Drugs used in the management of gout.

Acute attacks of gouty arthritis may occur early in treatment with allopurinol (Zyloprim, Purinol) because:
1. allopurinol (Zyloprim, Purinol) increases urate synthesis
2. urate crystals move from tissue to plasma
3. allopurinol (Zyloprim, Purinol) increases release of chemotactic factors
4. A & B
5. A, B & C
Important sources of uric acid:
1. amino acids
2. carbon dioxide
3. diet
4. A & B
5. A, B & C
Rational indication(s) for allopurinol (Zyloprim, Purinol) administration:
1. chronic tophaceous gout;when tophi reabsorption more rapid with uricosuric agents
2. when probenecid or sulfinpyrazone cannot be used
3. presence of renal functional impairment
4. in a patient with recurrent renal stones
5. all of the above
Previously most popular drug for treating inflammation of acute gouty arthritis -- NSAIDs now more commonly used because of diarrhea associated with earlier medication:
1. allopurinol (Zyloprim, Purinol)
2. colchicine
3. probenecid (Benemid)
4. sulfinpyrazone (Anturane)
5. acetaminophen (Tylenol, Panadol)
effective in management of mild to moderate pain, when anti-inflammatory action is not necessary
1. penicillamine (Cuprimine)
2. sulfasalazine (Azulfidine)
3. acetaminophen (Tylenol, Panadol)
4. etodolac (Lodine)
5. piroxicam (Feldene)
Probably the initial step in acute gouty arthritis attack:
1. polymorphonuclear leukocytes migration into the joint
2. increased numbers of mononuclear phagocytes (macrophages)
3. urate crystals phagocytosis by synoviocytes
4. prostaglandin, lysosomal &, interleukin 1 release
Probable direct effect of colchicine (mechanism of action):
1. direct membrane stabilization
2. binds to intracellular tubulin -- preventing/reducing microtubule formation
3. decreases purine synthesis directly
4. prevents IL-1 release directly
5. none of the above
Reduces likelihood of urate stone formation:
1. high-level urine volume
2. acidification of urine pH
3. both
4. neither
Reduces uric acid synthesis: for management of gout--
1. colchicine
2. probenecid (Benemid)
3. sulfinpyrazone (Anturane)
4. allopurinol (Zyloprim, Purinol)
5. oxaprozin (Daypro)
Site(s) of action: probenecid (Benemid) --
1. Loop of Henle
2. proximal tubule -- middle segment
3. both
4. neither