Deck 20: Nonnarcotic Analgesics Anti-Inflammatory,and Antigout Drugs

Question 1

Why do aspirin-sensitive patients substitute aspirin with acetaminophen to relieve 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 the above are correct.

Answer 1

All of the above are correct.

Question 2

Identify a true statement about petechia.

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 the above are correct.

Answer 2

Petechia is a small area of the skin or mucous membranes that is discolored because of localized hemorrhages.

Question 3

Which of the following is true of salicylates?

A) Salicylates directly irritate the stomach mucosal lining.
B) Salicylates inhibit prostaglandin synthesis.
C) Salicylates stimulate the medullary center known as the chemoreceptor trigger zone.
D) All of the above are correct.

Answer 3

All of the above are correct.

Question 4

Why should patients taking warfarin (Coumadin)limit their intake of acetaminophen to the lowest effective dose for short-term therapy only?

A) Acetaminophen has been reported to increase the anticoagulant effect of warfarin.
B) Acetaminophen has been reported to potentiate the inhibitory effects of warfarin on uric acid excretion.
C) Acetaminophen has been reported to decrease the antihypertensive effects of warfarin.
D) None of the above are correct.

Question 5

Which of the following is the recommended treatment option for acetaminophen poisoning?

A) Gastric aspiration and lavage
B) Maintenance of fluid balance by conventional means
C) Use of activated charcoal
D) All of the above

Question 6

Why do 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 that leads to nausea and vomiting.
C) Salicylates stimulate the medullary center known as the chemoreceptor trigger zone that directly excites the vomiting center so that emesis may occur.
D) None of the above are correct.

Question 7

Select the drugs preferred for the treatment of acute gout attacks,relief of pain,and interruption of the inflammatory process.

A) Probenecid, penicillins, and allopurinol
B) Colchicine, specific NSAIDs (indomethacin, naproxen), and sodium thiosalicylate
C) Salicylates, ketorolac tromethamine, and acetaminophen
D) None of the above

Question 8

Which of the following is true of the use of nonsteroidal anti-inflammatory drugs?

A) Nonsteroidal anti-inflammatory drugs are approved for the relief of pain arising from local inflammatory responses.
B) Nonsteroidal anti-inflammatory drugs are indicated for the chronic treatment of dysmenorrhea and for controlling the signs and symptoms of osteo- and rheumatoid arthritis.
C) Nonsteroidal anti-inflammatory drugs are approved for the relief of mild to moderate pain where opioids are not indicated or warranted.
D) All of the above are true.

Question 9

Identify the correct dose of acetaminophen for a 5-year-old boy weighing 45 pounds.

A) 240 mg every 4 to 6 hours
B) 160 mg every 4 to 6 hours
C) 320 mg every 4 to 6 hours
D) 650 mg every 4 to 6 hours

Question 10

Identify a true statement about megaloblastic anemia.

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) Megaloblastic anemia is a condition in which the number of red blood cells or the amount of hemoglobin inside the red blood cells is less than normal.
D) None of the above are correct.

Question 11

Which of the following is not true of nonopioid analgesics?

A) Nonopioid analgesics are chemically and structurally unrelated to morphine.
B) Nonopioid analgesics are effective against severe, sharp pain.
C) Nonopioid analgesics produce analgesia through a central, rather than a peripheral, mechanism of action.
D) Nonopioid analgesics produce tolerance or physical dependency with chronic use.

Question 12

Which of the following nonsteroidal anti-inflammatory drugs (NSAIDs)is commercially available for parenteral administration to induce closure of the atrial opening in premature infants with patent ductus arteriosis?

A) Ibuprofen
B) Ketorolac
C) Celecoxib
D) None of the above

Question 13

Which of the following drugs irreversibly inhibits the aggregation of platelets necessary for blood clot formation?

A) Aspirin
B) Acetaminophen
C) Naproxen sodium
D) None of the above

Question 14

Which of the following is a clinical indication for the use of nonsteroidal anti-inflammatory 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 the above

Question 15

Identify the physiological signs that indicate the presence of inflammation.

A) Swelling and redness
B) Pain and warmth
C) Loss of function
D) All of the above

Question 16

Select the correct dose of acetaminophen for a 3-year-old girl weighing 32 pounds.

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 17

Identify the physical ramifications of the excessive 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 pain and inflammation of the joints accompanied by elevated body temperature, which leads to rheumatic fever.
C) The excessive use of acetaminophen causes a reduction in blood supply and oxygen to a localized area of the body or tissue.
D) None of the above are correct.

Question 18

Why do aspirin-sensitive patients substitute aspirin with acetaminophen to relieve 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 the above are correct.

Question 19

Identify the chemical that stimulates peripheral nerve endings and helps carry pain impulses to the CNS.

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

Question 20

What is the mechanism of action of allopurinol (Zyloprim)in preventing the formation of uric acid in the body?

A) Allopurinol specifically alters the ability of phagocytes to attack uric acid crystals.
B) Allopurinol blocks prostaglandin stimulation of the central nervous system, so uric acid formation is blocked.
C) Allopurinol is a noncompetitive inhibitor of xanthine oxidase, so uric acid formation is blocked.
D) None of the above are correct.

Question 21

Penny has a headache,so she takes a 250-mg tablet of aspirin to alleviate the pain.After a while,she begins to feel nauseous.What is the reason for this occurrence?

A) Aspirin causes a buildup of COX-2 inhibitors in the body.
B) Aspirin is known to irritate the stomach mucosal lining.
C) A dose of 250 mg is double the recommended dose for an adult.
D) A headache is not an indication for the use of aspirin.

Question 22

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

A) Febuxostat 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.
D) Febuxostat is metabolized by the kidney and excreted by the liver.

Question 23

Which of the following statements about COX-2 inhibitors is true?

A) Selective COX-2 inhibitors exhibit potentially less serious cardiac or renal adverse effects than do other nonsteroidal anti-inflammatory drugs (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 the above are correct.

Question 24

Why should nonsteroidal anti-inflammatory drugs (NSAIDs)be used with caution in patients who are also receiving treatment with captopril or losartan?

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 the above are correct.

Question 25

Select the correct statement about cyclooxygenase (COX).

A) COX increases uric acid production and deposition in the joints, leading to gout.
B) COX makes various prostaglandins from arachidonic acid.
C) COX production is stimulated with the use of nonsteroidal anti-inflammatory drugs.
D) None of the above are correct.

Question 26

Which of following is recommended by the FDA to be used as a black box warning for OTC products that contain a nonsteroidal anti-inflammatory drug (NSAID)? rev: 09_04_2013_QC_34775

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

Question 27

Identify the primary mechanism of action of nonopioid analgesics in antipyresis and analgesia.

A) Inhibition of COX-3 receptors
B) Stimulation of the endocrine glands
C) Stimulation of skeletal muscle
D) Blockade of prostaglandin stimulation of the central nervous system

Question 28

Unlike COX-1,COX-2 is only manufactured in _____.

A) uterine muscle
B) the kidneys
C) the platelets
D) activated macrophages

Question 29

Why is acetaminophen effective in the treatment of headaches but not 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 anti-inflammatory activity.
B) Acetaminophen is effective against the pain of headache because it stimulates prostaglandin synthesis within the CNS but does not significantly stimulate the synthesis of prostaglandins in peripheral systems, which accounts for the lack of anti-inflammatory 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 anti-inflammatory activity.
D) None of the above are correct.

Question 30

_____ is involved in the production of erythema (abnormal redness),edema,and pain that accompany the inflammatory process.

A) PGE₂
B) PGF₂
C) PGE₁
D) PGF₂1 _$\alpha$

Question 31

According to the guidelines of the American Geriatric Society issued in 2009,which of the following statements is true about the use of nonsteroidal anti-inflammatory drugs (NSAIDs)in elderly patients?

A) Routine lab work should be included in the treatment plan of elderly patients to prevent overdosage of NSAIDs.
B) Elderly patients with moderate-to-severe pain or diminished quality of life due to pain should be considered for opioid treatment rather than NSAIDs.
C) Patients over 75 years of age should use NSAIDs with enteric coating to prevent gastrointestinal side effects.
D) None of the above are correct.

Question 32

Select a correct statement about the uricosuric drug probenecid.

A) The correct adult dose of probenecid 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 the above are correct.

Question 33

Which of the following statements is true of acetaminophen?

A) Acetaminophen is recommended for use in patients who experience GI upset from aspirin or nonsteroidal anti-inflammatory drugs (NSAIDs).
B) Acetaminophen is interchangeable with aspirin and NSAIDs for chronic therapy of inflammatory conditions such as osteoarthritis.
C) Acetaminophen has been shown to benefit patients who have suffered a stroke or myocardial infarction.
D) None of the above are correct.

Question 34

Which of the following NSAIDs causes ulcers more frequently than the others?

A) Ketorolac tromethamine
B) Ibuprofen
C) Aspirin
D) Acetaminophen

Question 35

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 the above are correct.