Overview Snapshot A 50-year-old man presents 4 months after an acute gout flare to his primary care physician. Since then, he has had 2 more episodes of minor flares that resolved on its own. He reports wanting better control of this disease. His physician describes several options for chronic gout and suggests allopurinol as a good first-line option. Introduction Chronic gout drugs mechanism of action prevents the build up of uric acid drugs allopurinol febuxostat pegloticase probenecid Acute gout drugs mechanism of action reduces inflammation drugs nonsteroidal anti-inflammatory drugs (NSAIDs) glucocorticoids (oral, intra-articular, and parenteral) colchicine Drugs to avoid low-dose salicylates decreases uric acid excretion, which may precipitate gout Allopurinol Mechanism of action competitive inhibition of xanthine oxidase, which decreases production of urate Clinical use chronic gout prevention of urate nephropathy from tumor lysis syndrome in lymphoma and leukemia Toxicity ↑ accumulation of azathioprine and 6-mercaptopurine (MP) both are metabolized by xanthine oxidase drug rash Febuxostat Mechanism of action inhibition of xanthine oxidase Clinical use chronic gout Toxicity ↑ accumulation of azathioprine and 6-MP some hepatotoxicity Pegloticase Mechanism of action pegloticase is a recombinant uricase catalyzes metabolism of uric acid to allantoin, which is more water-soluble Clinical use chronic gout Toxicity risk of new gout flare infusion reactions Probenecid Mechanism of action inhibition of proximal convoluted tubule resorption of uric acid Clinical use chronic gout Toxicity uric acid calculi this 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 prolonged penicillin serum levels inhibition of proximal convoluted tubule secretion of penicillin Colchicine Mechanism of action inhibition of microtubule polymerization by binding to tubulin, which impairs neutrophil chemotaxis and degranulation and decreases inflammation Clinical use acute and chronic gout Toxicity gastrointestinal irritation
QUESTIONS 1 of 3 1 2 3 Previous Next Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK (M1.MK.17.4740) 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 that decreases leukocyte migration and mitosis, and his pain eventually resolves; however, he develops nausea and vomiting as a result of therapy. Which of the following underlying mechanisms of action is characteristic of this patient’s new medication? Tested Concept QID: 108658 Type & Select Correct Answer 1 Inhibits microtubule polymerization 38% (105/274) 2 Prevents conversion of xanthine to uric acid 30% (81/274) 3 Decreases phospholipase A2-induced production of arachidonic acid 6% (16/274) 4 Decreases cyclooxygenase-induced production of prostaglandins 19% (53/274) 5 Metabolizes uric acid to water-soluble allantoin 4% (12/274) M 1 Question Complexity B Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 1 Review tested concept (M1.MK.15.4666) 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? Tested Concept QID: 107094 Type & Select Correct Answer 1 Naproxen 12% (9/73) 2 Colchicine 14% (10/73) 3 Allopurinol 14% (10/73) 4 Indomethacin 14% (10/73) 5 Probenecid 47% (34/73) M 3 Question Complexity E Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 5 Review tested concept