Page 19 - RxExam's Naplex Theory Book Part 2

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Dose Special Notes

Probenecid 3). Therapy with Probenecid should not be started until an acute gouty
(Tablet) attack has subsided. However, if an acute attack is precipitated during
therapy, Probenecid may be continued without changing the dosage
and full therapeutic dosage of colchicine or other appropriate therapy
should be given to control the acute attack.

4). As uric acid tends to crystallize out of an acid urine, a liberal fluid
intake is recommended, as well as sufficient sodium bicarbonate (3 to
7.5 g daily), or potassium citrate (7.5 g daily) to maintain an alkaline
urine. Alkalization of the urine is recommended until the serum urate
level returns to normal limits and tophaceous deposits disappear, i.e.,
during the period when urinary excretion of uric acid is at a high level.
Thereafter, alkalization of the urine and the usual restriction of purine-
producing foods may be somewhat relaxed.

5). Probenecid inhibits the tubular secretion of penicillin and usually
increases penicillin plasma levels by any route the antibiotic is given. A
2-fold to 4-fold elevation has been demonstrated for various
penicillins.

6). Probenecid has also been reported to inhibit the renal transport of
many other compounds including aminohippuric acid (PAH),
aminosalicylic acid, indomethacin, sulfonamides and sulfonylurea.

7). The use of salicylates and pyrazinamide antagonize the uricosuric
action of Probenecid.

8). Precipitation of acute gouty arthritis, nausea, vomiting, anorexia,
dermatitis, and hemolytic anemia are reported with the therapy.

D). Non-Steroidal Anti Inflammatory Agent

Indomethacin 1. Gouty arthritis: 1). Indomethacin (Indocin), an NSAID, has been found effective in
(Capsule) active stages of the following:
(Oral suspension) 25 to 50 mg PO
(Injection) TID. 1. Moderate to severe rheumatoid arthritis including acute flares of
chronic disease.
2. Moderate to severe ankylosing spondylitis.
3. Moderate to severe osteoarthritis.
4. Acute painful shoulder (bursitis and/or tendinitis).
5. Acute gouty arthritis.

2). Bleeding, ulceration, and perforation of the esophagus, stomach,
small intestine, or large intestine, hypertension, edema, congestive
heart failure are side effects of Indomethacin (Indocin).

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