questions 2

Gout Drugs

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Topic updated on 05/09/17 7:55am

Overview
  • Acute gout
    • treat acute inflammation
      • colchicine
      • indomethacin
      • NSAIDs
      • intra-articular steroids
  • Chronic gout
    • reduce amount of uric acid in the body
      • allopurinol
      • probenecid
  • Salicylates are contraindicated
    • depress uric acid clearance
      • note: high doses (5-6 g) have minor uricosuric activity
Colchicine
  • Mechanism
    • binds to tubulin
      • inhibits microtubule polymerization → inhibits mitosis
      • inhibits leukocyte and granulocyte migration
  • Clinical use
    • acute gout
  • Toxicity
    • GI upset
      • especially if given orally
Allopurinol
  • Mechanism
    • inhibits xanthine oxidase
      • prevents conversion of xanthine to uric acid
    • a "suicide inhibitor"
      • allopurinol metabolized to alloxanthine by xanthine oxidase itself
      • alloxanthine then inhibits xanthine oxidase
  • Clinical use
    • chronic gout
    • lymphoma
    • leukemia
      • prevents tumor lysis-associated urate nephropathy
  • Toxicity
    • rash
    • drug interactions
      • inhibits metabolism of
        • azathioprine
        • 6-MP
      • both metabolized by xanthine oxidase
Probenecid
  • Mechanism
    • inhibits reabsorption of uric acid in PCT
      • requires intact kidney function
  • Clinical use
    • chronic gout
  • Toxicity
    • drug interactions
      • inhibits secretion of acidic drugs
        • penicillins
        • cephalosporins
        • fluoroquinolones
    • Nephrolithiasis
      • uricosuric agents should only be used in uric acid underexcreters and should be avoided in patients who are uric acid overproducers 
      • A history of prior uric acid stones is a contraindication for initiating this agent 


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Qbank (2 Questions)

TAG
(M1.MK.4666) A 54-year-old male has a history of gout complicated by several prior episodes of acute gouty arthritis and 3 prior instances of nephrolithiasis secondary to uric acid stones. He has a serum uric acid level of 11 mg/dL (normal range 3-8 mg/dL), a 24 hr urine collection of 1300 mg uric acid (normal range 250-750 mg), and a serum creatinine of 0.8 mg/dL with a normal estimated glomerular filtration rate (GFR). Which of the following drugs should be avoided in this patient? Topic Review Topic

1. Naproxen
2. Colchicine
3. Allopurinol
4. Indomethacin
5. Probenecid

PREFERRED RESPONSE ▶
TAG
(M1.MK.4740) A 45-year-old male presents to the emergency room for toe pain. He reports that his right great toe became acutely painful, red, and swollen approximately five hours prior. He has had one similar prior episode six months ago that resolved with indomethacin. His medical history is notable for obesity, hypertension, and alcohol abuse. He currently takes hydrochlorothiazide (HCTZ). On physical examination, his right great toe is swollen, erythematous, and exquisitely tender to light touch. The patient is started on a new medication and his pain eventually resolves; however, he develops gastrointestinal upset a few days after starting the drug. Which of the following mechanisms of action is characteristic of this patient’s new medication? Topic Review Topic

1. Inhibits microtubule polymerization
2. Prevents conversion of xanthine to uric acid
3. Decreases phospholipase A2-induced production of arachidonic acid
4. Decreases cyclooxygenase-induced production of prostaglandins
5. Metabolizes uric acid to water-soluble allantoin

PREFERRED RESPONSE ▶


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