Pharm Arthritis And Gout Part 2

20 Questions | By Chachelly | Last updated: Nov 27, 2018 | Total Attempts: 198

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Welcome back to our two-part series on the topics of arthritis and its sub-category of gout. You may have faired well in the first chapter of this quiz, but do you know enough about the pharmacology of these disorders to get all these questions right? Let’s find out now!

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Questions and Answers

1.

A 62-year-old male suffering from osteoarthritis presented to the emergency room with nausea, headache, dizziness, tinnitus, difficulty in hearing and sweating. His body temperature was 104F. He had been overtreating himself for four days with aspirin in an attempt to relieve a severe pain from his right hip. Which of the following statements best explains the reason of hyperthermia in this patient?
- A.
  
  Increased uric acid reabsorption by the kidney
- B.
  
  Decreased water and Na+ reabsorption by the kidney
- C.
  
  Increased platelet aggregation
- D.
  
  Uncoupling of oxidative phosphorylation in skeletal muscle
- E.
  
  Metabolic alkalosis
2.

A 45-year-old man complained to his physician of severe pain at the base of his left big toe which had kept him awake the previous night. He described the pain as excruciating. On physical examination the first metatarsophalangeal joint was warm and tender, and the entire periarticular area was red and swollen. Which of the following drugs would be most appropriate to treat the patient pain?

Discuss
- A.
  
  Propoxyphene
- B.
  
  Indomethacin
- C.
  
  Auranofin
- D.
  
  Aspirin
- E.
  
  Probenecid
- F.
  
  Allopurinol
3.

A 55-year-old man suffering from gouty arthritis and hyperuricemia has been receiving allopurinol for one month. Now he presents with a maculopapular rash and the physician decides to discontinue the allopurinol and to start a treatment with probenecid. The physician should advice the patient not to use concurrently which of the following drugs?
- A.
  
  Acetaminophen
- B.
  
  Ibuprofen
- C.
  
  Celecoxib
- D.
  
  Aspirin
- E.
  
  Piroxicam
4.

A 55-year-old woman with a long history of osteoarthritis presented to the emergency room because of a severe colicky pain in the right lumbar region. The history of the patient was significant for episodes of severe arthritic pain, for which she was taking several types of pain killers, for hypertension presently treated with hydrochlorothiazide and captopril, and from hypothyroidism presently treated with thyroxine. A renal biopsy confirmed the diagnosis of papillary necrosis and tubulo-interstitial inflammation of the kidney. Which of the following events most likely caused the patient’s disease?
- A.
  
  Diuretic induced hypokalemia
- B.
  
  Captopril induced increase of bradykinin
- C.
  
  Chronic use of analgesic combinations
- D.
  
  Captopril induced hyperkalemia
- E.
  
  Diuretic induced dehydration
- F.
  
  Excessive dosage of thyroxine
5.

A 7-year-old boy with influenza received an antipyretic drug for 4 days. On the fifth day he lapsed into coma and died. The autopsy disclosed a diffuse microvescicular fatty infiltration of liver, heart, and kidney, and a cerebral edema. Which of the following antipyretics was most likely administered?

Discuss
- A.
  
  Acetaminophen
- B.
  
  Piroxicam
- C.
  
  Ibuprofen
- D.
  
  Aspirin
- E.
  
  Ketorolac
- F.
  
  Indomethacin
6.

A 55-year-old man complained of fatigue and shortness of breath, and looked pale and tired. The man, who was vegetarian, also noted that his stools recently had become dark. He has been receiving aspirin for six months to treat his rheumatoid arthritis. Which of the following pathologic states most likely caused the patient’s symptoms?
- A.
  
  Iron deficiency anemia
- B.
  
  Respiratory alkalosis
- C.
  
  Reye's syndrome
- D.
  
  Analgesic nephropathy
- E.
  
  Aspirin hypersensitivity
7.

An 18-year-old male presents to the emergency room with persistent nausea and vomiting, malaise and diaphoresis. He has been overtreating himself for four days with an analgesic medication to relieve severe discomfort from a neck injury. Two days earlier he got drunk at a party. Physical exam shows a slightly confused and dehydrated patient with icterus and a flapping tremor. Lab exams reveal extremely high serum transaminase levels. The patient has most likely taken an excessive dose of which of the following drugs?

Discuss
- A.
  
  Aspirin
- B.
  
  Indomethacin
- C.
  
  Acetaminophen
- D.
  
  Ibuprofen
- E.
  
  Ketorolac
8.

A 49-year-old alcoholic woman, brought to the emergency room by her husband, was disoriented, combative and complained of headache, vertigo, and “ringing in my ears.”. The husband referred that she recently said she wanted to commit suicide. Vital sings were: temperature 104 F°, pulse 108 bpm, respirations 6/min, blood pressure 85/60. Pertinent lab data on admission were: arterial blood pH 7.25, creatinine 2.2, bicarbonate 18 mEq/L, glucose 170 mg/dL. Arterial blood gases on room air were: Pa CO2 48 mm Hg (normal 35- 45), Pa O2 70 mm Hg (normal 75-100). Which of the following drugs most likely caused this poisoning?

Discuss
- A.
  
  Ethanol
- B.
  
  Celecoxib
- C.
  
  Ketorolac
- D.
  
  Ibuprofen
- E.
  
  Aspirin
9.

A 66-year-old man complained to his physician that he did not urinate for the last 24 hours. The man was being treated with digoxin and furosemide for exacerbation of congestive heart failure and the therapy improved his cardiac conditions. Two days ago the patient had pain on movement of his left leg that improved with indomethacin. The physician found no clinical signs of intravascular volume depletion and increased the furosemide dose without any effect. Which of the following was the most likely reason of oliguria in this patient?

Discuss
- A.
  
  Indomethacin-mediated renal vasoconstriction
- B.
  
  Worsening of cardiac failure in spite of the therapy
- C.
  
  Furosemide-induced increase in angiotensin II secretion
- D.
  
  Digoxin overdose toxicity
- E.
  
  Furosemide-induced hypokalemia
10.

A 14-year-old girl is seen in the primary care clinic because of severe abdominal pain secondary to her menstrual periods. The pain begins with the onset of her menstrual flow and has occurred monthly for the past 5 months. She states that her first menstrual period was at age 13. Her physical examination was within normal limits. A diagnosis of primary dysmenorrhea is made. Which of the following drugs would be most appropriate for this patient?

Discuss
- A.
  
  Acetaminophen
- B.
  
  Albuterol
- C.
  
  Dinoprostone
- D.
  
  Sumatriptan
- E.
  
  Misoprostol
- F.
  
  Ibuprofen
- G.
  
  Ergonovine
11.

A 850 gm male, prematurely born at 27 weeks gestational age, was intubated immediately and placed on positive pressure assisted ventilation. On the third day of life his nurse noticed that he had tachycardia and a widened pulse pressure. Echocardiography was performed and showed a significant left-to-right shunting. An IV drug treatment was started. Which of the following drugs was most likely administered?

Discuss
- A.
  
  Alprostadil
- B.
  
  Verapamil
- C.
  
  Indomethacin
- D.
  
  Acetaminophen
- E.
  
  Furosemide
- F.
  
  Propranolol
12.

A 75-year-old man complains of a dull, continuous bone pain which has been increasing during the past few days. The patient has been suffering from a prostatic carcinoma for two years. Past history of the patient is significant for an episode of hemolytic anemia, which was ascribed to his congenital G6PD deficiency, and erythema multiforme, apparently due to an allergic reaction to naproxen. Which of the following would be an appropriate analgesic drug for this patient?

Discuss
- A.
  
  Aspirin
- B.
  
  Acetaminophen
- C.
  
  Piroxicam
- D.
  
  Ibuprofen
- E.
  
  Propoxyphene
- F.
  
  Amitriptyline
13.

A 8-year-old boy presented with fever (103° F), general malaise and the characteristic rash of measles infection. Past medical history of the patient included an episode of hemolytic anemia, most probably related to his congenital deficiency of RBC glutathione synthase. Which of the following drugs would be a suitable antipyretic for this boy?

Discuss
- A.
  
  Aspirin
- B.
  
  Indomethacin
- C.
  
  Acetaminophen
- D.
  
  Ibuprofen
- E.
  
  Prednisone
14.

A 33-year-old man suffering from hemophilia has been recently diagnosed with tension headache. The headache occurs two to four times weekly, usually toward the end of his work day. The pain is constant, dull in character and usually lasts the rest of the day with variable intensity. Which of the following drug would be appropriate for this patient?
- A.
  
  Indomethacin
- B.
  
  Acetaminophen
- C.
  
  Aspirin
- D.
  
  Ketorolac
- E.
  
  Piroxicam
- F.
  
  Naproxen
15.

A 55-year-old man, who suffered in the past from gastric ulcer, has been recently diagnosed with rheumatoid arthritis and is now taking the antiinflammatory drug prescribed by his physician. Which of the following drugs is he most likely taking?
- A.
  
  Ibuprofen
- B.
  
  Piroxicam
- C.
  
  Indomethacin
- D.
  
  Ketorolac
- E.
  
  Celecoxib
- F.
  
  Aspirin
16.

A 55-year-old woman complained of blurred vision, night blindness, light flashes and photophobia. The woman, diagnosed with rheumatoid arthritis six months ago, started a therapy with aspirin, but her disease continued to progress and two months ago the physician decided to add a second drug to the therapeutic regimen. Which of the following drugs most likely caused the symptoms reported by the patient?

Discuss
- A.
  
  Ibuprofen
- B.
  
  Aspirin
- C.
  
  Acetaminophen
- D.
  
  Hydroxychloroquine
- E.
  
  Auranofin
- F.
  
  Celecoxib
17.

A 44-year-old woman was found to have a plasma urate levels of 13 mg/dl and 800 mg/24 hrs of uric acid in her urine, during a routine checkup. She started an appropriate treatment and three weeks later her plasma urate levels were 7.2 mg/dL and the urinary uric acid level 530 mg/24 hrs. Which of the following drugs was most likely prescribed?
- A.
  
  Probenecid
- B.
  
  Aspirin
- C.
  
  Furosemide
- D.
  
  Allopurinol
- E.
  
  Indomethacin
- F.
  
  Naproxen
18.

A 52-year-old man was seen in the clinic for a routine evaluation. Two years ago the patient had an operation to remove a big renal calculus. Last year he had two episodes of renal colic apparently due to small calculi located in the left ureter. Lab values on admission were: potassium 4.9 mEq/L, creatinine 2.8 mg/dL, uric acid 16 mg /dL, BUN 38 mg/dL. Which of the following drugs would be appropriate for this patient?
- A.
  
  Probenecid
- B.
  
  Furosemide
- C.
  
  Hydrochlorothiazide
- D.
  
  Allopurinol
- E.
  
  Indomethacin
19.

A 34-year-old man, recently diagnosed with a diffuse, poorly differentiated lymphoma, was admitted to the hospital and began the first cycle of chemotherapy. One day later he became anuric. Pertinent blood values were: potassium 6.9 mEq/L, calcium 6.4 mg/dL, Phosphorus 5.4 mg/dL, creatinine 3.8 mg/dL, uric acid 26 mg/dL, BUN 62 mg/dL. A pretreatment with which of the following drugs would likely have been avoided the patient’s anuria?

Discuss
- A.
  
  Hydrochlorothiazide
- B.
  
  Spironolactone
- C.
  
  Furosemide
- D.
  
  Probenecid
- E.
  
  Allopurinol
20.

A 50-year-old woman presented to the hospital with a pruritic rash on her abdomen, a bluish grey skin pigmentation and stomatitis. The woman, recently diagnosed with rheumatoid arthritis, was initially prescribed ibuprofen but three months ago her disease was still progressing and the physician added another drug to her regimen. Urinalysis upon admission showed albuminuria and microscopic hematuria. Which of the following drugs most likely caused the patient’s signs and symptoms?

Discuss
- A.
  
  Auranofin
- B.
  
  Naproxen
- C.
  
  Chloroquine
- D.
  
  Prednisone
- E.
  
  Piroxicam
- F.
  
  Aspirin

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