Urate-lowering therapy after a second gout flare in a patient on azathioprine
Write a prescription for recurrent gout and have every line marked: drug choice, dose, route, frequency and duration, checked against the patient's allergies, current medicines, renal function and the interaction database, with each error explained.
hard8 scoring rulesrenal impairment
- Patient
- 60 years, male, 80 kg
- Diagnosis
- Recurrent gout
- Renal function
- eGFR 55 mL/min/1.73m²
- Allergies
- None known
- Current medicines
- azathioprine 50 mg once daily
The scenario
Mr. B-217 is a 60-year-old man with a 10-year history of Crohn's disease, well controlled on maintenance azathioprine 50 mg once daily. He presents to the rheumatology clinic with his second documented gout flare in the past 12 months; the most recent flare resolved six weeks ago. He is currently pain-free. He is overweight at 80 kg. He has no known drug allergies. Renal function: serum creatinine 1.4 mg/dL, eGFR 55 mL/min/1.73m2. Liver function tests are normal. He takes no other regular medication. You are the junior doctor in the clinic. Please prescribe an appropriate urate-lowering therapy, including any required flare prophylaxis, for this patient, taking into account his current medication and renal function.
What gets marked
- Whether you chose an indicated drug, and whether you avoided the contraindicated ones.
- Dose, route, frequency and duration against the range for this patient.
- Renal and hepatic dose adjustment where this patient's numbers demand it.
- Allergy cross-reactivity and interactions with the medicines already on the chart.
- The instructions and monitoring you write, not only the drug you pick.
8 scoring rules apply to this scenario. A single critical error fails the attempt whatever the score.
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A free account opens the prescription pad: search the formulary, write the chart, and have it marked line by line by the safety engine.
Taught in
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Educational content for students and clinicians in training. It does not replace professional judgement, local protocols or current prescribing information.