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