an overall overview in corticosteroids and its application in oral and maxillofacial diagnostic medicine and pathology drawing to the conclusions of the limitations and drawbacks of these medicines. i have also included the precautions to be taken in dental therapeutic procedures fo
an overall overview in corticosteroids and its application in oral and maxillofacial diagnostic medicine and pathology drawing to the conclusions of the limitations and drawbacks of these medicines. i have also included the precautions to be taken in dental therapeutic procedures fo
Oxytetracycline 250mg tablets smpc taj pharmaceuticalsTaj Pharma
OXYTETRACYCLINE - Drug Information - Taj Pharma, OXYTETRACYCLINE dose Taj pharmaceuticals OXYTETRACYCLINE interactions, Taj Pharmaceutical OXYTETRACYCLINE contraindications, OXYTETRACYCLINE price, OXYTETRACYCLINE Taj Pharma OXYTETRACYCLINE 250MG TABLETS SMPC- Taj Pharma . Stay connected to all updated on OXYTETRACYCLINE Taj Pharmaceuticals Taj pharmaceuticals Hyderabad.
A proper description about Rheumatic arthritis. It containts DEFINITION, EPIDEMIOLOGY, ETIOLOGY, RISK FACTORS, PATHOPHYSILOGY, SIGN & SYMPTOMS, DIAGNOSIS, TREATMENT & DIFFERENCES BETWEEN RA & OA
Gout is an inflammatory condition of the arthritis-type that results from deposition of monosodium urate crystals in joint spaces or surrounding tissues, leading to an inflammatory reaction that causes intense pain, erythema, and joint swelling.
It is associated with hyperuricemia, defined as a Serum Uric Acid (SUA) level of 6.8 mg/dL (404 μmol/L) or greater, but not all patients with hyperuricemia demonstrate symptoms.
Inflammation of arthritis type
Hyperuricemia
Metatarsophalangeal joint
Pharmacotherapeutics
M.Pharmacy
Pharmacy practice
Unit 05
This presentation comprises of various chemotherapeutic agents used in ENT malignancies and other conditions. Its classifies the agents and briefly discusses the dosage and their common side effects.
Etoricoxib 120 mg film coated tablets smpc- taj pharmaceuticalsTaj Pharma
Etoricoxib Taj Pharma : Uses, Side Effects, Interactions, Pictures, Warnings, Etoricoxib Dosage & Rx Info | Etoricoxib Uses, Side Effects -: Indications, Side Effects, Warnings, Etoricoxib - Drug Information - Taj Pharma, Etoricoxib dose Taj pharmaceuticals Etoricoxib interactions, Taj Pharmaceutical Etoricoxib contraindications, Etoricoxib price, Etoricoxib Taj Pharma Etoricoxib 120 mg film-coated tablets SMPC- Taj Pharma . Stay connected to all updated on Etoricoxib Taj Pharmaceuticals Taj pharmaceuticals Hyderabad.
Gout is a type of inflammatory arthritis that causes permanent disability if left untreated. This presentation focuses on the important salient points we need to remember in Gout in all aspects - diagnosis, managment (both non-pharmacological and pharmacological approaches).
This presentation is useful to both MBBS and Postgraduate students of Pharmacology.
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Oxytetracycline 250mg tablets smpc taj pharmaceuticalsTaj Pharma
OXYTETRACYCLINE - Drug Information - Taj Pharma, OXYTETRACYCLINE dose Taj pharmaceuticals OXYTETRACYCLINE interactions, Taj Pharmaceutical OXYTETRACYCLINE contraindications, OXYTETRACYCLINE price, OXYTETRACYCLINE Taj Pharma OXYTETRACYCLINE 250MG TABLETS SMPC- Taj Pharma . Stay connected to all updated on OXYTETRACYCLINE Taj Pharmaceuticals Taj pharmaceuticals Hyderabad.
A proper description about Rheumatic arthritis. It containts DEFINITION, EPIDEMIOLOGY, ETIOLOGY, RISK FACTORS, PATHOPHYSILOGY, SIGN & SYMPTOMS, DIAGNOSIS, TREATMENT & DIFFERENCES BETWEEN RA & OA
Gout is an inflammatory condition of the arthritis-type that results from deposition of monosodium urate crystals in joint spaces or surrounding tissues, leading to an inflammatory reaction that causes intense pain, erythema, and joint swelling.
It is associated with hyperuricemia, defined as a Serum Uric Acid (SUA) level of 6.8 mg/dL (404 μmol/L) or greater, but not all patients with hyperuricemia demonstrate symptoms.
Inflammation of arthritis type
Hyperuricemia
Metatarsophalangeal joint
Pharmacotherapeutics
M.Pharmacy
Pharmacy practice
Unit 05
This presentation comprises of various chemotherapeutic agents used in ENT malignancies and other conditions. Its classifies the agents and briefly discusses the dosage and their common side effects.
Etoricoxib 120 mg film coated tablets smpc- taj pharmaceuticalsTaj Pharma
Etoricoxib Taj Pharma : Uses, Side Effects, Interactions, Pictures, Warnings, Etoricoxib Dosage & Rx Info | Etoricoxib Uses, Side Effects -: Indications, Side Effects, Warnings, Etoricoxib - Drug Information - Taj Pharma, Etoricoxib dose Taj pharmaceuticals Etoricoxib interactions, Taj Pharmaceutical Etoricoxib contraindications, Etoricoxib price, Etoricoxib Taj Pharma Etoricoxib 120 mg film-coated tablets SMPC- Taj Pharma . Stay connected to all updated on Etoricoxib Taj Pharmaceuticals Taj pharmaceuticals Hyderabad.
Gout is a type of inflammatory arthritis that causes permanent disability if left untreated. This presentation focuses on the important salient points we need to remember in Gout in all aspects - diagnosis, managment (both non-pharmacological and pharmacological approaches).
This presentation is useful to both MBBS and Postgraduate students of Pharmacology.
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
Follow us on: Pinterest
Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
1. PRAKTIKUM FARMAKOLOGI
BBS-2 Pr.6
Observasi kasus hiperurisemia dan DKA
(Interaksi dan peresepan)
Aznan Lelo
Siti Syarifah
FAKULTAS KEDOKTERAN
UNIVERSITAS SUMATERA UTARA
Medan, 2023
3. 10 penyakit terbanyak di kota Medan Th.2018
Jenis Penyakit
The Type of Disease
Jumlah Kasus
Number Of Cases
Persentase
Percentage
(1) (2) (3)
1. Infeksi Akut Lain Pada Saluran Pernafasan Bagian Atas 203 558 41,09
2. Hipertensi 89 333 18,03
3. Peny. Pada Sistem Otot dan Jaringan Pengikat 57 816 11,67
4. Peny. Pulpa dan Jaringan Periapikal 27 410 5,53
5. Diare 25 934 5,23
6. Penyakit Kulit Alergi 23 529 4,75
7. Penyakit Kulit Infeksi 19 513 3,94
8. Peny. Lain Pada Saluran Pernapasan Atas 18 209 3,68
9. Gingivitis dan Periodental 15 402 3,11
10. Karies Gigi 14 713 2,97
Jumlah 495 417 100,0
Sumber : Dinas Kesehatan Kota Medan
Source : Health Service of Medan Municipality
Badan Pusat Statistik –Dinas Kesehatan Kota Medan
4. KASUS 1
• Laki-laki, 42 tahun, mendapat serangan akut gout pada pangkal
jempol kaki kiri. Selama ini dia menderita penyakit jantung dan
teratur mengkonsumsi captopril, aspirin, furosemid dan
clopidogrel. Sehari sebelum serangan gout pebisnis muda ini
nongkrong di café, minum minuman beralkohol dan kopi susu
dingin. Pasien tersebut melakukan swamedikasi membeli obat ke
apotek dan diberi Na diclofenac 3 x 50 mg, allopurinol 3 x 100 mg
dan dexametason 3 x 5 mg.
• Pemeriksaan tanda serangan akut gout (+), TD 200/100 mmHg, nadi
96x/menit, edema pretibia (-).
• Kejadian farmakologis apakah yang terjadi, tindakan apakah yang
harus dilakukan?
5. KASUS 2
Wanita, 32 tahun, berobat ke RS X di Kota Medan
Dirujuk ke div. Alergi-imunologi diberi terapi obat-obatan berikut:
• Parasetamol tab 500 mg
• Soft U Derm (Carbamide carbonyl diamide)
• Atopiclair Lotion 120ml (natrium hyaluronate, vitis vinifera, butyrospermum parkii
butter, telmesteine, dan glycyrrhetinic acid)
• Desoksimetason 0,25% krim
• Metil Prednisolon 4 mg
• Ranitidin tab. 150 mg
• Setirizine 10 mg
• Vitamin - B Complex
6. KASUS 3
• Laki-laki, 45 tahun, pebisnis muda, hidup glamour,
perokok berat, peminum alkohol, batuk batuk kronis,
berobat ke dokter dan diterapi sebagai penderita TB.
Dua minggu setelah menggunakan obat paket TB,
pasien mengeluhkan semua badannya terutama sendi-
sendi kecil terutama di jari jempol kaki bengkak, merah,
sakit berdenyut sehingga susah beraktivitas.
• Apakah yang terjadi pada pebisnis muda ini?
7. TUGAS
ANALISIS GOL. OBAT
No Nama Obat Golongan
(kelas terapi)
Mekanisme
kerja
BSO Dosis
(dewasa)
Referensi:
1. FORNAS
2. MIMS/ISO
3. Medscape Drug checker
8. ANALISIS INTERAKSI OBAT
No Nama Obat Interaksi Farmakokinetik Interaksi
farmakodinamik
Absorpsi Distribusi Metabolisme Ekskresi
-Sinergisme (+)/
-Sinergisme (-)/
-Antagonis
1 A-B V
(deskripsi
x x x
Referensi:
1. FORNAS
2. MIMS/ISO
3. Medscape Drug checker
9. TUGAS
• Penulisan Resep
• Berdasarkan analisa gol .obat dan interaksi obat
- Pertimbangan kombinasi?
- Pertimbangan efek samping?
• Kesimpulan pada kasus?
• Laporan per meja : farterfkusu21@yahoo.com (max 1 minggu paska
praktikum)
10. Drug-induced-hyperuricaemia and
gout
• Drug-induced-hyperuricaemia and gout present an emergent
and increasingly prevalent problem in clinical practice.
• Drugs raise serum uric acid level by increasing uric acid reabsorption
and/or decreasing uric acid secretion in gout
• Hyperuricaemia is a common clinical condition that can be
defined as a serum uric acid level >6.8 mg/dl (404 µmol/l).
• Gout, a recognized complication of hyperuricaemia, is the most
common inflammatory arthritis in adults.
• Diuretics are one of the most important causes of secondary
hyperuricaemia.
• Drugs raise serum uric acid level by an increase of uric acid
reabsorption and/or decrease in uric acid secretion. Several drugs may
also increase uric acid production.
11. Alcohol and gout
• Drinking alcohol affects gout risk in two main ways:
• Some alcohol (particularly beer) is high in purines,
which are then broken down into uric acid.
• All alcohol — including beer, wine, and hard spirits —
affect processes in the kidneys that in turn impact how
uric acid is eliminated in urine
12. Common drugs leading to hyperuricaemia
Drug Suggested mechanism
Anti-tubercular drugs Increased uric acid reabsorption (pyrazinamide)
Decreased uric acid secretion (pyrazinamide)
Reduction in the fractional excretion of uric acid (ethambutol)
Aspirin (low dose) Increased uric acid reabsorption
Decreased uric acid secretion
Cytotoxic chemotherapy Massive disruption of tumour cells
Diuretics Increased uric acid reabsorption in the proximal tubules
Increased uric acid secretion
Volume contraction
Immunosuppressant agents Increased uric acid reabsorption in the proximal tubules (ciclosporin)
Decreased glomerular filtration rate secondary to afferent arteriolar vasoconstriction (ciclosporin)
Reduced urate excretion (tacrolimus)
Inhibition of the synthesis of guanine nucleotide (mizoribine)
Fructose Increased nucleotide turnover and nucleotide synthesis
Increased uric acid tubular reabsorption
Lactate infusion Increased uric acid reabsorption
Nicotinic acid Increased uric acid reabsorption
Decreased uric acid secretion
Increased uric acid synthesis
Testosterone Increased uric acid reabsorption
Xylitol Increased purine degradation
Increased production of lactate
13. Rheumatology (Oxford), Volume 56, Issue 5, May 2017, Pages 679–688, https://doi.org/10.1093/rheumatology/kew293
The content of this slide may be subject to copyright: please see the slide notes for details.
Fig. 1 Interference of drug leading to hyperuricaemia with renal
urate transporters
The dotted arrows indicate drug ...
14. Anti-tubercular drugs
• Pyrazinamide, an anti-mycobacterial drug, not only induces
hyperuricaemia, but may also lead to acute gouty attacks. It is a strong
urate retention agent, causing a >80% reduction in renal clearance of uric
acid at a 300 mg therapeutic daily dose
• Pyrazinecarboxylic acid or pyrazinoate (PZA), an active metabolite of
pyrazinamide, increases serum uric acid based on its trans-stimulatory
effect on URAT1, which is a member of the organic anion transporter
(OAT) family, causing the reabsorption of urate from the luminal side into
tubular cells
• Ethambutol, another antitubercular drug, induces also a significant
increase in serum uric acid levels. This effect was observed mainly in the
second, third and fourth week of ethambutol therapy
15. Rheumatology (Oxford), Volume 56, Issue 5, May 2017, Pages 679–688, https://doi.org/10.1093/rheumatology/kew293
The content of this slide may be subject to copyright: please see the slide notes for details.
Fig. 2 Non-glucose carbohydrate-induced hyperuricaemia
↑: Increase; ADP: adenosine diphosphate; AMP: adenosine ...
