Lippincott Chapter 36. Anti-inflammatory, Antipyretic, and Analgesic Agents

Question 1

36.1 A 64-year-old male presents with mild to moderate
musculoskeletal back pain after playing golf. He states
he has tried acetaminophen and that it did not help. His
past medical history includes diabetes, hypertension,
hyperlipidemia, gastric ulcer (resolved), and coronary
artery disease. Which of the following is the most
appropriate NSAID regimen to treat this patient’s pain?
A. Celecoxib.
B. Indomethacin and omeprazole.
C. Naproxen and omeprazole
D. Naproxen..

Answer 1

Correct answer = C. This patient is at high risk of future
ulcers, due to the history of gastric ulcer. Therefore, using a
regimen that includes an agent that is more COX-2 selec-
tive or a proton pump inhibitor is warranted. Therefore,
D is incorrect. Choices A and B are incorrect because this
patient has significant cardiovascular risk and a history
of coronary artery disease. Naproxen is thought of as the
safest NSAID regarding cardiovascular disease, though it
still can present risks. Therefore, C is correct as it uses the
first-choice NSAID with the GI protection of a proton pump
inhibitor.

Question 2

36.2 Which of the following correctly represents the mecha-
nism of action of tofacitinib in the treatment of RA?
A. TNF-α inhibitor.
B. Inhibitor of Janus kinases.
C. IL-6 receptor blocker.
D. Dihydrofolate reductase inhibitor.

Answer 2

Correct answer = B. Methotrexate inhibits dihydrofolate
reductase. Etanercept is a TNF-α inhibitor. An IL-6 inhibitor
is tocilizumab. Tofacitinib is an inhibitor of Janus kinase 1, 3,
and, to a lesser extent, 2.

Question 3

36.3 A 64-year-old male presents with signs and symptoms
of an acute gouty flare. His doctor wishes to treat
him accordingly to improve his symptoms. Which of
the following strategies would be the LEAST likely to
acutely improve his gout symptoms and pain?
A. Naproxen.
B. Colchicine.
C. Probenecid.
D. Prednisone.

Answer 3

Correct answer = C. Probenecid is a uricosuric agent indi-
cated to lower serum urate levels to prevent gout attacks.
It is not indicated during acute gout flares and should not
be started until after the resolution of an acute attack.
Naproxen, colchicine, and prednisone all represent viable
treatment options that acutely reduce pain and inflamma-
tion associated with acute gout attacks.

Question 4

36.4 Which of the following drugs for headache is contra-
indicated in patients with peripheral vascular disease?
A. Ergotamine.
B. Aspirin.
C. Acetaminophen.
D. Naproxen
E. Ibuprofen.

Answer 4

Correct answer = A. Ergotamine is contraindicated in periph-
eral vascular disease since it is a significant vasoconstrictor.