Pharm Arthritis And Gout Part 1

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Pharm Arthritis And Gout Part 1 - Quiz

In today’s pharmacology quiz we’ll be looking at arthritis – a disorder that affects the joints – with particular reference to gout, a form of arthritis which is cause by an excess amount of uric acid in the bloodstream. What can you tell us about these disorders and how to treat them? Find out now!


Questions and Answers
  • 1. 

    drug that decreases uric acid levels both in blood and in urine.

    • A.

      Acetaminophen

    • B.

      Allopurinol

    • C.

      Aspirin

    • D.

      Auranofin

    • E.

      Azathioprine

    • F.

      Celecoxib

    • G.

      Colchicine

    • H.

      Hydroxychloroquine

    • I.

      Indomethacin

    • J.

      Ketorolac

    • K.

      Mesalamine

    • L.

      Naproxen

    • M.

      Piroxicam

    • N.

      Probenecid

    Correct Answer
    B. Allopurinol
    Explanation
    Allopurinol is the correct answer because it is a medication that reduces the production of uric acid in the body. It inhibits the enzyme xanthine oxidase, which is responsible for the conversion of hypoxanthine to xanthine and then to uric acid. By reducing uric acid levels in both the blood and urine, allopurinol helps prevent the formation of urate crystals, which can cause gout and kidney stones.

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  • 2. 

    An irreversible inhibitor of cyclooxygenase

    • A.

      Acetaminophen

    • B.

      Allopurinol

    • C.

      Aspirin

    • D.

      Auranofin

    • E.

      Azathioprine

    • F.

      Celecoxib

    • G.

      Colchicine

    • H.

      Hydroxychloroquine

    • I.

      Indomethacin

    • J.

      Ketorolac

    • K.

      Mesalamine

    • L.

      Naproxen

    • M.

      Piroxicam

    • N.

      Probenecid

    Correct Answer
    C. Aspirin
    Explanation
    Aspirin is an irreversible inhibitor of cyclooxygenase, which means it permanently inactivates the enzyme. Cyclooxygenase is responsible for the production of prostaglandins, which are involved in inflammation, pain, and fever. By inhibiting cyclooxygenase, aspirin reduces the production of prostaglandins, thereby reducing inflammation, pain, and fever. Other drugs listed are not irreversible inhibitors of cyclooxygenase.

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  • 3. 

    An immunosuppressant drug used in the treatment of rheumatoid arthritis

    • A.

      Acetaminophen

    • B.

      Allopurinol

    • C.

      Aspirin

    • D.

      Auranofin

    • E.

      Azathioprine

    • F.

      Celecoxib

    • G.

      Colchicine

    • H.

      Hydroxychloroquine

    • I.

      Indomethacin

    • J.

      Ketorolac

    • K.

      Mesalamine

    • L.

      Naproxen

    • M.

      Piroxicam

    • N.

      Probenecid

    Correct Answer
    E. Azathioprine
    Explanation
    Azathioprine is an immunosuppressant drug commonly used in the treatment of rheumatoid arthritis. It works by suppressing the immune system, reducing inflammation and preventing joint damage. This drug is often prescribed when other medications have not been effective in managing the symptoms of rheumatoid arthritis. Azathioprine can help to reduce pain, swelling, and stiffness in the joints, improving overall quality of life for individuals with this condition. It is important to note that this medication can have side effects and should be used under the guidance of a healthcare professional.

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  • 4. 

    An inhibitor of cell mitosis used in the gouty attack.

    • A.

      Acetaminophen

    • B.

      Allopurinol

    • C.

      Aspirin

    • D.

      Auranofin

    • E.

      Azathioprine

    • F.

      Celecoxib

    • G.

      Colchicine

    • H.

      Hydroxychloroquine

    • I.

      Indomethacin

    • J.

      Ketorolac

    • K.

      Mesalamine

    • L.

      Naproxen

    • M.

      Piroxicam

    • N.

      Probenecid

    Correct Answer
    G. Colchicine
    Explanation
    Colchicine is the correct answer because it is an inhibitor of cell mitosis, making it useful in treating gouty attacks. It works by preventing the division of cells, particularly in the inflammatory response associated with gout. This helps to reduce the inflammation and pain caused by the condition.

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  • 5. 

    An antimalarial drug also used in the treatment of rheumatoid arthritis.

    • A.

      Acetaminophen

    • B.

      Allopurinol

    • C.

      Aspirin

    • D.

      Auranofin

    • E.

      Azathioprine

    • F.

      Celecoxib

    • G.

      Colchicine

    • H.

      Hydroxychloroquine

    • I.

      Indomethacin

    • J.

      Ketorolac

    • K.

      Mesalamine

    • L.

      Naproxen

    • M.

      Piroxicam

    • N.

      Probenecid

    Correct Answer
    H. Hydroxychloroquine
    Explanation
    Hydroxychloroquine is an antimalarial drug that is also used in the treatment of rheumatoid arthritis. It is known to reduce inflammation and pain in patients with rheumatoid arthritis. Additionally, hydroxychloroquine has been found to have immunomodulatory effects, meaning it can help regulate the immune system, which is beneficial in treating rheumatoid arthritis. Therefore, hydroxychloroquine is a suitable choice for a drug that can be used in the treatment of both malaria and rheumatoid arthritis.

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  • 6. 

    A salicylate derivative mainly used in inflammatory bowel disease.

    • A.

      Acetaminophen

    • B.

      Allopurinol

    • C.

      Aspirin

    • D.

      Auranofin

    • E.

      Azathioprine

    • F.

      Celecoxib

    • G.

      Colchicine

    • H.

      Hydroxychloroquine

    • I.

      Indomethacin

    • J.

      Ketorolac

    • K.

      Mesalamine

    • L.

      Naproxen

    • M.

      Piroxicam

    • N.

      Probenecid

    Correct Answer
    K. Mesalamine
    Explanation
    Mesalamine is a salicylate derivative that is primarily used in the treatment of inflammatory bowel disease. It works by reducing inflammation in the digestive tract, which helps to relieve symptoms such as abdominal pain, diarrhea, and rectal bleeding. This medication is commonly prescribed for conditions such as ulcerative colitis and Crohn's disease.

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  • 7. 

    A selective inhibitor of cyclooxygenase 2.

    • A.

      Acetaminophen

    • B.

      Allopurinol

    • C.

      Aspirin

    • D.

      Auranofin

    • E.

      Azathioprine

    • F.

      Celecoxib

    • G.

      Colchicine

    • H.

      Hydroxychloroquine

    • I.

      Indomethacin

    • J.

      Ketorolac

    • K.

      Mesalamine

    • L.

      Naproxen

    • M.

      Piroxicam

    • N.

      Probenecid

    Correct Answer
    F. Celecoxib
    Explanation
    Celecoxib is a selective inhibitor of cyclooxygenase 2. This means that it specifically targets and inhibits the action of cyclooxygenase 2 enzymes, which are responsible for producing inflammatory substances called prostaglandins. By inhibiting cyclooxygenase 2, celecoxib helps to reduce inflammation and relieve pain. It is commonly used to treat conditions such as arthritis, as well as acute pain and menstrual cramps.

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  • 8. 

    A gold compound used in the treatment rheumatoid arthritis.

    • A.

      Acetaminophen

    • B.

      Allopurinol

    • C.

      Aspirin

    • D.

      Auranofin

    • E.

      Azathioprine

    • F.

      Celecoxib

    • G.

      Colchicine

    • H.

      Hydroxychloroquine

    • I.

      Indomethacin

    • J.

      Ketorolac

    • K.

      Mesalamine

    • L.

      Naproxen

    • M.

      Piroxicam

    • N.

      Probenecid

    Correct Answer
    D. Auranofin
    Explanation
    Auranofin is a gold compound that is used in the treatment of rheumatoid arthritis. It is classified as a disease-modifying antirheumatic drug (DMARD) and works by reducing inflammation and suppressing the immune system. Auranofin is often used when other treatments have not been effective in managing the symptoms of rheumatoid arthritis. It is taken orally and has been shown to improve joint pain, swelling, and stiffness in patients with this condition.

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  • 9. 

    Which of the following statements regarding NSAIDs drugs are correct? (Check all that apply)

    • A.

      Individual drugs differ widely one from another in their potency

    • B.

      Their antipyretic effectiveness is the highest in case of fever due to heat stroke

    • C.

      Their analgesic effectiveness is the highest in case of visceral or ischemic pain

    • D.

      They are generally contraindicated in thromboembolic disorders

    • E.

      Their anti-inflammatory effect is most pronounced in the early phase of the inflammatory reaction

    • F.

      Most drugs of this class are able to block prostaglandin receptors in the hypothalamus

    Correct Answer(s)
    A. Individual drugs differ widely one from another in their potency
    E. Their anti-inflammatory effect is most pronounced in the early phase of the inflammatory reaction
    Explanation
    Potency refers to the dose needed to obtain a given effect. The lower the dose needed the
    higher the potency of the drug. NSAIDs differ widely in their potency. For example, about the
    same antiinflammatory effect can be obtained with 10 mg of piroxicam or 500 mg of aspirin.
    NSAIDs can counteract the vasodilation, increased vascular permeability and oedema that
    characterize the early phase of the inflammatory reaction. They have only limited effects on
    cellular accumulation either in acute or chronic inflammation, an have negligible effects on the B) By inhibiting prostaglandin biosynthesis NSAIDs promote the return of the hypothalamic
    thermostat to the normal set point. Therefore they can reduce fever due to an excessive
    stimulation of the hypothalamic thermostat, but they cannot reduce hyperthermia due to
    hypothalamic damage or malfunction (e.g. heat stroke).
    C) NSAIDs can reduce pain due to inflamed tissues (arthritis, etc.), surgery, dysmenorrhea,
    bone metastases, toothache, headache, but their analgesic effect is low (or even absent) in
    severe ischemic and visceral pain.
    D) NSAIDS are indicated, not contraindicated, in case of thromboembolic disorders, since they
    decrease platelet aggregation.
    F) NSAIDs block prostaglandin biosynthesis, but have no effect on prostaglandin receptors

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  • 10. 

    Administration of NSAIDs will reduce mainly the biosynthesis of which if the following pairs of endogenous compounds?

    • A.

      Thromboxanes and leukotrienes

    • B.

      Prostaglandins and leukotrienes

    • C.

      Prostacyclin and thromboxanes

    • D.

      Prostaglandins and bradykinin

    • E.

      Thromboxanes and bradykinin

    Correct Answer
    C. Prostacyclin and thromboxanes
    Explanation
    By blocking cyclooxygenase pathway, NSAIDs inhibit the biosynthesis of prostaglandins
    (including prostacyclin which is PGI2) and thromboxanes. They have negligible effect on
    lipoxygenase pathway or on bradykinin biosynthesis..
    A, B, D, E) (see explanation above)

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  • 11. 

    Which of the following are pharmacological effects of toxic doses of salicylates?

    • A.

      Depression of the respiratory center

    • B.

      Hypothermia

    • C.

      Stimulation of the chemoreceptor trigger zone

    • D.

      Increased coagulability of blood

    • E.

      Peripheral vasoconstriction

    • F.

      A & C

    • G.

      B & C

    • H.

      A & E

    Correct Answer
    F. A & C
    Explanation
    Toxic doses of salicylates cause a direct depression of the respiratory center in the medulla.
    Nausea and vomiting are common symptoms of salicylate toxicity. These symptoms are due in
    part to gastric irritation, but mainly to the stimulation of the chemoreceptor trigger zone.

    Rate this question:

  • 12. 

    Which of the following NSAIDs follows a zero order kinetics when given at intermediate to high doses?

    • A.

      Acetylsalicylic acid

    • B.

      Ibuprofen

    • C.

      Mesalamine

    • D.

      Indomethacin

    • E.

      Salicylic acid

    • F.

      Diflunisal

    Correct Answer
    E. Salicylic acid
    Explanation
    Salicylic acid is one of the few drugs (other examples include phenytoin and ethanol) that follow
    a zero order elimination kinetics. Because of this the clearance and the half life of the drug are
    not constant but depend upon the dose.

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  • 13. 

    Which of the following disease states is a contraindication to salicylate therapy?

    • A.

      Leukemias under methotrexate treatment

    • B.

      Osteoarthritis

    • C.

      Dysmenorrhea

    • D.

      Previous cerebrovascular disorders

    • E.

      Post-operative deep vein thrombosis

    Correct Answer
    A. Leukemias under methotrexate treatment
    Explanation
    Renal elimination of methotrexate involves active tubular secretion of the drug by the system
    that handles organic acids. Weak organic acids like salicylates can compete with methotrexate for
    secretion so delaying the elimination of the drug, which can result in severe myelosuppression.
    B, C, D, E) All these disorders are in fact indication, not contraindication, to salicylate therapy.

    Rate this question:

  • 14. 

    Which of the following statements best explains why aspirin, unlike other NSAIDs, causes an irreversible inhibition of prostaglandin biosynthesis?

    • A.

      It acetylates the enzyme cyclooxygenase

    • B.

      It competitively inhibits the enzyme cyclooxygenase

    • C.

      It acetylates the enzyme phospholipase A2

    • D.

      It irreversibly blocks the production of arachidonic acid

    • E.

      It stimulates the breakdown of cyclooxygenase into inactive metabolites

    Correct Answer
    A. It acetylates the enzyme cyclooxygenase
    Explanation
    Aspirin is the only NSAID that is able to acetylate the enzyme cyclooxygenase (the acetyl
    moiety is bound covalently to the enzyme) and therefore the inhibition of the enzyme is
    irreversible.
    B, C, D, E) Aspirin does not cause these effects.

    Rate this question:

  • 15. 

    Which of the following is a remission-inducing, disease-modifying antiarthritic drug that may stay in the body for months or even years after prolonged therapy?

    • A.

      Hydroxychloroquine

    • B.

      Methotrexate

    • C.

      Azathioprine

    • D.

      Auranofin

    • E.

      Sulfasalazine

    • F.

      Etanercept

    Correct Answer
    D. Auranofin
    Explanation
    Gold compounds like auranofin concentrate in synovial membranes, kidney, liver, spleen and
    bone marrow. Therefore the total body half life of these compounds is exceedingly long. The
    epithelial cells of the renal tubule, which have a particular affinity for gold, show its presence
    many year after therapy has ceased. Because of this there is no correlation between gold
    plasma levels and either therapeutic effect or toxicity.
    A, B, C, E, F) (see explanation above)

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  • 16. 

    The mother of a 17-month-old girl called the pediatrician because she found that the rectal temperature of her daughter was 39.5 C° (103.1 F°). After physical examination the pediatrician said that the fever was most likely due to a viral infection and prescribed ibuprofen, oral drops. Which of the following statements best explains the mechanism of the antipyretic effect of the drug in this patient?

    • A.

      Binding of the drug to prostaglandin receptors in the hypothalamus

    • B.

      Inhibition of phospholipase A2 in the hypothalamus

    • C.

      Inhibition of release of interleukin-1 from tissue macrophages

    • D.

      Decreased concentration of prostaglandins in the hypothalamus

    • E.

      Inhibition of cyclooxygenase in peripheral tissues

    Correct Answer
    D. Decreased concentration of prostaglandins in the hypothalamus
    Explanation
    Ibuprofen is a non-steroidal antiinflammatory drug (NSAID) of the propionic acid derivative
    class. All NSAIDs inhibit prostaglandin biosynthesis by blocking cyclooxygenase both in the
    peripheral tissues and In the CNS. The release of prostaglandins (PGE1, PGE2) in the
    hypothalamus seems the ultimate factor which adjusts the hypothalamic thermoregulatory
    mechanism to maintain body temperature at higher than normal level. By inhibiting
    prostaglandin synthesis NSAIDs promote the return of the hypothalamic thermostat to the
    normal set point.
    A, B, C) All these action can lead to an antipyretic effect but NSAIDs do not have these
    actions.
    E) The inhibition of cyclooxygenase in peripheral tissues can lead to an antiinflammatory effect
    which can reduce fever. However the main mechanism of the antipyretic effect of NSAIDs is
    central rather than peripheral.

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  • 17. 

    A 42-year-old woman recently diagnosed with rheumatoid arthritis started a treatment with aspirin, but after three days of therapy she complained of severe abdominal pain. The physician discontinued aspirin and prescribed ibuprofen. The inhibition of which of the following enzymes best explains the antiinflammatory effect of this drug?

    • A.

      Phospholipase A2

    • B.

      Cyclooxygenase 1

    • C.

      5-lipoxygenase

    • D.

      Phospholipase C

    • E.

      Cyclooxygenase 2

    • F.

      12-lipoxygenase

    Correct Answer
    E. Cyclooxygenase 2
    Explanation
    The antiinflammatory effect of NSAIDs is mediated by the inhibition of cyclooxygenase, the
    enzyme that catalyzes the synthesis of prostaglandins which are known inflammatory
    mediators.
    Two different isoforms of cyclooxygenase have been found, cyclooxygenase 1 (COX-1) and
    cyclooxygenase 2 (COX-2). Whereas COX-1 is expressed in most tissue of the body,
    inflammatory mediators like cytokines upregulate COX-2 expression, leading to high level of
    COX-2 in inflamed tissues. Most NSAIDs inhibit both isoforms of the enzyme, but their
    antiinflammatory activity is most likely mediated mainly by the inhibition of COX-2.
    B) (see explanation above)
    A, C, D, F) NSAIDs do not inhibit these enzymes.

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  • 18. 

    A 34-year-old woman, who underwent conization 6 months ago for a fibroid of the cervix, has been suffering severe pain during menses. The physician prescribed ibuprofen, one tablet as needed. Which of the following statements best explains the reason of the analgesic effect of the drug in this patient?

    • A.

      Binding of the drug to prostaglandin receptors in the myometrium

    • B.

      Decreased production of prostaglandins by the endometrium

    • C.

      Inhibition of prostaglandins biosynthesis in the hypothalamus

    • D.

      Anti-inflammatory action of the drug in the pelvic area

    • E.

      Decrease production of leukotrienes by the endometrium

    Correct Answer
    B. Decreased production of prostaglandins by the endometrium
    Explanation
    The pain occurring during menses is thought to result from uterine contractions and ischemia,
    likely mediated by prostaglandins produced in the secretory endometrium. Contributing factors
    may include an extremely tight cervical os because of thermocautery or conization, like in the
    present case. Pain occurs when the uterus attempt to expel tissue through the cervical os. The
    analgesic effects of NSAIDs in case of dysmenorrhea is due to the inhibition of prostaglandin biosynthesis in the endometrium.
    A) NSAIDs do not act on prostaglandin receptors.
    C) Even if a central action (inhibition of prostaglandins biosynthesis in the hypothalamus) may
    contribute to the analgesic effect of NSAIDs, the effect is mainly peripheral. Acetaminophen is
    the only analgesic-antipyretic drug whose analgesic effect is thought to be mediated by the
    inhibition of prostaglandins biosynthesis in the hypothalamus.
    D) Pelvic inflammatory disease may cause diffuse, continuous, low abdominal pain. In the
    present case however the pain is present only during menses, so a pelvic inflammatory disease
    is unlikely.
    E) Leukotrienes can increase nociceptive nerve ending sensitivity, but NSAIDs do not affect
    leukotrienes synthesis.

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  • 19. 

    A 56-year-old woman with sinusitis and nasal polyps was brought to the emergency room because of serious breathing difficulty. Two hours earlier she had taken a drug for headache. Physical examination showed a severe bronchospasm. Which of the following drugs most likely caused this adverse effect?

    • A.

      Ergotamine

    • B.

      Acetaminophen

    • C.

      Acetylsalicylic acid

    • D.

      Sumatriptan

    • E.

      Cyproheptadine

    Correct Answer
    C. Acetylsalicylic acid
    Explanation
    The symptoms and signs of the patient suggest that she was affected by aspirin
    hypersensitivity, a syndrome that can occur in 20-25% of middle-aged patients with asthma,
    chronic urticaria or nasal polyps, like in the present case. The reaction does not appear to be
    immunological in nature (it seems a pseudoallergic reaction). The mechanism is not known but
    is likely to be related to the formation of increased amount of leukotrienes and other products of
    lipoxygenase pathway, due to inhibition of cyclooxygenase pathway. Patients with this
    syndrome experience a high degree of cross-sensitivity to other NSAIDs, which support the
    conclusion that this reaction represents an abnormal response to a common pharmacological
    action.
    A, B, D, E) (see explanation above)

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  • 20. 

    A 10-year-old boy with acute rheumatic fever started a high dose salicylate treatment. One week later laboratory values indicated increased blood pH, decreased PCO2 and decreased plasma bicarbonate content. Which of the following acid-base disturbances was most likely caused by salicylate treatment?

    • A.

      Respiratory acidosis

    • B.

      Respiratory alkalosis

    • C.

      Metabolic acidosis

    • D.

      Metabolic alkalosis

    • E.

      Mixed acidosis

    Correct Answer
    B. Respiratory alkalosis
    Explanation
    The lab values indicate that the acid-base disturbance was respiratory alkalosis, which is an
    effect of high therapeutic doses of salicylates. These drugs stimulate the respiration both
    directly (by a direct effect on the respiratory center in the medulla) and indirectly (by increased
    production of CO2 due to increased oxygen consumption). Compensation is achieved by
    increased renal excretion of
    bicarbonate. Unless toxic doses are given this stage seldom proceed further.
    A, C, D, E) (see explanation above)

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