Deck 14: Drugs for Bone and Joint Disorders

Question 1

A patient will begin taking hydroxychloroquine for rheumatoid arthritis What test will the provider order as a baseline for ongoing monitoring?

A) Ophthalmological examination
B) Pulmonary function tests
C) Electrocardiogram
D) Hypersensitivity testing

Answer 1

Ophthalmological examination

Question 2

What guidance will the provider give to the patient beginning therapy with oral methotrexate for rheumatoid arthritis?

A) Routine tests of kidney and liver function will be needed.
B) You will need to take iron supplements while taking this drug.
C) You should avoid drinking grapefruit juice while taking this drug.
D) It is important to take this medication every day.

Answer 2

Routine tests of kidney and liver function will be needed.

Question 3

The provider has the patient take a tuberculin skin test and chest x-ray prior to starting etanercept. Testing results are a positive tuberculin skin test with a negative chest radiograph. What action will the provider take?

A) Prescribe antituberculosis drugs at the beginning of etanercept therapy.
B) Schedule periodic chest radiographs during treatment with etanercept.
C) Begin etanercept and advise the patient to report symptoms that indicate conversion from latent to active tuberculosis.
D) Prescribe treatment for tuberculosis prior to beginning etanercept treatment.

Answer 3

Prescribe treatment for tuberculosis prior to beginning etanercept treatment.

Question 4

A patient with severe glucocorticoid-induced osteoporosis will start therapy with teriparatide. What route and dose will the provider prescribe?

A) 20 $\mu$ g once daily subQ
B) 20 $\mu$ g twice daily subQ
C) 10 $\mu$ g once daily subQ
D) 10 $\mu$ g twice daily subQ

Question 5

A patient has had three gouty flare-ups in the past year. Which type of drug will the provider prescribe to decrease the frequency of flare-ups?

A) Antigout antiinflammatory drug
B) Glucocorticoid
C) Nonsteroidal antiinflammatory drug
D) Urate-lowering drug

Question 6

A patient presents to the clinic with weakness, fatigue, nausea, vomiting, constipation, and nocturia. Total serum calcium is 10.5 mg/dL. A dipstick urinalysis is positive for protein. The patient takes vitamin D and calcium supplements. What action does the provider take?

A) Decrease the amount of vitamin D and discontinue the calcium.
B) Prescribe calcitonin-salmon therapy.
C) Discontinue both supplements and prescribe a diuretic.
D) Discontinue the vitamin D, decrease the amount of calcium, and instruct the patient to increase fluid intake.

Question 7

A patient who will begin taking colchicine for gout currently takes ibuprofen, simvastatin, amoxicillin, and digoxin. What action will the provider take to manage this medication regime?

A) Prescribe a different antibiotic.
B) Discuss the potential risk of muscle injury.
C) Order cardiorespiratory monitoring.
D) Suggest that the patient discontinue the ibuprofen.

Question 8

A patient being treated with warfarin to prevent thrombus develops hyperuricemia, and the provider orders allopurinol. The provider will discuss ____ the ____ dose with the patient.

A) increasing; allopurinol
B) increasing; warfarin
C) reducing; allopurinol
D) reducing; warfarin

Question 9

A patient with rheumatoid arthritis takes leflunomide and an oral contraceptive. When the patient shares that she would like to get pregnant, what change will the provider make in the patient's medication regimen?

A) Taper off leflunomide over two weeks before discontinuing the oral contraceptive.
B) Discontinue the leflunomide and the oral contraceptive and begin folic acid supplementation.
C) Discontinue the lefluonomide and begin an 11-day course of cholestyramine.
D) Discontinue lefluonamide and initiate therapy with methotrexate.

Question 10

A patient who is hospitalized for an acute gout attack continues to ha moderate to severe pain despite receiving several doses of hourly oral colchicine. When the patient begins vomiting after the next dose, what action will the provider take?

A) Lower the dose of colchicine.
B) Put a temporary hold on the colchicine.
C) Explain that this is a common, but temporary, side effect.
D) Prescribe an antiemetic.

Question 11

A patient with refractory gout will be admitted for treatment with intravenous pegloticase. What additional action will the prescriber take to manage the patient's treatment?

A) Prescribe an antihistamine and a glucocorticoid to be administered prior to beginning the pegloticase infusion.
B) Initiate allopurinol therapy 24 hours prior to treatment with pegloticase.
C) Screen the patient for folic acid deficiency.
D) Prescribe a short-acting bronchodilator to be used as needed.

Question 12

A patient with severe Paget disease of the bone asks the provider what can be done to alleviate the pain. The provider will discuss the use of which medication with the patient?

A) Alendronate
B) Calcifediol
C) Calcitonin-salmon
D) Long-acting NSAIDs

Question 13

Alendronate is prescribed for the patient with postmenopausal osteoporosis. What information will the provider include when providing medication education?

A) Take the medication at bedtime to minimize adverse effects.
B) The therapy will last for a maximum of 1 to 2 years.
C) Take the medication with plenty of water and remain upright for at least 30 minutes.
D) Take the medication with orange juice to increase absorption.

Question 14

A patient with gout who has increasingly frequent acute gouty attacks will begin receiving allopurinol and colchicine. Which statement will the provider include when teaching the patient about this drug regimen?

A) "Allopurinol helps reduce the gastrointestinal side effects of colchicine."
B) "Allopurinol reduces the likelihood of acute gouty attacks that often occur when initiating colchicine therapy."
C) "The colchicine is given to enhance the effects of the allopurinol."
D) "You will take both drugs initially but the colchicine will be discontinued later."

Question 15

A patient is given a new diagnosis of rheumatoid arthritis. What is the basis for the provider's decision to prescribe methotrexate?

A) A methotrexate regimen can reduce overall costs.
B) Starting methotrexate early can help delay joint degeneration.
C) Methotrexate can prevent cancer in addition to managing the arthritis.
D) Methotrexate is the only drug known to cure rheumatoid arthritis.

Question 16

A patient who has gout will begin taking febuxostat. What information will the prescriber provide when teaching the patient about this drug regimen?

A) "This drug will prevent gout flares."
B) "I'm prescribing indomethacin to be taken with this drug to decrease gastrointestinal effects."
C) "Because this drug increases excretion of uric acid, we will need to schedule urine and blood tests."
D) "I will also be prescribing colchicine, but for no longer than 6 months.

Question 17

A patient who takes allopurinol for chronic gout develops a rash. Vital signs are within normal limits and there are no signs of patient distress. What action will the provider take?

A) Hold the allopurinol and confirm an existing drug reaction.
B) Discontinue the allopurinol and prescribe colchicine.
C) Prescribe an antihistamine to minimize the drug side effects.
D) Lower the dose of allopurinol.

Question 18

A patient experiences an acute gouty episode despite taking nonsteroidal antiinflammatory drugs for several months. The prescriber and patient had planned to begin therapy with probenecid. What effect will the acute episode have on the patient's planned medication therapy?

A) Probenecid will be prescribed as planned, but colchicine will be added to the medication regimen.
B) The provider will need to prescribe allopurinol instead of probenecid.
C) Probenecid therapy can begin but the patient must commit to increasing fluid intake.
D) The probenecid therapy will be delayed until the acute episode has subsided.

Question 19

A postmenopausal patient with a family history of breast cancer develops osteoporosis. What medication will the provider prescribe?

A) Estrogen estradiol
B) Pamidronate
C) Raloxifene
D) Teriparatide

Question 20

A provider will begin a course of abatacept for a child with juvenile idiopathic arthritis whose symptoms are inadequately controlled with methotrexate. What will the provider include when teaching the child's family about abatacept?

A) Schedule the abatacept to be given at least 2 hours after the methotrexate.
B) Your child should receive regularly scheduled vaccinations during therapy with abatacept, but live vaccines should be omitted.
C) Immediately report any symptoms of infection.
D) A tumor necrosis factor (TNF) antagonist may need to be added if this therapy is not effective.