Deck 4: Drugs Used in the Treatment of Bone and Joint Disorders

Question 1

A 42-year-old male visits the ENT clinic complaining of a 2-week history of tinnitus.Physical examination is negative for infectious or neurological pathology.What important history may explain the patient's symptoms?

A)He was diagnosed with cerumen impaction 3 months ago and successfully treated with cerumen softeners and ear flushing.
B)He was diagnosed with a ruptured tympanic membrane 5 years ago after which his hearing returned to normal.
C)He began taking etodolac 3 weeks ago for right shoulder pain and swelling.
D)There is a family history of brain tumors.

Answer 1

He began taking etodolac 3 weeks ago for right shoulder pain and swelling.

Question 2

Which agent is an example of a nonbiological disease-modifying antirheumatic drug?

A)adalimumab (Humara)
B)etanercept (Enbrel)
C)anakinra (Kineret)
D)methotrexate (Folex,Rheumatrex)

Answer 2

methotrexate (Folex,Rheumatrex)

Question 3

Which of the following changes is not typically seen in a patient with RA?

A)Joint and surrounding soft tissue inflammation
B)Synovial proliferation
C)Cartilage erosion
D)Bony erosion
E)Osteoporosis

Answer 3

Osteoporosis

Question 4

A patient visits her primary care provider for follow-up of bilateral knee osteoarthritis.She takes naproxen 250 mg 2 times a day with good relief of knee pain.She states that after the second dose she experiences "heartburn." Upon further questioning,she states that she takes the second dose just before bedtime with only a sip of water,stating that "Otherwise I have to get up during the night to urinate!" What patient education is most appropriate to potentially alleviate her presenting complaint?

A)She should take naproxen four times a day to decrease a nighttime "loading" effect that is most likely causing her complaint.
B)She should take the naproxen with juice because the acid content will help dissolve the medication faster.
C)She should take the naproxen with a full glass of water and remain upright for 30 minutes following ingestion.
D)She should crush the tablets and mix them with fluids.

Question 5

What factor best puts the elderly patient at risk for chronic salicylism that can spiral into an acute event with an expected morality rate of 1%?

A)The patient may consume an increasing amount of NSAIDs over several days to alleviate arthralgias and subsequently become confused,leading to increased medication consumption.
B)The gastrointestinal tracts of the elderly patients are more acidic,leading to the increased breakdown and subsequent absorption of NSAIDs.
C)An increased incidence of psychological conditions may lead to impaired judgment and increased medication consumption.
D)Increased hepatic and liver metabolism of NSAIDs in the elderly results in decreased effects of the medication over time,leading to increased consumption.

Question 6

Salicylism is common among those who self-medicate with any drug in the NSAID class.Which of the following is not a common presenting symptom of salicylism?

A)Headache
B)Dizziness
C)Thirst
D)Hypoventilation
E)Nausea

Question 7

The American College of Rheumatology's updated guidelines suggest which initial treatment protocol for rheumatoid arthritis (RA)patients diagnosed with a high level of disease?

A)leflunomide
B)aspirin
C)acetaminophen
D)corticosteroids

Question 8

What treatment of acute acetaminophen overdose is best directed at protection against hepatic damage?

A)Gastric lavage within 6 hours of ingestion
B)Administration of high doses of steroids
C)Administration of N-acetylcysteine within 24 hours of ingestion
D)Forced diuresis within 12 hours of ingestion

Question 9

Inflammation in the body leads to cell membrane destruction and the release of chemical mediators.What enzyme is necessary in order to produce these mediators?

A)Lipo-oxygenase
B)Cytokine
C)Histamine
D)Prostaglandin
E)Leukotriene

Question 10

A 55-year-old female patient is referred to a rheumatologist after being diagnosed with RA by her primary care physician 3 months ago.She was initially prescribed ketoprofen.She is referred due to no improvement in her symptoms.What is the most appropriate pharmacologic agent to add to the patient's regimen?

A)corticosteroid
B)etanercept (Enbrel)
C)acetaminophen
D)oxycodone (Percocet)

Question 11

COX-1-inhibiting NSAIDs result in adverse effects on the gastrointestinal tract.What causes this adverse effect?

A)COX-1 regulates gastric acid secretion.
B)COX-1 inhibits the synthesis of prostaglandins.
C)COX-1 regulates endothelial cells in the kidney.
D)COX-1 promotes the secretion of histamine.

Question 12

A patient has taken NSAIDs for an extended period of time for the treatment of RA.What presenting symptoms most appropriately indicate the patient may have hepatic failure?

A)History of black,tarry stools;left lower quadrant pain;and fever
B)Abdominal skin rashes,pruritis,nail pitting,and decreased capillary refill
C)Flank pain,urinary frequency,urinary urgency,and hematuria
D)Right upper quadrant tenderness,fatigue,lethargy,and persistent headaches

Question 13

Patient noncompliance regarding use of NSAIDs for bone and joint disorders is a significant cause of medication ineffectiveness.What is one possible explanation for this noncompliance?

A)NSAIDs often leave an unpleasant bitter aftertaste that may affect a patient's ability to properly appreciate the taste of food.
B)Once a patient begins to take NSAIDs,it may take up to 2 weeks to see improvement in arthritis symptoms.
C)NSAIDs often cause moderate lethargy in patients,decreasing their daily productivity.
D)Patients who initiate a course of NSAIDs may be afraid that they will gain an excessive amount of weight due to water retention (predominantly women).

Question 14

Although gold salts have been utilized for the treatment of inflammation for more than 65 years,why are they currently agents of last resort-reserved for those patients who do not respond to anything else?

A)Gold salts are slow acting.
B)Gold salts are less toxic than DMARDs.
C)Gold salts are an older and less expensive drug.
D)Gold salts require regular urine protein monitoring.

Question 15

A 36-year-old woman is diagnosed with RA.She is a stay-at-home mother of two school-age children.She begins a treatment protocol that includes anakinra 100 mg SQ once daily.What additional therapeutic intervention is least relevant to her pathology management?

A)Avoidance of infections
B)Physical therapy
C)Exercise
D)Rest
E)Hydration

Question 16

What is the most appropriate situation in which corticosteroids can be used in conscientious prescribing of DMARDs?

A)Late in treatment to provide symptomatic relief when biologic DMARDs fail
B)In high doses for patients who fail to get adequate response from a DMARD
C)In bursts to treat acute flares of disease
D)If adequate response was achieved by a biologic DMARD

Question 17

Patients taking low doses of aspirin daily are at risk for gouty attacks.What is the mechanism by which this situation may occur?

A)Aspirin interferes with uric acid secretion.
B)Aspirin interferes with uric acid excretion.
C)Aspirin interferes with the production of uric acid.
D)Aspirin blocks the inflammatory cascade.

Question 18

What unique property does aspirin possess that differs from other NSAIDs?

A)Antipyretic properties
B)Anti-inflammatory properties
C)Analgesic properties
D)Antiplatelet properties

Question 19

Which agent used to treat hyperuricemia also increases circulating levels of antibiotics?

A)probenecid (Benemid)
B)colchicine
C)allopurinol (Zyloprim)
D)sulfinpyrazone (Anturane)

Question 20

Tumor necrosis factor (TNF)was developed by recombinant DNA synthesis.By what mechanism does etanercept affect the pathology of RA?

A)Etanercept targets TNF-alpha and is specific to only the human form.
B)Etanercept acts by blocking the action of interleukin-1.
C)Etanercept interferes with the inflammatory cascade initiated by TNR-alpha,thereby lowering circulating cytokines.
D)Etanercept interferes with collagen biosynthesis.

Question 21

Match the pathology with its correct therapeutic intervention.Pathologies may be used more than once.

NSAIDs

A)Improved joint mobility and function
B)Treatment of gout
C)Prescribed for pain

Question 22

Match the drug with its correct mechanism of action.

auranofin (Ridaura)

A)Decreases the T-cell response to mitogens
B)Chimeric monoclonal antibody
C)Alters cellular mechanisms such as collagen biosynthesis
D)Folate antimetabolite that inhibits DNA synthesis
E)Triggers p53 translocation,inhibiting pyrimidine

Question 23

Match the pathology with its correct therapeutic intervention.Pathologies may be used more than once.

Gold salts

A)Improved joint mobility and function
B)Treatment of gout
C)Prescribed for pain

Question 24

A 76-year-old patient has not had significant reduction in osteoarthritic shoulder pain after 8 weeks of nondrug therapy.The most symptomatic shoulder is the patient's dominant arm.She has taken acetaminophen for pain without relief.What consideration is the least significant in choosing an NSAID for her?

A)The cost of the drug
B)Prior history of gastrointestinal intolerance to NSAIDs
C)History of congestive heart failure
D)History of reaction to colchicine
E)Bleeding disorder history

Question 25

Match the NSAID adverse reaction with the correct signs and symptoms.

Tylenol toxicity

A)Fatigue,lethargy,pruritus,jaundice,and headache
B)Black tarry stool,skin rash,edema,and weight gain
C)Nausea,vomiting,and diaphoresis
D)Headache,dizziness,tinnitus,and hearing loss

Question 26

Match the pathology with its correct therapeutic intervention.Pathologies may be used more than once.

Tumor necrosis factor

A)Improved joint mobility and function
B)Treatment of gout
C)Prescribed for pain

Question 27

Match the drug with its correct mechanism of action.

methotrexate (Folex,Rheumatrex)

A)Decreases the T-cell response to mitogens
B)Chimeric monoclonal antibody
C)Alters cellular mechanisms such as collagen biosynthesis
D)Folate antimetabolite that inhibits DNA synthesis
E)Triggers p53 translocation,inhibiting pyrimidine

Question 28

Match the pathology with its correct therapeutic intervention.Pathologies may be used more than once.

colchicine

A)Improved joint mobility and function
B)Treatment of gout
C)Prescribed for pain

Question 29

Match the drug with its correct mechanism of action.

infliximab (Remicade)

A)Decreases the T-cell response to mitogens
B)Chimeric monoclonal antibody
C)Alters cellular mechanisms such as collagen biosynthesis
D)Folate antimetabolite that inhibits DNA synthesis
E)Triggers p53 translocation,inhibiting pyrimidine

Question 30

What advantage do COX-2 isomers possess that makes them more desirable than COX-1 isomers for the treatment of osteoarthritis?

A)COX-2 isomers are present in all cells and thus are constantly available.
B)COX-2 isomers are released upon the initiation of inflammation.
C)COX-2 isomers play a role in prostaglandin production.
D)COX-2 isomers are expressed by the human kidney.

Question 31

A 67-year-old patient is diagnosed with bilateral osteoarthritic knee pain.The patient begins to successfully lose weight and completes 6 weeks of range of motion and muscle strengthening therapy.He states during his follow-up visit that he has significantly reduced knee pain.What is the most appropriate course of management?

A)A 4-week course of acetaminophen
B)Topical capsaicin
C)A 6-week course of celecoxib (Celebrex)
D)Continuation of current management

Question 32

Which of the following drugs used to treat gout does not affect the circulatory levels of uric acid?

A)colchicine
B)allopurinol (Zyloprim)
C)probenecid (Benemid)
D)sulfinpyrazone (Anturane)

Question 33

Match the drug with its correct mechanism of action.

leflunomide (Arava)

A)Decreases the T-cell response to mitogens
B)Chimeric monoclonal antibody
C)Alters cellular mechanisms such as collagen biosynthesis
D)Folate antimetabolite that inhibits DNA synthesis
E)Triggers p53 translocation,inhibiting pyrimidine

Question 34

Match the pathology with its correct therapeutic intervention.Pathologies may be used more than once.

DMARDs

A)Improved joint mobility and function
B)Treatment of gout
C)Prescribed for pain

Question 35

Match the NSAID adverse reaction with the correct signs and symptoms.

Salicylism

A)Fatigue,lethargy,pruritus,jaundice,and headache
B)Black tarry stool,skin rash,edema,and weight gain
C)Nausea,vomiting,and diaphoresis
D)Headache,dizziness,tinnitus,and hearing loss

Question 36

Which gold compound is exclusively utilized for the treatment of juvenile rheumatoid arthritis (JRA)?

A)hydroxychloroquine
B)aurothioglucose suspension
C)sodium aurothiomalate
D)infliximab

Question 37

Match the NSAID adverse reaction with the correct signs and symptoms.

Hepatic failure

A)Fatigue,lethargy,pruritus,jaundice,and headache
B)Black tarry stool,skin rash,edema,and weight gain
C)Nausea,vomiting,and diaphoresis
D)Headache,dizziness,tinnitus,and hearing loss

Question 38

Match the drug with its correct mechanism of action.

hydroxyychloroquine (Plaquenil)

A)Decreases the T-cell response to mitogens
B)Chimeric monoclonal antibody
C)Alters cellular mechanisms such as collagen biosynthesis
D)Folate antimetabolite that inhibits DNA synthesis
E)Triggers p53 translocation,inhibiting pyrimidine

Question 39

Match the pathology with its correct therapeutic intervention.Pathologies may be used more than once.

COX

A)Improved joint mobility and function
B)Treatment of gout
C)Prescribed for pain

Question 40

Match the NSAID adverse reaction with the correct signs and symptoms.

Gastrointestinal ulceration

A)Fatigue,lethargy,pruritus,jaundice,and headache
B)Black tarry stool,skin rash,edema,and weight gain
C)Nausea,vomiting,and diaphoresis
D)Headache,dizziness,tinnitus,and hearing loss

Question 41

Match the therapeutic agent with its correct mechanism of action.Mechanism of actions may be used more than once.

colchicine

A)Enzyme xanthine oxidase inhibitor
B)Plant alkaloid believed to interfere with leukocyte function
C)Inhibits renal tubular absorption of uric acid

Question 42

Match the therapeutic agent with its correct mechanism of action.Mechanism of actions may be used more than once.

allopurinol (Zyloprim)

A)Enzyme xanthine oxidase inhibitor
B)Plant alkaloid believed to interfere with leukocyte function
C)Inhibits renal tubular absorption of uric acid

Question 43

Match the therapeutic agent with its correct mechanism of action.Mechanism of actions may be used more than once.

probenecid (Benemid)

A)Enzyme xanthine oxidase inhibitor
B)Plant alkaloid believed to interfere with leukocyte function
C)Inhibits renal tubular absorption of uric acid

Question 44

Match the therapeutic agent with its correct mechanism of action.Mechanism of actions may be used more than once.

sulfinpyrazone (Anturane)

A)Enzyme xanthine oxidase inhibitor
B)Plant alkaloid believed to interfere with leukocyte function
C)Inhibits renal tubular absorption of uric acid