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Adding on to daily XOI therapy for gout, if UA remains > 6, includes all except which of the following?
Lesinurad
Probenecid
Acetaminophen
IV Pegloticase
The correct answer is: Acetaminophen
In the context of gout management, when the uric acid (UA) levels remain above 6 despite daily xanthine oxidase inhibitor (XOI) therapy, additional pharmacological interventions may be needed to achieve the target UA levels and prevent gout flares. Option A, Lesinurad, is a selective uric acid reabsorption inhibitor that can be considered to help lower UA levels in patients with gout who have not achieved the target levels with XOI therapy alone. Option B, Probenecid, is a uricosuric agent that works by increasing the excretion of uric acid by the kidneys, thereby lowering UA levels. It is another option that can be added on to XOI therapy in patients with gout who have not achieved the desired UA levels. Option D, IV Pegloticase, is a recombinant uricase enzyme indicated for the treatment of chronic gout in adult patients who have not responded adequately to conventional therapy. Pegloticase works by converting uric acid into allantoin, a more soluble compound that is easily excreted by the kidneys, thus lowering UA levels. Option C, Acetaminophen, is not typically used to lower uric acid levels in gout patients. Acetaminophen is commonly used for pain relief and fever reduction but does not directly impact uric acid levels. Therefore, it would not be a suitable option to add on to daily XOI therapy for gout in the scenario described in the question.