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Answer 3
  1. Allopurinol. Because this patient is not currently experiencing an attack of gout, there is no need for acute therapy (eg, prednisone, indomethacin, IV colchicine). IV colchicine should not be used in patients with renal failure, and therefore its use would be contraindicated in this patient.3 Similarly, indomethacin is a poor choice in this patient given his age and decreased kidney function. Although often forgotten, probenecid can be used as a uric acid-lowering agent; however, it is only beneficial in patients who undersecrete uric acid (24-hour uric acid level < 800 mg) and have a creatinine clearance greater than 60 mg/dL. Allopurinol should be used with caution and at a reduced dose in patients with decreased renal function.

    3. Bonnel RA, Villalba ML, Karwoski CB, Beitz J. Deaths associated with inappropriate intravenous colchicine administration. J Emerg Med 2002;22:385-7.

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