NSG 6320 AGNP BOARD EXAM QUESTIONS (latest) Orthopedics Prescribing (103 Questions) – South University Savannah | 100% CORRECT ANSWERS - $18.49   Add to cart

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NSG 6320 AGNP BOARD EXAM QUESTIONS (latest) Orthopedics Prescribing (103 Questions) – South University Savannah | 100% CORRECT ANSWERS

NSG 6320 AGNP BOARD EXAM QUESTIONS (latest) Orthopedics Prescribing (103 Questions) – South University Savannah Question: Which medication is NOT a brand name for acetaminophen?    Mapap      Cetafen      Aleve      Feverall   Explanation: Brand names for acetaminophen include Mapap, Cetafen, FeverAll and Tylenol. Aleve is the brand name for naproxen sodium. Question: To treat low back pain in a patient for whom nonsteroidal anti-inflammatory drugs (NSAIDs) are contraindicated, the recommended therapy is:    acetaminophen (Tylenol).      ibuprofen (Motrin).      cyclobenzaprine (Amrix).      tramadol (Ultram).   Explanation: To treat low back pain in a patient for whom nonsteroidal anti-inflammatory drugs (NSAIDs) are contraindicated, the recommended therapy is acetaminophen (Tylenol). A nonsteroidal anti-inflammatory drug (ibuprofen) is recommended as initial therapy for the treatment of back pain. The trial should be short-term, usually 2 to 4 weeks. Acetaminophen is a reasonable option for initial therapy in patients with contraindications to NSAIDs. Question: The patient at highest risk for side effects from cyclobenzaprine (Amrix) is a:    20-year-old man with spasticity and a history of seizures.      40-year-old woman diagnosed with diabetes mellitus.      50-year-old woman with a history of asthma.      70-year-old man diagnosed with benign prostatic hypertrophy.   Explanation: Cyclobenzaprine (Amrix) is identified in the Beers Criteria as a potentially inappropriate medication and should be to be avoided in patients 65 years and older (independent of diagnosis or condition). This is because most muscle relaxants are poorly tolerated in older adults due to anticholinergic effects. Amrix may also increase sedation and fracture risk. Cyclobenzaprine (Amrix) has strong anticholinergic properties. In addition, efficacy is questionable at doses tolerated by geriatric patients. Although cyclobenzaprine may lower the seizure threshold, it is not a contraindication. The provider should weigh the risks versus the benefits. Question: When assessing a patient with suspected acetaminophen (Tylenol) overdose, the time of ingestion can be confirmed by checking:    acetaminophen levels now and in 4 hours.      baseline acetaminophen levels.      liver function studies now and in 4 hours.      acetylcysteine levels.   Explanation: When assessing a patient with suspected acetaminophen (Tylenol) overdose, the time of ingestion can be confirmed by checking serum acetaminophen levels at the time of presentation and again in 4 hours. This is especially important if the time of acetaminophen ingestion is unknown. Question: A patient with severe osteoarthritis is complaining of a pain exacerbation due to weather change. Ketorolac should be avoided in this patient due to a drug-drug interaction with:    diclofenac (Zorvolex).      lisinopril (Zestril).      omega-3 fatty acids.      spironolactone (Aldactone).   Explanation: The concomitant use of ketorolac (Toradol) and other nonsteroidal anti-inflammatory drugs (NSAIDs), such as diclofenac (Zorvolex), is absolutely contraindicated due to enhancement of the adverse/toxic effect of NSAIDs. Therapy should be monitored in the presence of ACE inhibitors, omega-3 fatty acids and potassium-sparing diuretics, but it is not contraindicated. Question: The half-life elimination of colchicine (Colcrys), used in the treatment of gout, is approximately:    8 hours.      15 hours.      30 hours.      48 hours.   Explanation: The half-life elimination of colchicine (Colcrys) in an otherwise healthy person is about 27-31 hours. Colchicine is an alkaloid indicated for the treatment of acute gout and for the prophylactic treatment of gout. It is approved for use in patients aged 16 and older for gout prophylaxis. Question: Dantrolene (Dantrium) reduces skeletal muscle spasticity by:    interfering with the release of potassium from the sarcoplasmic reticulum.      interfering with the release of calcium from the sarcoplasmic reticulum.      centrally blocking action potentials.      blocking the actin-myosin binding site in striated muscle.   Explanation: Dantrolene (Dantrium) reduces skeletal muscle spasticity by acting directly on skeletal muscle and interfering with release of calcium ion from the sarcoplasmic reticulum. It is classified as a peripherally-acting muscle relaxant. It is not a centrally-acting muscle relaxant. Question: Which formulation of naproxen would result in fewer GI side effects?    Naprosyn      Naprosyn suspension      Anaprox DS      EC-Naprosyn   Explanation: EC-Naprosyn dissolves in the small intestine rather than in the stomach. Fewer GI side effects would be expected with this medication. However, this results in delayed absorption and thus delayed relief of acute pain could also be anticipated. The other listed forms of naproxen are absorbed in the stomach and produce a greater risk of GI upset. Question: Salicylates, such as aspirin,:    prevent the formation of clots by affecting blood coagulation.      inhibit vitamin K epoxide reductase and prevent blood clots.      inhibit the synthesis of prostaglandin in the process of inflammation.      block the activity of clotting factor X and prevent blood clots.   Explanation: Salicylates are nonsteroidal anti-inflammatory drugs (i.e. aspirin [Ecotrin] and magnesium salicylate [Doan's]). Salicylates inhibit the synthesis of prostaglandins and other mediators in the process of inflammation and have anti-inflammatory, antipyretic and analgesic properties. Question: When evaluating the effectiveness of baclofen (Lioresal), the LEAST appropriate goal is to:    reduce caregiver challenges such as dressing, feeding, transport, and bathing.      reduce the pain and frequency of muscle contractions.      improve voluntary motor functions such as reaching, releasing and grasping.      significantly reduce muscle spasticity and contractions.   Explanation: “Reducing spasticity” per se is not an appropriate treatment goal. Appropriate goals include increasing range of motion, easing care, decreasing pain, improving quality of life, improving gait, or decreasing the development of contractures. Use with caution when spasticity is utilized to sustain upright posture and balance in locomotion, or when spasticity is necessary to obtain increased function. Question: The concomitant use of aspirin and nonsteroidal anti-inflammatory drugs (NSAIDs) can cause:    hypoglycemia.      abnormally high serum levels of potassium.      a decrease in the development of angioedema.      reduced absorption of nonsteroidal anti-inflammatory drugs (NSAIDs).   Explanation: The concomitant use of aspirin and NSAIDs can cause abnormally high serum levels of potassium by inducing a hyporeninemic hypoaldosteronism state via inhibition of prostaglandin synthesis. Question: Clindamycin (Cleocin) is NOT indicated for the treatment of serious infections, such as septic arthritis, caused by:    Streptococcus pyogenes.      Staphylococcus aureus.      Streptococcus pneumoniae.      Escherichia coli.   Explanation: Clindamycin (Cleocin) is not effective against infections caused by Escherichia coli. Clindamycin (Cleocin) is indicated in the treatment of serious infections caused by susceptible gram-positive bacteria. Examples include Streptococcus and Staphylococcus. Septic arthritis may be caused by Neisseria gonorrhea in sexually active people. Staphylococcus aureus is the cause of the vast majority of cases of acute bacterial arthritis in adults and in children older than 2 years. Streptococcal species, such as Streptococcus viridans, S pneumoniae, and group B Streptococcus, account for about 20% of cases. Question: Intra-articular steroid injections are NOT contraindicated:    when the skin over the injection site is infected.      in patients with diabetes.      when skin at the injection site is broken.      in the presence of an osteochondral fracture.   Explanation: Single intra-articular steroid injections have little or no effect on glycemic control. Intra-articular corticosteroid injections are contraindicated for broken skin over the injection site, known hypersensitivity to intra-articular agents, osteochondral/intra-articular fracture, prosthetic joint (relative), severe joint destruction, skin infection overlying injection site, and unstable coagulopathy. Question: Patients should be instructed to take tizanidine (Zanaflex):    daily, not exceeding 16 mg daily.      before bedtime only.      with food only.      consistently fasting or nonfasting.   Explanation: The administration of tizanidine (Zanaflex) with food compared to administration in the fasting state results in clinically significant differences in absorption and other pharmacokinetic parameters. Patients should be consistent and should not switch administration of the tablets or the capsules between the fasting and nonfasting state. In addition, switching between the capsules and the tablets in the nonfasting state will also result in significant differences in absorption. Dosing is every 6-8 hours with a maximum of 3 doses in 24 hours and not exceeding 36 mg/day. Question: Before prescribing Dantrolene (Dantrium), a peripherally-acting muscle relaxant, obtain a baseline serum:    blood urea nitrogen (BUN).      complete blood count (CBC).      calcium level.      liver function test.   Explanation: Before prescribing Dantrolene (Dantrium), a peripherally-acting muscle relaxant, a baseline serum liver function test should be performed. Liver function tests (baseline and at appropriate intervals thereafter) should be monitored for potential hepatotoxicity. Dantrolene directly acts on skeletal muscle by interfering with the release of calcium ions from the sarcoplasmic reticulum. Question: The brand name for cyclobenzaprine is:    Elavil.      Amrix.      Skelaxin.      Soma.   Explanation: The brand name for cyclobenzaprine is Amrix; Fexmid and Flexeril are two other brand names for cyclobenzaprine. The generic name for Elavil is amitriptyline (a tricyclic antidepressant); Skelaxin is metaxalone; Soma is carisoprodol. Skelaxin and Soma are skeletal muscle relaxants. Question: The intra-articular steroid with the longest duration of action is:    dexamethasone acetate (Decadron).      methylprednisolone acetate (Depo-Medrol).      triamcinolone acetonide (Kenalog).      triamcinolone hexacetonide (Aristospan).   Explanation: The intra-articular steroid with the longest duration of action is triamcinolone hexacetonide (Aristospan). The duration of action of Aristospan is about 21 days. The duration of action of triamcinolone acetonide (Kenalog) is approximately 14 days. Methylprednisolone acetate (Depo-Medrol) and dexamethasone acetate (Decadron) have a duration of action of approximately 8 days. Question: Ketorolac (Toradol), administered intramuscularly, would be indicated for the patient with a complaint of:    shoulder strain with a pain rating of 3.      new onset headache with a pain rating of 7.      dental abscess with a pain rating of 7.      gastrointestinal pain with a pain rating of 3.   Explanation: Ketorolac (Toradol) is indicated for the treatment of moderate to severe pain related to dental and/or musculoskeletal trauma and pain. For new onset headache, intracranial hemorrhage should be ruled out as a cause prior to the administration of ketorolac. Further exploration would be needed before administration of ketorolac (Toradol) for gastrointestinal pain, due to potential side effects. A rating of 1 to 3 is considered mild pain. Question: Dosing of acetaminophen (Tylenol) in children weighing less than 50 kg is:    5 mg/kg/dose.      15 mg/kg/dose.      45 mg/kg/day.      60 mg/kg/day.   Explanation: The recommended dosing of acetaminophen for infants and children weighing less than 50 kg is 10 to 15 mg/kg/dose given every 4 to 6 hours as needed. No more than 5 doses should be administered in a 24-hour period, and the maximum daily dose should not exceed 4 grams daily. Question: The maximum FDA-recommended single dose of oral acetaminophen (Tylenol) in an adult is:    650 mg.      1 gram.      2 grams.      4 grams.   Explanation: The maximum FDA-recommended single dose of oral acetaminophen (Tylenol) in an adult is 1 gram. The maximum adult dose in a 24-hour period is 4 grams. Question: Which medication would NOT be appropriate for the treatment of acute gout?    Aspirin (Ecotrin)      Meloxicam (Mobic)      Indomethacin (Indocin)      Naproxen (Aleve)   Explanation: Aspirin (Ecotrin) is not used to treat acute gout because of the paradoxical effects of salicylates on serum urate, resulting from renal uric acid retention at low doses (<2 to 3 g/day) and from uricosuria at higher doses. However, low-dose aspirin that is being used for cardiovascular prophylaxis generally does not need to be discontinued during the treatment of acute gout. These very low doses can increase serum uric acid levels modestly in some patients. Question: A 42-year-old woman was started on naproxen sodium (Aleve) for the treatment of tendinitis in the right ankle. The patient calls 3 days later and reports swelling in both ankles. The nurse practitioner should advise the patient to:    continue naproxen, increase fluid intake and decrease sodium intake.            stop the naproxen sodium, since this is an adverse reaction.      elevate the left ankle and minimize overuse.   Explanation: Edema is a significant adverse reaction to naproxen sodium (Aleve). It occurs in up to 9% of the population. Naproxen sodium is classified as a nonsteroidal anti-inflammatory drug (NSAID). NSAIDs increase the risk of serious and potentially fatal cardiovascular thrombotic events, including MI and stroke. Risk may occur early in treatment and may increase with duration of use. Development of a DVT is not likely to cause edema in both ankles. Question: Oral ketorolac (Toradol) should not be taken for more than:    5 days.      7 days.      10 days.      14 days.   Explanation: Ketorolac (Toradol) is classified as a nonsteroidal anti-inflammatory drug. It is indicated for the short-term management of moderately severe acute pain. The maximum combined duration of treatment (parenteral and oral) is 5 days. Low-dose opioids should be considered as a viable supplement if needed for breakthrough pain. Question: Which medication minimizes bone loss, decreasing the risk for osteoporosis?    Glucocorticoids      Medroxyprogesterone      Thiazide diuretics      Thyroid hormone   Explanation: Many drugs can negatively affect bone mineral density. Thiazide diuretics (i.e. hydrochlorothiazide [Microzide]) can minimize bone loss because they promote active calcium reabsorption in the distal tubules. Bone density studies have shown improvement when a patient is receiving thiazide diuretics. Heparin, warfarin (Coumadin), cyclosporine (Neoral, an immunosuppressant), glucocorticoids (prednisone), medroxyprogesterone acetate (Depo-Provera), anti-neoplastics and thyroid hormone (i.e. levothyroxine [Synthroid]) can cause bone loss leading to osteopenia and osteoporosis. Question: In adults with normal renal function, the half-life elimination of naproxen sodium (Aleve) is approximately:    8 hours.      10 hours.      14 hours.      24 hours.   Explanation: The half-life elimination of naproxen sodium (Aleve) in adults with normal renal function is 12 to 17 hours. In patients with moderate to severe renal impairment, it is approximately 15 to 21 hours. The onset of action of naproxen sodium (Aleve) is 30 to 60 minutes. Question: Which diagnosis is NOT a contraindication to nonsteroidal anti-inflammatory agents?    Anticoagulant use      Creatinine clearance <60 mL/min      Chronic constipation      Uncontrolled hypertension   Explanation: Contraindications to the use of nonsteroidal antiinflammatory drugs (NSAID) include chronic kidney disease with a creatinine clearance <60 mL/min; active duodenal or gastric ulcer; cardiovascular disease (particularly heart failure or hypertension that is difficult to control); NSAID allergy; and/or ongoing treatment with an anticoagulant. Chronic constipation is not a contraindication to the use of NSAIDs. NSAIDs may be appropriate, especially for short-term treatment of gout or other acute conditions. Question: Which adverse event is NOT related to colchicine?    liver failure      pancreatitis      peripheral neuropathy      rhabdomyolysis   Explanation: Severe colchicine toxicity may include combinations of serious, life-threatening or fatal adverse events, such as blood cytopenias, rhabdomyolysis or myopathy, peripheral neuropathy, liver failure, or severe cutaneous eruption. Question: The recommended antidote for acetaminophen toxicity is:    N-acetylcysteine.      naloxone.      charcoal.      paracetamol.   Explanation: Acetaminophen (Excedrin) is classified as a nonopioid analgesic. It does not have antiinflammatory properties. N-acetylcysteine is the recommended antidote for acetaminophen toxicity. Naloxone and charcoal are not recommended. Paracetamol is another name for acetaminophen. Question: Symptoms of salicylate (i.e., aspirin) poisoning may include:    ecchymosis, peripheral edema, and chest pain.      abdominal pain, tinnitus and headache.      angioedema, slurred speech, and noise sensitivity.      diarrhea, chills, and fever.   Explanation: Symptoms of salicylate (i.e., aspirin) poisoning may include angioedema, abdominal pain, hives, headaches, respiratory difficulty, tinnitus, and anxiety. The other symptoms are not associated with salicylate poisoning. Question: The brand name for tizanidine is:    Skelaxin.      Amrix.      Soma.      Zanaflex.   Explanation: The brand name for tizanidine is Zanaflex. The generic name for cyclobenzaprine is Amrix; Skelaxin is metaxalone; and Soma is carisoprodol. These are centrally-acting muscle relaxants that potentiate norepinephrine and bind to serotonin receptors to reduce spasticity. Question: Caution is advised with concomitant use of salicylates and:    amoxicillin (Amoxil).      cephalexin (Keflex).      azithromycin (Zithromax).      celecoxib (Celebrex).   Explanation: Celecoxib (Celebrex) is also a nonsteroidal antiinflammatory drug (NSAID) that decreases the antiplatelet effect of low-dose aspirin by blocking the active site of platelet cyclooxygenase. The administration of aspirin (Ecotrin) plus NSAIDs can increase the risk of gastrointestinal bleeding. Question: Baclofen (Lioresal), used in the treatment of spondylosis, may be administered:    orally and intramuscularly.      orally and intrathecally.      orally, intravenously and topically.      orally, intrathecally and topically.   Explanation: Baclofen is a centrally-acting muscle relaxant used in the treatment of spasticity. It may be administered orally or intrathecally. Baclofen is indicated for the treatment of spasticity that may be related to multiple sclerosis, traumatic brain injury, encephalitis, or spinal cord injury. Question: Patients should be advised to avoid combining tizanidine (Zanaflex) with:    oxycodone.      escitalopram.      tetracycline.      magnesium sulfate.   Explanation: Concomitant use of oxycodone and benzodiazepines or other CNS depressants (such as tizanidine [Zanaflex]) should be avoided. The combination of these drugs may potentiate central nervous system depression including somnolence and respiratory depression. These agents should only be combined if alternative treatment options are inadequate. If combined, the dosages and duration of each should be limited. Question: Patients should be instructed to avoid abrupt withdrawal of baclofen (Lioresal) to prevent the occurrence of:    hypotonia.      urinary retention.      seizures.      hypothermia.   Explanation: Abrupt withdrawal of oral baclofen (Lioresal) therapy has been associated with hallucinations and seizures. Gradual dose reductions (over approximately 1 to 2 weeks) are recommended in the absence of severe adverse reactions. Baclofen is a centrally-acting muscle relaxant used in the treatment of spasticity. Question: The generic name of Toradol, a nonsteroidal anti-inflammatory drug, is:    methadone.      etodolac.      ketorolac.      triamcinolone.   Explanation: The generic name of Toradol is ketorolac. The brand name for methadone is Dolophine (an opioid agonist); etodolac is Lodine (an NSAID); and triamcinolone is Kenalog (a topical corticosteroid). Question: NSAIDs should be used with caution in the patient who has:    polycythemia vera.      cataracts.      hypertension.      systemic lupus erythematous.   Explanation: New-onset hypertension or exacerbation of hypertension may occur with the administration of ibuprofen (Motrin). NSAIDs impair prostaglandin synthesis. Renal prostaglandin inhibition produces sodium and water retention, which increases blood pressure. NSAIDs may also impair response to ACE inhibitors, thiazide diuretics, or loop diuretics. Question: Raloxifene (Evista) is indicated for the treatment of osteoporosis. It also:    increases the risk for breast cancer.      decreases the risk for breast cancer.      increases risk for heart disease.      decreases the risk for thromboembolic events.   Explanation: Raloxifene (Evista) is a selective estrogen receptor modulator (SERM) used in the treatment of osteoporosis. It inhibits bone resorption and reduces the risk of vertebral fracture. Nonskeletal considerations with SERMs may play an important role in the selection of postmenopausal women for therapy, including potential beneficial effects on breast cancer risk reduction. However, it is associated with an increase in thromboembolic events and possibly hot flashes. It has no apparent effect on heart disease or the endometrium. Question: Which amount of calcium and vitamin D does the National Osteoporosis Foundation recommend to prevent osteoporosis in women 50 years and older?    400 mg of calcium and 400 IU of vitamin D      400 mg of calcium and 800 IU of vitamin D      800 mg of calcium and 800 IU of vitamin D      1,200 mg of calcium and 1,000 IU of vitamin D   Explanation: The National Osteoporosis Foundation recommends 1,000 mg of calcium supplementation per day for most adults and 1,200 mg per day for women older than 50 or men older than 70. The recommended daily dose of vitamin D is 400-800 International Units (IU) for adults younger than age 50, and 800-1,000 IU for patients aged 50 and older. For patients with low levels of serum vitamin D, higher doses may be required, sometimes as high as 50,000 units a week for 12 weeks to deficiencies. Question: The concomitant use of tizanidine (Zanaflex) and other drugs that inhibit the CYP1A2 enzyme pathway is absolutely contraindicated. Other CYP1A2 inhibitors include:    ketoconazole and clarithromycin.      ciprofloxacin and fluvoxamine.      fluoxetine and indomethacin.      celecoxib and cimetidine (CYP2D6).   Explanation: Ciprofloxacin and fluvoxamine are strong CYP1A2 inhibitors and are absolutely contraindicated with the administration of tizanidine (Zanaflex). Concomitant use may increase the serum concentration of tizanidine. If use with another strong inhibitor cannot be avoided, initiate tizanidine at an adult dose of 2 mg and increase in 2- to 4-mg increments based on response. Ketoconazole and clarithromycin are CYP3A4 inhibitors. Celecoxib and cimetidine are CYP2D6 inhibitors. Fluoxetine and indomethacin are CYP2C19 inhibitors. Question: The drug of choice for analgesic and antipyretic use during pregnancy is:    aspirin.      ibuprofen.      acetaminophen.      naproxen.   Explanation: The drug of choice for analgesic and antipyretic use during pregnancy is acetaminophen. There is no known risk of fetal harm with short-term use of acetaminophen. Question: For patients taking tizanidine (Zanaflex), diagnostic testing at baseline and when maximum dose is achieved includes:    Hgb, Hct and renal function.      Hgb, Hct and ECG.      AST, ALT and blood pressure.      AST, ALT and platelets.   Explanation: Patients taking tizanidine (Zanaflex) should have liver function (aminotransferases, AST, ALT) and renal function checked at baseline and 1 month after maximum dose is achieved. Hepatotoxicity and renal dysfunction have been observed. Tizanidine may produce hypotension, so blood pressure should be monitored. uestion: The brand name of dantrolene, a skeletal muscle relaxant, is:    Skelaxin.      Amrix.      Dantrium.      Soma.   Explanation: The brand name of dantrolene is Dantrium. The generic name of Skelaxin is metaxalone; Amrix is cyclobenzaprine; Soma is carisoprodol. These are all skeletal muscle relaxants. Question: When treating a fracture, factors that influence acetaminophen (Tylenol) toxicity do NOT include:    excessive intake.      excessive cytochrome P450 activity.      acute alcohol ingestion.      depletion of glutathione stores.   Explanation: Acute alcohol ingestion is NOT a risk factor for hepatotoxicity when taking acetaminophen (Tylenol). It may even be protective by competing with acetaminophen for CYP2E1 enzyme. Excessive acetaminophen intake, excessive cytochrome P450 activity, depletion of glutathione stores, and decreased capacity for glucuronidation or sulfation are clinical factors that may influence toxicity. Question: A commonly reported side effect of tizanidine (Zanaflex), a skeletal muscle relaxant, is:    hypertension.      tachycardia.      incontinence.      somnolence.   Explanation: The most commonly reported side effects of tizanidine (Zanaflex), a centrally-acting skeletal muscle relaxant, include: hypotension, somnolence, dizziness, xerostomia and weakness. Question: The recommended interval between subacromial intra-articular steroid injections is:    3 weeks.      6 weeks.      12 weeks.      16 weeks.   Explanation: The recommended interval between intra-articular steroid injections is 3 months (12 weeks). Intra-articular steroid injections are used in the treatment of rotator cuff syndrome, hammertoe, DeQuervain's tenosynovitis, bursitis, epicondylitis, and other joint derangements. Question: A potential side effect related to the use of ketorolac (Toradol) is:    increased urinary output.      increased range of motion.      edema of the lower extremities.      weight loss.   Explanation: Potential side effects related to the use of ketorolac (Toradol) are weight gain, edema, decreased urinary output, bleeding, bruising, abdominal pain, dyspepsia and disorientation. Ketorolac (Toradol) is a nonsteroidal anti-inflammatory drug. Desired responses to ketorolac (Toradol) would include decreased pain, improved range of motion, grip strength, mobility and ADL function. Question: Ketorolac (Toradol), a nonsteroidal antiinflammatory drug, reduces pain by:    decreasing the synthesis of prostaglandins by irreversibly inhibiting cyclooxygenase-1 enzymes.      increasing synthesis of cylooxygenase-1 enzymes, resulting in increased resistance to prostaglandins.      producing a prodrug that blocks the synthesis of prostaglandins through the destruction of cyclooxygenase-1 and 2 (COX-1 and 2) enzymes.      decreasing the synthesis of prostaglandins by reversibly inhibiting cyclooxygenase-1 and 2 (COX-1 and 2) enzymes.   Explanation: Ketorolac (Toradol), a nonsteroidal antiinflammatory drug, reversibly inhibits cyclooxygenase-1 and 2 (COX-1 and 2) enzymes, which results in decreased formation of prostaglandin precursors. The drug has antipyretic, analgesic, and anti-inflammatory properties. Question: Two black box warnings for ibuprofen (Motrin) include increased risk for:    cardiovascular thrombotic events and gastrointestinal bleeding.      gastrointestinal bleeding and hepatoxicity.      cardiovascular thrombotic events and hepatotoxicity.      gastrointestinal bleeding and renal failure.   Explanation: Nonsteroidal anti-inflammatory drugs (NSAIDs) increase the risk for serious cardiovascular thrombotic events, including myocardial infarction and stroke. This risk may occur early in treatment and may increase with duration of use. NSAIDs cause an increased risk for serious gastrointestinal (GI) adverse events including bleeding, ulceration, and perforation of the stomach or intestines. Question: When corticosteroids are used in combination with nonsteroidal anti-inflammatory drugs (NSAIDs), patients may develop:    osteoarthritis.      diabetes insipidus.      gastrointestinal bleeding.      hypoglycemia.   Explanation: When corticosteroids are used in combination with nonsteroidal anti-inflammatory drugs (NSAIDs), patients may develop increased gastrointestinal symptoms and bleeding because both products diminish the gastroprotective effects of prostaglandins. Question: Naproxen (Aleve) is NOT indicated for relief of signs and symptoms associated with:    acute gout.      ankylosing spondylitis.      migraines.      rheumatoid arthritis.   Explanation: Naproxen is indicated for the relief of symptoms of acute gout, ankylosing spondylitis, rheumatoid arthritis, dysmenorrhea, tendinitis, and bursitis. Prevention and treatment of migraines is an off-label use. Question: In a 50-year-old nondiabetic man with moderate inflammation secondary to septic bursitis, the most appropriate therapy is:    clarithromycin (Biaxin).      clindamycin (Cleocin).      erythromycin base (Ery-Tab).      vancomycin (Vancocin).   Explanation: Septic bursitis is commonly caused by Staphylococcus aureus and other gram-positive organisms. Dicloxacillin (Dycill) and clindamycin (Cleocin) are appropriate choices for first-line therapy. Clindamycin, doxycycline (Doryx) and trimethoprim-sulfamethoxazole (Bactrim) are appropriate in regions with high rates of soft tissue infection related to methicillin-resistant S. aureus. Question: Ketorolac (Toradol), a nonsteroidal anti-inflammatory drug, is:    indicated for short-term treatment of moderate pain.      not known to cause renal insufficiency.      indicated for the treatment of moderate pain in children.      indicated for pain following coronary artery bypass graft surgery.   Explanation: Ketorolac (Toradol) is indicated for the short-term (up to 5 days in adults) management of moderately severe acute pain. It is not indicated for use in pediatric patients and is contraindicated in coronary artery bypass graft (CABG) surgery because it can cause an increased risk of serious cardiovascular thrombotic events. Prolonged use of ketorolac (Toradol) may cause acute kidney injury. Question: Allopurinol (Zyloprim) is NOT indicated for the treatment of:    asymptomatic hyperuricemia.      cancer therapy-induced hyperuricemia.      prophylactic gout.      recurrent calcium oxalate calculi.   Explanation: Allopurinol (Zyloprim) is NOT indicated for the treatment of asymptomatic hyperuricemia. It is classified as an antigout agent and a xanthine oxidase inhibitor. It is indicated for the management of primary or secondary gout (acute attack, tophi, joint destruction, uric acid lithiasis, and/or nephropathy); management of hyperuricemia associated with cancer treatment for leukemia, lymphoma, and other malignancies; and the management of recurrent calcium oxalate calculi (with uric acid excretion >800 mg/day in men and >750 mg/day in women). Question: The risk for gastrointestinal bleeding may increase with concomitant use of ibuprofen (Motrin) and:    aminoglycosides.      disease-modifying antirheumatic drugs.      ACE inhibitors.      corticosteroids.   Explanation: Ibuprofen should be used with caution in patients who are taking other medications known to increase the risk for GI bleeding (e.g., aspirin, anticoagulants and/or corticosteroids, selective serotonin reuptake inhibitors). NSAIDs and steroids both inhibit prostaglandin synthesis, which is critical for prevention of GI bleeds. Question: Patients who have difficulty swallowing tizanidine (Zanaflex) capsules should be:    prescribed an elixir.      considered for an intrathecal pump.      instructed that capsule contents can be sprinkled on food.      instructed to crush the tablets and make a slurry.   Explanation: Patients who have difficulty swallowing tizanidine (Zanaflex) capsules should be instructed that the content of the capsules may be sprinkled on food. Sprinkling of the capsule contents is not bioequivalent to administration of an intact capsule under fasting conditions. Tablets should not be crushed. Skelaxin is not formulated as an elixir or for intrathecal administration. Question: Cyclobenzaprine (Fexmid) should not be administered concomitantly with:    antihistamines.      acetylcholinesterase Inhibitors.      antihypertensives.      anticholinergics.   Explanation: The administration of anticholinergics and cyclobenzaprine (Fexmid) is contraindicated and is classified as a Risk X drug-drug reaction. Cyclobenzaprine causes anticholinergic activity including increased intraocular pressure, urinary retention and dry mouth. When administered with other anticholinergic drugs, the side effects are potentiated. Question: Colchicine (Colcrys) is an alkaloid that is:    approved for the acute and prophylactic treatment of gout.      approved for gout prophylaxis in patients aged 12 years and older.      known to cause extrapyramidal symptoms with long-term administration.      should be avoided in older adults.   Explanation: Colchicine (Colcrys) is an alkaloid indicated for the treatment of acute gout and for the prophylactic treatment of gout. It is approved for gout prophylaxis in patients aged 16 and older. It has been used in younger children for the treatment of familial Mediterranean fever. The most common side effects are diarrhea, vomiting and nausea. It is not known to cause extrapyramidal effects. Dosing adjustments and renal monitoring are recommended in older adults. Question: The maximum recommended daily dose of acetaminophen (Tylenol) for the management of pain associated with a clavicular fracture is:    1 gram.      2 grams.      3 grams.      4 grams.   Explanation: The maximum recommended daily dose of acetaminophen (Tylenol) in adults and children is 4 grams. Chronic daily dosing may result in liver damage in some patients. When calculating the maximum daily dose, healthcare professionals, patients and parents should consider all medications that contain acetaminophen. In pediatrics, do not exceed more than 5 doses daily. Question: Baclofen (Lioresal), a centrally-acting muscle relaxant, is indicated for the treatment of:    restless leg syndrome.      intermittent claudication.      spasticity.      essential tremor.   Explanation: Baclofen (Lioresal) is indicated for the treatment of spasticity that may be related to multiple sclerosis, traumatic brain injury, encephalitis, and spinal cord injury. Trigeminal neuralgia, nystagmus, hiccups, alcohol abstinence and gastroesophageal reflux are off-label uses. The use of Lioresal will not help with restless leg syndrome, leg pain related to intermittent claudication, or reduction of essential tremors. Question: The generic name for Advil, sometimes used in the treatment of joint pain, is:    ketoprofen.      meloxicam.      indomethacin.      ibuprofen.   Explanation: The generic name for Advil is ibuprofen. The brand name for ketoprofen is Orudis; meloxicam is Mobic; and indomethacin is Indocin. Question: Initial monotherapy for the treatment of low back pain is:    prednisone (Sterapred).      ibuprofen (Motrin).      cyclobenzaprine (Amrix).      tramadol (Ultram).   Explanation: A nonsteroidal anti-inflammatory drug (NSAID, ie. ibuprofen [Motrin]) is recommended as initial therapy for the treatment of back pain. The trial should be short-term, usually 2 to 4 weeks. Acetaminophen is a reasonable option for initial therapy in patients with contraindications to NSAIDs. Cyclobenzaprine (Amrix) is a skeletal muscle relaxant and may be added after the initial course of treatment, if needed. Tramadol (Ultram) is a central opioid agonist and a controlled substance. It may be habit forming. There is no evidence of benefit for the use of oral, intramuscular, or epidural corticosteroids in acute axial low back pain. Question: Which muscle relaxant is monitored by the Drug Enforcement Agency and is listed as a Schedule IV medication?    Cyclobenzaprine (Amrix)      Tizanidine (Zanaflex)      Methocarbamol (Robaxin)      Carisoprodol (Soma)   Explanation: Due to its drug dependency potential and abuse, carisoprodol (Soma) is regulated by the Drug Enforcement Agency and is listed as a Schedule IV medication. The others do require a prescription, but are not scheduled medications. Use with caution in patients with a history of drug abuse or acute alcoholism, or when the potential for drug dependency exists. Tolerance, psychological dependence, and physical dependence to carisoprodol (or its metabolite meprobamate) may occur with prolonged use. Question: When administering allopurinol (Zyloprim) for the treatment of gout, it is important to instruct the patient to:    avoid anti-inflammatory medications.      drink plenty of water daily.      stop at the first sign of gout flare-up.      take with food.   Explanation: When administering allopurinol (Zyloprim) for the treatment of gout, it is important to instruct the patient to take each dose with a full glass of water to reduce the risk of kidney stones. The patient should drink 8 to 10 full glasses of fluid every day. Anti-inflammatory agents may be used for acute flare-ups. For the patient who is already taking allopurinol when an acute exacerbation occurs, there is no need to discontinue. However, allopurinol should not be initiated until the acute exacerbation has subsided. Question: Probenecid, used in the treatment of gout, works by:    decreasing the tubular secretion of uric acid and inhibiting the secretion of penicillin.      destroying uric acid crystals in the renal tubular system and slowing the metabolism of penicillin.      increasing the urinary excretion of uric acid and inhibiting the secretion of penicillin.      promoting the bactericidal activity of penicillin and breaking down uric acid.   Explanation: Probenecid is a uricosuric and renal tubular transport blocking agent. It inhibits the tubular reabsorption of urate, thus increasing the urinary excretion of uric acid and decreasing serum urate levels. Probenecid inhibits the tubular secretion of penicillin and usually increases penicillin plasma levels by any route the antibiotic is given. A twofold to fourfold elevation has been demonstrated for various penicillins. Question: The medication initially recommended to control pain associated with non-inflammatory osteoarthritis is:    acetaminophen (Tylenol).      cyclobenzaprine (Amrix).      tramadol (Ultram).      prednisone (Sterapred).   Explanation: The initial treatment choice for noninflammatory osteoarthritis (OA), in which signs and symptoms of inflammation are not present, is acetaminophen. If prn dosing is inadequate, prescribe Tylenol on a regular basis up to three or four times daily. If this is inadequate, oral NSAIDs, topical NSAIDs, intra-articular glucocorticoids, opioid analgesics or glucosamine may be considered. Question: Brand names for naproxen, a nonsteroidal anti-inflammatory drug, do NOT include:    Anaprox.      Aleve.      Naprelan.      Advil.   Explanation: Anaprox, Aleve, and Naprelan are all brand names for naproxen. Advil is a brand name for ibuprofen. Naproxen and ibuprofen are nonsteroidal anti-inflammatory drugs. Question: Which medication helps the kidneys excrete uric acid?    Allopurinol (Zyloprim)      Colchicine (Colcrys)      Indomethacin (Indocin)      Probenecid   Explanation: Probenecid helps the kidneys excrete uric acid. Only patients with good kidney function who do not overproduce uric acid should take probenecid. Prior to administration of probenecid, the provider should ensure that the creatine clearance is greater than 50 mL/minute. Probenecid is classified as a uricosuric agent and is used in the treatment of gout. It is also used in combination with beta-lactam antibiotics to increase their serum concentration levels. Question: Corticosteroids, sometimes prescribed to reduce inflammation related to rheumatoid arthritis, should NOT be given in combination with:    live vaccines.      aspirin.      macrolides.      cephalosporins.   Explanation: Corticosteroids used to treat rheumatoid arthritis should NOT be given in combination with live vaccines. The immunosuppressive effects of steroid treatment vary, but a dose equivalent to 2 mg/kg of body weight or a total of 20 mg/day of prednisone is sufficiently immunosuppressive to increase the risk of contracting the disease from a live vaccine. Corticosteroids used in greater than physiologic doses also may reduce the immune response to vaccines. Wait at least 3 months after discontinuation of high-dose systemic steroid therapy before administering a live-virus vaccine. Question: Which of the following is NOT classified as a muscle relaxant:    metaxalone (Skelaxin).      cyclobenzaprine (Amrix).      methocarbamol (Robaxin).      tramadol (Ultram).   Explanation: Metaxalone (Skelaxin), cyclobenzaprine (Amrix) and methocarbamol (Robaxin) are all muscle relaxants. Tramadol (Ultram) is classified as a central opioid agonist. Question: The use of carisoprodol (Soma) should be limited to 2-3 weeks, mostly due to the potential for:    renal failure.      physical dependence.      suicide.      deep vein thrombosis.   Explanation: The use of carisoprodol (Soma), a centrally-acting skeletal muscle relaxant, should be limited to 2-3 weeks, mostly due to the potential for physical dependence. Use with caution in patients with a history of drug abuse or acute alcoholism or the potential for drug dependency. Tolerance, psychological dependence or physical dependence to carisoprodol (or its metabolite meprobamate) may occur with prolonged use. Question: Clindamycin (Cleocin) is indicated for the treatment of serious infections of:    the central nervous system.      the joints.      the urinary tract.      sexually transmitted diseases.   Explanation: Clindamycin (Cleocin) is indicated for the treatment of serious infections of the skin and soft tissue, joints, respiratory tract, intra-abdominal organs, and some infections of the female pelvis and genital tract. Clindamycin (Cleocin) is indicated in the treatment of serious infections caused by susceptible anaerobic bacteria. Examples include Streptococci, Staphylococci, and Pneumococci. Septic arthritis may be caused by Neisseria gonorrhea in sexually active people. Staphylococcus aureus is the cause of the vast majority of cases acute bacterial arthritis in adults and in children older than 2 years. Streptococcal species, such as Streptococcus viridans, S pneumoniae, and group B Streptococci, account for about 20% of cases. Question: Which of the following is NOT a reason to discontinue allopurinol (Zyloprim)?    Acute gout exacerbation      Dysuria      Jaundice      Skin rash   Explanation: Patients who are already receiving allopurinol (Zyloprim) to decrease the production of uric acid should continue allopurinol in the event of an acute gout exacerbation. Adverse reactions that warrant discontinuation include painful urination, anuria, jaundice (symptoms of hepatoxicity) and hypersensitivity including skin rash. Question: Prior to initiating pharmacologic therapy for the treatment of osteoporosis, the nurse practitioner should evaluate baseline serum:    bicarbonate and calcium levels.      calcium and 25 (OH) vitamin D levels.      calcium and phosphorous.      renal and hepatic function.   Explanation: Hypocalcemia has been reported with the use of bisphosphonates such as alendronate (Fosamax), ibandronate (Boniva), and risedronate (Actonel). Prior to therapy initiation, hypocalcemia must be ed if present. In measuring vitamin D serum levels, the 25(OH)D is utilized because this compound has the longest half-life (2 weeks). In vitamin D deficiency states, decreased calcium absorption occurs from the intestines, causing increased osteoclast production, which enhances the mobilization of calcium from bone. Adequate calcium and vitamin D stores must be present to allow pharmacologic treatments for osteoporosis to be effective. The antiresorptive medication serves as the "bricks" of bone building, while adequate calcium and vitamin D serve as the "mortar." Question: The term systemic corticosteroids refers to corticosteroids that are:    instilled in the eyes.      instilled in the ears.      inhaled.      given intramuscularly.   Explanation: Systemic corticosteroids are administered orally or by injection and distributed throughout the body. Systemic corticosteroids do not include corticosteroids used in the eyes, ears, or nose, on the skin or that are inhaled. Small amounts of these types of corticosteroids can be absorbed into the body but do not have systemi effects. Question: Acetaminophen (Tylenol) works to reduce pain by:    decreasing prostaglandin synthesis by irreversibly inhibiting cyclooxygenase-1 enzymes.      increasing the synthesis of cylooxygenase-1 enzymes to increase resistance to prostaglandins.      inhibiting the synthesis of prostaglandins in the central nervous system and working peripherally to block pain impulse generation.      decreasing synthesis of prostaglandins by reversibly inhibiting cyclooxygenase-1 and 2 (COX-1 and 2) enzymes.   Explanation: The mechanism of action of acetaminophen (Tylenol) is to inhibit the synthesis of prostaglandins in the central nervous system and work peripherally to block pain impulse generation. Acetaminophen is a nonopioid analgesic. Question: Patients who are taking bisphosphonates (i.e., alendronate [Fosamax]) for osteoporosis should be advised to:    take with meals.      take with dairy products.      stay upright for at least 30 minutes.      take with a full glass of mineral water or other beverage.   Explanation: To reduce esophageal irritation, bisphosphonates should be administered in the morning and at least 30 minutes before the first food, beverage (except plain water), or other medication of the day. Patients should not take the medication with mineral water or with beverages other than plain water. Patients should be instructed to stay upright for at least 30 minutes and until after first food of the day. Intestinal absorption is low and variable (1-10%). It takes place by passive diffusion in the stomach and upper small intestine, and it is reduced if the drug is given with calcium or iron. Therefore, bisphosphonates are never given at meal times or with dairy products. Question: Ketorolac (Toradol), for the treatment of moderate pain, is classified as a(n):    analgesic.      opioid partial agonist.      non-steroidal anti-inflammatory drug.      opioid agonist.   Explanation: Ketorolac (Toradol) is a nonsteroidal anti-inflammatory drug. It is indicated for the short-term (up to 5 days in adults) management of moderately severe acute pain. It is not indicated for use in pediatric patients and is contraindicated in coronary artery bypass graft (CABG) surgery because it can cause an increased risk for serious cardiovascular thrombotic events. Prolonged use of ketorolac (Toradol) may cause acute kidney injury. Question: Allopurinol (Zyloprim), used in the treatment of gout, decreases serum uric acid by:    activating xanthine oxidase to stop the production of uric acid.      binding to uric acid to speed up elimination.      inhibiting xanthine oxidase, the enzyme responsible for production of uric acid.      inhibiting oxypurinol production, which converts to uric acid.   Explanation: Allopurinol (Zyloprim) inhibits xanthine oxidase, the enzyme responsible for the conversion of hypoxanthine to xanthine to uric acid. Allopurinol is metabolized to oxypurinol, which is also an inhibitor of xanthine oxidase. Allopurinol acts on purine catabolism, reducing the production of uric acid without disrupting the biosynthesis of vital purines. Question: Acetaminophen (Tylenol) is contraindicated in patients who have:    hepatitis.      low body mass index.      migraine headaches.      varicella.   Explanation: Acetaminophen (Tylenol) is contraindicated in patients with acute liver failure, diminished hepatic function, severe renal impairment, shock, or poor nutrition. Question: Cyclobenzaprine (Fexmid), a skeletal muscle relaxant, should not be taken consistently for more than:    3 weeks.      8 weeks.      12 weeks.      6 months.   Explanation: Cyclobenzaprine, a skeletal muscle relaxant, is indicated for skeletal muscle spasms. It is indicated for the short-term treatment of skeletal muscle spasms. Therapy should be limited to 2-3 weeks. Efficacy has not been established for longer periods of use. Question: Ibandronate (Boniva), a biphosphonate, is approved for:    prevention of osteoporosis in men and women.      treatment of osteoporosis in men and women.      prevention and treatment of postmenopausal osteoporosis in women.      prevention and treatment of osteoporosis caused by glucocorticoid use in men and women.   Explanation: Ibandronate (Boniva), classified as a biphosphonate, is approved for the prevention and treatment of postmenopausal osteoporosis in women. Alendronate (Fosamax) and risedronate (Actonel) are indicated for the prevention and treatment of postmenopausal osteoporosis in women and osteoporosis in men, and the treatment of osteoporosis due to the use of glucocorticoid medicines in women and men. Risedronate (Actonel) is additionally indicated for the prevention of osteoporosis due to the use of glucocorticoid medicines in women and men. Question: The generic name for Indocin, used in the treatment of gout, is:    ketoprofen.      meloxicam.      indomethacin.      ibuprofen.   Explanation: The generic name for Indocin is indomethacin. The brand name for ketoprofen is Orudis; meloxicam is Mobic; and ibuprofen is Motrin. Question: Baclofen (Lioresal), a centrally-acting muscle relaxant, is indicated for the treatment of symptoms related to:    rheumatic disorders.      Huntington's chorea.      multiple sclerosis.      Parkinson disease.   Explanation: Baclofen (Lioresal) is indicated for the treatment of spasticity that may be related to multiple sclerosis, traumatic brain injury, encephalitis, or spinal cord injury. Efficacy of oral baclofen (Lioresal) has not been established in patients with stroke, Parkinson disease, or cerebral palsy; therefore, use for these conditions is not recommended. It is NOT indicated for spasticity associated with rheumatic disorders. Question: The most common adverse reaction to cyclobenzaprine (Fexmid) is:    blurred vision.      bradycardia.      xerostomia.      tremors.   Explanation: The most common adverse reactions to cyclobenzaprine (Fexmid) are drowsiness, dizziness and xerostomia (oral dryness). These symptoms occur in more than 10% of patients receiving cyclobenzaprine. Cyclobenzaprine, a skeletal muscle relaxant, is indicated for skeletal muscle spasms. Question: The onset of analgesic action of naproxen sodium (Aleve) occurs within:    15 minutes.      45 minutes.      75 minutes.      90 minutes.   Explanation: Onset of action of naproxen sodium (Aleve) is 30-60 minutes. The half-life elimination of naproxen sodium (Aleve) in adults with normal renal function is 12 to 17 hours. In patients with moderate-to-severe renal impairment, it is approximately 15 to 21 hours. Question: Bisphosphonates, used in the treatment of osteoporosis,:    increase renal tubular reabsorption of calcium.      increase gastrointestinal calcium absorption.      inhibit bone resorption by osteoclasts.      stimulate osteoblast function.   Explanation: The bisphosphonates inhibit the resorption of bone by osteoclasts and may have an effect on osteoblasts, thus leading to an indirect increase in bone mineral density. Medications in the bisphosphonate class include alendronate (Fosamax), ibandronate (Boniva), and risedronate (Actonel). Teriparatide, a recombinant human parathyroid hormone, increases renal tubular reabsorption of calcium, increases gastrointestinal calcium absorption, and stimulates osteoblast function. Question: The most significant adverse reaction associated with the overuse of acetaminophen (Tylenol) is:    decreased serum bilirubin.      increased serum calcium.      decreased ammonia levels.      increased serum alkaline phosphatase.   Explanation: The most significant adverse reaction associated with the overuse of acetaminophen (Tylenol) is increased serum alkaline phosphatase, indicating hepatotoxicity. Hepatotoxicity is usually associated with excessive acetaminophen intake and often involves more than one product that contains acetaminophen. This would cause an increase in serum bilirubin and alkaline phosphatase. Ammonia levels may be increased and serum calcium will be decreased. The maximum daily dose of acetaminophen is 4 grams daily in adults and children who have normal liver function. Question: Acetaminophen (Tylenol) for the treatment of osteoarthritic pain is classified as a(n):    salicylate.      nonopioid analgesic.      non-steroidal anti-inflammatory drug.      anti-inflammatory agent.   Explanation: Acetaminophen (Tylenol) is classified as a nonopioid analgesic. It does not have anti-inflammatory properties. Aspirin is classified as a salicylate. Ibuprofen (Motrin) and naproxen (Naprosyn) are nonsteroidal anti-inflammatory drugs. Prednisone (Deltasone) is a systemic steroid that has anti-inflammatory properties. Question: The generic name for Lioresal is:    bethanechol.      baclofen.      betaxolol.      methocarbamol.   Explanation: The generic name for Lioresal is baclofen. Baclofen is a centrally-acting muscle relaxant used in the treatment of spasticity. It may be administered orally or intrathecally. The brand name for bethanechol is Urecholine (a cholinergic agonist); betaxolol is Kerlone (a beta-blocker); and methocarbamol is Robaxin (a skeletal muscle relaxant). Question: Acetaminophen (Tylenol) does NOT produce:    analgesia.      antipyresis effects.      potentiated opioid analgesia.      anti-inflammatory activity.   Explanation: Acetaminophen (Tylenol) does not exhibit anti-inflammatory activity. It is used in the management of mild to moderate pain in patients >2 years of age. It does temporarily reduce fever and potentiates the reduction of pain when combined with opioids. Question: The mechanism of action of NSAIDs is to:    decrease synthesis of prostaglandins by reversibly inhibiting cyclooxygenase-1 and 2 (COX-1 and 2) enzymes.      decrease synthesis of prostaglandins by irreversibly inhibiting cyclooxygenase-1 enzymes.      increase synthesis of cylooxygenase-1 enzymes, resulting in increased resistance to prostaglandins.      produce a prodrug that blocks the synthesis of prostaglandins through the destruction of cyclooxygenase-1 and 2 (COX-1 and 2) enzymes.   Explanation: Ibuprofen (Motrin) works by reversibly inhibiting cyclooxygenase-1 and 2 (COX-1 and 2) enzymes, which results in decreased formation of prostaglandin precursors. The drug has antipyretic, analgesic, and anti-inflammatory properties. It is used to relieve pain in patients who have osteoarthritis, dysmenorrhea and other conditions that produce mild to moderate pain. Question: The maximum daily dose of ibuprofen (Motrin), sometimes used for relief of moderate low back pain, is:    800 mg.      1,600 mg.      1,800 mg.      2,400 mg.   Explanation: The recommended dose for the relief of mild to moderate low back pain is 400-600 mg PO q 6 hours. The maximum dose in a 24-hour period is 2,400 mg. Question: Cyclobenzaprine (Fexmid) and tizanidine (Zanaflex) are classified as:    peripherally-acting smooth muscle relaxants.      centrally-acting smooth muscle relaxants.      peripherally-acting skeletal muscle relaxants.      centrally-acting skeletal muscle relaxants.   Explanation: Cyclobenzaprine (Fexmid) and tizanidine (Zanaflex) are centrally-acting skeletal muscle relaxants. They are pharmacologically related to tricyclic antidepressants. These drugs potentiate norepinephrine and bind to serotonin receptors to reduce spasticity. Question: The generic name for Robaxin is:    cyclobenzaprine.      tizanidine.      carisoprodol.      methocarbamol.   Explanation: The generic name for Robaxin is methocarbamol. The brand name for tizanidine is Zanaflex; cyclobenzaprine is Amrix; and carisoprodol is Soma. These are centrally-acting muscle relaxants that potentiate norepinephrine and bind to serotonin receptors to reduce spasticity. Question: Cyclobenzaprine (Fexmid), a skeletal muscle relaxant, is indicated in the treatment of:    bladder spasms.      temporomandibular joint disorder.      cervicalgia.      lateral epicondylitis .   Explanation: Cyclobenzaprine (Fexmid), a skeletal muscle relaxant, is indicated for skeletal muscle spasms. The term cervicalgia covers a broad range of neck pain causes, including muscle strain and spasm. Bladder spasms would be best treated with a smooth muscle relaxant. Question: Patients taking acetaminophen (Tylenol) should be advised to avoid:    alcohol.      aspartame.      fava beans.      red meats.   Explanation: Patients taking acetaminophen (Tylenol) should be advised to avoid alcohol and alcohol-containing products due to increased risk of hepatotoxicity. Some formulations may contain aspartame and phenylalanine; these substances should be avoided in patients with rare conditions. Fava beans have no bearing on acetaminophen levels. Question: The most common side effect associated with ketorolac (Toradol) for the treatment of moderate musculoskeletal pain is:    hypotension.      bradycardia.      xerostomia.      gastrointestinal pain.   Explanation: The most commonly reported side effects of ketorolac (Toradol) are headache, gastrointestinal pain, dyspepsia and nausea. Ketorolac (Toradol) is a nonsteroidal anti-inflammatory drug. It is indicated for the short-term (up to 5 days in adults) management of moderately severe acute pain. Question: Caution is advised with the concomitant administration of angiotensin-converting enzyme (ACE) inhibitors and nonsteroidal antiinflammatory drugs (NSAIDs) because:    NSAIDs potentiate the effects of ACE inhibitors, causing hypotension.      ACE inhibitors decrease the effect of NSAIDs on prostaglandin synthesis.      NSAIDs enhance the photosensitizing effect of ACE inhibitors.      the combination may significantly decrease renal function.   Explanation: The combination of angiotensin-converting enzyme (ACE) inhibitors and nonsteroidal antiinflammatory drugs (NSAIDs) may result in a significant decrease in renal function. NSAIDs may diminish the antihypertensive effects of ACE Inhibitors, thus resulting in hypertension. ACE inhibitors do not cause a photosensitizing effect and do not reduce the effects of NSAIDs. Question: The best initial medication for the treatment of acute gout in the great toe of a patient with a creatinine clearance of 50 mL/min is:    aspirin.      colchicine.      indomethacin.      intraarticular steroid.   Explanation: Provided there are no contraindications, colchicine is the best initial choice for treatment of gout in the great toe. Indomethacin and other nonsteroidal antiinflammatory drugs (NSAIDs) would not be appropriate because the patient has a creatinine clearance less than 60 mL/min. Aspirin is not appropriate therapy because it can increase serum uric acid. Intraarticular steroids may be appropriate if the patient cannot take NSAIDs or colchicine, but they should be reserved for providers who are confident in administering intraarticular injections. Question: Glucocorticoids, sometimes used to treat rheumatoid arthritis,:    increase immunity.      suppress inflammation.      regulate salt and water balance.      prevent the breakdown of proteins.   Explanation: Glucocorticoids suppress inflammation and immunity and assist in the breakdown of fats, carbohydrates, and proteins. Mineralocorticoids regulate the balance of salt and water. Question: The generic name for Soma is:    cyclobenzaprine.      tizanidine.      carisoprodol.      methocarbamol.   Explanation: The generic name for Soma is carisoprodol. The brand name for tizanidine is Zanaflex; cyclobenzaprine is Amrix; and methocarbamol is Robaxin. These are centrally-acting muscle relaxants that potentiate norepinephrine and bind to serotonin receptors to reduce spasticity. Soma is a schedule IV medication due to the potential for abuse. None of the other muscle relaxants listed are scheduled drugs. Question: A nonsteroidal anti-inflammatory drug (NSAID) that can be administered orally and intramuscularly is:    ibuprofen (Motrin).      ketoprofen (Orudis).      ketorolac (Acuvail).      diclofenac (Cambia).   Explanation: Ketorolac may be administered orally, intramuscularly, or intravenously. Ketorolac is classified as a nonsteroidal anti-inflammatory drug (NSAID). It is indicated for the short-term treatment of joint and back pain. Duration of use should not exceed 5 days. Ibuprofen (Motrin) may be administered by IV or oral route. Diclofenac (Cambia) and ketoprofen (Orudis) are administered orally. Question: Oral ibuprofen (Motrin) has a bioavailability of:    40%.      60%.      80%.      100%.   Explanation: Bioavailability is the degree and rate at which an administered drug is absorbed by the body's systemic circulation. The oral bioavailability of ibuprofen (Motrin) is 80%. Ibuprofen works by reversibly inhibiting cyclooxygenase-1 and 2 (COX-1 and 2) enzymes, resulting in decreased formation of prostaglandin precursors. Ibuprofen is metabolized by the CYP2C9 substrate of the CYP450 enzyme system of the liver. It is primarily excreted in the urine and has a half-life of 1.8 to 2 hours.

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