Gout & Colchicine | MCQ 3-22 | Dr. Shantanu R. Joshi | 2022
Myself dr shantanuar joshi a clinician a pharmacologist and a drug researcher dear students welcome to acure life science foundation please like share and subscribe keep watching happy learning dear students this is the third mcq of the video lecture series of mcqs let’s see the mcq now selected drug which is neither analgesic it is neither nor the
Anti-inflammatory it is neither eurococcus what is this irrigatory the drugs which increase the uric acid excretion through the urine are known as eurovision drugs but is highly ficacious drug in gout gout gout is a disease related with uric acid excess of the uric acid now the options available are britney salon all of you know solar is a steroid and it is
A known anti-inflammatory drug and that’s why it cannot be the answer then the next is colchicine colchicine is a drug which is effective only in gout it is neither anti-inflammatory it is neither analgesic it is neither uracusa it acts in a very different way that i am going to explain to you soon but yes collection is a drug which is the answer of this mcq
Now i should tell you others also naproxen all of you know it is an ancient it is from the group of propanic acid derivatives sulpinal sulfur in parallelon is a drug which is effective in gout but is a known euroco surrender it’s a urococylic drug and that’s why neither nephroxone neither surfing parasite nor prednisone are the answer of this mcq the answer
Is consciousness now you might be thinking sir how colloquisein works and this is how i am going to tell you about it gout is a disease where there is hyper aerobic condition hyperurismic condition what do you mean by hyperiasmic condition it means that the blood uric acid level is raised the simple equation is that in your mind how much it should be raised it
Should be above 6.5 milligram per deal so for international standards are concerned now what happens in the gout in the gout most of the time say at least in 50 percent of the patient it’s a monoarticular arthritis and a joint that is a joint related with the stove inflam it inflames in such a way that it becomes difficult for the patient to move it may have
The inflammation of your knee joint or other joints also but maximum time say fifty percent of the times it takes the grade two grato is the major site and a toffee s topping s deposition of the uric acid crystals are there monosodium urine crystals are there those i will be talking about it this is all about gout just give the introduction to the cow now this
Is the plant there is an ayurveda the people call it suranjan karuwa suranjan is the right word for it if you want to go in detail of it and if you go with the botanical lime it is called chicken autumnal see this autumnal is not available in india but in india you get alchikam indicum this autumnal is typically in the west especially with the european countries
You must find it and this is the flower of that plant but a bulb of this plant rhizome of this plant is used for treating gout in ayurveda since a long time the same drug is used in uni medicine also they use it for rheumatism in ayurveda it is being used for the treatment of gout it is known as water ayurveda and those people are using it i should tell you
In detail now this is the pathophysiology of gout what happens in gout my dear students the uric acid excess of the uric acid which is there present in the sinual fluid reacts with sodium the reaction of the uric acid with the sodium will give you mono sodium urine crystals known as mseu now this monosodium uric crystals are engulfed by the synovial cells those
Cells which are present in the cylon membrane those will encode this msu that is monosodium urine crystals now engulfment of these monosodium urine crystals by this cell will stimulate the cell and the cell will secrete some chemical mediators of inflammation though cyanide cell will secrete some chemical mediators of inflammation so that they will attract t
Lymphocytes and monocytes t lymphocytes and monocyte from the blood will be attracted towards the site where there are the cyanogen in very simple language the synovial cell which are there will secrete some chemicals and the chemicals are responsible for immigration of the lymphocytes and monocytes now these cells are inflammatory cells they will produce huge
Inflammatory response what happens this cell come there and i’ll show engulf the monosodium urine crystals first the crystals were angled by the samuel cell now these t lymphocytes and monocyte they are going to engulf the unit crystals now after engulfing the point is very important here they secrete a glycoprotein t lymphocytes and the monocyte they secrete
The glycoprotein and this glycoprotein is responsible for release of some lysosomal enzymes and all of you know lysosomal enzyme lysis means to break down and that’s why they will bring about destructive changes in the bone tissue and this is responsible for the deformities sometimes seen in the gout not regularly seeing the gout but sometimes the deformities
Are seen and those are related with the release of this lysosomal enzyme though are the those are the enzyme which are going to distract the thing now on the other hand this glycoprotein is responsible for local lactic acidosis and due to local lactic acidosis there is lowering of the ph the acidic medium develops ph reduces and when the ph reduces there is more
Precipitation of this mono sodium unit crystal because the solubility of this uric acid reduces reaction with the sodium increases and the production of ms increases all of you know that monosodium urine crystals if they are there they will again be angled by t lymphocytes again it will release glycoprotein glycobalatin will further increase acidosis further it
Will increase lactic acidosis further acidic ph will be developed that is the ph will be reducing when ph is reducing there is more precipitation of the united crystals more river crystals again more enhancement again more engagement more release of glycoprotein and that is the point that a vicious cycle the vicial cycle will continue to break this vishya cycle you
Should use cultures in what cultures is going to do collages in acts on the multiple level the first level of action is that it act on these synovial cells and reduces the secretion of the chemical mediators consciousness act on the cyanide cells to reduce the chemical mediators of inflammation secondly colchicine act on the tubulin which is responsible for the
Movement of amoeboid moment of the w disease especially the t lymphocytes and the monocytes the movement depend upon this tubulin and this collagen is going to block this tubulin so that the immigration of t lymphocyte and monocyte will reduce once the immigration of t lymphocyte and monocyte is going to reduce common sense is that the inflammatory response will
Reduce because these are the major materials of inflammation these two are the common things now the third and the most important thing is that the major effect of colchicine is on the release of the glycoprotein the release of the glycoprotein by t lymphocytes and monocytes is blocked by colchicine when you block this glycoprotein this vicious cycle ultimately
Stops this vicious cycle ultimately breaks and this is how consciousness give you excellent result in government do remember my dear students the inhibition of release of glycoprotein is the major action of colchicine these are the minor actions of cultures but yes it reduces the wbc immigration at the set of inflammation now this is one effect of colchicine
Calcium is also effective in stopping the multiplication it reduces the multiplication of the cells because the cell when the cell is in metaphase of its multiplication all of you know the spindles get formed and spindles are these are the microtubules of the spindles these are the microtubules and this collision is going to act on these microtubules they block
The microtubule naturally the cell division will not take place this is how it arrives the side division now when inflammation is there the bone marrow has to undergo repeated mitotic divisions and due to those mitotic divisions new and new cells will be formed more and more wbcs will be formed those can also be arrested by cultures to some extent do remember my
Dear student this arrest of the metaphase is responsible for stopping of multiplication of wbcs also and this is how collision helps on multiple levels if i if you want ask me to summarize i will tell you that it reduces the chemical mediators of inflammation from the synovial side cells it reduces the movement of the t lymphocytes and monocytes those are moving
Towards the inflammatory side that also reduces it reduces the secretion of it blocks the secretion of glycoprotein by the activated t lymphocytes as well as the monocytes and the fourth colchicine inhibits the multiplication of the cells ultimately it block the multiplication of the wbcs also so that laser wvcs will be available at the site of inflammation
These are the multiple routes by which the cultures in nigeria and it’s a very effective drug in gout it should be used only in the acute gout where there is a inflammation it should not be used in chronic gout because there are nothing to do with the uric acid production or uric acid now my dear student i would like to continue with the cultures in so that you
Will understand cultures and more properly my dear student do remember my words cultism is potentially a toxic it should not be used beyond six milligram within one course it should not be used more than two milligrams in a day it’s a very important thing remember the toxicity is related to nausea vomiting diarrhea and abdominal cramps do remember it increases
The peristaltic movement it increases the spasm of the intestine and this is how my dear students it is responsible for abdominal cramps do remember i am repeating my words collection is potentially a toxic drug it must be used with caution only a qualified doctor should use this culture all of you know that it arrives the metaphase by binding to the microtubules
At the time of cell division and this may be responsible for the cellular toxicity of culture cell now dosing of collection already i told you tablet of colchison is available in the market by the name of gautama see i am using this gout nil and that’s why i written the name gautner many many trade names are available and i had nothing to do with gaud nil the
Trade name gout nail but just i am using it to have written it the tablet is of 0.5 milligrams now my point is important you should not exceed 4 doses in a day i mean to say in a day 2 milligram is max maximum generally in general right is what we give 0.5 milligram twice a day or at the max thrice a day not even 2 milligrams we complete now maximum dose in one
Schedule one course should not exceed six milligrams that is if you are using it 0.5 milligram two times a day it should not exceed six days what i mean to say 12 doses of this 0.5 milligram should not exit maximum if you are using it steady as four days if you are using it in bedded doses that is six days maximum then if you want to give the same drug you should
Take at least three to seven days without drug or short period the drug should not be given for at least three to seven days and again you can start for the second dose second course not those course these should and must be followed while you’re treating the patient of gout so do remember my words this drug should be used only by a qualified doctor this is a
Very very important sentence it is potentially a toxic drug it’s not a game of a general person or anyone anyone who is not a doctor this is a very important thing now the other options what we are seeing there the first option was prednisone already i told you that it is a short acting corticosteroid and all of the corticosteroids can be used in acute gout in
Some selected cases it is not a regular drug to be used generally what we prefer we prefer dexamethasone for the purpose one eight milligram dose injectable dose we give single dose only single dose in a case which is not responding even to collagen generally steroids are not used during the attack of gout and in the crotting out that must not be used because all
Of the all of these drugs increases the uric acid retention they try to retain uric acid and uric acid levels will rise and that’s why these are not routinely used in count steroids may be used in acute gout at the time of inflammation not responding to colchicine but generally we avoid the use and for that purpose we generally prefer to go with dexamethasone
Already i told you now option c was naproxen say naproxen is a regular nsid it’s a strong pg inhibitor prostaglandin inhibitor it is compared with endomethacin it is next to endometriosis endometriosis is the strongest pigeon emitter followed by it is naproxen you can use endometriosis or you can use naproxen see it’s a propionic as a derivative used in this
Gout do remember it’s a potent inhibitor of leukocyte immigration the immigration of the leukocyte towards the inflammatory site can be blocked partially by this naproxen and that’s when aproximation can be used is used in the patients of gout now the last option was sulfine parazone see do remember this sulfine parasite is a drug which is related to phenyl
Beta zone but only chemical it is related phenylbeta zone was in the use as nsh it is used in veterinary today also in veterinary medicine but in humans it is not used today and only chemically this sulfine parasite was related with phenylalanine only chemically not pharmacologically pharmacologically sulfine perizone is used as a urococeric drug it increases
The excretion of uric acid but right now today sulfen parazon is not used because it’s a very strong gastric editor and that’s why my dear students our option is only conscious in act by multiple ways it blocks the secretion of inflammatory chemicals from the synovial sense it blocks the immigration of t lymphocytes and monocytes to the inflammatory side it stops
The or reduces the excretion of glycoprotein from the activated t lymphocytes and monocytes and at the last it binds to the microtubules and reduces the multiplication of the cell it arrests the metaphase and these are by this multiple ways calcisinides and really consciousness very effective drug in acute gout but should not be used in chronic gout it should be
Used very very very cautiously only by a qualified doctor thank you dear students you
Transcribed from video
Gout & Colchicine | MCQ 3-22 | Dr. Shantanu R. Joshi | 2022 By Acuere