Pharmacology MNS Part I

A 62-year-old man with chronic gout and stage 3 chronic kidney disease is prescribed a xanthine oxidase inhibitor. Which drug is most appropriate for this patient’s renal condition?

• A) Allopurinol

• B) Ferbuxostat

• C) Colchicine

• D) Probenecid

Answer explanation

Ferbuxostat has better renal clearance than allopurinol and is preferred in patients with moderate renal impairment.

A 58-year-old male with gout started on ferbuxostat returns after 3 months complaining of chest tightness. What important risk of ferbuxostat should be considered?

• A) Hepatotoxicity

• B) Bone marrow suppression

• C) Cardiovascular events

• D) Pancreatitis

Answer explanation

Ferbuxostat has been associated with an increased risk of cardiovascular death in some patients compared to allopurinol.

Allopurinol works by which of the following mechanisms?

• A) Inhibiting microtubule polymerization

• B) Increasing uric acid excretion

• C) Non-selective xanthine oxidase inhibition

• D) Blocking COX-2 enzymes

Answer explanation

A) Colchine MoA

B) Probenecid(Uricosuric Agent) MoA

D) NSAIDs

=> Allopurinol inhibits both oxidized and reduced forms of xanthine oxidase, thereby decreasing uric acid production.

A patient developed a rash and elevated liver enzymes after starting treatment for chronic gout. Which drug is most likely responsible?

• A) Ferbuxostat

• B) Colchicine

• C) Allopurinol

• D) Naproxen

Answer explanation

Allopurinol can cause hypersensitivity reactions, including rash and hepatotoxicity.

Which drug increases uric acid excretion and is classified as a uricosuric agent?

• A) Allopurinol

• B) Probenecid

• C) Indomethacin

• D) Colchicine

Answer explanation

Probenecid acts on the renal tubules to inhibit uric acid reabsorption, enhancing its excretion.

6) Colchicine primarily acts by interfering with what process in neutrophils?

• A) COX enzyme inhibition

• B) Microtubule polymerization

• C) Lysosomal enzyme production

• D) Histamine release

Answer explanation

B) Microtubule polymerization
Explanation: Colchicine disrupts microtubule formation, preventing neutrophil chemotaxis and degranulation.

7) Why are NSAIDs often considered first-line treatment for acute gout attacks?

• A) They lower serum uric acid levels

• B) They dissolve urate crystals

• C) They reduce inflammation effectively

• D) They are uricosuric

Answer explanation

Explanation: NSAIDs help relieve pain and inflammation rapidly in acute gout attacks only.

8) Colchicine is not preferred as a first-line drug for acute gout due to which of the following?

• A) Poor oral absorption

• B) Severe cardiovascular risk

• C) Narrow therapeutic index and high GIT/neurotoxicity

• D) Limited anti-inflammatory activity

Answer explanation

C) Narrow therapeutic index and high GIT/neurotoxicity
Explanation: Colchicine can cause diarrhea, vomiting, and neuromuscular toxicity, especially in renal dysfunction.

9) 9. In which scenario would colchicine be most appropriately used?

• A) As first-line in all patients

• B) In combination with NSAIDs routinely

• C) When NSAIDs are contraindicated

• D) Only for chronic gout

Answer explanation

C) When NSAIDs are contraindicated
Explanation: Due to toxicity, colchicine is reserved for patients who cannot tolerate NSAIDs or steroids.

10 ) A 65-year-old patient with peptic ulcer disease presents with acute gout. Which of the following is the best treatment option for this acute attack?

• A) Naproxen

• B) Indomethacin

• C) Colchicine

• D) Probenecid

Answer explanation

C) Colchicine
Explanation: NSAIDs are contraindicated in peptic ulcer disease; colchicine is a suitable alternative despite its side effects.