Which of the following is NOT a cardinal sign of inflammation?
Inflammation ends with permanent destruction of tissue or with complete healing after removal of injurious stimulus
Chronic inflammation is beneficial
Cell damage results in the release of
All of the above
A fundamental feature of inflammation is
Increase permeability of the microvasculature
Suppression of leukocytes
Relief of symptoms
Impaired quality of life
Which of the following is NOT a goal of treatment of inflammation?
Maintenance of function
Slowing tissue damage
Short term control
Which of the following is NOT considered a drug treatment of arthritis?
Which of the following is true about NSAIDS?
Increases the inflammatory pain response
COX-2 inhibitors can decrease the chance of cardiovascular effects
COX-2 inhibitors are found to cause Upper GI complications as well as lower GI complications
COX-2 selective drugs inhibit PG synthesis through selective inhibition of COX-2 isoenzyme
Which of the following is best against release of arachidonic acid?
Which of the following is NOT a physiologic effect of COX-1?
Production of TXA2
Regulate renal blood flow
Maintain mucosal integrity
Induce inflammation and pain
Choose ALL of the following that can be seen in OA
Thickened synovial membrane
Which best describes Osteoarthritis?
Causes systemic symptoms
Radiographic findings of narrowed joint space and lipping of marginal bone
The least common form of joint disease
Can be diagnosed with laboratory findings
Prevalence of OA increased due to aging population and obesity
Which of the following is NOT a radiographic finding of OA?
Thinning subchondral bone
Hypertrophy of bone at articular margins
OA is overtreated
Which of the following would NOT be effective to treat nociceptive and inflammatory pain syndromes?
COX-2 selective inhibitors
Which of the following would NOT be effective in treating neuropathic and functional pain syndromes?
Nociceptive and inflammatory pain are both adaptive (protective)
OA pain mechanisms are unknown
Which of the following is NOT a method of pain management in OA?
Which of the following is TRUE regarding acetominophen?
It has potenet anti-inflammatory activity
It acts as a prodrug, activating CB1 receptors in the CNS
The recommended daily max dose for alcoholics is 4g
It decreases risk of bleeding
95% of Acetaminophen is conjugated into NAPQ1, a toxic metabolite
Why does chronic ingestion of ethanol increase risk of hepatotoxicity?
Because ethanol induces the CYP2E1 enzymes
Because ethanol decreases the amount of glutathione, therefore there isn't enough to convert NAPQ1 into an inactive mtabolite
Because ethanol inhibits the CYP2E1enzyme
Because it inhibits conjugation of acetominophen
Why is acetylcysteine used as an antidote for acetaminophen toxicity?
It acts as a precursor for glutathione
It is an expectorant, thus it expectorates acetominophen from the body
It inhibits the CYP2E1 enzymes
It induces the CYP2E1 enzyme
How do NSAIDs block the COX protein?
They block the hydrophobic channel of the COX protein where arachidonic acid binds
They block the production of arachidonic acid
They bind to Phospholipid A2
They bind to the COX protein, which causes inactivation of the enzyme
Which of the following is NOT possible from the use of NSAIDs?
Decrease renal blood flow resulting in renal ischemia
Which of the following is true regarding -oxicam like drugs
It is a selective COX inhibitor
They inhibit collagenase and proteoglycanase
It has a short half-life and therefore requires multiple doses daily
Low percentage of patients report adverse effects
Which of the following is a possible side effect of -oxicam like drugs when taken for a long period of time?
Fenamate derivatves are used for severe dysmenorrhea
Which of the following is NOT true regarding Indomethicin?
Used for spondylitis
It is an acetic acid derivative
Promotes closure of PDA
Used when ibuprofen is ineffective or not tolerated
Which of the following best describes the mechanism of Indomethacin?
Promotes the incorporation of arachidonic acid into triglycerides, thus reducing its availability for COX
Inhibits collagenase and proteoglycanase
Block the COX-2 enzyme ONLY
It is a folic acid analogue
Which of the following is true regarding ASA?
Decreases the duration of pregnancy
Used in treat fetal PDA
Reversibly binds to platelets so prolongs bleeding for one day
Can cause bronchoconstriction in ASA-sensitive asthmatics
Reye's syndrome develops in children who suffer a bacterial infection
Mr. Smith is a 70 year old male with history of inflammatory GI and gastric ulcers. You would like to prescribe NSAIDs to treat his OA. Which of the following drugs could you also co-prescribe to avoid worsening his other pre-existing conditions?
What advantage does Sulindac have over any other NSAID?
It causes less renal toxicity
It is a synthetic prostaglandin E1 analogue
It has no significant effect on bleeding time because it is a Cox-2 inhibitor
It decreases gastric irritation
Long-term NSAID analgesic medication is perfectly acceptable in patients with history of CV disease
Which of the following drugs is MOST appropriate for a nursing mother?
Why does ASA interact with antihypertensives?
Because antihypertensives depend on renal PG to work
Because it can cause prolonged bleeding
Because ASA prevents excretion of antihypertensives
Because antihypertensives increase plasma levels of ASA
Why should you not use SSRIs in combination with NSAIDs?
Because they can increase the risk of upper GI bleed
Because they cause more CNS effects
Because together can cause increase in hypersensitivity reactions
Because together they can worsen bronchoconstrition
The use of anticoagulants and ________ has caused reported fatal hemorrhages
Both A and B
Choose ALL of the following drugs whose renal clearance is reduced due to use of ASAs and NSAIDS
High ASA dose can inhibit the metabolism of which drug?
Which of the following drugs should be avoided in patients with sulfa allergy (according to Foong, not Chand)?
Celecoxib is metabolized by CYP 2D6
Which of the following drugs does NOT interact with COX-2 inhibitors?
Which of the following is NOT an adverse effect of COX-2 inhibitors?
Celecoxib and Ibuprofen are overall similar, except for cost, GI effects, and bleeding time effects
High carb diet can decrease absorption of acetominophen
SSRIs are more effective than TCAs as adjuvant analgesics
How can you delay absorption of ASA?
A and B
Under normal conditions, which of the following prevents platelet aggregation?
Phospholipase A2 is activated by which of the following?
Which of the following medications can lower the seizure threshold?
Which of the following is NOT a substrate of CYP2D6?
Which of the following is NOT a clinical use of Naltrexone?
Treatment of alcohol dependence
Prevent opioid addiction
Analgesia during the induction and maintenance of general anesthesia
Which of the following is NOT true regarding tramadol?
Its active metabolite has a greater affinity for mu receptors than codeine
Inhibits reuptake of NE and 5HT
Suppresses cough reflex
Has a quick onset of action
Which of the following is NOT true regarding opioids with mixed mechanisms?
Large doses can cause anxiety and dysphoria
They may antagonize action of opioids
Respiratory depression has a ceiling effect
Has full agonist effect at mu receptors, thus increasing addiction liability
Which of the following is NOT an indication for use of opioids with mixed mechanisms?
Obstetric analgesia during labor and delivery
Pre and post operative analgesia
Orally for mild pain
These are all indications
OA primarily attacks the joints but also skn, lungs, vessels and muscles
Rheumatoid arthritis, along with bacterial endocarditis and SLE, is found to have elevated levels of autoantibodies against
None of the above
Rheumatoid can occur at any age
Which of the following is NOT a goal of treating RA
Active patient and family participation
Preservation of function
These are all objectives
Successful treatment of RA is seen with when ________ are started immediately
What is the role of glucocorticoids in RA
Slow bone erosion and prevent new bone erosion
Reverse bone erosion
Prevent secondary fungal infection
Increase blood sugar
Newer biologic DMARDs are known to
Mask serious infections (bacterial or fungal)
Which of the following DMARDs is a folic acid analogue that may also increase adenosine levels?
Which of the following drugs requires monthly monitoring of CBC, liver, and renal function
Use of methotrexate increases risk of hepatotoxicity with fibrosis and cirrhosis
Which of the following DMARDs blocks synthesis of UMP, thus reducing B and T cell populations?
Leflunomide is currently used for
Cholestyramine can be given to clear hydroxychloroquine from the system quickly
How does Hydroxychloroquine work against RA?
Inhibits chemotaxis of eosinophils and neutrophils
It is a pyrimidine synthesis inhibitor
It inhibits macrophages responsible for inflammation
It inhibits matrix metalloproteinase
Which drug causes the least toxicity?
Which of the following is NOT an adverse effect of hydroxychloroquine?
Which of the following is a mechanism of Minocycline
Inhibits inflammatory cell migration and transformation of lymphocytes
Which of the following is NOT true regarding Chrysotherapy?
It is erratically absorbed orally
It acts by inhibition of macrophages responsible for inflammation
It is excreted through the kidneys
The intravenous route is preferred
Which of the following is true regarding the use of cyclophosphamide in the use of RA?
Increases bone erosion
It is used to reverse the progression of RA
It s used in patients where other anti-inflammatory drugs have been successful
Each of the following is a mechanism of penicillamine except
Reduces numbers of T-lymphocytes
Decreases IL-1 and rheumatoid factor
Prevents collagen from cross-linking
Inhibits inflammatory cell migration
Monitoring the CBC and liver enzymes is necessary when taking which drug?
Which of the following is NOT a common side effect of penicillamine?
Bone marrow suppression
Which of the following is NOT a disadvantage when using biological DMARDs?
They are very expensive
They increase risk of bcterial infections
Demyelination can occur
These are all disadvantages of biological DMARDs
Biological DMARDs are not recommended until at least one non-biological DMARD has been administered without sufficient success
Which of the following is FALSE regarding TNF inhibitors such as Entanercept?
They inhibit cytokines, thus preventing PG production and up-regulation of COX-2
They decrease joint destruction
They are also used for Crohn's disease
They prevent latent infections such as fungal or tuberculoid
Which of the following is true regarding rituximab?
Not used with methotrexate
Rash occurs in 30% of patients
No cardiovascular effects
It is a T-cell activation inhibitor
Rituximab depletes B lymphocytes by apoptosis
Which of the following best describes the mechanism of abatacept?
Prevents T-cell activation by complexing with 'co-stimulatory' molecules
Inhibits cytokines such as TNF alpha/IL-1 thus preventing PG production
Targets CD20 and depletes T lymphocytes
Abatacept cannot be used as monotherapy but can be used combination with other DMARDS
Which of the following is best described as "unique" and caused by deposition of urate crystals in joints
Which of the following is NOT one of the four stages of gout?
These are all stages of gout
Which of the following would not be used for gout
Colchicine can be used in low doses as prophylaxis for acute attacks of gout
Colchicine can be taken continuously at high doses
Colchicine limits the inflammatory response by which of the following mechanisms?
Decreasing motility of neutrophils
Deactivating URAT 1 transporter
Inhibit cytokines such as TNF alpha/IL-1 thus preventing PG production and up-regulation of COX-2
All of the above
Which drug shares the same mechanism as Allopurinol?
Why can't allopurinol be used for monotherapy?
Because it does not have any anti-inflammatory effects
Because it has no uric acid prevention mechanism
Because allopurinol only works in the presence of colchicine
Because it only works in the presence of NSAIDs
Which of the following is NOT an adverse effect of Allopurinol?
Steven Johnson rash
Which of the following is NOT true regarding Probenecid
It deactivates the URAT 1 transporter, thus preveting reabsorption of urate
Can cause renal stones
Used for treatment of chronic hyperuricemia
Makes uric acid levels fall which causes more crystal deposition in the synovium
Febuxostat requires dose adjustment during renal insufficiency
Which of the following gout medications could also be useful in a patient with hypertension
Which of the following has a similar mechanism to Probenecid but should be used with caution in patients taking anticoagulants?
Which of the following is NOT true regarding SLE?
Can be cause by environmental factors
Increased IgA production
Failure to remove immune complexes from circulation can lead to vasculitis and disease
There is impaired T cell regulation
There is a prevalence of SLE in women. One possible reason for this is because
Calcium is a B-cell stimulator
IL-10 is a B-cell stimulator
Estrogen is a B-cell stimulator
Prolactin is a B-cell stimulator
Increased levels of erythrocyte sedimentation rate is specific to SLE
For treatment of SLE, we should NOT use drugs with
the least side effects
the lowerst dose to control disease
long term damage prevention
steroids in mild disease
Corticosteroids can cause muscle wasting
What is a concern with abruptly withdrawing corticosteroids?
Possible adrenal insufficiency
Which of the following is NOT true regarding the use of hydroxychloroquine?
Exact mechanism is unknown
May lead to regression of skin lesions
May improve psoriasis
Ophthalmologic examinations should be performed prior to administration and periodically after
What leads to the formation of PGE2 and PGI2?
Which of the following does NOT use a voltage-gated calcium channel?
Which of the following is NOT a common mediator in peripheral sensitization?
For peripheral sensitization, which of the following is NOT used to target analgesia?
Which of the following does NOT contribute to central sensitization?
Nitric oxide synthase
L-NAME can be used to inhibit NOS which prevents further retrograde stimulation of glutamate release
Which ion is usually associated with NMDA in its inactive state ?
Which of the following inhibits the dissociation of Mg from the NMDA receptor, thus preventing activation?
Both A and C
Which of the following is NOT a mechanism of opioids?
They activate descending PAG neurons
They directly activate opioid receptors
They activate descending NMR and LC neurons
They activate presynaptic potassium channels which decreases conductance
Which of the following opioid receptors does NOT mediate the main pharmacological effects of opiates?
Which opioid receptor subunit is responsible for most of the analgesic effects along with some unwanted effects?
Opioid receptor activation is G-coupled
Select ALL of the strong opiods
Select ALL of the pure opioid agonists
Opiod pure agonists have a higher affinity for_________ receptors.
B and C
Pentazocine is an antagonist at the ___________ receptor, but a partial agonist at the _____________ receptor.
Mu; Kappa and delta
Kappa; Mu and delta
Delta; kappa and mu
Mu; Kappa and sigma
Most mixed mechanism opioids cause
Which peripherally acting opioid antagonist can be used to reduce post-op ileus and opioid-induced constipation?
Opioids have a ceiling effect
Which of the following does NOT have a 90% first pass effect?
Which of the following receptors does codeine activate?
Both B and C
How is morphine excreted?
Through the bile
Both and A and B
How is codeine excreted?
Through breast milk
Which of the following is true?
Codeine is a more effective analgesia than morphine
Codeine provides little euphoria
Physical dependence is common in users of low daily dose
No risk of opiate withdrawal symptoms with sudden stop
Codeine does not cause tolerance over prolonged use
Which of the following is an alternative to codeine when a weak opiod is required?
Which of the following is an alternative to codeine when a strong opiod is required?
Which of the following is equipotent to morphine but has greater oral efficacy?
Which of the following is used to treat opioid addiction?
Which of the following opioids can prolong QT interval
Methadone has a long duration and therefore can be given has a single dose daily
It is better to give meperidine orally rather than IV because it decreases risk of anxiety and other CNS side effects
Which of the following is correct, starting with the least potent to the most potent
Which of the following is NOT true regarding fentanyl?
It may induce skeletal rigidity at high doses
Does NOT cause histamine release
Smaller safety margin than morphine
Minimal respiration depression
There is no ceiling effect of respiratory depression with use of opioids with mixed mechanisms
Which of the following is an advantage of fentanyl patches?
Good if concerned about drug abuse
Residual activity after patch is removed
Which of the following is true regarding opioids with mixed mechanisms
May antagonize action of opioid agonists
Increases addiction liability
Small doses can cause hallucinations
Large doses can cause euphoria