Gout Drugs

Question 1

Probenecid

Answer 1

MOA: Inhibits reabsorption of uric acid in proximal
convoluted tubule (also inhibits secretion of
penicillin). Can precipitate uric acid calculi.

Clinical use: chronic gout (preventative)

Adverse effects:

Question 2

Allopurinol

Answer 2

MOA: Competitive inhibitor of xanthine oxidase
–> ↓ conversion of hypoxanthine and xanthine
to urate. Also used in lymphoma and leukemia
to prevent tumor lysis–associated urate
nephropathy. ↑ concentrations of xanthine
oxidase active metabolites, azathioprine, and
6-MP.

Clinical use: chronic gout (preventative)

Adverse effects:

Question 3

Pegloticase

Answer 3

MOA: Recombinant uricase catalyzing uric acid to
allantoin (a more water-soluble product).

Clinical use: chronic gout (preventative)

Adverse effects:

Question 4

Febuxostat

Answer 4

MOA: Inhibits xanthine oxidase.

Clinical use: chronic gout (preventative)

Adverse effects:

Question 5

NSAIDs

Answer 5

Clinical use: acute gout

Any NSAID. Use salicylates with caution (may
decrease uric acid excretion, particularly at
low doses).

Question 6

Glucocorticoids

Answer 6

Oral, intra-articular, or parenteral.

Clinical use: acute gout

Question 7

Colchicine

Answer 7

MOA: Binds and stabilizes tubulin to inhibit
microtubule polymerization, impairing
neutrophil chemotaxis and degranulation.

Clinical use: acute gout; Acute and prophylactic value

Adverse effects: GI,
neuromyopathic side effects.