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Chapter 59. Gout and Hyperuricemia

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Which one of the following statements concerning febuxostat in the treatment of gout is correct?

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A. It is more effective in reducing acute gouty flares than allopurinol titrated to the serum uric acid (SUA) target.

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B. It should not be used in patients with a history of allopurinol hypersensitivity syndrome.

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C. Liver function tests should be monitored when initiating and titrating therapy.

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D. Combination therapy with allopurinol and febuxostat can achieve greater decreases in SUA than either agent alone.

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E. Febuxostat should be avoided in patients with mild-to-moderate renal impairment.

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What would be an appropriate starting dose of allopurinol in a 55-year-old man with gout and chronic kidney disease if his serum creatinine is 2.1 mg/dL (186 μmol/L)? He is 5’7” (170 cm) and weighs 75 kg (165 lb).

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A. 50 mg daily

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B. 100 mg every other day

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C. 100 mg daily

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D. 300 mg daily

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E. Allopurinol is not recommended in patients with chronic kidney disease

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A 42-year-old woman presents to her family physician 48 hours after the onset of her third acute gout flare this year with complaints of severe pain and swelling of her left knee. She is currently prescribed febuxostat 40 mg once daily (initiated last month) and her serum uric acid today is 9.6 mg/dL (571 μmol/L). Except for gout, her past medical history is unremarkable, and she is adherent to current therapy. What do you recommend to optimize the patient’s pharmacotherapy regimen?

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A. Increase febuxostat to 80 mg daily and add colchicine for acute treatment followed by anti-inflammatory prophylaxis.

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B. Continue febuxostat 40 mg daily and add naproxen for acute treatment followed by anti-inflammatory prophylaxis.

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C. Continue febuxostat 40 mg daily and add colchicine for acute treatment followed by anti-inflammatory prophylaxis.

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D. Increase febuxostat to 80 mg daily and add naproxen for acute treatment followed by anti-inflammatory prophylaxis.

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E. Continue febuxostat 40 mg daily and add probenecid for additional urate lowering once acute attack resolves.

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Which one of the following statements concerning indomethacin use in acute gout is correct?

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A. Studies have determined that indomethacin is the most ...

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