Xanthine Oxidase Inhibitors: Allopurinol and Febuxostat

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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?

Colchicine Signup and view all the answers

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

Lesinurad Signup and view all the answers

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

Colchicine Signup and view all the answers

What is the primary mechanism of action of colchicine?

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

Which antigout drug is associated with hepatotoxicity?

Allopurinol and colchicine Signup and view all the answers

Which antigout drug is a parenteral drug?

Pegloticase Signup and view all the answers

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

Probenecid Signup and view all the answers

What is the primary cause of gout syndrome?

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

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

Remission phase Signup and view all the answers

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

First metatarsal joint of the great toe Signup and view all the answers

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

Use of antigout and uricosuric agents Signup and view all the answers

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

Prevent synthesis of uric acid Signup and view all the answers

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

Both NSAIDs and corticosteroids Signup and view all the answers

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

40 mg/d Signup and view all the answers

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

200 mg/d 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?

Probenecid Signup and view all the answers

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

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

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

At 2 months and 4 months after starting therapy 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?

NSAIDs and colchicine Signup and view all the answers

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

3 g/d 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?

Every 6 months Signup and view all the answers

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

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

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

To prevent acute gout flares 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?

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

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

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

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

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

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

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

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

Adequate studies on the use of these drugs in pregnant women have not been performed 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?

Both a and b Signup and view all the answers

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

Cholestatic jaundice Signup and view all the answers

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

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

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

Allopurinol Signup and view all the answers

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

Colchicine Signup and view all the answers

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

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

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

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 Signup and view all the answers

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

Colchicine alters the function of the ileal mucosa Signup and view all the answers

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

Colchicine Signup and view all the answers

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

Salicylates have a mutually antagonistic effect with colchicine Signup and view all the answers

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

To minimize the potential for adverse reactions Signup and view all the answers

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

To prevent the development of acute allergic-type reactions during infusion 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?

Probenecid inhibits the tubular secretion of these antibiotics, increasing their plasma levels 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?

Transdermal colchicine provides faster relief of articular pain and swelling compared to oral colchicine 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?

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

Xanthine Oxidase Inhibitors: Allopurinol and Febuxostat

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Questions and Answers

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

Which of the following drugs is not an analgesic?

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

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

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

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

What is the primary mechanism of action of colchicine?

Which antigout drug is associated with hepatotoxicity?

Which antigout drug is a parenteral drug?

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

What is the primary cause of gout syndrome?

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

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

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

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

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

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

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

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?

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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