Question 1
A 50-year-old patient with an acute gout attack receives an intra-articular injection. What does “intra-articular” refer to in this context?
A) Injection into the bloodstream
B) Injection into the joint space
C) Injection into the muscle
D) Injection into the skin
E) Injection into the bone
Click here to see the answer
Correct Answer: B) Injection into the joint space
Explanation: “Intra-articular” refers to an injection that is administered directly into the joint space, commonly used to deliver corticosteroids or other medications to reduce inflammation and pain in conditions like gout.
Question 2
A 60-year-old patient with recurrent gout attacks is being treated with colchicine for his acute flare-ups. What is the primary role of colchicine in the management of acute gout?
A) It lowers serum uric acid levels by inhibiting xanthine oxidase
B) It reduces inflammation by inhibiting neutrophil activity and migration
C) It increases renal excretion of uric acid
D) It prevents the formation of uric acid crystals
E) It neutralizes uric acid in the joint space
Click here to see the answer
Correct Answer: B) It reduces inflammation by inhibiting neutrophil activity and migration
Explanation: Colchicine works by reducing inflammation in acute gout attacks through the inhibition of neutrophil migration and activity, thus decreasing the inflammatory response in the joints.
Question 3
A 45-year-old man with a history of acute gout attacks is prescribed allopurinol to manage his hyperuricemia. What is the mechanism of action of allopurinol in treating hyperuricemia?
A) It blocks the reabsorption of uric acid in the renal tubules
B) It inhibits xanthine oxidase, decreasing the conversion of xanthine to uric acid
C) It binds to uric acid in the bloodstream, preventing its deposition in joints
D) It neutralizes uric acid in the bloodstream
E) It stimulates the excretion of uric acid through the gastrointestinal tract
Click here to see the answer
Correct Answer: B) It inhibits xanthine oxidase, decreasing the conversion of xanthine to uric acid
Explanation: Allopurinol inhibits xanthine oxidase, the enzyme responsible for converting xanthine to uric acid. This reduces uric acid levels and helps prevent gout attacks.
Question 4
A 62-year-old man with chronic gout is currently experiencing an acute gout attack. He is also being treated for hypertension and congestive heart failure (CHF). Which of the following drugs would be the most appropriate choice for treating his acute gout attack?
A) Allopurinol
B) Febuxostat
C) Colchicine
D) Sulfinpyrazone
E) Probenecid
Click here to see the answer
Correct Answer: C) Colchicine
Explanation: Colchicine is commonly used for acute gout attacks, particularly in patients with comorbidities like hypertension and CHF, where NSAIDs may be contraindicated due to cardiovascular risk. Allopurinol and Febuxostat are used for chronic management, not acute attacks.
Question 5
A 50-year-old man with a history of gout asks if smoking will increase his risk of future gout attacks. What is the most appropriate response?
A) Smoking is a significant risk factor for gout attacks
B) Smoking can cause gout when combined with high-purine diets
C) Smoking does not increase the risk of gout attacks
D) Smoking should be avoided, but it primarily affects cholesterol, not gout
E) Smoking will increase uric acid production, leading to gout
Click here to see the answer
Correct Answer: C) Smoking does not increase the risk of gout attacks
Explanation: Smoking is not considered a risk factor for gout attacks. Risk factors for gout include high-purine foods, certain medications, and conditions like hyperlipidemia.
Question 6
A 63-year-old man with acute gout is considering over-the-counter options for pain relief. Why is acetaminophen not a preferred drug for relieving pain during a gout attack?
A) Acetaminophen increases uric acid levels
B) Acetaminophen lacks anti-inflammatory effects
C) Acetaminophen causes renal toxicity in gout patients
D) Acetaminophen interacts with gout medications
E) Acetaminophen increases the risk of gout attacks
Click here to see the answer
Correct Answer: B) Acetaminophen lacks anti-inflammatory effects
Explanation: Acetaminophen is not typically used for pain relief in acute gout attacks because it lacks the anti-inflammatory properties needed to reduce the inflammation associated with gout.
Question 7
A 55-year-old patient with chronic gout is started on allopurinol. Which of the following is the principal metabolite of allopurinol?
A) Febuxostat
B) Oxipurinol
C) Sulfinpyrazone
D) Colchicine
E) Indomethacin
Click here to see the answer
Correct Answer: B) Oxipurinol
Explanation: Oxipurinol is the principal metabolite of allopurinol and contributes to the drug’s long-lasting inhibition of xanthine oxidase.
Question 8
A 48-year-old patient with gout is prescribed allopurinol. The pharmacist warns him about the potential for serious allergic reactions. What severe allergic reaction is most commonly associated with allopurinol?
A) Anaphylaxis
B) Angioedema
C) Stevens-Johnson syndrome
D) Serum sickness
E) Drug rash with eosinophilia and systemic symptoms (DRESS)
Click here to see the answer
Correct Answer: C) Stevens-Johnson syndrome
Explanation: Allopurinol is most likely associated with severe allergic reactions, including Stevens-Johnson syndrome, a life-threatening skin reaction that requires immediate discontinuation of the drug.
Question 9
A 57-year-old man is experiencing an acute gout attack. He is prescribed indomethacin to manage his symptoms. What is the mechanism by which indomethacin reduces inflammation in acute gout arthritis?
A) Inhibiting uric acid production by blocking xanthine oxidase
B) Blocking prostaglandin formation by inhibiting cyclooxygenase (COX)
C) Enhancing uric acid excretion through the kidneys
D) Inhibiting neutrophil migration to inflamed joints
E) Preventing the formation of urate crystals
Click here to see the answer
Correct Answer: B) Blocking prostaglandin formation by inhibiting cyclooxygenase (COX)
Explanation: Indomethacin, a nonsteroidal anti-inflammatory drug (NSAID), reduces inflammation by inhibiting the cyclooxygenase (COX) enzyme, which is responsible for prostaglandin synthesis, thereby relieving inflammation in acute gout arthritis.
Question 10
A 60-year-old man with gout is prescribed allopurinol. He is also taking azathioprine for his autoimmune condition. What adjustment should be made to his azathioprine dosage while he is on allopurinol?
A) Increase the dose of azathioprine
B) Continue azathioprine without any dosage adjustment
C) Reduce the dose of azathioprine
D) Switch from azathioprine to methotrexate
E) Stop azathioprine immediately
Click here to see the answer
Correct Answer: C) Reduce the dose of azathioprine
Explanation: Allopurinol inhibits xanthine oxidase, which metabolizes azathioprine. To avoid toxicity, the dose of azathioprine must be reduced when used in combination with allopurinol.
Question 11
A 58-year-old man with recurrent gout is prescribed indomethacin for acute attacks but continues to experience elevated uric acid levels. Why is indomethacin not effective in lowering uric acid levels?
A) Indomethacin only reduces pain, not uric acid
B) Indomethacin increases uric acid production
C) Indomethacin blocks uric acid reabsorption
D) Indomethacin is ineffective in treating gout
E) Indomethacin only works when combined with allopurinol
Click here to see the answer
Correct Answer: A) Indomethacin only reduces pain, not uric acid
Explanation: Indomethacin, an NSAID, reduces inflammation and pain during acute gout attacks but does not affect uric acid levels. Other drugs, such as allopurinol or uricosuric agents, are required to manage hyperuricemia.
Question 12
A 55-year-old man with gout is currently taking allopurinol but continues to experience elevated uric acid levels. His doctor decides to switch him to another medication. What is the most appropriate alternative treatment?
A) Colchicine
B) Indomethacin
C) Hydrochlorothiazide
D) Febuxostat
E) Probenecid
Click here to see the answer
Correct Answer: D) Febuxostat
Explanation: Febuxostat is an alternative xanthine oxidase inhibitor used in patients who are not responding to or cannot tolerate allopurinol in the management of gout.
Question 13
A 65-year-old man with hypertension, hyperuricemia, and a history of gout attacks is being treated for his high blood pressure. Which of the following antihypertensive drugs would also help reduce his uric acid levels?
A) Hydrochlorothiazide
B) Lisinopril
C) Losartan
D) Metoprolol
E) Amlodipine
Click here to see the answer
Correct Answer: C) Losartan
Explanation: Losartan is an angiotensin receptor blocker (ARB) with the additional benefit of reducing uric acid levels, making it an excellent choice for hypertensive patients with hyperuricemia and gout.
Question 14
A 55-year-old man has been living with untreated gout for several years. He now presents with visible urate crystal deposits on his hands and feet. What complication of chronic hyperuricemia is he likely experiencing?
A) Renal calculi
B) Tophaceous gout
C) Acute kidney injury
D) Osteoarthritis
E) Rheumatoid arthritis
Click here to see the answer
Correct Answer: B) Tophaceous gout
Explanation: Tophaceous gout results from prolonged elevated uric acid levels, leading to the deposition of urate crystals in soft tissues, causing visible nodules (tophi).
Question 15
A 63-year-old man with hypertension and a history of gout is currently taking hydrochlorothiazide for blood pressure control. He presents with an acute gout attack. What is the most likely reason for his gout flare?
A) Hydrochlorothiazide is known to cause hyperuricemia, which can trigger gout attacks
B) Hydrochlorothiazide increases uric acid excretion, which precipitates gout
C) Hydrochlorothiazide lowers blood pressure, leading to gout
D) Hydrochlorothiazide decreases renal clearance of anti-gout medications
E) Hydrochlorothiazide reduces the effect of NSAIDs
Click here to see the answer
Correct Answer: A) Hydrochlorothiazide is known to cause hyperuricemia, which can trigger gout attacks
Explanation: Thiazide diuretics like hydrochlorothiazide can increase uric acid levels, contributing to hyperuricemia and precipitating gout attacks.
Question 16
A 62-year-old patient with chronic gout has declining renal function and is unable to tolerate allopurinol. What would be the most appropriate alternative treatment for his hyperuricemia?
A) Indomethacin
B) Losartan
C) Colchicine
D) Febuxostat
E) Hydrochlorothiazide
Click here to see the answer
Correct Answer: D) Febuxostat
Explanation: Febuxostat is a xanthine oxidase inhibitor and a suitable alternative for patients who cannot tolerate allopurinol, especially those with declining renal function.
Question 17
A 50-year-old patient with acute gout is treated with colchicine. Shortly after beginning treatment, he experiences severe abdominal cramping and diarrhea. What is the most likely cause of these symptoms?
A) Colchicine-induced hepatotoxicity
B) Colchicine-induced gastrointestinal toxicity
C) Colchicine-induced nephrotoxicity
D) Colchicine-induced myopathy
E) Colchicine-induced neuropathy
Click here to see the answer
Correct Answer: B) Colchicine-induced gastrointestinal toxicity
Explanation: The most common toxicity associated with colchicine is gastrointestinal toxicity, manifesting as nausea, vomiting, abdominal pain, and diarrhea.
Question 18
A 70-year-old patient with recurrent gout attacks and congestive heart failure (CHF) presents for management. Which drug would be the best option for treating his acute gout while considering his cardiovascular condition?
A) NSAIDs
B) Allopurinol
C) Colchicine
D) Hydrochlorothiazide
E) Febuxostat
Click here to see the answer
Correct Answer: C) Colchicine
Explanation: Colchicine is a suitable alternative to NSAIDs in patients where fluid retention could be harmful, such as in those with CHF or hypertension. It helps manage acute gout without worsening cardiovascular conditions.
Question 19
A 58-year-old man presents to the emergency department with severe pain and swelling in his big toe. He has a history of gout and is currently experiencing an acute flare. What is the most appropriate treatment for his acute gout attack?
A) Allopurinol
B) Febuxostat
C) Indomethacin
D) Losartan
E) Hydrochlorothiazide
Click here to see the answer
Correct Answer: C) Indomethacin
Explanation: Indomethacin, an NSAID, is the drug of choice for treating acute gout attacks by inhibiting inflammation. Allopurinol and Febuxostat are used for managing chronic hyperuricemia, not acute flares.
Question 20
A 58-year-old patient with cardiovascular disease and recurrent gout attacks is unable to tolerate NSAIDs. Which medication would be the best option for treating his acute gout?
A) Hydrochlorothiazide
B) Allopurinol
C) Colchicine
D) Febuxostat
E) Losartan
Click here to see the answer
Correct Answer: C) Colchicine
Explanation: Colchicine is the best option for treating acute gout attacks in patients with cardiovascular disease, renal issues, and contraindications to NSAIDs.
Question 21
A 65-year-old patient with chronic gout is being treated with allopurinol but presents with recurrent acute gout attacks. What is the primary reason allopurinol is not suitable for treating acute gout flares?
A) Allopurinol decreases the excretion of uric acid
B) Allopurinol exacerbates gout inflammation
C) Allopurinol primarily manages hyperuricemia, not acute inflammation
D) Allopurinol increases fluid retention, worsening gout symptoms
E) Allopurinol is a diuretic that leads to dehydration
Click here to see the answer
Correct Answer: C) Allopurinol primarily manages hyperuricemia, not acute inflammation
Explanation: Allopurinol is used for chronic management of hyperuricemia in gout patients but is not used during acute attacks as it does not target the inflammation and pain associated with acute flares.
Question 22
A patient with a history of gout is prescribed allopurinol for long-term management. Which of the following drugs requires special attention when co-administered with allopurinol due to the risk of increased toxicity?
A) Colchicine
B) 6-mercaptopurine
C) Ibuprofen
D) Prednisone
E) Methotrexate
Click here to see the answer
Correct Answer: B) 6-mercaptopurine
Explanation: Allopurinol inhibits xanthine oxidase, which is responsible for the metabolism of 6-mercaptopurine. This can lead to increased levels of 6-mercaptopurine and a higher risk of toxicity, necessitating dose adjustments and careful monitoring.
Question 23
A 58-year-old man with recurrent gout has been prescribed sulfinpyrazone for long-term management of his condition. What is the primary mechanism of action of this drug in the treatment of gout?
A) Reduces the production of uric acid by inhibiting xanthine oxidase
B) Increases the renal excretion of uric acid by inhibiting its reabsorption
C) Inhibits the conversion of hypoxanthine to xanthine
D) Blocks the inflammatory pathway of neutrophils during gout attacks
E) Decreases the production of pro-inflammatory cytokines
Click here to see the answer
Correct Answer: B) Increases the renal excretion of uric acid by inhibiting its reabsorption
Explanation: Sulfinpyrazone is a uricosuric agent that increases uric acid excretion by inhibiting its reabsorption in the renal tubules, helping to lower serum uric acid levels in patients with chronic gout.
Question 24
A 55-year-old woman with a history of recurrent gout attacks is advised to modify her diet to reduce her risk of future attacks. Which of the following dietary habits should she avoid to reduce her risk of gout flares?
A) Increased intake of dairy products
B) High consumption of seafood
C) Increased intake of citrus fruits
D) Vegetarian diet with high legumes
E) Increased water consumption
Click here to see the answer
Correct Answer: B) High consumption of seafood
Explanation: Seafood is rich in purines, which can increase uric acid levels and the risk of gout flares. Patients with gout are advised to limit purine-rich foods like seafood and red meat.
Question 25
A 58-year-old man presents with an acute gout flare and is prescribed colchicine. He has chronic kidney disease with a creatinine clearance (CrCl) of 25 mL/min. What is the most appropriate action regarding his colchicine therapy?
A) Administer the standard dose of colchicine without adjustment
B) Decrease the colchicine dose and monitor closely for toxicity
C) Discontinue colchicine and start NSAIDs instead
D) Increase the colchicine dose for faster relief
E) Avoid colchicine and administer allopurinol immediately
Click here to see the answer
Correct Answer: B) Decrease the colchicine dose and monitor closely for toxicity
Explanation: In patients with severe renal impairment (CrCl <30 mL/min), the colchicine dose should be reduced due to the increased risk of toxicity. Monitoring for signs of gastrointestinal and neuromuscular toxicity is critical in these patients.
Question 26
A 65-year-old patient with a history of gout and coronary artery disease presents with an acute gout flare. He is taking simvastatin and clarithromycin for his underlying conditions. Which of the following interactions poses the most significant risk if colchicine is administered?
A) Clarithromycin increases colchicine levels via CYP3A4 inhibition, leading to severe toxicity
B) Simvastatin increases the risk of myopathy, especially when combined with colchicine
C) Colchicine reduces the effectiveness of clarithromycin, increasing the risk of infection
D) Colchicine decreases the absorption of simvastatin, reducing its efficacy
E) Clarithromycin increases the clearance of colchicine, reducing its effectiveness
Click here to see the answer
Correct Answer: A) Clarithromycin increases colchicine levels via CYP3A4 inhibition, leading to severe toxicity
Explanation: Clarithromycin is a strong CYP3A4 inhibitor, which can significantly increase colchicine levels, leading to severe and potentially fatal toxicity, including gastrointestinal, hematologic, and neuromuscular effects.
Question 27
A 55-year-old patient with recurrent gout flares has been taking colchicine prophylactically at a dose of 0.6 mg twice daily. He recently developed numbness and tingling in his extremities. What is the most likely explanation for his symptoms?
A) Colchicine-induced hepatotoxicity
B) Colchicine-induced neuropathy
C) Colchicine-induced myopathy
D) Colchicine-induced renal toxicity
E) Colchicine-induced alopecia
Click here to see the answer
Correct Answer: B) Colchicine-induced neuropathy
Explanation: Long-term use of colchicine, particularly at higher doses, can lead to peripheral neuropathy. Patients may experience numbness and tingling in the extremities, and dose reduction or discontinuation may be necessary.
Question 28
A 68-year-old woman with gout and a history of atrial fibrillation is prescribed colchicine for an acute flare. She is also taking verapamil and warfarin. What is the most appropriate action for managing her gout flare?
A) Start colchicine at the standard dose
B) Reduce colchicine dose due to interaction with warfarin
C) Avoid colchicine due to interaction with verapamil and risk of fatal toxicity
D) Administer colchicine and monitor INR closely
E) Start colchicine and increase the warfarin dose to maintain efficacy
Click here to see the answer
Correct Answer: C) Avoid colchicine due to interaction with verapamil and risk of fatal toxicity
Explanation: Verapamil is a P-gp inhibitor, which can increase colchicine levels and lead to fatal toxicity. Colchicine should be avoided in patients taking strong P-gp inhibitors like verapamil.
Question 29
A 45-year-old patient with a history of recurrent gout attacks is currently on long-term colchicine therapy. He is concerned about the possibility of liver toxicity. What monitoring should be recommended?
A) Annual liver function tests
B) Frequent complete blood counts
C) Monitoring for signs of myopathy
D) Regular renal function tests
E) Monitor for hepatotoxicity only if symptoms develop
Click here to see the answer
Correct Answer: A) Annual liver function tests
Explanation: Colchicine can cause hepatotoxicity, particularly with long-term use, so periodic monitoring of liver function tests is recommended, especially in patients with pre-existing liver conditions.
Question 30
A 60-year-old patient with gout takes colchicine regularly but experiences severe diarrhea and vomiting after increasing his dose during an acute flare. What is the most appropriate course of action?
A) Continue colchicine and treat the gastrointestinal symptoms with antiemetics
B) Discontinue colchicine immediately and switch to an NSAID
C) Reduce the colchicine dose and advise supportive care for the gastrointestinal symptoms
D) Administer an opioid to manage the gastrointestinal side effects
E) Increase the colchicine dose to overcome the flare
Click here to see the answer
Correct Answer: C) Reduce the colchicine dose and advise supportive care for the gastrointestinal symptoms
Explanation: Colchicine-induced gastrointestinal toxicity is common and dose-dependent. Reducing the dose is the most appropriate action, and supportive care for the gastrointestinal symptoms should be provided.
Question 31
Which of the following is the primary mechanism of action of allopurinol?
A) Inhibition of xanthine oxidase
B) Inhibition of leukocyte migration
C) Increase in uric acid excretion
D) Decrease in uric acid reabsorption
E) Inhibition of microtubule polymerization
Click here to see the answer
Correct Answer: A) Inhibition of xanthine oxidase
Explanation: Allopurinol is a non-competitive inhibitor of xanthine oxidase, reducing uric acid production by blocking the conversion of hypoxanthine to xanthine and xanthine to uric acid.
Question 32
Which of the following conditions is allopurinol commonly used to treat?
A) Acute gout flares
B) Hyperuricemia
C) Osteoporosis
D) Rheumatoid arthritis
E) Hypertension
Click here to see the answer
Correct Answer: B) Hyperuricemia
Explanation: Allopurinol is used to prevent recurrent gout attacks and manage hyperuricemia in conditions like tumor lysis syndrome and Lesch-Nyhan syndrome.
Question 33
Which of the following is a serious side effect of allopurinol that may require immediate discontinuation?
A) Diarrhea
B) Drowsiness
C) Stevens-Johnson Syndrome (SJS)
D) Hypertension
E) Alopecia
Click here to see the answer
Correct Answer: C) Stevens-Johnson Syndrome (SJS)
Explanation: Allopurinol can cause severe skin reactions, including SJS and toxic epidermal necrolysis (TEN). It should be discontinued immediately if a rash develops.
Question 34
Allopurinol is contraindicated in patients taking which of the following medications without dose adjustments?
A) NSAIDs
B) Azathioprine
C) Colchicine
D) Diuretics
E) Statins
Click here to see the answer
Correct Answer: B) Azathioprine
Explanation: Allopurinol inhibits the metabolism of azathioprine and mercaptopurine, increasing their toxicity. Dose adjustments are necessary when these drugs are co-administered.
Question 35
Which genetic polymorphism increases the risk of allopurinol hypersensitivity reactions, particularly in Asian populations?
A) HLA-B5801
B) CYP2C92
C) TPMT3
D) HLA-A0201
E) CYP3A4*5
Click here to see the answer
Correct Answer: A) HLA-B5801
Explanation: The HLA-B5801 allele is associated with an increased risk of allopurinol hypersensitivity reactions, including SJS/TEN, particularly in certain ethnic groups like Asians.
Question 36
Which of the following is the primary mechanism of action of probenecid?
A) Inhibition of uric acid production
B) Increased renal excretion of uric acid
C) Inhibition of xanthine oxidase
D) Increased gastrointestinal excretion of uric acid
E) Inhibition of urate crystal formation
Click here to see the answer
Correct Answer: B) Increased renal excretion of uric acid
Explanation: Probenecid inhibits the reabsorption of uric acid in the proximal renal tubule, leading to increased urinary excretion and reduced serum uric acid levels.
Question 37
Which of the following is a contraindication for probenecid therapy?
A) Hyperlipidemia
B) Chronic kidney disease (CrCl <30 mL/min)
C) Hypertension
D) Hyperkalemia
E) Osteoporosis
Click here to see the answer
Correct Answer: B) Chronic kidney disease (CrCl <30 mL/min)
Explanation: Probenecid is ineffective in patients with severe renal impairment, and its use is contraindicated in chronic kidney disease with CrCl <30 mL/min.
Question 38
Which of the following drugs can interact with probenecid and reduce its uricosuric effect?
A) Methotrexate
B) Colchicine
C) Aspirin (low dose)
D) Warfarin
E) Statins
Click here to see the answer
Correct Answer: C) Aspirin (low dose)
Explanation: Low-dose aspirin can antagonize the uricosuric effect of probenecid, reducing its efficacy in treating hyperuricemia.
Question 39
Sulfinpyrazone has which additional pharmacologic effect besides increasing uric acid excretion?
A) Antiplatelet effect
B) Antimicrobial effect
C) Anticoagulant effect
D) Anti-inflammatory effect
E) Antineoplastic effect
Click here to see the answer
Correct Answer: A) Antiplatelet effect
Explanation: In addition to its uricosuric properties, sulfinpyrazone inhibits platelet aggregation, contributing to an antiplatelet effect.
Question 40
Which of the following conditions is a contraindication for sulfinpyrazone therapy due to the increased risk of serious side effects?
A) Asthma
B) Peptic ulcer disease
C) Hypertension
D) Hypercholesterolemia
E) Anemia
Click here to see the answer
Correct Answer: B) Peptic ulcer disease
Explanation: Sulfinpyrazone can increase the risk of gastrointestinal bleeding due to its antiplatelet effects, making it contraindicated in patients with peptic ulcer disease.