Question

Gout can be precipitated by all of the following EXCEPT:

• A. Thiazides
• B. Furosemide
• C. Cyclosporine
• D. High dose salicylates

Hint:

Salicylates are biphasic: low doses retain urate, but high doses are uricosuric.

Answer 1

The Correct Option is D

Step 1: The question is really about which agent does not raise uric acid. Hyperuricemia triggers acute gout, so we look for the drug that does not retain urate.

Step 2: Thiazide and loop diuretics both compete with urate for tubular secretion and curtail its excretion, raising serum levels. Calcineurin inhibitors like cyclosporine impair urate clearance similarly. All three are classic precipitants.

Step 3: Aspirin and other salicylates act in a biphasic way. Small doses block urate secretion and elevate uric acid, but large doses (above about 3 g/day) block reabsorption and promote uricosuria, lowering serum urate. So high-dose salicylate would not provoke gout.

Step 4: The agent that does not precipitate gout is high-dose salicylate.

\[\boxed{\text{High dose salicylates}}\]