*

Xanthine Oxidase inhibitor like Allopurinol - Tx for Gout

Recombinant Uric Oxidase enzyme that does not naturally exist in humans

Converts Uric Acid --> Allantoin which is more readily excreted

*It's a protein thus must be administered IV, and can only be used ONCE due to immune hypersensitivity

Tumor Lysis Syndrome in some cancer pts

Initially compete w/ UA for secretion resulting in hyperuricemia --> gouty attack

Eventually reach high enough levels to interfere with reabsorption and thus induce uricosuria
*High dose aspirin has the same effect - but toxic at this dose

5-HT1D agonist - HIGHLY SELECTIVE intracranial

Treatment of Migraines

Causes *Vasoconstriction* - NO analgesia
SE related to Vasoconstriction ie Bowel Ischemia in the 3 watersheds

*Short t1/2 - may need repeated doses

Ergot Alkaloid - partial agonist of 5-HT AND a2 receptors

Tx of Migraines

More potent vasoconstrictor than the -triptans

Dihydroergotamine is administered IV

Naproxen (high potency) - and others

Methysergide: Ergot alkaloid (less potent)
Propranolol - B-blocker
Verapamil - Ca channel blocker
Amitriptyline - Antidepressent
Clonidine - a2 agonist

Valproic acid, Topiramate Anticonvlusants

Botox, Lithium, Angiotensin II Receptor Blocker (ARBS) - Losartan -sartans