A patient has very high serum uric acid levels, has had two acute gout attacks, and is at imminent risk of developing acute uric acid nephropathy We will treat the patient with proper anti-inflammatory drugs and other agents, but feel that reducing solubility of uric acid in the urine, by raising urine $\mathrm{pH}$, might help stave-off the development of renal problems. Which of the following drugs produce this desired renal effect without appreciably increasing systemic risks of the hyperuricemia?

Correct Answer: A

Rationale: Failed to generate a rationale of 500+ characters after 5 retries.

Correct Answer: D

Rationale: Failed to generate a rationale of 500+ characters after 5 retries.

Correct Answer: A

Rationale: The correct answer is A (15 minutes) because insulin lispro (Humalog) is a rapid-acting insulin that typically starts to have an effect within 15 minutes of administration. This rapid onset of action is essential for managing postprandial glucose levels. Insulin lispro is designed to mimic the body's natural insulin response to food intake, ensuring timely glucose regulation. Choices B, C, and D are incorrect because they suggest longer onset times, which do not align with the rapid action profile of insulin lispro. Waiting 1 to 2 hours, 80 minutes, or 3 to 5 hours for insulin lispro to take effect would be inaccurate and potentially dangerous in managing blood glucose levels effectively.

Correct Answer: D

Rationale: The correct answer is D, to contact the prescriber for further orders. Since the patient has been NPO and is scheduled for an oral procedure, it is crucial to clarify whether the oral antidiabetic drugs should be administered, withheld, or adjusted. Contacting the prescriber ensures patient safety and adherence to specific protocols. Administering half the original dose (choice A) without consulting the prescriber can lead to hypoglycemia. Withholding all medications (choice C) may result in uncontrolled blood sugar levels. Choice B is incomplete. Contacting the prescriber is the best course of action to confirm the appropriate management plan.

Correct Answer: C

Rationale: The correct answer is C: Administer intravenous glucose (50% dextrose). In this scenario, the patient is unconscious due to severe hypoglycemia, which requires immediate intervention to raise blood glucose levels rapidly. Oral glucose would be ineffective as the patient is unconscious and cannot swallow. Intravenous glucose is the fastest way to raise blood sugar levels and is crucial in this emergent situation. Fruit juice or crackers would be too slow and unreliable in this critical state. Administering 50% dextrose intravenously is the most appropriate action to quickly address the hypoglycemia and potentially save the patient's life.