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Allopurinol
27%
23/86
Colchicine
12%
10/86
Hydrochlorothiazide
50%
43/86
Indomethacin
2%
2/86
Methotrexate
5%
4/86
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This patient’s presentation of a swollen, erythematous, and painful MTP joint of the big toe is classic for gout, which can be exacerbated by thiazide diuretics. Gout is an acute inflammation of the joints caused by precipitation of monosodium urate crystals and is caused by either underexcretion (more common) or overproduction of uric acid. Underexcretion of uric acid is often idiopathic, but is exacerbated by renal failure as well as certain medications, including thiazide diuretics, pyrazinamide, furosemide, niacin, and cyclosporine. Incorrect Answers: Answer 1: Allopurinol, a xanthine oxidase inhibitor, is prescribed as a prophylactic treatment for gout. Answer 2: Colchicine, a drug that acts on microtubules, is used in the acute treatment of gout and pseudogout. Answer 4: Indomethacin, an NSAID, can be used in the acute treatment of gout attacks. Answer 5: Methotrexate is a drug that competitively inhibits dihydrofolate reductase to inhibit pyrimidine synthesis, and can cause adverse effects of megaloblastic anemia, pulmonary fibrosis, myelosuppression, hepatoxicity, mucositis, folate deficiency, and nephrotoxicity. Hyperuricemia/gout is not a typical adverse effect of methotrexate. Bullet Summary: Thiazide diuretics are a risk factor for hyperuricemia, which can result in gout.
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