Deck 30: Drug Therapy for Osteoporosis, Arthritis, and Skeletal Muscle Relaxation

Question 1

In what way do uric acid synthesis inhibitors reduce gout symptoms?

A) Increasing the amount of enzymes that enhance urinary excretion of uric acid
B) Suppressing the reabsorption of sodium and calcium by the kidney tubules
C) Decreasing the inflammation and pain caused by joint damage
D) Suppressing the conversion of purines into uric acid crystals

Answer 1

Suppressing the conversion of purines into uric acid crystals

Question 2

For which patient would intravenous ibandronate (Boniva)be a better choice of drug therapy for osteoporosis instead of the oral form of the drug?

A) 66-year-old woman whose osteoporosis is severe has not responded to oral therapy.
B) 64-year-old woman who runs 5 miles daily and has type 2 diabetes mellitus.
C) 70-year-old woman who is undergoing radiation therapy for breast cancer.
D) 58-year-old woman who has early stage Alzheimer's disease.

Answer 2

58-year-old woman who has early stage Alzheimer's disease.

Question 3

For which patient who has severe osteoporosis is a drug from the bisphosphonate class of drug a better choice of therapy than a drug from the estrogen agonist/antagonist class?

A) 40-year-old premenopausal woman who engages in aerobic exercise daily.
B) 64-year-old woman who takes hormone replacement therapy for hypothyroidism.
C) 70-year-old woman who is 3 weeks postoperative from a total abdominal hysterectomy.
D) 80-year-old woman who has had a stroke and must use a walker for all ambulation.

Answer 3

40-year-old premenopausal woman who engages in aerobic exercise daily.

Question 4

Why are women overall at a greater risk for osteoporosis than men?

A) Women now tend to live longer than men.
B) Men generally have a larger stature than women.
C) Women eat more vegetables and fruits;whereas men eat more meat.
D) Women who have been pregnant lose bone density faster than either women who have not had children or men.

Question 5

Which process replaces new bone cells within bone to keep the bone dense?

A) Osteoporosis
B) Osteoblastic activity
C) Osteoclastic activity
D) Bone resorption of calcium

Question 6

How does rasburicase work to lower uric acid levels?

A) By increasing the production of enzymes that inactivate uric acid.
B) By inhibiting the synthesis of uric acid from metabolic purines.
C) By breaking down uric acid crystals so they can be excreted.
D) By converting uric acid crystals into purines and pyrimidines.

Question 7

Which patient is at greater risk for having a severe allergic reaction from an infusion with denosumab (Prolia)?

A) The patient who is also being treated for gastroesophageal reflux disease.
B) The patient who has been taking Prolia every 6 months for 2 years.
C) The patient who is about to receive her first dose of prolia.
D) The patient who has an allergy to peanuts.

Question 8

What is the maximum daily oral dose of allopurinol (Zyloprim)for an adult?

A) 100 mg
B) 400 mg
C) 800 mg
D) 1200 mg

Question 9

Which type of skeletal muscle relaxant has a chemical structure similar to the tricyclic antidepressants?

A) Benzodiazepines
B) Cyclobenzaprine
C) Carbamates
D) Meperidine

Question 10

What is the most common side effect of all drug therapy for skeletal muscle relaxants?

A) Nausea
B) Diarrhea
C) Drowsiness
D) Urinary incontinence

Question 11

What is the most important precaution to take when administering rasburicase?

A) Wearing gloves to prevent absorption of the drug through skin and mucous membranes
B) Placing the patient in an upright position for 30 minutes after the drug is administered
C) Keeping the emergency equipment in the room during administration of the drug
D) Ensuring that the patient drinks at least 16 ounces of fluid with each dose

Question 12

Which drug used to treat osteoporosis is available only by subcutaneous injection?

A) Alendronate (Fosamax)
B) Raloxifene (Evista)
C) Ibandronate (Boniva)
D) Denosumab (Prolia)

Question 13

Which action is most important to teach a patient prescribed to take allopurinol (Zyloprim)daily for gout?

A) "Avoid operating heavy machinery."
B) "Drink plenty of water."
C) "Avoid alcohol and caffeine."
D) "Take the drug only when symptoms of gout are present."

Question 14

What is the main goal of therapy with uric acid synthesis inhibitors for gouty arthritis?

A) Reducing pain
B) Curing the disease
C) Slowing of joint damage
D) Reducing uric acid levels to zero

Question 15

Which patient is at greatest risk for developing a hematologic problem while receiving rasburicase?

A) 32-year-old patient taking chemotherapy for kidney cancer
B) 42-year-old patient who has a glucose-6-phosphate dehydrogenase deficiency
C) 52-year-old patient who has a deficiency of the enzyme alpha-1-antitrypsin
D) 62-year-old patient who was first diagnosed with gout at the age of 21 years

Question 16

Which bone or joint is most likely to be adversely affected by bisphosphonates?

A) Eye orbit
B) Jawbone
C) Big toe
D) Wrist

Question 17

A patient asks whether he can take an anti-inflammatory drug while he is also taking febuxostat (Uloric)daily for gout.What is your best response?

A) "No,the two drugs are from the same class and more severe side effects are possible."
B) "No,the two drugs are metabolized by the same enzymes and can interfere with each other's effectiveness.
C) "Yes,you may take them both if you are careful to take one in the morning and one at night."
D) "Yes,one reduces the inflammation resulting from gout and the other reduces the cause of gout."

Question 18

A patient prescribed to take allopurinol (Zyloprim)once daily asks,when is the best time to take the drug.What is your best response?

A) Right before bed to reduce the side effect of nausea.
B) Right after a full meal to prevent conversion of purines into uric acid.
C) On an empty stomach to ensure the best absorption of this oral drug.
D) It doesn't matter whether your stomach is full or empty,just take it at the same time every day.

Question 19

Why is it necessary to slow or prevent osteoporosis?

A) To reduce the incidence of bone fractures.
B) To reduce the need for calcium supplementation.
C) To increase skeletal muscle strength and flexibility.
D) To prevent excessive weight gain after menopause.

Question 20

Why are estrogen agonist/antagonists preferred as preventive therapy for osteoporosis instead of pure estrogen agonists?

A) Pure estrogen agonists promote cell growth in the breast and uterus as well as in the bones.
B) Pure estrogen agonists are less effective at balancing osteoclastic and osteoblastic activity.
C) Estrogen agonists/antagonists can be used in both premenopausal women and in women after menopause.
D) Estrogen agonists/antagonists act as estrogen agonists in breast and uterine tissues and act as estrogen antagonists in bones.

Question 21

For which patient should you question the order for cyclobenzaprine (Flexeril)?

A) 25-year-old man with severe back spasms who also has epilepsy
B) 66-year-old man with spasms from collapsed vertebrae who also has prostate cancer
C) 45-year-old woman with muscles spasms and a broken femur who also has hypotension
D) 28-year-old woman with severe leg muscle spasms from a pinched nerve who is 7 months pregnant

Question 22

Which electrolyte imbalance is most likely to trigger skeletal muscle spasms?

A) Low serum calcium level
B) High serum magnesium level
C) Low serum potassium level
D) High serum chloride level

Question 23

A patient who weighs 154 lb is prescribed to receive rasburicase (Elitek)0.2 mg/kg intravenously.The available drug has a concentration of 7.5 mg/mL.How many milliliters should you prepare to administer.

Question 24

A patient is prescribed to receive methocarbamol 300 mg by direct intravenous push.The drug available is a 10% solution of 1000 mg/10 mL.How many milliliters will you prepare to administer?

Question 25

A patient taking methocarbamol (Robaxin)for skeletal muscle cramping reports facial flushing.How should you respond?

A) Tell the patient to go to the nearest emergency department.
B) Ask the patient whether he or she is taking any other drugs.
C) Notify the prescriber to obtain a prescription for a different drug.
D) Remind the patient that this is a mild side effect of the drug.

Question 26

Which drugs belong to the estrogen agonist/antagonist class? (select all that apply)

A) Alendronate (Fosamax)
B) Densosumab (Prolia)
C) Estrogen/bazedoxifene (Duavee)
D) Ibandronate (Boniva)
E) Raloxifene (Evista)

Question 27

Which action by a skeletal muscle relaxant is the major mechanism of action?

A) Dilating blood vessels in skeletal muscles and reducing the need for contraction.
B) Binding to opioid and serotonin receptors in the brain to induce sleep.
C) Reducing motor nerve impulse transmission to the skeletal muscles.
D) Inhibiting glucose uptake in skeletal muscles.

Question 28

A patient is prescribed to start cyclobenzaprine (Flexeril).Before administering the drug,you find he has a slow and irregular heartbeat.What is your best action?

A) Administer the drug as prescribed.
B) Hold the dose and notify the prescriber.
C) Apply a heart monitor before administering the drug.
D) Substitute methocarbamol (Robaxin)for the Flexeril.