Deck 20: Nonopioid Analgesic, nonsteroidal Antiinflammatory, and Antigout DR

Question 1

Summarize the approved clinical indications for the use of nonsteroidal antiinflammatory drugs (NSAIDs).

A) Relief of mild to moderate pain where opioids are not indicated or warranted.
B) Chronic treatment of dysmenorrhea.
C) Control of the signs and symptoms of osteoarthritis and rheumatoid arthritis.
D) All of these are correct.

Answer 1

All of these are correct.

Question 2

Use the side-effects profile of the salicylates to select the false statement related to their use.

A) Salicylates directly irritate the stomach mucosal lining.
B) Salicylates stimulate prostaglandin synthesis.
C) Salicylates stimulate the medullary center known as the chemoreceptor trigger zone.
D) None of these are correct.

Answer 2

Salicylates stimulate prostaglandin synthesis.

Question 3

Select the statement that best explains the reason why patients taking warfarin (Coumadin) should take only the lowest effective dose of acetaminophen for short term therapy only.

A) Acetaminophen has been reported to increase the anticoagulant effect of warfarin. The mechanism is the inhibition of the liver enzyme metabolism of warfarin, resulting in increased circulating anticoagulant.
B) Acetaminophen has been reported to decrease the anticoagulant effect of warfarin. The mechanism is the stimulation of the liver enzyme metabolism of warfarin, resulting in decreased circulating anticoagulant.
C) Acetaminophen has been reported to increase the anticoagulant effect of warfarin. The mechanism is the stimulation of the liver enzyme metabolism of warfarin, resulting in increased circulating anticoagulant.
D) None of these are correct.

Answer 3

Acetaminophen has been reported to increase the anticoagulant effect of warfarin. The mechanism is the inhibition of the liver enzyme metabolism of warfarin, resulting in increased circulating anticoagulant.

Question 4

Match the term megaloblastic anemia with the correct definition.

A) Megaloblastic anemia is a condition in which there is a large, immature form of the red blood cell, which does not function as efficiently as the mature form.
B) Megaloblastic anemia is a condition in which the total number of white blood cells circulating in the blood is less than normal.
C) None of these are correct.

Question 5

Using your knowledge of the pediatric dosing guidelines for aspirin,select the correct dose for a 4-year-old child.

A) 243 mg every 4 to 6 hours
B) 162 mg every 4 to 6 hours
C) 324 mg every 4 to 6 hours
D) 650 mg every 4 to 6 hours

Question 6

Identify the physiological signs that indicate the presence of inflammation.

A) Swelling and edema
B) Pain and warmth
C) Redness and loss of body function
D) All of these are correct.

Question 7

Use the adverse-effects profile of acetaminophen to determine the recommended treatment options for acetaminophen poisoning.

A) The treatment for acetaminophen poisoning includes gastric aspiration and lavage.
B) Maintenance of fluid balance by conventional means is necessary in the treatment of acetaminophen poisoning.
C) Use of activated charcoal will absorb the acetaminophen if administered within hours of the overdose.
D) All of these are correct.

Question 8

Use the mechanism of action of allopurinol (Zyloprim) to select the statement that best explains its action potential.

A) Allopurinol specifically alters the ability of the phagocytes to attack uric acid crystals.
B) Allopurinol is a competitive inhibitor of xanthine oxidase, so uric acid formation is blocked.
C) Allopurinol is a noncompetitive inhibitor of xanthine oxidase, so uric acid formation is blocked.
D) None of these are correct.

Question 9

Use the clinical indications for the use of nonsteroidal antiinflammatory drugs to select the true statement about their use.

A) Nonsteroidal antiinflammatory drugs are approved for the relief of pain arising from local inflammatory responses including headache, dental extraction, soft tissue injury, sunburn, musculoskeletal, and joint overexertion and strain.
B) Because of the direct action on regional prostaglandin production, NSAIDs are indicated for the chronic treatment of dysmenorrhea and for controlling the signs and symptoms of osteo- and rheumatoid arthritis.
C) Nonsteroidal antiinflammatory drugs are approved for the relief of mild to moderate pain where opioids are not indicated or warranted.
D) All of these are true.

Question 10

Use the administration guidelines for the nonsteroidal antiinflammatory drugs to select the NSAID that is commercially available for parenteral administration to induce closure of the atrial opening in premature infants with patent ductus arteriosis.

A) Ibuprofen and indomethacin
B) Ibuprofen and ketorolac
C) Ketorolac and indomethacin
D) None of these are correct.

Question 11

Select the statement that best explains why some patients develop nausea and vomiting after taking aspirin.

A) Salicylates stimulate the microsomal metabolizing system in the liver, resulting in an increase in the amount of acid produced in the GI tract.
B) Salicylates stimulate the mucopolysaccharides in the stomach, causing hydrochloric acid erosion.
C) Salicylates stimulate the medullary center known as the chemoreceptor trigger zone. This zone directly excites the vomiting center so that emesis may occur.
D) None of these are correct.

Question 12

Match the term petechia with its correct description.

A) Petechia is a condition in which there is a large, immature form of the red blood cell, which does not function as efficiently as the mature form.
B) Petechia is a small area of the skin or mucous membranes that is discolored because of localized hemorrhages.
C) Petechia is a condition in which the total number of white blood cells circulating in the blood is less than normal.
D) None of these are correct.

Question 13

Use your knowledge of the opioids and nonopioids to select the false statement related to the differences in their mechanisms of action.

A) Nonopioid analgesics are not chemically or structurally related to morphine, nor are they related to each other by a common structure.
B) Nonopioid analgesics are effective against severe, sharp visceral pain.
C) Nonopioid analgesics produce analgesia through both a central nervous system and a peripheral mechanism of action at the site of injury.
D) Nonopioid analgesics do not produce tolerance or physical dependency with chronic use.

Question 14

Using your knowledge of the pediatric dosing guidelines for acetaminophen,select the correct dose for an 11-month-old child.

A) 40 mg every 4 to 6 hours
B) 160 mg every 4 to 6 hours
C) 80 mg every 4 to 6 hours
D) 240 mg every 4 to 6 hours

Question 15

Identify the chemicals that stimulate peripheral nerve endings and carry pain impulses to the CNS.

A) Bradykinin
B) Serotonin
C) Epinephrine
D) Dopamine

Question 16

Describe the physical ramifications of excess use of acetaminophen.

A) The excessive use of acetaminophen causes metabolites of the drug to bind to tissue groups in the kidney and liver, causing hepatotoxicity.
B) The excessive use of acetaminophen causes metabolites of the drug to bind to tissue groups in the intestinal tract, causing diarrhea.
C) The excessive use of acetaminophen causes metabolites of the drug to bind to tissue groups in the pancreas, causing pancreatitis.
D) None of these are correct.

Question 17

Match the term margination with its correct description.

A) Margination is the process by which the white blood cell moves toward the source of the inflammatory chemicals.
B) Margination is the process by which the white blood cell crawls through the capillary wall.
C) Margination is the process by which the white blood cell adheres to the capillary wall.
D) None of these are correct.

Question 18

Explain the reason why aspirin-sensitive patients may substitute acetaminophen for headache pain.

A) Acetaminophen does not produce GI irritation or ulceration in therapeutic doses.
B) Acetaminophen does not affect platelet aggregation.
C) Acetaminophen does not affect prothrombin response.
D) All of these are correct.

Question 19

Identify the drug agent that irreversibly inhibits the aggregation of platelets necessary for blood clot formation.

A) Aspirin
B) Acetaminophen
C) Naproxen sodium
D) None of these are correct.

Question 20

Using the preferred drug therapy for the treatment of acute gout attacks,select the true statement.

A) For the treatment of acute gout attacks, relief of pain, and interruption of the inflammatory process, colchicine and aspirin and sodium thiosalicylate are indicated.
B) For the treatment of acute gout attacks, relief of pain, and interruption of the inflammatory process, colchicine and specific NSAIDs (indomethacin, naproxen) and sodium thiosalicylate are indicated.
C) For the treatment of acute gout attacks, relief of pain, and interruption of the inflammatory process, colchicine and specific acetaminophen and sodium thiosalicylate are indicated.
D) None of these are correct.

Question 21

Select the statement that best explains why acetaminophen is effective in the treatment of headache pains but not effective in the treatment of muscle aches and inflammation.

A) Acetaminophen is effective against the pain of headache because it inhibits prostaglandin synthesis within the CNS but does not significantly inhibit the synthesis of prostaglandins in peripheral systems, which accounts for the lack of antiinflammatory activity.
B) Acetaminophen is effective against the pain of headache because it stimulates prostaglandin synthesis within the CNS but does not significantly inhibit the synthesis of prostaglandins in peripheral systems, which accounts for the lack of antiinflammatory activity.
C) Acetaminophen is effective against the pain of headache because it stimulates prostaglandin synthesis within the CNS but does not affect platelet aggregation or prothrombin time, which accounts for the lack of antiinflammatory activity.
D) None of these are correct.

Question 22

Select the correct statement related to the uricosuric drug agent probenecid.

A) The correct adult dose is 100-200 mg BID.
B) Probenecid increases renal excretion, thereby decreasing plasma concentrations of hypoglycemic agents.
C) Probenecid causes GI disturbances, so it is recommended that it be taken with milk, meals, or antacids.
D) None of these are correct.

Question 23

Select the correct statement about the enzymes referred to as cyclooxygenase (COX).

A) Cyclooxygenase (COX) increases uric acid production and deposition in the joints, leading to gout.
B) Cyclooxygenase makes various prostaglandins needed from arachidonic acid.
C) Cyclooxygenase production is stimulated with NSAID use.
D) None of these are correct.

Question 24

Select the statement that best describes the reason why NSAIDs should be used with caution in patients also receiving treatment with captopril or losarten.

A) NSAIDs reduce the antihypertensive effects of the ACE inhibitors captopril and losartan on both systolic and diastolic blood pressure.
B) NSAIDs reduce the antihypertensive effects of the ACE inhibitors captopril and losartan on systolic blood pressure.
C) NSAIDs reduce the antihypertensive effects of the ACE inhibitors captopril and losartan on diastolic blood pressure.
D) None of these are correct.

Question 25

Select the statement that best describes the mechanism of action of colchicine.

A) Colchicine specifically alters the ability of the phagocytes to attack uric acid crystals. As a result, the pH of the joint fluid does not fall.
B) Colchicine is a competitive inhibitor of xanthine oxidase, so uric acid formation is blocked.
C) Colchicine is a noncompetitive inhibitor of xanthine oxidase, so uric acid formation is blocked.
D) None of these are correct.

Question 26

Differentiate between the COX-2 inhibitors and other NSAIDs,and select the true statement about COX-2.

A) The selective COX-2 inhibitors exhibit potentially less serious cardiac or renal adverse effects than do other NSAIDs because they focus only on one group of enzymes.
B) Selective COX-2 inhibitors do not have the antithrombotic (clot prevention) protective action of aspirin and other COX-1 inhibitors because platelets are predominately a COX-1 pathway.
C) NSAIDs and COX-2 inhibitor drugs do not promote sodium and water retention.
D) All of these are correct.

Question 27

Use the guidelines of the American Geriatric Society issued in 2009 to select the true statement related to the use of pain medications in elderly patients.

A) Because patients over 75 years of age often have multiple chronic conditions associated with pain and are usually more susceptible to the adverse effects of NSAIDs, especially the cardiovascular and gastrointestinal effects, the newest guidelines specifically recommend that routine lab work be included in the treatment plan to prevent overdosage of NSAIDs in elderly patients.
B) Because patients over 75 years of age often have multiple chronic conditions associated with pain and are usually more susceptible to the adverse effects of NSAIDs, especially the cardiovascular and gastrointestinal effects, the newest guidelines specifically recommend that patients with moderate-to-severe pain or diminished quality of life due to pain should be considered for opioid treatment rather than NSAIDs.
C) Because patients over 75 years of age often have multiple chronic conditions associated with pain and are usually more susceptible to the adverse effects of NSAIDs, especially the cardiovascular and gastrointestinal effects, the newest guidelines specifically recommend that patients with moderate-to-severe pain or diminished quality of life due to pain should use only enteric coated naproxen sodium to prevent the gastrointestinal effects.
D) None of these are correct.

Question 28

Differentiate between acetaminophen and the NSAIDs,and select the true statement related to their use.

A) Acetaminophen is recommended for use in patients who experience GI upset from aspirin or nonsteroidal antiinflammatory drugs (NSAIDs); however, it is interchangeable with these products for chronic therapy of inflammatory conditions such as osteoarthritis.
B) Acetaminophen is recommended for use in patients who experience GI upset from aspirin or nonsteroidal antiinflammatory drugs (NSAIDs); however, it is not interchangeable with these products for chronic therapy of inflammatory conditions such as osteoarthritis.
C) Acetaminophen has shown benefit associated with the use of this drug in patients who have suffered a stroke or myocardial infarction.
D) None of these are correct.

Question 29

Select the true statement related to the treatment of gout with febuxostat (Uloric).

A) It is used for the acute management of hyperuricemia in patients with gout.
B) Administration of febuxostat with food and antacids affects the absorption of febuxostat.
C) Febuxostat is the first selective xanthine oxidase inhibitor that is not a purine analog.

Question 30

Select the statement that best summarizes the recommendation made by the FDA as a black box warning for OTC products that contain an NSAID.

A)Every OTC product containing an NSAID will have to include a bolded warning advising consumers about the potential risks for "Severe stomach bleeding," especially
B)in people who are aged 60 years or older and have had stomach ulcers or bleeding problems.
C)Every OTC product containing an NSAID will have to include a bolded warning advising consumers about the potential risks for "severe stomach bleeding," especially
D)in people who take a blood thinning or steroid drug or take other drugs containing prescription or nonprescription NSAIDs.
E)Every OTC product containing an NSAID will have to include a bolded warning advising consumers about the potential risks for "Severe stomach Bleeding," especially
F)in people who have three or more alcoholic drinks a day while using the product or take more of the product than directed.
G)All of these are correct.