Question 1

Jeremy has painful muscle spasms associated with rheumatoid arthritis.He knows that his friend Tanya,who has multiple sclerosis,has experienced relief from her muscle spasms with dantrolene.Is dantrolene also appropriate for Jeremy?

Accepted Answer

Dantrolene is specifically indicated for conditions like spasticity associated with spinal cord injuries, cerebral palsy, or multiple sclerosis, and for malignant hyperthermia. It is not indicated for muscle spasms associated with rheumatic conditions such as rheumatoid arthritis.

Question 2

Carla,67 years of age,has a history of breast cancer and thromboembolic disorders,and cannot take hormone replacement or selective estrogen-receptor modifier therapy to treat her osteoporosis.What hormonal agent might be effective?

Accepted Answer

Calcitonin-salmon is a hormonal agent that can be used to treat osteoporosis and is suitable for patients with a history of thromboembolic disorders, unlike raloxifene, which is contraindicated.

Question 3

Caitlin strained her back and her doctor prescribes a centrally-acting muscle relaxant during the initial checkup.After the pain subsides,her doctor is likely to prescribe .

Accepted Answer

After the pain subsides, the doctor is likely to prescribe exercise as this can help in strengthening the muscles in the affected area and prevent future injuries. Immobilization is not recommended as it can lead to stiffness and further weakening of the muscles. NSAIDs may be used to manage pain and inflammation, but they are not the first choice of treatment after the pain subsides. A peripherally-acting muscle relaxant may also not be necessary if the pain is well managed and the muscles are strong enough to support the spine. Therefore, exercise is the best choice.

Question 4

Prior to orthopedic surgery,Azalea meets with the anesthesiologist who,when explaining the medications that will be used,mentions that one will paralyze all of her muscles,including her diaphragm.What agent has this effect?

Accepted Answer

Succinylcholine is a neuromuscular blocking agent that causes temporary paralysis of skeletal muscles, including the diaphragm. The other options listed (tizanidine, dantrolene, and carisoprodol) are muscle relaxants that work via different mechanisms and do not cause paralysis of the diaphragm.

Question 5

Tanya has multiple sclerosis and sometimes experiences painful muscle spasms.What muscle relaxant is indicated for the spasms associated with her condition?

Accepted Answer

Dantrolene is indicated for the spasms associated with multiple sclerosis.

Question 6

Just as Kendall is experiencing relief from painful muscle spasms with methocarbamol,her spring allergies hit full force and she cannot stop sneezing.Should this be of additional concern?

Accepted Answer

The effects of muscle relaxants such as methocarbamol can be potentiated by antihistamines. Therefore, if Kendall takes both medications together, it could potentially lead to increased drowsiness or other side effects. It would be best for her to consult with her healthcare provider before taking both medications at the same time.

Question 7

Dina has osteoporosis.What factor is most effective in determining her risk of fracture?

Accepted Answer

Bone mineral density is the most effective factor in determining the risk of fracture in individuals with osteoporosis. Osteoporosis is characterized by low bone mineral density, which weakens bones and increases the likelihood of fracture. Factors such as serum calcium, serum vitamin D, and estrogen levels can also affect bone health, but they are not as specific or sensitive as bone density measurements in predicting fracture risk.

Question 8

Delbert has cerebral palsy and experiences painful muscle contractions.What peripherally-acting muscle relaxant may help him?

Accepted Answer

Dantrolene is a peripherally-acting muscle relaxant that directly targets the muscle, reducing muscle contractions and spasms. It is often used to treat spasticity in conditions such as cerebral palsy. Diazepam and methocarbamol are centrally-acting muscle relaxants and may have more sedative and systemic side effects. Rocuronium is a neuromuscular blocking agent used for anesthesia, and would not be appropriate for treating chronic muscle spasms.

Question 9

Lincoln has rheumatoid arthritis and a history of gastrointestinal bleeds.What characteristic of COX-2 inhibitors is important for Lincoln?

Accepted Answer

COX-2 inhibitors selectively decrease the production of prostaglandins that cause inflammation and pain without affecting the production of prostaglandins that are protective to the stomach lining and heart. Therefore, for Lincoln who has a history of gastrointestinal bleeds, the ability of COX-2 inhibitors to spare the prostaglandins that protect the stomach lining is important. Additionally, since he has rheumatoid arthritis, the ability of COX-2 inhibitors to reduce inflammation and pain is also beneficial. COX-2 inhibitors can increase the risk of cardiovascular events, but they only decrease the production of prostaglandins that are good for the heart to a lesser extent, hence they are safer for Lincoln.

Question 10

Myra is taking a bisphosphonate for treatment of osteoporosis.She should take the bisphosphonate with a .

Accepted Answer

Bisphosphonates should be taken on an empty stomach with a full glass of plain water, and the patient should remain upright for at least 30 minutes after taking the medication to prevent esophageal irritation and allow for proper absorption. Taking the medication with food or other beverages, especially calcium-rich ones, can interfere with absorption and effectiveness.

Question 11

Cayden is using a diclofenac patch for pain from his recent knee injury.How does the patch compare to oral medications?

Accepted Answer

The diclofenac patch is applied directly to the skin over the affected area, allowing for higher concentrations of the drug to be delivered directly to the joint tissues for targeted pain relief. This is unlike oral medications, which undergo digestion and metabolism before entering the bloodstream, resulting in lower concentrations of the drug reaching the affected area.

Question 12

After a serious gastrointestinal bleed,Alina,who has rheumatoid arthritis,and her doctor discuss options for continued NSAID therapy.He suggests that she take a drug that combines an NSAID with another drug that will protect the gastric mucosa.What agent combines diclofenac with misoprostol?

Accepted Answer

Arthrotec is the only drug mentioned that combines an NSAID (diclofenac) with another drug that protects the gastric mucosa (misoprostol). This combination is designed to reduce the risk of gastrointestinal bleeding, making it a suitable option for Alina who has already experienced a serious gastrointestinal bleed. Caldolor, Daypro, and Mobic are all NSAIDs, but they do not contain misoprostol to protect the gastric mucosa.

Question 13

Rajesh,an active and fit young adult,injures his shoulder in a weekend baseball game.His doctor tells him to take an NSAID and reminds him of the acronym RICE.What does the R indicate?

Accepted Answer

RICE acronym stands for Rest, Ice, Compression, and Elevation. The R in RICE indicates rest, which is crucial during the acute phase of injury to allow the body to heal properly.

Question 14

Ellis is having surgery and a neuromuscular blocking agent has been administered.What else must also be administered?

Accepted Answer

When a neuromuscular blocking agent is administered, the patient is paralyzed and cannot move or breathe on their own. Therefore, it is crucial to administer analgesics and sedatives to ensure the patient is comfortable and does not experience pain or awareness during the surgery. Antihypertensives and anticonvulsants may also be necessary for some patients, but they are not necessarily required in every case. A loading dose of glucose is not indicated in this situation.

Question 15

For years,the only medication Jayla has taken to help with her severe knee pain is an NSAID.She has just been diagnosed with cancer and is to be treated with,among other agents,methotrexate.What is the potential interaction between the methotrexate and the NSAID?

Accepted Answer

Methotrexate and NSAIDs can both cause gastrointestinal side effects and increase the risk of bleeding. Combining them can increase the risk of methotrexate toxicity, including potentially life-threatening damage to the liver or kidneys. Therefore, it is important to closely monitor patients on this combination and consider alternative pain management options.

Question 16

Kolby is a long distance truck driver,and despite taking regular breaks and stretching,he often experiences painful muscle spasms.Would taking a muscle relaxant be an appropriate solution for Kolby?

Accepted Answer

Muscle relaxants can cause sedation and confusion, which can be dangerous for a long distance truck driver. It is important for Kolby to find alternative solutions for his muscle spasms that do not impair his ability to operate his vehicle safely.

Question 17

While helping her friend move into a third floor walk-up,Elisabeth experiences painful muscle spasms in her back.Her doctor prescribes a centrally acting muscle relaxant.This medication is most likely .

Accepted Answer

Diazepam is a centrally acting muscle relaxant, which means it works by acting on the central nervous system to decrease muscle spasms and stiffness. This medication is commonly prescribed for musculoskeletal conditions and is effective for short-term use. A and B are neuromuscular blockers and are not commonly used for muscle spasms. Diclofenac is a nonsteroidal anti-inflammatory drug (NSAID) and is used for pain and inflammation but not for muscle spasms.

Question 18

Alice has experienced a number of fractures due to Paget's disease of the bone.What agent is indicated for treatment of this disease?

Accepted Answer

Paget's disease is characterized by abnormal bone remodeling, resulting in weakened and deformed bones. Bisphosphonates, such as risedronate, are the first-line treatment for Paget's disease as they can inhibit bone resorption and lead to increased bone density. Calcitonin-salmon and teriparatide may also be used in certain cases, but raloxifene is not indicated for the treatment of Paget's disease.

Question 19

Francesca attends doctor's appointments with her mother,who is in her late 80s.Her mother is taking NSAIDs for arthritis pain and Francesca asks what might indicate that her mother was having a GI bleed as a result.What should the doctor tell Francesca?

Accepted Answer

Elderly individuals may not exhibit typical signs and symptoms of a GI bleed, and even serious bleeding can be silent. Therefore, it is important to monitor for any changes in bowel movements or signs of weakness and seek medical attention if there is any concern. Option B is incorrect as vomiting blood is not always a symptom of a GI bleed, especially in the elderly. Option C is also incorrect as GI bleeds can occur in anyone, regardless of age or gender. Option D is incorrect as sudden onset delirium is not a specific sign of a GI bleed.

Question 20

The labels of non-selective NSAIDs must indicate that they .

Accepted Answer

The labels of non-selective NSAIDs must indicate that they should be used in strict accordance with label directions. This is because non-selective NSAIDs can have serious side effects if not used as directed, such as increased risk of heart attack and stroke. It is important for individuals to follow the instructions on the label and speak with their doctor before using these medications.

Quiz 21: Musculoskeletal and Anti-Inflammatory Drugs