NSG 6320 AGNP Board Exam – Orthopedics Prescribing Exam

NSG 6320 AGNP Board Exam – Orthopedics Prescribing 1. Question: Which medication is NOT a brand name for acetaminophen? Mapap Cetafen Aleve Correct Feverall Explanation: Brand names for acetaminophen include Mapap, Cetafen, FeverAll and Tylenol. Aleve is the brand name for naproxen sodium. 2. Question: To treat low back pain in a patient for whom nonsteroidal anti-inflammatory drugs (NSAIDs) are contraindicated, the recommended therapy is: acetaminophen (Tylenol). Correct 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. 3. 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. Correct 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. 4. 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. Correct 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. 5. 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). Correct 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. 6. Question: The half-life elimination of colchicine (Colcrys), used in the treatment of gout, is approximately: 8 hours. 15 hours. 30 hours. Correct 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. 7. 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. Correct 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. 8. Question: Which formulation of naproxen would result in fewer GI side effects? Naprosyn Naprosyn suspension Anaprox DS EC-Naprosyn Correct 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. 9. 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. Correct 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. 10. 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. Correct 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. 11. Question: The concomitant use of aspirin and nonsteroidal anti-inflammatory drugs (NSAIDs) can cause: hypoglycemia. abnormally high serum levels of potassium. Correct 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. 12. 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. Correct 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. 13. Question: Intra-articular steroid injections are NOT contraindicated: when the skin over the injection site is infected. in patients with diabetes. Correct 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. 14. 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. Correct 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. 15. 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. Correct 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. 16. Question: The brand name for cyclobenzaprine is: Elavil. Amrix. Correct 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. 17. Question: The intra-articular steroid with the longest duration of action is: dexamethasone acetate (Decadron). methylprednisolone acetate (Depo-Medrol). triamcinolone acetonide (Kenalog).