25: Drugs used in treating inflammatory processes

Question 1

1. Henry presents to clinic with a significantly swollen, painful great toe and is diagnosed with gout. Of the following, which would be the best treatment for Henry?
2. High-dose colchicine
3. Low-dose colchicine
4. High-dose aspirin
5. Acetaminophen with codeine

Answer 1

2. Low-dose colchicine

Question 2

2. Patient education when prescribing colchicine includes:
3. Colchicine may be constipating.
4. Colchicine always causes some degree of diarrhea.
5. Mild muscle weakness is normal.
6. Moderate amounts of alcohol are safe with colchicine.

Answer 2

2. Colchicine always causes some degree of diarrhea.

Question 3

3. Larry is taking allopurinol to prevent gout. Monitoring of a patient who is taking allopurinol includes:
4. Complete blood count
5. Blood glucose
6. C-reactive protein
7. BUN, creatinine, and creatinine clearance

Answer 3

4. BUN, creatinine, and creatinine clearance

Question 4

4. Phil is starting treatment with febuxostat (Uloric). Education of patients starting febuxostat includes:
5. Gout may worsen with therapy.
6. Febuxostat may cause severe diarrhea.
7. He should consume a high-calcium diet.
8. He will need frequent CBC monitoring.

Answer 4

1. Gout may worsen with therapy.

Question 5

5. Sallie has been taking 10 mg per day of prednisone for the past 6 months. She should be assessed for:
6. Gout
7. Iron deficiency anemia
8. Osteoporosis
9. Renal dysfunction

Answer 5

3. Osteoporosis

Question 6

6. Patients whose total dose of prednisone will exceed 1 gram will most likely need a second prescription for:
7. Metformin, a biguanide to prevent diabetes
8. Omeprazole, a proton pump inhibitor to prevent peptic ulcer disease
9. Naproxen, an NSAID to treat joint pain
10. Furosemide, a diuretic to treat fluid retention

Answer 6

2. Omeprazole, a proton pump inhibitor to prevent peptic ulcer disease

Question 7

7. Daniel has been on 60 mg of prednisone for 10 days to treat a severe asthma exacerbation. It is time to discontinue the prednisone. How is prednisone discontinued?
8. Patients with asthma are transitioned directly off the prednisone onto inhaled corticosteroids.
9. Prednisone can be abruptly discontinued with no adverse effects.
10. Develop a tapering schedule to slowly wean Daniel off the prednisone.
11. Substitute the prednisone with another anti-inflammatory such as ibuprofen.

Answer 7

3. Develop a tapering schedule to slowly wean Daniel off the prednisone.

Question 8

8. Patients with rheumatoid arthritis who are on chronic low-dose prednisone will need co-treatment with which medications to prevent further adverse effects?
9. A bisphosphonate
10. Calcium supplementation
11. Vitamin D
12. All of the above

Answer 8

4. All of the above

Question 9

9. Patients who are on or who will be starting chronic corticosteroid therapy need monitoring of:
10. Serum glucose
11. Stool culture
12. Folate levels
13. Vitamin B12

Answer 9

1. Serum glucose

Question 10

10. Patients who are on chronic long-term corticosteroid therapy need education regarding:
11. Receiving all vaccinations, especially the live flu vaccine
12. Reporting black tarry stools or abdominal pain
13. Eating a high carbohydrate diet with plenty of fluids
14. Small amounts of alcohol are generally tolerated.

Answer 10

2. Reporting black tarry stools or abdominal pain

Question 11

11. All nonsteroidal anti-inflammatory drugs (NSAIDS) have an FDA Black Box Warning regarding:
12. Potential for causing life-threatening GI bleeds
13. Increased risk of developing systemic arthritis with prolonged use
14. Risk of life-threatening rashes, including Stevens-Johnson
15. Potential for transient changes in serum glucose

Answer 11

1. Potential for causing life-threatening GI bleeds

Question 12

12. Jamie has fractured his ankle and has received a prescription for acetaminophen and hydrocodone (Vicodin). Education when prescribing Vicodin includes:
13. It is okay to double the dose of Vicodin if the pain is severe.
14. Vicodin is not habit-forming.
15. He should not take any other acetaminophen-containing medications.
16. Vicodin may cause diarrhea; increase his fluid intake.

Answer 12

3. He should not take any other acetaminophen-containing medications.

Question 13

13. When prescribing NSAIDS, a complete drug history should be conducted as NSAIDs interact with these drugs:
14. Omeprazole, a proton pump inhibitor
15. Combined oral contraceptives
16. Diphenhydramine, an antihistamine
17. Warfarin, an anticoagulant

Answer 13

4. Warfarin, an anticoagulant

Question 14

14. Josefina is a 2-year-old child with acute otitis media and an upper respiratory infection. Along with an antibiotic she receives a recommendation to treat the ear pain with ibuprofen. What education would her parent need regarding ibuprofen?
15. They can cut an adult ibuprofen tablet in half to give Josefina.
16. The ibuprofen dose can be doubled for severe pain.
17. Josefina needs to be well-hydrated while taking ibuprofen.
18. Ibuprofen is completely safe in children with no known adverse effects.

Answer 14

3. Josefina needs to be well-hydrated while taking ibuprofen.

Question 15

15. Henry is 82 years old and takes two aspirin every morning to treat the arthritis pain in his back. He states the aspirin helps him to “get going” each day. Lately he has had some heartburn from the aspirin. After ruling out an acute GI bleed, what would be an appropriate course of treatment for Henry?
16. Add an H2 blocker such as ranitidine to his therapy.
17. Discontinue the aspirin and switch him to Vicodin for the pain.
18. Decrease the aspirin dose to one tablet daily.
19. Have Henry take an antacid 15 minutes before taking the aspirin each day.

Answer 15

1. Add an H2 blocker such as ranitidine to his therapy.

Question 16

16. The trial period to determine effective anti-inflammatory activity when starting a patient on aspirin for rheumatoid arthritis is:
17. 48 hours
18. 4 to 6 days
19. 4 weeks
20. 2 months

Answer 16

2. 4 to 6 days

Question 17

17. Patients prescribed aspirin therapy require education regarding the signs of aspirin toxicity. An early sign of aspirin toxicity is:
18. Black tarry stools
19. Vomiting
20. Tremors
21. Tinnitus

Answer 17

4. Tinnitus

Question 18

18. Monitoring a patient on a high-dose aspirin level includes:
19. Salicylate level
20. Complete blood count
21. Urine pH
22. All of the above

Answer 18

4. All of the above

Question 19

19. Patients who are on long-term aspirin therapy should have ______ annually.
20. Complete blood count
21. Salicylate level
22. Amylase
23. Urine analysis

Answer 19

1. Complete blood count