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Flashcards in GOUT Med Chem Deck (44)
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1

This is the strucutre of a purine. The structure circled in blue is a ____ and the strucutre circled in red is a ____.

A. Pyrimidine, Imidazole 

B. Imidazole, Pyrimidine

A

2

What is the function of purines in the body? (select all)

A. To break down nucleic acids

B. To synthesize nucleic acids for DNA

C. To create inflammatory mediators for Gout

D. To synthesize nucleic acids from RNA

B, D

3

Which of the following are purine bases? (Select All)

A. Adenine

B. Cytosine

C. Thiamine

D. Guanine

E. Uracil

A,D

 

Remember PURE AS GOLD

Purine=Adenine and Guanine

4

Catabolism of ____ bases leads to the synthesis of uric acid.

A. Pyrimidine 

B. Purine

 

B

5

The following picture shows the Purine Adenine being metabolized in the body. What is happening between the first two steps seen here?

A. Reduction

B. Hydrolysis

C. Deamination

D. None of the above

D

6

Hypoxanthine is created when Adenine is deaminated. Hypoxanthine is then metabolized to _____ by the enzyme _____.

A. Uric acid, Xanthine Oxidase

B. Xanthine, Adenine Deaminase

C. Uric Acid, Adenine Deaminase

D. Xanthine, Xanthine Oxidase

D

7

Xanthine is formed when hypoxanthine undergoes metabolism by Xanthine Oxidase. From there, Xanthine will undergo metabolism via the enzyme____ in order to form ____.

A. Xanthine Deaminase, Uric Acid

B. Xanthine Oxidase, Uric Acid

C. Xanthine Deaminase, Urate

D. None of the above

B

In order to remember the strucutre of uric acid remember its a purine base with 3 hydroxy groups.

8

What enzyme is responsible for metabolizing Guanine into Xanthine?

A. Adenosine Deaminase

B. Xanthine Oxidase

C. Guanine Deaminase

D. None of the above

C

9

Based on the picture provided, which statements are true regarding the solubility of these molecules? (Select All)

A. Purines are the most soluble of all of them

B. Hypoxanthine is less soluble than Uric Acid

C. Xanthine is less soluble than Hypoxanthine

D. Uric acid is the least soluble of all of them

E. Uric acid is the most soluble of all of them

A, C, D

10

Answer the following question provided:

A

11

When comparing the structures of Hypoxanthine to Uric Acid the blue bonds represent ____ bonds and the red bonds represent _____ bonds

A. Intramolecular, Intermolecular

B. Intermolecular, Intramolecular

A

Intermolecular bonds- bonds between two different atoms between two different molecules

Intramolecular bonds- bonds between two different atoms within the same molecule

12

Based on the picture provided comparing Hypoxanthine to Uric Acid, why is it that Hypoxanthine is more soluble than Uric Acid? (select all)

A. More Intramolecular bonds are present on Hypoxanthine and allow it to bind to H2O molecules and become soluble

B. Three Intramolecular bonds and one Intermolecular bond are present on Uric Acid and limit its solubility in water.

C. 3 Intermolecular bonds are one Intramolecular bond are present on Hypoxanthine and allow it to interact more with water, increasing its solubility

D. They both have equal solubility due to their similar structures

B, C

13

Uric acid becomres ___ soluble at lower temperatures and ___soluble at higher temperatures

A. More, Less

B. Less, More

B

14

Uric Acid is ____ soluble at a lower pH and ____ soluble at a higher pH.

A. Less, More

B. More, Less

A

15

At physiologic pH uric acid exists as:

A. A completely unionized form

B. Partially ionized form (Sodium Urate)

C. A completely Ionized form

D. none of the above

B

16

T/F The Sodium Urate form of Uric Acid has a very LOW solubility.

T

17

Which NSAID should NOT be used for treating gout?

A. Naproxen

B. Ibuprofen

C. Indomethacin

D. Aspirin

D

18

If an acute gout attack has occured and I want to treat my patient, which agents will I use first? (Select All)

A. NSAIDs

B. Colchicine

C. Probenacid

D. Allopurinol

E. Glucocorticoids

A, B, E

19

Which of the following agents should you use In order to prevent recurrent flare-ups of gout attacks? (Select All)

A. Probenecid

B. NSAIDs

C. Colchicine

D. Allopurinol

E. Febuxostat

A, D, E

20

Which of these agents is meant to decrease the formation of uric acid? (Select All)

A. Colchicine

B. Probenecid

C. Allopurinol

D. Glucocorticoids

E. Febuxostat

C, E

21

Which of the agents listed is meant to increase uric acid excretion from the body?

A. Probenecid

B. Allopurinol

C. Febuxostat

D. Naproxen

E. Prednisone

A

22

How are corticosteroids typically given when treating gout? (Select All)

A. Systemically

B. Rectally

C. Inhaled

D. Intraarticular injection

A, D

23

All of the following are mechanisms of action in the treatment of gout for corticosteroids EXCEPT:

A. Inhibits the Phospholipase A2 (PLA2) 

B. Decreases PMN migration and vasodilation

C. Suppresses the immune system by decreasing levels of monocytes and decreasing IL-1 and TNF-a production.

D. Decreases uric acid synthesis by blocking Xanthine Oxidase

D

24

When using corticosteroids, triamcinolone is typically given as a(an) ______ and prednisone is typically given as a _____.

A. Intraarticular injection, Systemic agent

B. Systemic agent, Intraarticular injection

A

25

When Prednisone is metabolized it loses its ketone group to form an alcohol on the ____ form of the molecule known as___.

A. Inactive, Methylprednisolone

B. Active, Methylprednisolone

C. Inactive, Prednisolone

D. Active, Prednisolone

D

26

The MOA of colchicine is not completely known. All of the following are suspected MOA of colchicine EXCEPT:

A. Decreased leukocyte chemotaxis (Anti-mitotic)

B. Reduces phagocytosis of urate crystals in joint

C. Reduces lactic acid and production by PMN leukocytes.

D. Reduces the formation of lactic acid by blocking Xanthine Oxidase

D

27

When looking at the metabolism of Colchicine (Colcrys) what is the reaction that is happening and what enzyme is taking place?

A. CYP3A4, Amide Hydrolysis 

B. CYP3A4, Ester Hydrolysis

C. CYP2C9 Amide Hydrolysis

D. CYP2C9 Ester Hydrolysis

A

28

T/F Colchicine is a substrate for PgP

T

This is important because being a substrate for PgP could mean that the drug may not be absorbed very well if somone has strong PgP activity or if someone is taking a PgP inducer it could redcue the bioavailability of colchicine

29

T/F Colchicine has a narrow therapeutic window and needs to be renally adjusted in patients with renal dysfunction

T

30

What enzyme are the drugs Allopurinol and Febuxostat blocking here?

A. Deaminase

B. Xanthine Oxidase

C. CYP3A4

D. CYP2C9

B