MSK Gout

Question 1

What are some drug/dietary factors that cause urate overproduction?

Answer 1

• Excessive ethanol
• Dietary purine-rich foods - asparagus, cauliflower, mushroom, red meat, anchovies (ikan bilis), durian, peanuts, organ meat (e.g. liver)
• Fructose
• Cytotoxic drugs

Question 2

What are some drug/dietary factors that cause decreased uric acid excretion?

Answer 2

• Diuretics
• Cyclosporine, tacrolimus
• Low dose salicylates
• Ethambutol, Pyrazinamide
• Ethanol
• Levodopa
• Laxative abuse
• Salt restriction
• Nicotinic acid

Question 3

List out 5 non-pharmacological points for a patient with gout.

Answer 3

• Topical ice for pain (gout generates heat)
• Rest affected joints during gout attack
• Limit alcohol intake
• Limit purine-rich foods
• Limit high-fructose corn syrup and sugary drinks
• Maintain a healthy diet
• Include more low-fat dairy products, vegetables, and fluids
• Weight management
• Exercise regularly
• Avoid smoking

Question 4

List out the drugs that interact with allopurinol in the following way:
1. Increase bone marrow suppression due to increased concentrations of:
2. Increase hypersensitivity reaction/ toxicity of allopurinol:
3. Monitoring required due to allopurinol causing increased concentrations of:
4. Increased adverse/ toxic effect of:

Answer 4

1. 6-mercaptopurine, azathioprine, cyclophosphamide
2. ACEi, loop diuretics, thiazide diuretics, thiazide-like diuretics, ampicillin, amoxicillin
3. carbamazepine, warfarin, theophylline
4. pegloticase (category: X)