Frage 1
Frage
Which of the following is NOT a cardinal sign of inflammation?
Antworten
-
Rubor
-
Tumor
-
Functio Laesa
-
Crepitus
Frage 2
Frage
Inflammation ends with permanent destruction of tissue or with complete healing after removal of injurious stimulus
Frage 3
Frage
Chronic inflammation is beneficial
Frage 4
Frage
Cell damage results in the release of
Antworten
-
Prostaglandins
-
Prostacyclines
-
Eiocosanoids
-
All of the above
Frage 5
Frage
A fundamental feature of inflammation is
Frage 6
Frage
Which of the following is NOT a goal of treatment of inflammation?
Antworten
-
Relief of symptoms
-
Maintenance of function
-
Slowing tissue damage
-
Short term control
Frage 7
Frage
Which of the following is NOT considered a drug treatment of arthritis?
Antworten
-
NSAIDS
-
Corticosteroids
-
DMARDS
-
Naltrexone
Frage 8
Frage
Which of the following is true about NSAIDS?
Antworten
-
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
Frage 9
Frage
Which of the following is best against release of arachidonic acid?
Antworten
-
ASA
-
Indomethacin
-
Corticosteroids
-
Acetominophen
Frage 10
Frage
Which of the following is NOT a physiologic effect of COX-1?
Antworten
-
Production of TXA2
-
Regulate renal blood flow
-
Maintain mucosal integrity
-
Induce inflammation and pain
Frage 11
Frage
Choose ALL of the following that can be seen in OA
Frage 12
Frage
Which best describes Osteoarthritis?
Antworten
-
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
Frage 13
Frage
Prevalence of OA increased due to aging population and obesity
Frage 14
Frage
Which of the following is NOT a radiographic finding of OA?
Frage 15
Frage 16
Frage
Which of the following would NOT be effective to treat nociceptive and inflammatory pain syndromes?
Frage 17
Frage
Which of the following would NOT be effective in treating neuropathic and functional pain syndromes?
Antworten
-
Gabapentin
-
Amytriptyline
-
Venlafaxine (SNRI)
-
Opioids
Frage 18
Frage
Nociceptive and inflammatory pain are both adaptive (protective)
Frage 19
Frage
OA pain mechanisms are unknown
Frage 20
Frage
Which of the following is NOT a method of pain management in OA?
Frage 21
Frage
Which of the following is TRUE regarding acetominophen?
Antworten
-
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
Frage 22
Frage
95% of Acetaminophen is conjugated into NAPQ1, a toxic metabolite
Frage 23
Frage
Why does chronic ingestion of ethanol increase risk of hepatotoxicity?
Antworten
-
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
Frage 24
Frage
Why is acetylcysteine used as an antidote for acetaminophen toxicity?
Antworten
-
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
Frage 25
Frage
How do NSAIDs block the COX protein?
Antworten
-
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
Frage 26
Frage
Which of the following is NOT possible from the use of NSAIDs?
Frage 27
Frage
Which of the following is true regarding -oxicam like drugs
Antworten
-
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
Frage 28
Frage
Which of the following is a possible side effect of -oxicam like drugs when taken for a long period of time?
Antworten
-
Tinnitus
-
Thrombosis
-
CNS effects
-
Blurred vision
Frage 29
Frage
Fenamate derivatves are used for severe dysmenorrhea
Frage 30
Frage
Which of the following is NOT true regarding Indomethicin?
Frage 31
Frage
Which of the following best describes the mechanism of Indomethacin?
Antworten
-
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
Frage 32
Frage
Which of the following is true regarding ASA?
Antworten
-
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
Frage 33
Frage
Reye's syndrome develops in children who suffer a bacterial infection
Frage 34
Frage
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?
Antworten
-
Cytotec
-
ASA
-
Sulindac
-
Naproxen
Frage 35
Frage
What advantage does Sulindac have over any other NSAID?
Antworten
-
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
Frage 36
Frage
Long-term NSAID analgesic medication is perfectly acceptable in patients with history of CV disease
Frage 37
Frage
Which of the following drugs is MOST appropriate for a nursing mother?
Antworten
-
ASA
-
Ibuprofen
-
Celecoxib
-
Ketorolac
Frage 38
Frage
Why does ASA interact with antihypertensives?
Antworten
-
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
Frage 39
Frage
Why should you not use SSRIs in combination with NSAIDs?
Antworten
-
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
Frage 40
Frage
The use of anticoagulants and ________ has caused reported fatal hemorrhages
Antworten
-
ASA
-
NSAIDS
-
Acetominophen
-
Both A and B
Frage 41
Frage
Choose ALL of the following drugs whose renal clearance is reduced due to use of ASAs and NSAIDS
Antworten
-
Digoxin
-
Methotrexate
-
Anticoagulants
-
Ethanol
Frage 42
Frage
High ASA dose can inhibit the metabolism of which drug?
Antworten
-
Valproic acid
-
Methotrexate
-
Digoxin
-
Cyclosporine
Frage 43
Frage
Which of the following drugs should be avoided in patients with sulfa allergy (according to Foong, not Chand)?
Antworten
-
Celecoxib
-
Sulfasalazine
-
Sulfinpyrazone
-
Cyclosporine
Frage 44
Frage
Celecoxib is metabolized by CYP 2D6
Frage 45
Frage
Which of the following drugs does NOT interact with COX-2 inhibitors?
Antworten
-
ACE inhibitors
-
Fluconazole
-
Rifampin
-
Valproic acid
Frage 46
Frage
Which of the following is NOT an adverse effect of COX-2 inhibitors?
Antworten
-
Bleeding time
-
Gastric disorder
-
Bronchoconstriction
-
Cardiovascular toxicity
Frage 47
Frage
Celecoxib and Ibuprofen are overall similar, except for cost, GI effects, and bleeding time effects
Frage 48
Frage
High carb diet can decrease absorption of acetominophen
Frage 49
Frage
SSRIs are more effective than TCAs as adjuvant analgesics
Frage 50
Frage
How can you delay absorption of ASA?
Antworten
-
Increase pH
-
Food
-
Decrease pH
-
A and B
Frage 51
Frage
Under normal conditions, which of the following prevents platelet aggregation?
Antworten
-
PG12
-
PGE2
-
TXA2
-
Both A and B
Frage 52
Frage
Phospholipase A2 is activated by which of the following?
Antworten
-
Cytokines
-
Growth factors
-
LPS
-
All of the above
Frage 53
Frage
Which of the following medications can lower the seizure threshold?
Antworten
-
Tramadol
-
Morphine
-
Codeine
-
Vicodin
Frage 54
Frage
Which of the following is NOT a substrate of CYP2D6?
Antworten
-
Codeine
-
Tramadol
-
Oxycodone
-
Celecoxib
Frage 55
Frage
Which of the following is NOT a clinical use of Naltrexone?
Frage 56
Frage
Which of the following is NOT true regarding tramadol?
Antworten
-
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
Frage 57
Frage
Which of the following is NOT true regarding opioids with mixed mechanisms?
Antworten
-
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
Frage 58
Frage
Which of the following is NOT an indication for use of opioids with mixed mechanisms?
Antworten
-
Obstetric analgesia during labor and delivery
-
Pre and post operative analgesia
-
Orally for mild pain
-
These are all indications
Frage 59
Frage
OA primarily attacks the joints but also skn, lungs, vessels and muscles
Frage 60
Frage
Rheumatoid arthritis, along with bacterial endocarditis and SLE, is found to have elevated levels of autoantibodies against
Antworten
-
Rheumatoid factor
-
IgG
-
IgA
-
None of the above
Frage 61
Frage
Rheumatoid can occur at any age
Frage 62
Frage
Which of the following is NOT a goal of treating RA
Frage 63
Frage
Successful treatment of RA is seen with when ________ are started immediately
Antworten
-
Biological DMARDs
-
Non-biological DMARDs
-
Acetominophen
-
NSAIDs
Frage 64
Frage
What is the role of glucocorticoids in RA
Frage 65
Frage
Newer biologic DMARDs are known to
Frage 66
Frage
Which of the following DMARDs is a folic acid analogue that may also increase adenosine levels?
Antworten
-
Methotrexate
-
Leflunomide
-
Hydroxychloroquine
-
Penicillamine
Frage 67
Frage
Which of the following drugs requires monthly monitoring of CBC, liver, and renal function
Antworten
-
Methotrexate
-
Leflunomide
-
Gold
-
Minocycline
Frage 68
Frage
Use of methotrexate increases risk of hepatotoxicity with fibrosis and cirrhosis
Frage 69
Frage
Which of the following DMARDs blocks synthesis of UMP, thus reducing B and T cell populations?
Antworten
-
Methotrexate
-
Leflunomide
-
Minocycline
-
Hydroxychloroquine
Frage 70
Frage
Leflunomide is currently used for
Antworten
-
RA
-
SLE
-
Myasthenia gravis
-
All of the above
Frage 71
Frage
Cholestyramine can be given to clear hydroxychloroquine from the system quickly
Frage 72
Frage
How does Hydroxychloroquine work against RA?
Antworten
-
Inhibits chemotaxis of eosinophils and neutrophils
-
It is a pyrimidine synthesis inhibitor
-
It inhibits macrophages responsible for inflammation
-
It inhibits matrix metalloproteinase
Frage 73
Frage
Which drug causes the least toxicity?
Antworten
-
Hydroxychloroquine
-
Methotrexate
-
Leflunomide
-
TNF inhibitors
Frage 74
Frage
Which of the following is NOT an adverse effect of hydroxychloroquine?
Antworten
-
Pigmentary retinitis
-
Irreversible myopathies
-
Photophobia
-
Visual loss
Frage 75
Frage
Which of the following is a mechanism of Minocycline
Frage 76
Frage
Which of the following is NOT true regarding Chrysotherapy?
Antworten
-
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
Frage 77
Frage
Which of the following is true regarding the use of cyclophosphamide in the use of RA?
Frage 78
Frage
Each of the following is a mechanism of penicillamine except
Antworten
-
Reduces numbers of T-lymphocytes
-
Decreases IL-1 and rheumatoid factor
-
Prevents collagen from cross-linking
-
Inhibits inflammatory cell migration
Frage 79
Frage
Monitoring the CBC and liver enzymes is necessary when taking which drug?
Antworten
-
Leflunomide
-
Gold
-
Penicillamine
-
None of the above
Frage 80
Frage
Which of the following is NOT a common side effect of penicillamine?
Antworten
-
Bone marrow suppression
-
Dysgeusia
-
Anorexia
-
Dizziness
Frage 81
Frage
Which of the following is NOT a disadvantage when using biological DMARDs?
Frage 82
Frage
Biological DMARDs are not recommended until at least one non-biological DMARD has been administered without sufficient success
Frage 83
Frage
Which of the following is FALSE regarding TNF inhibitors such as Entanercept?
Antworten
-
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
Frage 84
Frage
Which of the following is true regarding rituximab?
Antworten
-
Not used with methotrexate
-
Rash occurs in 30% of patients
-
No cardiovascular effects
-
It is a T-cell activation inhibitor
Frage 85
Frage
Rituximab depletes B lymphocytes by apoptosis
Frage 86
Frage
Which of the following best describes the mechanism of abatacept?
Antworten
-
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
-
All of the above
Frage 87
Frage
Abatacept cannot be used as monotherapy but can be used combination with other DMARDS
Frage 88
Frage
Which of the following is best described as "unique" and caused by deposition of urate crystals in joints
Antworten
-
Gout
-
Rheumatoid
-
Osteoartritis
-
Kidney stones
Frage 89
Frage
Which of the following is NOT one of the four stages of gout?
Frage 90
Frage
Which of the following would not be used for gout
Antworten
-
NSAIDs
-
Colchine
-
Allopurinol
-
Rituximab
Frage 91
Frage
Colchicine can be used in low doses as prophylaxis for acute attacks of gout
Frage 92
Frage
Colchicine can be taken continuously at high doses
Frage 93
Frage
Colchicine limits the inflammatory response by which of the following mechanisms?
Antworten
-
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
Frage 94
Frage
Which drug shares the same mechanism as Allopurinol?
Antworten
-
Febuxostate
-
Cochicine
-
Methotrexate
-
Probenecid
Frage 95
Frage
Why can't allopurinol be used for monotherapy?
Antworten
-
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
Frage 96
Frage
Which of the following is NOT an adverse effect of Allopurinol?
Antworten
-
Steven Johnson rash
-
Hepatic necrosis
-
Vomiting
-
Renal stones
Frage 97
Frage
Which of the following is NOT true regarding Probenecid
Antworten
-
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
Frage 98
Frage
Febuxostat requires dose adjustment during renal insufficiency
Frage 99
Frage
Which of the following gout medications could also be useful in a patient with hypertension
Antworten
-
Losartan
-
Sulfinpyrazone
-
Glucocorticoids
-
Febuxostate
Frage 100
Frage
Which of the following has a similar mechanism to Probenecid but should be used with caution in patients taking anticoagulants?
Antworten
-
Losartan
-
Sulfinpyrazone
-
Glucocorticoids
-
None of the above
Frage 101
Frage
Which of the following is NOT true regarding SLE?
Antworten
-
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
Frage 102
Frage
There is a prevalence of SLE in women. One possible reason for this is because
Antworten
-
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
Frage 103
Frage
Increased levels of erythrocyte sedimentation rate is specific to SLE
Frage 104
Frage
For treatment of SLE, we should NOT use drugs with
Frage 105
Frage
Corticosteroids can cause muscle wasting
Frage 106
Frage
What is a concern with abruptly withdrawing corticosteroids?
Frage 107
Frage
Which of the following is NOT true regarding the use of hydroxychloroquine?
Antworten
-
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
Frage 108
Frage
What leads to the formation of PGE2 and PGI2?
Frage 109
Frage
Which of the following does NOT use a voltage-gated calcium channel?
Antworten
-
Ziconitide
-
Omega-conotoxin
-
Gabapentin
-
Glutamate
Frage 110
Frage
Which of the following is NOT a common mediator in peripheral sensitization?
Antworten
-
Glutamate
-
Bradykinins
-
Protons
-
NGF
Frage 111
Frage
For peripheral sensitization, which of the following is NOT used to target analgesia?
Antworten
-
ASA
-
COX-2 inhibitors
-
Indomethicin
-
Acetominophen
Frage 112
Frage
Which of the following does NOT contribute to central sensitization?
Antworten
-
Nitric oxide synthase
-
Glutamate
-
Substance P
-
Bradykinins
Frage 113
Frage
L-NAME can be used to inhibit NOS which prevents further retrograde stimulation of glutamate release
Frage 114
Frage
Which ion is usually associated with NMDA in its inactive state ?
Antworten
-
Magnesium
-
Sodium
-
Calcium
-
Potassium
Frage 115
Frage
Which of the following inhibits the dissociation of Mg from the NMDA receptor, thus preventing activation?
Antworten
-
Ketamine
-
DM
-
GABA
-
Both A and B
-
Both A and C
Frage 116
Frage
Which of the following is NOT a mechanism of opioids?
Antworten
-
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
Frage 117
Frage
Which of the following opioid receptors does NOT mediate the main pharmacological effects of opiates?
Frage 118
Frage
Which opioid receptor subunit is responsible for most of the analgesic effects along with some unwanted effects?
Frage 119
Frage
Opioid receptor activation is G-coupled
Frage 120
Frage
Select ALL of the strong opiods
Antworten
-
Morphine
-
Meperidine
-
Methadone
-
Fentanyl
-
Codeine
-
Oxycodone
-
Pentazocine
-
Hydrocodone
Frage 121
Frage
Select ALL of the pure opioid agonists
Antworten
-
Morphine
-
Hydromorphone
-
Codeine
-
Oxycodone
-
Meperidine
-
Fentanyl
-
Pentazocine
-
Naloxone
-
Naltrexone
-
Buprenorphine
Frage 122
Frage
Opiod pure agonists have a higher affinity for_________ receptors.
Frage 123
Frage
Pentazocine is an antagonist at the ___________ receptor, but a partial agonist at the _____________ receptor.
Antworten
-
Mu; Kappa and delta
-
Kappa; Mu and delta
-
Delta; kappa and mu
-
Mu; Kappa and sigma
Frage 124
Frage
Most mixed mechanism opioids cause
Antworten
-
Dysphoria
-
Euphoria
-
Respiratory depression
-
Physical dependence
Frage 125
Frage
Which peripherally acting opioid antagonist can be used to reduce post-op ileus and opioid-induced constipation?
Antworten
-
Alvimopan
-
Morphine
-
Naltrexone
-
Pentazocine
Frage 126
Frage
Opioids have a ceiling effect
Frage 127
Frage
Which of the following does NOT have a 90% first pass effect?
Antworten
-
Morphine
-
Codeine
-
Hydromorphone
-
Meperidine
Frage 128
Frage
Which of the following receptors does codeine activate?
Antworten
-
Kappa
-
Delta
-
Mu
-
Both B and C
Frage 129
Frage
How is morphine excreted?
Antworten
-
Renally
-
Through the bile
-
Both and A and B
-
None of the above
Frage 130
Frage
How is codeine excreted?
Antworten
-
Renally
-
Through breast milk
-
Hepatic
-
Both A and B
-
Both A and C
Frage 131
Frage
Which of the following is true?
Antworten
-
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
Frage 132
Frage
Codeine does not cause tolerance over prolonged use
Frage 133
Frage
Which of the following is an alternative to codeine when a weak opiod is required?
Antworten
-
Meperidine
-
Fentanyl
-
Propoxyphene
-
Oxycodone
Frage 134
Frage
Which of the following is an alternative to codeine when a strong opiod is required?
Antworten
-
Morphine
-
Meperidine
-
Propoxyphene
-
Fentanyl
Frage 135
Frage
Which of the following is equipotent to morphine but has greater oral efficacy?
Antworten
-
Methadone
-
Meperidine
-
Codeine
-
Fentanyl
Frage 136
Frage
Which of the following is used to treat opioid addiction?
Antworten
-
Methadone
-
Meperidine
-
Morphine
-
Codeine
Frage 137
Frage
Which of the following opioids can prolong QT interval
Antworten
-
Methadone
-
Meperidine
-
Morphine
-
Fentanyl
Frage 138
Frage
Methadone has a long duration and therefore can be given has a single dose daily
Frage 139
Frage
It is better to give meperidine orally rather than IV because it decreases risk of anxiety and other CNS side effects
Frage 140
Frage
Which of the following is correct, starting with the least potent to the most potent
Antworten
-
Fentanyl<morphine<codeine
-
Fentanyl<codeine<morphine
-
Morphine<codeine<fentanyl
-
Codeine<morphine<fentanyl
Frage 141
Frage
Which of the following is NOT true regarding fentanyl?
Antworten
-
It may induce skeletal rigidity at high doses
-
Does NOT cause histamine release
-
Smaller safety margin than morphine
-
Minimal respiration depression
Frage 142
Frage
There is no ceiling effect of respiratory depression with use of opioids with mixed mechanisms
Frage 143
Frage
Which of the following is an advantage of fentanyl patches?
Frage 144
Frage
Which of the following is true regarding opioids with mixed mechanisms
Antworten
-
May antagonize action of opioid agonists
-
Increases addiction liability
-
Small doses can cause hallucinations
-
Large doses can cause euphoria