Xanthine Oxidase Inhibitors: Allopurinol and Febuxostat
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Questions and Answers

What is the primary mechanism of action of allopurinol and febuxostat?

  • They interfere with the function of the mitotic spindles and inhibit the migration of granulocytes.
  • They change uric acid into inert chemicals that are renally excreted.
  • They inhibit the conversion of hypoxanthine and xanthine to uric acid. (correct)
  • They increase the renal excretion of uric acid.

    • Which of the following drugs is not an analgesic?

  • Probenecid
  • Colchicine (correct)
  • Lesinurad
  • Pegloticase

    • Which drug is only used in combination with a xanthine oxidase inhibitor and not as monotherapy?

  • Lesinurad (correct)
  • Febuxostat
  • Probenecid
  • Allopurinol

    • Which antigout drug is not affected by a high-fat meal?

    <p>Colchicine</p> Signup and view all the answers

    Which antigout drug is contraindicated when creatinine levels drop below 45 mL/min?

    <p>Lesinurad</p> Signup and view all the answers

    Which antigout drug is not effective in the presence of renal failure?

    <p>Colchicine</p> Signup and view all the answers

    What is the primary mechanism of action of colchicine?

    <p>It binds to microtubular proteins to interfere with the function of the mitotic spindles and inhibits the migration of granulocytes.</p> Signup and view all the answers

    Which antigout drug is associated with hepatotoxicity?

    <p>Allopurinol and colchicine</p> Signup and view all the answers

    Which antigout drug is a parenteral drug?

    <p>Pegloticase</p> Signup and view all the answers

    Which antigout drug is not intended for the treatment of acute attacks?

    <p>Probenecid</p> Signup and view all the answers

    What is the primary cause of gout syndrome?

    <p>Alteration in purine metabolism leading to increased uric acid levels</p> Signup and view all the answers

    Which of the following is NOT one of the four phases of gout?

    <p>Remission phase</p> Signup and view all the answers

    Which joint is most commonly affected in early acute gout attacks?

    <p>First metatarsal joint of the great toe</p> Signup and view all the answers

    Which of the following is a key element in the treatment of gout?

    <p>Use of antigout and uricosuric agents</p> Signup and view all the answers

    What is the primary function of antigout drugs (xanthine oxidase inhibitors)?

    <p>Prevent synthesis of uric acid</p> Signup and view all the answers

    Which of the following drugs are mentioned for managing acute gout pain?

    <p>Both NSAIDs and corticosteroids</p> Signup and view all the answers

    What is the recommended starting dose of febuxostat for the chronic management of hyperuricemia in patients with gout?

    <p>40 mg/d</p> Signup and view all the answers

    What is the maximum recommended daily dose of lesinurad when used in combination with a xanthine oxidase inhibitor?

    <p>200 mg/d</p> Signup and view all the answers

    Which of the following is the uricosuric agent of choice for the treatment of gout due to its well-established safety and relatively long duration of action?

    <p>Probenecid</p> Signup and view all the answers

    What is the recommended dosage of allopurinol for the treatment of mild gout?

    <p>200 to 300 mg/d</p> Signup and view all the answers

    When should liver function tests be performed for patients taking febuxostat?

    <p>At 2 months and 4 months after starting therapy</p> Signup and view all the answers

    What is the recommended prophylactic treatment to prevent acute gout flares during the first 6 months of febuxostat therapy?

    <p>NSAIDs and colchicine</p> Signup and view all the answers

    What is the recommended maximum daily dose of probenecid for the treatment of gout?

    <p>3 g/d</p> Signup and view all the answers

    When should the maintenance dose of probenecid be decreased for patients who have had no acute gout attacks for 6 months?

    <p>Every 6 months</p> Signup and view all the answers

    What is the minimum effective daily dose of allopurinol for the treatment of gout?

    <p>100 to 200 mg/d</p> Signup and view all the answers

    What is the purpose of administering NSAIDs or colchicine prophylactically during the first 6 months of febuxostat therapy?

    <p>To prevent acute gout flares</p> Signup and view all the answers

    What is the main reason why colchicine and probenecid are used cautiously in patients with peptic ulcer disease or spastic colon?

    <p>These drugs can cause gastrointestinal adverse reactions that may worsen these conditions</p> Signup and view all the answers

    Why should patients with known or suspected sulfa allergies not use probenecid?

    <p>Probenecid is a sulfa drug and can cross-react with other sulfa-containing medications</p> Signup and view all the answers

    What is the risk when starting uric acid-lowering agents like febuxostat and allopurinol?

    <p>There is a risk of gout flare-up due to the sudden increase in serum uric acid mobilization</p> Signup and view all the answers

    How can the risk of gout flare-up when starting uric acid-lowering agents be mitigated?

    <p>By starting the patient on a course of NSAIDs or colchicine for prophylaxis</p> Signup and view all the answers

    Why are allopurinol and febuxostat not recommended for use in pregnant women?

    <p>Adequate studies on the use of these drugs in pregnant women have not been performed</p> Signup and view all the answers

    What is the recommended treatment to prevent the development of renal stones in patients taking uric acid-lowering agents?

    <p>Both a and b</p> Signup and view all the answers

    What is the most severe adverse reaction associated with allopurinol use?

    <p>Cholestatic jaundice</p> Signup and view all the answers

    Why is the HLA-B*5801 carrier screening tool not recommended for universal use?

    <p>The screening tool is not accurate enough to justify the cost</p> Signup and view all the answers

    Which of the following drugs is contraindicated in patients being treated with drugs requiring xanthine oxidase for metabolism?

    <p>Allopurinol</p> Signup and view all the answers

    Which of the following drugs is not associated with an increased risk of hypersensitivity reactions?

    <p>Colchicine</p> Signup and view all the answers

    Which patient population may benefit from using colchicine as a treatment?

    <p>African American and Hispanic patients who have a disproportionate incidence of these reactions</p> Signup and view all the answers

    What is the typical dosage regimen for using colchicine to treat an acute gout flare?

    <p>An initial dose of 1.2 mg followed by 0.6 mg 1 hour later, for a maximum of 1.8 mg over 1 hour</p> Signup and view all the answers

    What is the mechanism by which colchicine can induce reversible malabsorption of vitamin B12?

    <p>Colchicine alters the function of the ileal mucosa</p> Signup and view all the answers

    Which of the following medications is NOT associated with major cardiovascular (CV) events according to the text?

    <p>Colchicine</p> Signup and view all the answers

    What is the potential interaction between colchicine and salicylates (e.g., aspirin)?

    <p>Salicylates have a mutually antagonistic effect with colchicine</p> Signup and view all the answers

    What is the purpose of adjusting the dosage of colchicine for patients with impaired renal or hepatic function?

    <p>To minimize the potential for adverse reactions</p> Signup and view all the answers

    What is the purpose of premedication with antihistamines and steroids when administering pegloticase?

    <p>To prevent the development of acute allergic-type reactions during infusion</p> Signup and view all the answers

    How does the interaction between probenecid and antibiotics (penicillins and cephalosporins) differ from the interactions of other medications mentioned in the text?

    <p>Probenecid inhibits the tubular secretion of these antibiotics, increasing their plasma levels</p> Signup and view all the answers

    What is the rationale for using a transdermal formulation of colchicine (Colcigel) for the treatment of acute gout flares?

    <p>Transdermal colchicine provides faster relief of articular pain and swelling compared to oral colchicine</p> Signup and view all the answers

    What is the recommended preventive therapy regimen for patients who have more than one acute gout attack per year?

    <p>0.6 mg/d of colchicine for 3 or 4 days a week</p> Signup and view all the answers

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