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Review Question - QID 107094

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QID 107094 (Type "107094" in App Search)
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?

Naproxen

12%

29/237

Colchicine

12%

28/237

Allopurinol

19%

46/237

Indomethacin

10%

23/237

Probenecid

44%

104/237

Select Answer to see Preferred Response

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Uricosuric drugs, such as probenecid, should be avoid in patients with high uric acid excretion (generally, > 800 mg/24hr is indicative of a uric acid overproducer) because this increases the risk of forming uric acid stones.

Uricosuric medications should only be used in patients who underexcrete uric acid. These agents should not be used in patients with a history of kidney stones, unless the stones have been confirmed to NOT be uric acid stones. Patients taking uricosuric agents should be instructed to have high fluid intake to minimize the risk of uric acid precipitation and stone formation.

Incorrect Answers:
Answer 1: Naproxen, a nonsalicylate NSAID, will decrease the risk of future acute arthritic attacks; however, it will NOT alter serum uric acid levels or prevent the formation of tophi or nephrolithiasis.

Answer 2: Colchicine will decrease the risk of future acute arthritic attacks; however, it will NOT alter serum uric acid levels or prevent the formation of tophi or nephrolithiasis.

Answer 3: Allopurinol is useful in both uric acid underexcretors and overproducers.

Answer 4: Indomethacin, a nonsalicylate NSAID, will decrease the risk of future acute arthritic attacks; however, it will NOT alter serum uric acid levels or prevent the formation of tophi or nephrolithiasis.

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