Gout Holistic Treatments
Nucleic acid metabolism results in the prodution of the burine base derivatives adenosine and guanosine. These bases can be reused or oxidized to uric acid for elimination from the body. Uric acid is secreted into the urine by the kidney tubules by an active transport system and is reabsorbed to a great extent. The total body uric acid content is about 1.1 grams, one-sixth of which is in the blood, the rest residing in tissues. Uric acid has two ionizable hydrogens. Its first pKa is 5.75 so at physiological pH you would expect to find mainly its monobasic salt form. The acid and its salts have a very low solubility in water and should the uric acid content of the tissues increase or should the pH drop so as to convert the sodium urate salt to the less soluble acid form, uric acid crystals will form in the joints and kidney tubules (renal stones). The immune system will respond to this imbalance causing inflammation, swelling, and pain. A joint commonly affected is that in the big toe....
For women of childbearing age, therefore, gout therapy is only a minimal issue. Gout is caused by an elevated level of uric acid in the blood and in the tissue. Uric acid is the end product of purine metabolism. Interval treatment between gout attacks with uricosurics and allopurinol aims to lower uric acid levels. Uricosurics, like benzbromaron and probenecid, promote the excretion of uric acid by inhibiting renal absorption. Allopurinol causcs a decrease of uric acid levels in blood by inhibiting the enzyme xanthine-oxidase. Since allopurinol is structurally similar to xanthines, there is the theoretic possibility that the drug or its metabolites will be incorporated into the nucleic acids of the embryo. In animal studies, allopurinol did not prove to be teratogenic in rats in mice there was an increase in cleft palate. Experience in humans is limited to a few case reports. Due to additional Recommendation. During pregnancy, probenecid is the...
Allopurinol reduces the uric acid concentration in the blood by inhibiting the enzyme xanthin oxidase. One report describes an unremarkable infant whose mother took 300 mg of allopurinol daily. The active metabolite, oxypurinol, could be detected in the milk at about 50mg l in the child's serum it was 7 mg l. The therapeutically effective serum concentration is 13-19 mg l. The daily dosage that the infant received - just about 8 mg of oxypurinol kg -just reaches the lower therapeutic dose level (Kamilli 1991). There is no experience with benzbromaron. The uricosuric probenecid is an interval medication that promotes the excretion of uric acid by inhibiting renai reabsorption. In a case report where milk was collected over a dose interval at steady-state, the average concentration of probenecid in milk was 964 ig l, corresponding to absolute and relative infant doses of 145 (ig kg per day and 0.7 (lllett 2006). The breastfed infant developed severe diarrhea, which was ascribed to the...
Acipimox (S-methylpyrazine-2-carboxylic acid 4-oxide) is structurally related to nicotinic acid. There were flushing and gastrointestinal disturbances in 7137 patients, of whom 15 stopped taking the drug because of adverse effects there were no adverse effects on blood glucose or uric acid (1). Of 32 patients with hypertriglyceridemia, excessive hypertriglyceridemia, and combined hyper-lipidemia, acipimox had to be withdrawn in 10 cases, because of adverse effects or absence of clinical response (2). The other 22 completed 6 months of treatment with no adverse effects. The authors claimed that acipimox is much better tolerated than nicotinic acid it has fewer adverse effects and can therefore be used as a second-line drug.
Pyrazinamide is contraindicated in patients with a history of hypersensitivity to the drug. The drug is also contraindicated in patients with acute gout (a metabolic disorder resulting in increased levels of uric acid) and in patients with severe hepatic damage. The drug is used with caution during lactation, in patients with hepatic and renal impairment, and during pregnancy (Category C). Pyrazinamide is used cautiously in patients infected with human immunodeficiency virus, who may require longer treatment, and in patients with diabetes mellitus, in whom management is more difficult. Pyrazinamide decreases the effects of allopurinol, colchicines, and probenecid.
Acute reversible ciclosporin toxicity occurred in a renal transplant patient a few days after colchicine was administered for an acute attack of gout (SEDA-16, 115). Other potential adverse effects of combining colchicine with ciclosporin include diarrhea, increases in serum liver enzymes, bilirubin, and creatinine, and less often severe myalgia (SEDA-19, 101). Acute myopathy, associated with neuropathy in one case, has been observed in two young renal transplant recipients (SEDA-22, 119).
The potassium-sparing diuretics are contraindicated in patients with known hypersensitivity to the drugs, serious electrolyte imbalances, significant renal impairment, or anuria, and those receiving another potassium-sparing diuretic. The potassium-sparing diuretics are contraindi-cated in patients with hyperkalemia and are not recommended for children. The potassium-sparing diuretics are used cautiously in patients with renal or kidney impairment. The diuretics are Pregnancy Category B (amiloride, triamterene) and D (spironolactone) drugs and must be used cautiously during pregnancy and lactation. The potassium-sparing diuretics are used cautiously in patients with liver disease, diabetes, or gout.
In all clinical studies carried out to date, G-CSF has been well tolerated, whether given subcutaneously or intravenously. At the recommended doses (5-10 micrograms kg), generalized musculoskeletal and transient bone pains, headache, and mild rash are the commonest adverse effects (2). No additional adverse effects or delayed consequences have been so far reported in neo-nates treated at birth for presumed bacterial sepsis (SEDA-20, 337). An increase in the size of the spleen has been reported (3,4). Transient rises in alkaline phos-phatase, lactate dehydrogenase, and uric acid are considered to be normal physiological consequences of the rise in the neutrophil count (5). Long-term G-CSF administration in patients with severe congenital neutropenia has also been considered to be relatively safe, with discontinuation or temporary withdrawal in only seven of 44 patients (6).
The effects and the safety of a 5-day regimen of G-CSF (n 9) or GM-CSF (n 8) have been compared (10). Most patients complained of flu-like symptoms in both groups (six and seven respectively), but rash at the injection site was observed only in four patients treated with GM-CSF. In the G-CSF group, there was a fall in platelet count (below 150 x 109 l) in five patients, raised serum lactic dehydrogenase activity, and raised uric acid concentrations three patients required transient treatment with allopurinol.
Nifedipine can increase urinary potassium loss in patients treated with thiazide diuretics (17), but it has no effect on adrenaline-induced hypokalemia (18). In the Treatment of Mild Hypertension Study, 4 years of monotherapy with amlodipine maleate caused no change compared with placebo in the serum potassium, uric acid, aspartate transaminase, or creatinine of 114 hypertensive patients (19).
Concurrent use of the thiazides with allopurinol may increase the incidence of hypersensitivity to allopurinol. The effects of anesthetics may be increased by thiazide administration. The effects of anticoagulants may be diminished when they are administered with a thiazide diuretic. Because thi-azide diuretics may raise blood uric acid levels, dosage adjustments of antigout drugs may be necessary. Thiazide diuretics may prolong antineoplastic-induced leukopenia. Hyperglycemia may occur when the thiazides area administered with the antidiabetic drugs. Synergistic effects may occur when the thi-azide diuretics are administered concurrently with the loop diuretics, causing profound diuresis and serious electrolyte abnormalities. There is an increased risk of glycoside toxicity if the patient experiences hypokalemia while taking the thiazide diuretics.
The observation that sibutramine, which blocks the re-uptake of noradrenaline and serotonin and to a lesser extent dopamine (6), causes a raised blood pressure has been a cause of concern (1,16). Some insight into this problem and its magnitude comes from two recent studies (17,18). Most studies have shown a positive relation between blood pressure and weight (19). The failure of the blood pressure to fall with weight loss in normotensive and hypertensive patients treated with sibutramine differs from the fall seen with orlistat (20-22) or weight loss induced by life-style modifications (23,24). In the case of sibutramine, the potentially detrimental effect due to the failure of the blood pressure to fall with weight loss may be offset by the reductions in lipids, insulin, and uric acid that occur with weight loss (25).
A number of adverse reactions can occur such as dehydration this is a common risk in the use of all diuretics especially in the elderly patients. Other effects include hypokalemia (usually mild), hyperuricemia gout, impaired glucose tolerance diabetes mellitus, insulin resistance (significance is uncertain), Hypercholesterolemia (usually in short-term therapy rather than in long-term therapy), impotence, and hypercalcemia. Contraindications are gout, diabetes mellitus, and renal disease.
Knowing what adverse reactions may occur allows the nurse to prepare for any event that will happen. For example, a hemorrhagic syndrome may be seen with the administration of plicamycin. Knowing this, assessments for hemorrhage are incorporated in the nursing care plan. Another example is the development of hyper-uricemia (elevated blood uric acid levels), which may be seen with drugs, such as melphalan (Alkeran) or mercaptopurine (Purinethol). When this adverse reaction is known to occur, fluid intake and output measurements, as well as encouragement to increase fluid intake to at least 2000 mL of oral fluid per day, are included in the nursing care plan. Other antineoplastic drugs are nephrotoxic. Therefore, blood urea nitrogen levels and serum creatinine are monitored closely during therapy.
Uses Orthosiphon stamineus Bth. is principally used to promote urination. In Indonesia and Malaysia, a decoction of leaves is drunk to alleviate bladder and kidneys discomfort, as well as to treat arteriosclerosis, gout and rheumatism. In Vietnam, an infusion of 15g-40g of the plant is drunk to promote urination, treat edema, control eruptive fever, and to treat influenza, rheumatism, hepatitis, jaundice and biliary lithiasis. In India, the plant is mixed with Andrographis paniculata Nees to treat diabetes.
Vitreous humor has been shown to be particularly useful for the postmortem analysis of glucose, urea nitrogen, uric acid, creatinine, sodium, and chloride. Measuring these analytes is important for documenting diabetes, degree of hydration, electrolyte balance, and the state of renal function prior to death. A recent article has reviewed the extent and breadth of chemistry analyte analysis applied to vitreous fluid, among other postmortem specimens.27
It is very good against the gout, and other humours that fall upon the nervous, muscular, and tendinous parts. It abates inflammations, dissolves tumors and hard swellings upon the joints. Beat and pounded in a mortar, with butter, when it is still fresh, it is applied to burns, which relieves greatly when it is often renewed.
Theophrastus One should draw three circles round the mamirakv with a sword and at the cutting of the second pitee onti should dancc around the patient. The leaf, they say, is useful for wounds, and the root for red skin welts, when scraped and steeped in vinegar, and also for gout, for sleeplessness, and Sot low potions.
Although some herbal medicines are effective in the treatment of diseases against which modern medicines are inefficient, very often these drugs are unscientifically exploited and improperly used. Numerous plants and polyherbal formulations are used for the treatment of liver diseases. However, in most of the severe cases, the treatments are not satisfactory. Experimental evaluation in most cases has been incomplete and insufficient and the therapeutic values have been tested against chemically induced subclinical levels of damage in rodents. Even common dietary antioxidant and micronutrients such as tocopherol 44 , ascorbic acid 45 , beta-carotene 45 , glutathione, uric acid, and bilirubin, and proteins such as ceru-loplasmin can provide protection from liver damage.
The possibilities for intracellular sites of action are numerous. We have already discussed enzyme inhibition and induction. There are compounds used in cancer chemotherapy which will become involved in DNA and RNA superstructures preventing transcription and translation or replication. Also recall the action of colchichine, the drug used for gout. It interfered with microtubule and microfilament formation necessary for cell proliferation during the inflammatory response of the immune system.
The mystical Chinese emperor Shen Neng introduced these pharmaceutical uses of cannabis. He also discovered many other medicines. These included ephedra, a natural stimulant that helped asthma and led to the invention of amphetamine camellia sinensis, the first caffeinated tea and ginseng, the popular herbal panacea (Aldrich, 1997). Legends often develop around people who make new discoveries, and Shen Neng is no exception. He purportedly could see into his own stomach and observe the impact of herbs on his body, making him a phenomenal authority on their pharmaceutical effects (Wallnofer & Von Rottauscher, 1965). Emperor Shen Neng prescribed cannabis tea for gout, malaria, beriberi, rheumatism, and, curiously, poor memory (Abel, 1980). Although other treatments have developed for most of these maladies, marijuana's impact on rheumatism remains part of modern research (Turner & ElSohly, 1981). Increased travel to the Middle East, Africa, and India invariably led to...
Extracts of Colchicum autumnale, and later colchicine itself, have been used in the treatment of gout, a painful condition in which impaired purine metabolism leads to a build-up of uric acid crystals in the joints. Colchicine is an effective treatment for acute attacks, but it is very toxic, and this restricts its general use. It appears to act primarily as an anti-inflammatory agent, and does not itself affect uric acid metabolism, which needs to be treated with other agents, e.g. a xanthine oxidase inhibitor such as allopurinol. The cytotoxic properties of colchicine and related alkaloid structures from C. autumnale led to their being tested as potential anticancer agents, though they still proved too toxic for medicinal use. Colchicine binds to tubulin in the mitotic spindle, preventing polymerization and assembly into microtubules as do podophyllotoxin (see page 136) and vincristine (see page 356), and is a useful biochemical probe. However, the ability of colchicine to act as a...
Acipimox (S-methylpyrazine-2-carboxylic acid 4-oxide) is structurally related to nicotinic acid. Flushing and gastrointestinal disturbances, but there were no effects on blood glucose or uric acid in 7137 patients, of whom 15 stopped taking the drug because of adverse effects (12). In another open study blood glucose was on average slightly lowered in 3009 patients with type 2 diabetes given acipi-mox for at least 2 months (13).
The classic profile of the stroke victim is one with high blood pressure, evidence of arterial hardening, and high levels of cholesterol and other lipid substances in the blood. Diabetes or gout are frequently present as is a long history of smoking. All of these factors have been found to compound the risk of morbidity and mortality greatly.
Uses In Burma, a paste made from the seeds of Adenanthera pavonina L. is applied externally. In Malaysia, the leaves are used to invigorate health. In India, a decoction of the leaves is used externally to treat chronic rheumatism, gout and impotence, and to treat bleeding. The seeds are used in necklaces.
Our student has now decided that she has no desire to stitch wounds, prescribe blood pressure medication or provide strippers with bust enhancement surgery. Instead, she finds herself spending more and more time in the lab and decides that getting a PhD in biomedical sciences is her path in life. Instead of six figures' worth of debt, she can get a free education actually, tuition is free and she will get paid to go to graduate school. No annoying patients and no old people complaining about their gout, and you get pocket money instead of debt - where do you sign up The promises of graduate school sound like an ad for the military, and might be nearly as divisive. 'Pay' is really a bit of an exaggeration for what students are actually getting for their effort. In reality, they will earn less than minimum wage per hour. Their salary is often not enough to pay the bills, requiring student loans or money borrowed from family to make up the difference.
Effects A good source of lecithin and choline, both of which are beneficial to memory, plus the antioxidant carotenoids lutein and violaxanthin. It may be helpful in treating constipation, fever, gout, hepatitis, insomnia, stiff joints, liver disorders, and chronic rheumatism.
Lithium salts were proposed in medicine for treating gout and dissolving kidney stones. However, it was later discovered that lithium drugs were capable of stopping severe mania excitement in humans and preventing affective attacks. The mechanism of action of lithium drugs is not conclusively known however, it is clear that lithium ions influence sodium transport ions in nerve and muscle cells, which results in lithium ions acting as antagonists to sodium ions.
Effects Sarsaparilla is said to increase energy, regulate hormonal activity and protect against radiation. Herbalists have used it for catarrhal problems, colds, fever, flatulence, frigidity, gout, hives, impotence, infertility, nervous system disorders, PMS, rheumatism, and certain blood disorders.
Precautions It should not be taken by those with Leber's disease (optic nerve atrophy). Those with gout should consult a physician before taking supplements. The RDA for adults is 3 micrograms, yet no toxicity was observed in tests where individuals took 500 to 1000 micrograms (0.5 to 1 mg) for up to five years, or took 100,000 micrograms in a single dose. Allergies to this vitamin are rare, and reactions (the symptoms for which include acne, eczema, and a swelling or crusting of skin around the lips) usually occur with injections, rather than tablets. Rare side effects consist of itchy skin, wheezing, and diarrhea. Life-threatening symptoms, usually resulting from overdose, consist of faintness (from anaphylaxis), hives, itching, and rash.
Hydrochlorothiazide, chlorthalidone, mefruside, bemetizide, ben-dwflumethiazide, butizide, chlorazanil, clopamide, indapamide, metolazone, polythiazide, quinethazone, trichlormethiazide, and xipamide are benzthiazide derivatives whose action depends on the inhibition of absorption of sodium and chloride in the distal tubule area. These drugs cause a potassium loss and lead to a reduction in the plasma volume In addition, they inhibit the excretion of uric acid. Benzthiazides are well-absorbed in the intestinal tract and are excreted unchanged in the urine. They cross the placenta and, when they are given sub partu, can lead to electrolyte changes (hyponatremia, hypokalemia), to thrombopenia, and to reactive hypoglycemia in the newborn as a result of their diabetogenic effect on the mother. In addition, prolonged labor has been described as a result of the inhibitory action on the smooth muscles.
Precautions It should not be taken by those with gout or high urate levels, as it produces large amounts of uric acid, the cause of gout (the uric acids forms crystals in the joints and kidneys, resulting in extreme pain and permanent damage to the body). Its acidity can also cause upset stomach, possibly prevented with the ingestion of baking soda with the supplements.
In 1972, the National Commission on Marihuana and Drug Abuse presented a report to Congress titled Marihuana, A Signal of Misunderstanding, which traced a detailed history of marijuana from ancient times to the early 1970s. According to the report, some of the earliest references to marijuana appear in a Chinese medical text dated 2737 B.c. The Chinese emperor Shen-Nung recommended it as a treatment for the nutritional disease beriberi, constipation, female weakness, gout, malaria, rheumatism, and absentmindedness. However, the Chinese appear not to have used marijuana as an intoxicant.
Antimetabolite drugs may antagonize the effects of antigout drugs by increasing the serum uric acid concentration. Toxicity from methotrexate may be increased by other nephrotoxic drugs. When the antimetabolites are administered with other antineoplastic drugs, bone marrow suppression is additive. Vitamin preparations containing folic acid may decrease the effects of methotrex-ate. Alcohol ingestion while taking methotrexate may increase the risk of hepatotoxicity. Concurrent use of methotrexate and the nonsteroidal anti-inflammatory drugs (NSAIDs) may cause severe methotrexate toxicity. Fluorouracil is not compatible with the diazepam, dox-orubicin, and methotrexate. Food decreases the absorption of fluorouracil. Live viral vaccines should not be administered if the patient is receiving fluorouracil because a decrease in antibody production may occur, causing the vaccine to be ineffective. Severe cardiomy-opathy with left ventricular failure has occurred when fluorouracil and...
In a study of the efficacy and tolerability of a modified-release formulation in 269 adults and 230 additional adults for whom short-term safety data were available, 13 of 269 patients (4.8 ) withdrew because of flushing (41). During the first 4 weeks about half had flushing. The mean intensity was about 4.0 on a visual analogue scale (representing none'' to intolerable''). Patients were encouraged to use aspirin prophylactically to minimize flushing. Other nicotinic acid-related adverse effects leading to withdrawal included nausea (3.3 ) sometimes with vomiting, other gastrointestinal symptoms (1.5 ), and pruritus (2.6 ). Once case each of gout, acanthosis nigricans, headache, palpitation, raised glucose concentrations, and shoulder pain led to patient withdrawal. Certain adverse events thought to be associated with nicotinic acid were uncommon in the study group. There was one case of peptic ulcer, amblyopia occurred in three patients, and leg aches and myalgias in one patient...
Ance policy where everyone pays about the same for healthcare, regardless of their health status. For example, a twenty-something health nut who hasn't seen a doctor in years pays the same as a fifty-something suffering from heart disease, diabetes and gout who sees the doctor on a regular basis and takes a library of prescription medicines. The system is set up to ensure that healthier people in essence wind up paying for the insurance of sick people, but are assured that if their health is compromised, they will have access to healthcare. This system of social distribution of cost works well everywhere but here, because it has slowly been infected by a newer philosophy where your insurance rate depends upon your use of the system.
Compounds known to inhibit the mitotic phase of the cell cycle offer potential usefulness in the treatment of cancer. Few such drugs, however, have reached clinical application either because of unacceptable toxicity or ineffectiveness. Two antimitotic agents are used for other purposes. The antibiotic griseofulvin is utilized for its antifungal properties. The alkaloid colchicine, although having antitumor activity, is used in the treatment of gout. Colchicine, obtained from the seeds of Colchicum autumnale, combines with tubulin reversibly. Tubulin is a protein, normally polymerizing to form microtubules found in animal and plant cells. Of particular interest is their function in chromosomal motion during mitosis. The ketonic area of the tropolone ring portion is the likely binding site. Inhibition of leukocyte microtubules is the probable reason for the alkaloid's strong antiinflammatory effect in gout. Podophyllotoxin, which is obtained from the resin of the May Apple or
Medicinal uses for cannabis date back to 2737 B.C., when the Chinese emperor and pharmacologist Shen Neng prescribed the drug for gout, malaria, beriberi, rheumatism, and memory problems. News of the medication spread throughout the world. The drug helped reduce symptoms in India, Africa, Greece, and Rome. Many authors assert that medical marijuana treatments would not have reached other countries unless they had meaningful efficacy. Dr. William O'Shaughnessy introduced the medication to Europe in the 1830s. By the early 1900s, some of the most prominent drug companies in Europe and America marketed cannabis extracts as cures for a variety of symptoms, including headache, nausea, cramps, and muscle spasms. Tinctures of cannabis may have had problems because of inconsistent potency, but they were often as good or better than other medications available for the same symptoms (Abel, 1980).
The potent physiological activity of many alkaloids has also led to their use as pharmaceuticals, stimulants, narcotics and poisons. Alkaloids currently in clinical use include the analgesics morphine and codeine, the anticancer agent vinblastine, the gout suppressant colchicine, the muscle relaxant (+) tubocurarine, the antiar-rythemic ajmalicine, the antibiotic sanguinarine and the sedative scopolamine. The plant alkaloids like caffeine in tea and coffee and nicotine in all preparations (smoking, chewing) of tobacco are widely consumed daily 4 . Purine alkaloids are widely distributed within the plant kingdom (Fig. 2.2) and have been detected in at least 90 species belonging to 30 genera. Caffeine and thre-obromine, methylated derivatives of xanthine, are generally the main purine alkaloids and are regularly accompanied in low concentrations by the two methylxan-thines theophylline and paraxanthine, as well as by methylated uric acids such as theacrine, methylliberine and liberine....
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