Introduction: Anti-gout drugs MCQs With Answer is a focused study resource for B. Pharm students covering pharmacology of gout therapies including xanthine oxidase inhibitors, uricosurics, colchicine, pegloticase and anti-inflammatory agents. This concise guide emphasizes mechanisms of action, pharmacokinetics, adverse effects, drug interactions (for example allopurinol–azathioprine), dosing adjustments in renal impairment, and clinical monitoring like serum uric acid targets. Keywords: anti-gout drugs, gout pharmacology, xanthine oxidase inhibitors, uricosurics, colchicine, pegloticase, drug interactions, adverse effects, B. Pharm. Clinical pearls and exam-style MCQs will help deepen understanding and exam readiness. Now let’s test your knowledge with 30 MCQs on this topic.
Q1. Which drug increases renal excretion of uric acid by inhibiting URAT1 transporters in the proximal tubule?
- Allopurinol
- Probenecid
- Colchicine
- Pegloticase
Correct Answer: Probenecid
Q2. What is the primary mechanism of action of allopurinol in gout management?
- Inhibits microtubule polymerization
- Converts uric acid to allantoin
- Inhibits xanthine oxidase, reducing uric acid synthesis
- Enhances renal uric acid secretion via OAT1 activation
Correct Answer: Inhibits xanthine oxidase, reducing uric acid synthesis
Q3. Which adverse reaction is most characteristically associated with allopurinol and requires HLA-B*5801 screening in high‑risk populations?
- Nephrolithiasis
- Allopurinol hypersensitivity syndrome (AHS) with severe cutaneous reactions
- Agranulocytosis
- Renal tubular acidosis
Correct Answer: Allopurinol hypersensitivity syndrome (AHS) with severe cutaneous reactions
Q4. Which drug is a recombinant uricase used for refractory chronic gout and can cause infusion reactions?
- Febuxostat
- Pegloticase
- Lesinurad
- Sulfinpyrazone
Correct Answer: Pegloticase
Q5. Which anti-gout agent works by inhibiting microtubule polymerization and neutrophil migration to reduce inflammation?
- Indomethacin
- Colchicine
- Allopurinol
- Probenecid
Correct Answer: Colchicine
Q6. Which drug interaction is clinically significant when allopurinol is co-administered with azathioprine?
- Decreased azathioprine efficacy due to induction of TPMT
- Increased azathioprine toxicity due to reduced metabolism of 6-mercaptopurine
- Reduced allopurinol levels via CYP3A4 induction
- No significant interaction
Correct Answer: Increased azathioprine toxicity due to reduced metabolism of 6-mercaptopurine
Q7. Which lab target is generally recommended when treating gout with urate-lowering therapy?
- Serum uric acid <12 mg/dL
- Serum uric acid <6 mg/dL
- Serum uric acid <3 mg/dL
- Serum uric acid <8 mg/dL
Correct Answer: Serum uric acid <6 mg/dL
Q8. Febuxostat differs from allopurinol because it is:
- A purine analog metabolized to oxypurinol
- A non‑purine selective xanthine oxidase inhibitor
- A uricosuric agent increasing renal excretion
- An enzyme converting urate to allantoin
Correct Answer: A non‑purine selective xanthine oxidase inhibitor
Q9. Which anti-gout therapy is contraindicated in patients with a history of urolithiasis due to risk of kidney stones?
- Allopurinol
- Probenecid
- Colchicine
- Pegloticase
Correct Answer: Probenecid
Q10. What is the recommended prophylactic strategy when initiating urate-lowering therapy to reduce risk of acute gout flares?
- Start high-dose uricosuric immediately without prophylaxis
- Use short-term colchicine or low-dose NSAID prophylaxis while initiating ULT
- Begin with pegloticase immediately
- Delay urate-lowering therapy for one year
Correct Answer: Use short-term colchicine or low-dose NSAID prophylaxis while initiating ULT
Q11. Which adverse effect is classically associated with colchicine overdose or toxicity?
- Hypotension and bradycardia
- Severe gastrointestinal symptoms and bone marrow suppression
- Hepatotoxicity only
- Nephrogenic diabetes insipidus
Correct Answer: Severe gastrointestinal symptoms and bone marrow suppression
Q12. Which laboratory parameter is most important to monitor when a patient is on allopurinol long-term?
- Complete blood count and liver function tests only
- Serum uric acid and renal function
- Serum potassium
- Serum magnesium
Correct Answer: Serum uric acid and renal function
Q13. Rasburicase is primarily indicated for:
- First-line chronic gout management
- Treatment of tumor lysis syndrome to rapidly lower uric acid
- Long-term prevention of gout flares
- Management of hypercalcemia
Correct Answer: Treatment of tumor lysis syndrome to rapidly lower uric acid
Q14. Which statement about pegloticase is correct?
- It is an oral xanthine oxidase inhibitor
- It converts uric acid to allantoin and is given intravenously
- It is safe in G6PD-deficient patients
- It is primarily a uricosuric agent
Correct Answer: It converts uric acid to allantoin and is given intravenously
Q15. Which anti-inflammatory is commonly used as first-line therapy for an acute gout attack in patients without contraindications?
- Allopurinol
- Indomethacin (an NSAID)
- Probenecid
- Pegloticase
Correct Answer: Indomethacin (an NSAID)
Q16. Sulfinpyrazone is classified pharmacologically as a:
- Xanthine oxidase inhibitor
- Uricosuric agent
- Recombinant uricase
- Antiplatelet agent only
Correct Answer: Uricosuric agent
Q17. Which factor most commonly precipitates an acute gout flare?
- Rapid lowering of serum uric acid after initiation of ULT
- Chronic use of allopurinol at maintenance dose
- Consistent hydration and low-purine diet
- Daily use of febuxostat
Correct Answer: Rapid lowering of serum uric acid after initiation of ULT
Q18. Which patient is least suitable for a uricosuric agent like probenecid?
- A patient with frequent uric acid kidney stones
- A patient with normal renal function and underexcretion of urate
- A patient intolerant to xanthine oxidase inhibitors
- A patient with no history of nephrolithiasis
Correct Answer: A patient with frequent uric acid kidney stones
Q19. Which enzyme’s activity is inhibited by febuxostat leading to reduced production of uric acid?
- Xanthine oxidase
- Uricase
- Adenine deaminase
- Glucose-6-phosphatase
Correct Answer: Xanthine oxidase
Q20. A key counseling point for probenecid is:
- It increases urinary excretion of penicillin, decreasing antibiotic levels
- It may increase serum uric acid levels
- Maintain good hydration to reduce risk of uric acid kidney stones
- Avoid taking with allopurinol due to severe interaction
Correct Answer: Maintain good hydration to reduce risk of uric acid kidney stones
Q21. Which medication requires dose adjustment or caution in severe renal impairment when used for gout?
- Colchicine (high-dose) and most uricosurics like probenecid
- Pegloticase with no renal concerns
- All xanthine oxidase inhibitors require no adjustment
- NSAIDs are always safe in severe renal impairment
Correct Answer: Colchicine (high-dose) and most uricosurics like probenecid
Q22. Which adverse effect is most associated with febuxostat compared to allopurinol?
- Lower risk of cardiovascular events
- Potential increased risk of cardiovascular mortality in some studies
- No drug interactions with azathioprine
- Frequent formation of kidney stones
Correct Answer: Potential increased risk of cardiovascular mortality in some studies
Q23. During an acute gout attack, which class of drugs should generally NOT be initiated immediately for long-term urate lowering?
- Uricosurics like probenecid
- Colchicine for flare management
- NSAIDs for acute pain
- Corticosteroids for severe attacks
Correct Answer: Uricosurics like probenecid
Q24. Which is a major pharmacokinetic property of allopurinol’s active metabolite oxypurinol?
- Extensively metabolized by CYP3A4
- Primarily excreted unchanged by the kidney, requiring renal dose adjustment
- Converted to allantoin in the liver
- Highly protein bound with biliary excretion
Correct Answer: Primarily excreted unchanged by the kidney, requiring renal dose adjustment
Q25. Which condition is an absolute contraindication to pegloticase therapy?
- History of gout flares
- G6PD deficiency due to risk of hemolysis
- Mild renal impairment
- Concurrent NSAID use
Correct Answer: G6PD deficiency due to risk of hemolysis
Q26. Which mechanism explains how NSAIDs relieve symptoms of an acute gout attack?
- Directly lowering serum uric acid
- Reducing prostaglandin-mediated inflammation and pain
- Enhancing renal excretion of monosodium urate crystals
- Blocking xanthine oxidase
Correct Answer: Reducing prostaglandin-mediated inflammation and pain
Q27. Which monitoring parameter is critical when a patient is receiving febuxostat?
- Blood pressure only
- Cardiovascular status and serum uric acid
- Urine glucose levels
- Serum calcium
Correct Answer: Cardiovascular status and serum uric acid
Q28. Which statement about initiating allopurinol therapy is appropriate?
- Start at the maximum dose to quickly normalize uric acid
- Initiate at a low dose and titrate up to avoid hypersensitivity and flares
- It should always be stopped during acute flares
- No need for renal dose adjustment
Correct Answer: Initiate at a low dose and titrate up to avoid hypersensitivity and flares
Q29. In a patient on chronic allopurinol, which clinical sign should prompt immediate evaluation for allopurinol hypersensitivity?
- Mild transient headache
- Fever, rash, eosinophilia and rising serum creatinine
- Occasional nausea only
- Intermittent muscle cramps
Correct Answer: Fever, rash, eosinophilia and rising serum creatinine
Q30. Which strategy reduces the risk of uric acid nephrolithiasis in patients treated with uricosuric drugs?
- Encourage low fluid intake
- Acidify the urine with ammonium chloride
- Maintain high fluid intake and alkalinize the urine if indicated
- Avoid allopurinol concurrently
Correct Answer: Maintain high fluid intake and alkalinize the urine if indicated
I am a Registered Pharmacist under the Pharmacy Act, 1948, and the founder of PharmacyFreak.com. I hold a Bachelor of Pharmacy degree from Rungta College of Pharmaceutical Science and Research. With a strong academic foundation and practical knowledge, I am committed to providing accurate, easy-to-understand content to support pharmacy students and professionals. My aim is to make complex pharmaceutical concepts accessible and useful for real-world application.
Mail- Sachin@pharmacyfreak.com