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