5.承上題，上述病人10年後某日突發右腰劇痛，上廁所發現有血尿現象。急診室醫師以超音波檢查發現病人兩側 腎臟中皆有結石，最大者直徑約1.2公分，但照一般X光片卻無法明顯看到結石。有關此病人結石之處置，下列何種藥物治療最不恰當？
(A)allopurinol
(B)potassiumcitrate
(C)probenecid
(D)sodiumbicarbonate

Ref:Uric Acid Nephrolithiasis - StatPearls - NCBI Bookshelf (nih.gov)
Medical Management  [14]

• Urinary alkalinization helps dissolve and prevent uric acid stones. The goal is a urinary pH that is consistently above 6.5. Ultrasound and CT scans can be used to monitor the response to treatment. Potassium citrate is usually preferred, but sodium citrate and sodium bicarbonate can also be used. However, sodium-based alkalinizing agents tend to increase urinary calcium excretion and may promote the formation of calcium-based nephrolithiasis.[67]

  • Potassium citrate: 15 to 30 mEq, 2 or 3 times daily
  • Sodium bicarbonate: 500 to 1000 mg 3 times a daily
  • Acetazolamide: 500 mg per day increases urinary pH by inhibiting urinary bicarbonate absorption, but it also lowers citrate excretion and can cause volume depletion

• Xanthine oxidase inhibitors are used in patients with hyperuricemia or hyperuricosuria. Adjust as needed for optimal serum uric acid levels of 6 mg/dL or less and urinary levels of 600 mg/d or less.

  • Allopurinol: 100 to 300 mg daily; usual dose is 300 mg
  • Febuxostat: 40 to 80 mg daily (typically administered when the patient does not tolerate allopurinol). Use was limited in 2019 per the FDA due to an increased risk of cardiovascular death compared to allopurinol.[68][69] 
  • See the companion StatPearls reference articles "Hyperuricemia," "Allopurinol," and "Febuxostat."[70][71][72]