Question 1

All nonsteroidal anti-inflammatory drugs (NSAIDS) have an FDA Black Box Warning regarding:

Accepted Answer

All NSAIDs have an FDA Black Box Warning regarding the potential for causing life-threatening GI bleeds.

Question 2

Phil is starting treatment with febuxostat (Uloric). Education of patients starting febuxostat includes:

Accepted Answer

Education of patients starting febuxostat includes informing them that gout may worsen with therapy initially due to mobilization of urate crystals. This is a common occurrence and should resolve over time as serum urate levels decrease. Choice B is incorrect as severe diarrhea is not a well-known side effect of febuxostat. Choice C is also incorrect as consumption of a high-calcium diet is not specifically relevant to febuxostat therapy. Choice D is not necessary as routine CBC monitoring is not typically needed with the use of febuxostat.

Question 3

Monitoring a patient on a high-dose aspirin level includes:

Accepted Answer

Monitoring a patient on a high-dose aspirin level should include checking their salicylate levels (to monitor for toxicity), complete blood count (to monitor for bleeding or other blood-related issues), and urine pH (because aspirin can cause acidosis). Therefore, all of the options (A, B, and C) are necessary for proper monitoring.

Question 4

Patients who are on long-term aspirin therapy should have ______ annually.

Accepted Answer

Patients who are on long-term aspirin therapy should have an annual complete blood count to monitor for anemia or changes in platelet counts. Salicylate levels may be checked if there is concern for toxicity, but this is not typically done on an annual basis. Amylase is a test for pancreatic function and would not be necessary for monitoring aspirin therapy. Urine analysis may be done in some cases, but it is not necessary for monitoring aspirin therapy.

Question 5

Patient education when prescribing colchicine includes:

Accepted Answer

The answer of Patient education when prescribing colchicine includes:
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Question 6

Patients whose total dose of prednisone will exceed 1 gram will most likely need a second prescription for:

Accepted Answer

Patients who are taking high doses of prednisone for an extended period of time are at risk for developing peptic ulcer disease due to the drug's ability to increase stomach acid production. Omeprazole is a proton pump inhibitor that can decrease acid production and reduce the risk of developing ulcers.

Question 7

Larry is taking allopurinol to prevent gout. Monitoring of a patient who is taking allopurinol includes:

Accepted Answer

Allopurinol can cause kidney damage, so monitoring kidney function with BUN, creatinine, and creatinine clearance is recommended. A complete blood count and C-reactive protein are not typically needed for monitoring allopurinol therapy, and blood glucose monitoring is not specifically related to allopurinol use.

Question 8

When prescribing NSAIDS, a complete drug history should be conducted as NSAIDs interact with these drugs:

Accepted Answer

NSAIDs can increase the risk of bleeding when taken with anticoagulants such as warfarin. Therefore, it is important to consider this interaction and adjust dosages accordingly. It is still important to obtain a complete drug history, including any other medications the patient is taking, in order to ensure safe and effective use of the NSAID.

Question 9

Jamie has fractured his ankle and has received a prescription for acetaminophen and hydrocodone (Vicodin). Education when prescribing Vicodin includes:

Accepted Answer

Acetaminophen is an ingredient in Vicodin, so taking other medications containing acetaminophen can result in an overdose and liver damage. It is important for Jamie to know this to avoid complications. The other choices are incorrect. It is not okay to double the dose of Vicodin without consulting a healthcare provider, as it can lead to an overdose. Vicodin is habit-forming and can lead to addiction, so patients should use it only as prescribed. Vicodin can cause constipation, not diarrhea, so patients are advised to increase their fiber and fluid intake to counteract this effect.

Question 10

Daniel has been on 60 mg of prednisone for 10 days to treat a severe asthma exacerbation. It is time to discontinue the prednisone. How is prednisone discontinued?

Accepted Answer

Prednisone should not be abruptly discontinued as this can result in adrenal gland suppression and withdrawal symptoms. Instead, a tapering schedule should be developed to slowly wean the patient off the medication to prevent these adverse effects. Patients with asthma may also need to transition onto inhaled corticosteroids, but this does not address how the prednisone should be discontinued. Substituting prednisone with ibuprofen is not recommended as it does not have the same anti-inflammatory effects.

Question 11

Patients who are on chronic long-term corticosteroid therapy need education regarding:

Accepted Answer

Chronic long-term corticosteroid therapy can cause gastrointestinal bleeding, so patients should be educated to report any signs of bleeding such as black tarry stools and abdominal pain to their healthcare provider immediately.

Answer: A
 Patients on chronic long-term corticosteroid therapy should avoid all live vaccinations, including the live flu vaccine, as they may cause severe infections. Inactivated vaccinations are recommended, and patients should receive all necessary vaccines to prevent infections.

Answer: C
 Patients on chronic long-term corticosteroid therapy are at an increased risk of developing diabetes, so they should maintain a healthy diet with a moderate carbohydrate content and plenty of fluids to prevent fluid retention.

Answer: D
 Patients on chronic long-term corticosteroid therapy should avoid alcohol consumption as it may increase the risk of gastrointestinal bleeding and may interfere with drug metabolism.

Question 12

Josefina is a 2-year-old child with acute otitis media and an upper respiratory infection. Along with an antibiotic she receives a recommendation to treat the ear pain with ibuprofen. What education would her parent need regarding ibuprofen?

Accepted Answer

It is important for children to stay well-hydrated while taking ibuprofen to prevent any potential kidney damage. Options A and B are incorrect because the dose of ibuprofen should be based on the child's weight and age, and cutting tablets can affect the accuracy of the dose. Option D is incorrect because ibuprofen has potential side effects in children, such as gastrointestinal bleeding or damage to the kidneys.

Question 13

Sallie has been taking 10 mg per day of prednisone for the past 6 months. She should be assessed for:

Accepted Answer

Long-term use of prednisone can lead to decreased bone density and increase the risk of osteoporosis. Sallie should be assessed for this potential complication. While gout and iron deficiency anemia may be side effects of prednisone, they are less common and not as directly related to the medication. Renal dysfunction is also a potential complication, but is more closely monitored with higher doses of prednisone than what Sallie is taking.

Question 14

The trial period to determine effective anti-inflammatory activity when starting a patient on aspirin for rheumatoid arthritis is:

Accepted Answer

The trial period to determine effective anti-inflammatory activity when starting a patient on aspirin for rheumatoid arthritis is usually 4 to 6 days. This time frame allows for the aspirin to reach therapeutic levels in the blood and demonstrate its effectiveness in reducing inflammation. Longer trial periods are not necessary as patients typically experience relief within this time frame.

Question 15

Henry presents to clinic with a significantly swollen, painful great toe and is diagnosed with gout. Of the following, which would be the best treatment for Henry?

Accepted Answer

Low-dose colchicine is the best treatment for acute gout attacks as it reduces inflammation and pain. High-dose colchicine can cause side effects such as nausea and diarrhea, and aspirin can exacerbate gout symptoms. Acetaminophen with codeine may provide pain relief but does not address the underlying inflammation of gout.

Question 16

Patients with rheumatoid arthritis who are on chronic low-dose prednisone will need co-treatment with which medications to prevent further adverse effects?

Accepted Answer

Chronic low-dose prednisone use can lead to bone loss and increased risk of fractures. Bisphosphonates, calcium supplementation, and vitamin D are all recommended to prevent further adverse effects on bone density in patients with rheumatoid arthritis who are on chronic low-dose prednisone. Therefore, all of the above options are necessary.

Question 17

Henry is 82 years old and takes two aspirin every morning to treat the arthritis pain in his back. He states the aspirin helps him to "get going" each day. Lately he has had some heartburn from the aspirin. After ruling out an acute GI bleed, what would be an appropriate course of treatment for Henry?

Accepted Answer

Adding an H2 blocker such as ranitidine can help alleviate the heartburn caused by the aspirin while still allowing Henry to receive the arthritis pain relief he needs. Discontinuing the aspirin or switching to Vicodin, which is an opioid pain medication, may not be appropriate for Henry's specific condition and can have potential  negative side effects. Decreasing the aspirin dose may reduce the heartburn, but it may not be enough to manage Henry's pain. Taking an antacid 15 minutes before taking the aspirin may help with immediate heartburn relief but does not address the underlying issue and can lead to other health problems if overused.

Question 18

Patients prescribed aspirin therapy require education regarding the signs of aspirin toxicity. An early sign of aspirin toxicity is:

Accepted Answer

Tinnitus (ringing in the ears) is an early sign of aspirin toxicity and should be reported immediately to a healthcare provider. Black tarry stools may indicate gastrointestinal bleeding and vomiting may occur later in aspirin toxicity. Tremors are not typically associated with aspirin toxicity.

Question 19

Patients who are on or who will be starting chronic corticosteroid therapy need monitoring of:

Accepted Answer

Chronic corticosteroid therapy can cause hyperglycemia, so monitoring serum glucose is necessary to identify and manage this potential side effect. Stool culture and folate levels are not typically affected by corticosteroid therapy. Vitamin B12 levels may be monitored in some cases, but it is not a routine monitoring parameter specific to corticosteroid therapy.

Quiz 25: Drugs Used in Treating Inflammatory Processes