A 52-year-old woman with hypertension and a history of peptic ulcer disease comes to the physician because of a 1-day history of severe pain and swelling of her right great toe. She has had similar episodes sporadically over the past 3 years. She drinks 6 beers daily. She does not smoke or use illicit drugs. She is allergic to hydrochlorothiazide and glipizide. Her current medications are amlodipine and metformin. Examination shows erythema, warmth, and tenderness of the right first metatarsophalangeal joint and a nodule over the right elbow. The most appropriate next step in treatment is the administration of a drug that has which of the following mechanisms of action?

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Eductional Objective: Colchicine is a second-line agent for treating acute gouty arthritis.  It inhibits tubulin polymerization and microtubule formation in leukocytes, reducing neutrophil chemotaxis and emigration to sites inflamed by tissue deposition of monosodium urate crystals.  Gastrointestinal mucosal function is also impaired by microtubule disruption, leading to diarrhea and, less commonly, nausea, vomiting, and abdominal pain.

A 52-Year-Old Woman with Hypertension and a History of Peptic