Anti-inflammatory Questions
A 2 year old girl is suffering from symptoms of an influenza infection and presents to the emergency department with a fever of 104 C. Which of the following drugs would you most likely administer to this patient to reduce her fever? A. Acetaminophen B. Amoxicillin C. Aspirin D. Ciprofloxacin E. Indomethacin
A. Acetaminophen has antipyretic effects by inhibiting COX enzymes in the brain . Prostaglandin production in the hypothalamus is associated with increased body temperature. Aspirin use especially in children with influenza or varicella is associated with Reye Syndrome. This is a condition associated with progressive encephalopathy and hepatic dysfunction. Characteristics of this syndrome include vomiting and confusion that can evolve into seizures and coma.
A 50-year-old woman has progressive erosive rheumatoid arthritis that has not responded to conservative therapy. Her physician prescribes a disease-modifying antirheumatic drug (DMARD) that once administered IV, bi-weekly, reduces the activity of TNFα. Which of the following drug did the physician prescribe? A. Adalimumab B. Hydroxychloroquine C. Methotrexate D. Penicillamine E. Sulfasalazine
A. Adalimumab, is a fully humanized monoclonal antibody that binds to TNF alpha
You are treating a patient who over the last several months has had repeated symptoms of intense pain, warmth, and redness in the great toe of her right foot. Her serum concentration of uric acid was elevated during these episodes. Which of the following anti-gout drug therapies can be used to decrease this woman's rate of production of uric acid? A. Allopurinol B. Aspirin C. Colchicine D. Etanercept E. Probenecid
A. Allopurinol, inhibits xanthine oxidase, prevents urate formation from dietary purines (allopurinol is a purine analog while febuxostat is not)
A 56-year-old woman was diagnosed rheumatoid arthritis 1 year ago. She has been taking non-steroidal-anti-inflammatory agents with adequate dosing and meticulous compliance. However, her inflammation and erosive bone changes are still evident and appear to be getting worse. Which type of drug treatment is helpful in managing this patient's persistent and active arthritis but is associated with low patient compliance due to common side effects of dermatitis, cytopenias, proteinuria and gastrointestinal upset? A. Aurothiomalate (parenteral Gold) B. Etanercept C. Indomethacin D. Leflunamide E. Naproxen
A. Aurothiomalate
A 60-year-old woman is diagnosed with rheumatoid arthritis. She is currently being managed with methotrexate. After 6 months of management with this therapy her symptoms are still present. A new drug is given that when used in combination with methotrexate improves her ACR 70 value. The new drug is given subcutaneously once a week and works by inhibiting tumor necrosis factor-alpha. Prior to administering this drug you screen your patient for tuberculosis and warn her about the possible increased risk of B-cell lymphomas. Which drug was added? A. Etanercept B. Gold compound C. Hydroxychloroquine D. Leflunomide E. Sulfasalazine
A. Etanercept
Which is INNCORRECT regarding adverse or toxic effects of aspirin? A. GI intolerance or bleeding is only found in patients who take doses higher than recommended B. Aspirin use may increase bleeding time C. Toxic doses may lead to metabolic acidosis and respiratory depression D. Aspirin can cause tinnitus, vertigo and decreased hearing E. Aspirin may inhibit normal renal regulation of water and electrolytes
A. GI intolerance and bleeding are associated with aspirin use even at relatively low doses.
A common toxicity of ibuprofen use is which of the following? A. Gastroduodenal ulceration & bleeding B. Platelet aggregation C. Thrombocytopenia D. Reyes Syndrome E. Respiratory failure
A. GI ulcers and bleeding
Which of the following statements is correct? A. The conversion of arachidonic acid to leukotrienes is carried out by cyclooxygenase I B. PGE1 (alprostadil) is used to treat male impotence via smooth muscle relaxation C. Leukotrienes have prominent anti-inflammatory and bronchodilatory effects D. Prostaglandin production in the gut often leads to gastric ulcers E. Thromboxane stimulates receptor-mediated conversion of intracellular ATP into cAMP
B. Alprostadil can be injected into the corpus cavernous or placed as a pill transurethral. This is a less sought after alternative to phosphodiesterase inhibitors like sildenafil (Viagra), etc. Leukotrienes are the products of conversion of arachidonic acid by lipooxygenase. C and D are opposite to what these compounds do.
A 46-year-old male suffering from ischemic heart disease is put on a medication that irreversibly inhibits both cyclooxygenase 1 and 2. Which drug is this patient taking? A. Allopurinol B. Aspirin C. Ibuprofen D. Naprosyn E. Methotrexate
B. Aspirin
Which of the following should not be used on children because it is associated with Reyes Syndrome? A. Acetaminophen B. Aspirin C. Ibuprofen D. Prednisone E. Celecoxib
B. Aspirin, aspirin use especially in children with influenza or varicella is associated with Reye Syndrome. This is a condition associated with progressive encephalopathy and hepatic dysfunction. Characteristics of this syndrome include vomiting and confusion that can evolve into seizures and coma.
Which of the following is a potent, long-duration, glucocorticoid? A. Cortisone B. Betamethasone C. Hydrocortisone D. Piroxicam E. Prednisone
B. Betamethasone
Which of the following statements best describes an advantage of celecoxib over naproxen to treat arthritic symptoms in a patient with a history of ulcers? A. Celecoxib is a more effective anti-inflammatory and analgesic agent than naproxen B. Celecoxib inhibits more specifically the COX enzyme isotype that is inducible by cytokines and growth factors C. Celecoxib is a specific COX 1 inhibitor D. Celecoxib use can increase prostaglandin synthesis in the gastrointestinal tract E. Celecoxib use inhibits the constitutively regulated COX enzyme isotype found in the gastrointestinal tract
B. Celecoxib is more selective for COX 2 (pro-inflammatory), which is the inducible isotype of the COX enzymes.
A 32 year old woman complains to her family doctor of mild to moderate pain in all of her joints, a swollen right knee, and stiffness every morning. These symptoms have been occurring with increasing severity for the past week. She has swelling in 3,4,5 proximal interphalangeal joints bilaterally. Joint deformity 3, 4 bilaterally is visible with ulnar deviation bilaterally. She has decreased grip strength, L>R. She also has decreased range of motion in her shoulders, hips and knees. Blood tests are positive for serum rheumatoid factor. Her personal medical history indicates a history of GI bleeding from peptic ulcer disease and has no significant cardiovascular issues. The most appropriate drug to treat this woman's pain with the least amount gastrointestinal side effects is which of the following? A. Aspirin B. Celecoxib C. Dexamethasone D. Ibuprofen E. Indomethacin
B. Celecoxib is the selective COX 2 inhibitor in this list.
A 43-year-old female patient with a history of gastrointestinal bleeding suffers an orthopedic injury and requires a minimum of a 4-week course of NSAID therapy to treat some of the symptoms associated with her injury. Which of the following NSAIDS would you most likely advise this woman to use? A. Aspirin B. Celecoxib C. Diclofenac D. Indomethacin E. Ketorolac
B. Celecoxib of this list is the most selective for COX 2.
Which of the following represents an immunoconjugate? A. Gemtuzumab ozogamicin (Mylotarg) B. Etanercept (Enbrel) C. Levamisole (Ergamisole) D. Alefacept (Amevive) E. Abatacept (Orencia)
B. Etanercept is a TNF-alpha receptor lined to IgG1.
Which of the following is a potentially significant advantage of celecoxib over aspirin? A. Aspirin inhibits COX 1 only B. Celecoxib has less corrosive effects on gastrointestinal lining C. Celecoxib inhibits both COX 1 and COX 2 D. Celecoxib is a more efficacious anti-inflammatory agent E. Celecoxib is an irreversible inhibitor of COX 1 and COX 2
B. In theory, because celocoxib is more selective for COX 2 (pro-inflammatory) than COX 1(pro-cytoprotection in the gut) it should have less corrosive effects on GI lining.
A 44 year old male is seen by his physician for severe pain in his left great toe. His toe is swollen, hot, tender, with normal joint space and erythematous. His serum uric acid level is 11.5 mg/dl (normal is 3.5-8.0 mg/dl). Synovial fluid aspirate demonstrates PMNs and monosodium urate crystals. A. Aspirin B. Allopurinol C. Indomethacin D. Probenecid E. Sulfinpyrazone Which drug listed above would most likely be used to treat this patient's acute gouty attack?
C Indomethacin is the NSAID of choice to treat acute inflammatory episodes associated with gout. Aspirin is avoided because it can prevent excretion of uric acid in the renal tubules.
Which of the drug is correctly matched to its therapeutic use? Drug treatment : Disease treated A. PGF2α (Latanoprost) : asthma B. Thromboxane A2 : pulmonary hypertension C. PGE1 (Alprostadil) : erectile dysfunction D. Leukotriene B4 : Rheumatoid Arthritis E. PGE2 (Dinoprostone) : Unwanted Premature labor
C. Alprostadil can be injected into the corpus cavernous or placed as a pill transurethral. This is a less sought after alternative to phosphodiesterase inhibitors like sildenafil (Viagra), etc.
Which effect of aspirin requires the highest dose of the drug? A. Analgesic B. Antipyretic C. Anti-inflammatory D. Anti-thrombotic E. All effects need about the same dose
C. Anti-inflammatory dose. Gram quantities are used per dose vs mg quantities for the rest.
A 43-year-old man is suffering from muscle pain and mild joint inflammation associated that developed acutely after playing basketball. He decides to take ibuprofen to relieve the symptoms associated with this pain and inflammation. Which statement is true regarding the use of ibuprofen? A. After cessation of ibuprofen use the Antiplatelet effects can last 8-10 days B. Ibuprofen is a selective COX 2 inhibitor C. Ibuprofen can have similar effects to aspirin in patients with bronchospastic reactivity to aspirin D. Ibuprofen use is not associated with gastrointestinal irritation E. The Antiplatelet effects of ibuprofen and aspirin are synergistic
C. Both aspirin and ibuprofen are non-selective inhibitors of the COX enzymes. Arachidonic acid can shift over to the leukotriene pathway if these enzymes are inhibited. Asthmatics (especially with nasal polyps) can be sensitive to this shift.
Which of the following drugs has the highest salt-retaining potency? A. Beclomethasone B. Dexamethasone C. Fludrocortisone D. Metyrapone E. Triamcinolone
C. Fludrocorisone in addition to activated glucocorticoid receptors can activate aldosterone receptors in the renal tubule which leads to sodium retention in the body.
A 32 year old woman complains to her family doctor of mild to moderate pain in all of her joints, a swollen right knee, and stiffness every morning. These symptoms have been occurring with increasing severity for the past week. She has swelling in 3,4,5 proximal interphalangeal joints bilaterally. Joint deformity 3, 4 bilaterally is visible with ulnar deviation bilaterally. She has decreased grip strength, L>R. She also has decreased range of motion in her shoulders, hips and knees. Blood tests are positive for serum rheumatoid factor. Her personal medical history indicates a history of GI bleeding from peptic ulcer disease and has no significant cardiovascular issues. Which of the following antirheumatic drugs should have the best oral availability? A. Adalimumab B. Etanercept C. Hydroxychloroquine D. Infliximab
C. Hydroxychloroquine. The rest are biologic DMARDS
A 60-year-old woman is diagnosed with rheumatoid arthritis. She is currently being managed with methotrexate. After 6 months of management with this therapy her symptoms are still present. A new drug is given that when used in combination with methotrexate improves her symptoms. The new drug is given intravenously (IV) once a month and works by binding to tumor necrosis factor-alpha. Prior to administering this drug you screen your patient for tuberculosis and warn her about the possible increased risk of B-cell lymphomas. Which drug was added? A. Gold compound B. Hydroxychloroquine C. Infliximab D. Leflunomide E. Sulfasalazine
C. Infliximab is a partially humanized antibody directed against TNF alpha.
Colchicine: A. Inhibits zanthine oxidase B. Inhibits COX 2 enzyme C. Inhibits microtubule polymerization D. Blocks TNF-alpha from binding to its receptor E. Increases excretion of uric acid
C. Inhibits microtubule polymerization which is required for movement of immune cells. For this reason it is used to treat inflammation associated with gout.
A 45-year-old male who is suffering from multiple minor injuries is taking ibuprofen daily to treat his injuries. Unfortunately, his injuries occur often preventing him from terminating the current course of ibuprofen. He has been taking the drug for over a month. He now is suffering from gastro-intestinal (GI) ulcers. The principle mechanism that ibuprofen is producing these GI symptoms is mediated by which action? A. Irreversible inhibition of the cyclo-oxygenase one enzyme B. Irreversible inhibition of the cyclo-oxygenase two enzyme C. Reversible inhibition of the cyclo-oxygenase one enzyme D. Reversible inhibition of the cyclo-oxygenase two enzyme E. Reversible inhibition of lipoxygenase
C. Reversible inhibition of COX 1 preventing pro-cytoprotectant prostaglandins from being made in the GI tract.
This patient accidentally takes twice the amount of aspirin as was indicated by her physician. She now experiences symptoms of tinnitus, decreased hearing and vertigo. You administer sodium bicarbonate to alkalinize the urine. At what renal tubular pH would aspirin or its metabolites, which have a similar pKa, be most efficiently excreted in the urine? A. 5 B. 6 C. 7 D. 8
D. Aspirin is a weak acid. Weak acids H+ + A- = HA . Weak acids become disassociated when the hydrogen ion concentration is reduced. Therefore, the higher the pH (lower the hydrogen ion concentration) the more charged aspirin will be present. The charged form will not be reabsorbed and will be excreted.
You are treating a patient that has symptoms consistent with early stage rheumatoid arthritis. The patient's disease responded initially to celecoxib and methotrexate. However, recently her symptoms began to worsen and radiologic studies of her hands indicated progressive destruction in the joints of several fingers. Treatment with a new second-line agent for this patient was considered. This drug is available only in a parenteral formulation; its mechanism of anti-inflammatory action involves direct antagonism of tumor necrosis factor. The drug being considered is A. Allopurinol B. Penicillamine C. Auranofin D. Infliximab E. Probenecid
D. Infliximab is a monoclonal antibody, when injected into patients with RA, binds to TNF alpha. The reduction in levels of TNF alpha decreases the immune response and slows the progression of RA-induced joint erosion. Allopurinol and probenecid are used for patients with Gout. Penicillamine and auronofin's mechanism of action are less clear.
A 43-year-old man routinely takes aspirin to control muscle and joint pain. He has his wisdom tooth extracted, and he experiences excessive bleeding. The most likely cause of the excessive bleeding is A. Hepatic damage caused by aspirin use B. Inhibition of leukotriene synthesis by aspirin C. Inhibition of thromboxane synthesis by aspirin D. Inhibition of prostacyclin synthesis by aspirin E. Metabolic acidosis caused by aspirin use
D. Inhibition of thromboxane synthesis by aspirin. Aspirin prevents the production of PGH2 in platelets by inhibiting COX1. TXA2 is made when PGH2 is converted to TXA2 by thromboxane synthase.
The anti-inflammatory mechanism of action of aspirin is produced by A. Competitive inhibition of cyclooxygenase (COX) one enzyme B. Competitive inhibition of cyclooxygenase (COX) two enzyme C. Irreversible inhibition of cyclooxygenase (COX) one enzyme D. Irreversible inhibition of cyclooxygenase (COX) two enzyme E. Irreversible inhibition of lipoxygenase enzyme
D. Irreversible inhibition of cyclooxygenase (COX) two enzyme. The COX 2 isotype is associated with inflammation.
What is the mechanism of action of aspirin? A. Selective reversible inhibitor of cyclooxygenase 1 B. Reversible inhibitor of both cyclooxygenase 1 and 2 C. Irreversible inhibitor of both cyclooxygenase and lipooxygenase D. Irreversible inhibitor of both cyclooxygenase 1 and 2 E. Irreversible inhibitor of lipoxygenase
D. Irreversible non-selective COX inhibitor
A 44 year old male is diagnosed with rheumatoid arthritis and requires the treatment of a drug that stops the progression or the bone erosion associated with this disease. His clinician prescribes a drug that inhibits autoimmune T cell proliferation by inhibiting dihydroorate dehydrogenase. The prescription of this drug necessitates baseline and monthly liver function test because it is associated with hepatotoxicity at high doses. Which drug was prescribed to this patient? A. Aspirin B. Hydroxychloroquine C. Infliximab D. Leflunomide E. Methotrexate
D. Leflonomide, a metabolite that inhibits dihydro orate dehydrogenase and prevents de novo ribonucleotide synthesis, which is required for T cell proliferation and B cell function
A 56-year-old woman was diagnosed rheumatoid arthritis 1 year ago. She has been taking non-steroidal-anti-inflammatory agents with adequate dosing and meticulous compliance. However, her inflammation and erosive bone changes are still evident and appear to be getting worse. Which of the following drugs can be administered orally to the above patient and has similar efficacy in treating rheumatoid arthritis as methotrexate? A. Aurothiomalate (parenteral Gold) B. Etanercept C. Indomethacin D. Leflunamide E. Naproxen
D. Leflunamide is a metabolite that inhibits dihydro orate dehydrogenase and de novo ribonucleotide synthesis,. This stops T cell proliferation and B cell function.
An economical, safe, and effective way to prevent NSAID-associated ulcers is the simultaneous use of A. Antacids B. Misoprostol C. Pepto-Bismol D. Proton pump inhibitors E. Sucralfate
D. Proton pump inhibitors. Many of the choices could be used to treat NSAID-associated GI irritation. Misoprostol could be used to replace cyto-protective prostaglandins not produced when COX one is inhibited but it is not economical and is associated with its own toxicities (Headache, constipation, dyspepsia,which are common (1-10%).
Which of the following is NOT typically involved in mediating the direct glucocorticoid effects in various cells? A. Glucocorticoid response elements on DNA B. Heat shock proteins C. Intracellular glucocorticoid receptor protein D. Seven-domain trans-membrane receptors E. Transcription factors
D. Seven-transmembrane receptors. Glucocorticoids pass through cell wall to activated a transcriptional regulator. When bound by glucocorticoids the intracellular receptor disassociates from the heat shock protein (HSP 90), moves into nucleus, where it activates or inhibits DNA transcription when it binds to the glucocorticoid response element in several genes.
Which of the following is used for the treatment of ulcerative colitis? A. Sulfadiazine B. Sulfadoxine C. Sulfamethoxazole D. Sulfasalazine E. Trimethoprim
D. Sulfasalazine
Corticosteroids inhibit the following processes, EXCEPT A. Adhesion of leukocytes to the vascular endothelium B. Induction of cyclooxygenase II C. Release of ACTH from the pituitary D. Synthesis of pulmonary surfactant protein E. The effect of vitamin D on calcium absorption
D. Synthesis of pulmonary surfactant protein
Which of the following statements is most correct regarding the use of ibuprofen and aspirin? A. Aspirin is not used as an antipyretic B. Ibuprofen is more effective than aspirin at reducing inflammation C. Ibuprofen is not associated with any serious gastrointestinal effects D. The duration of action of aspirin on platelet function is longer than ibuprofen E. Ibuprofen does not have any analgesic properties
D. The duration of action of aspirin on platelet function is longer than ibuprofen. Aspirin is an irreversible inhibitor while ibuprofen in not. Platelets don't make new enzymes. Therefore, the effects of aspirin will last for the life of the platelet.
Infliximab is a chimeric anti-TNF-α monoclonal antibody of molecular weight of 149,100. Which statement is correct regarding Infliximab? A. Increasing the concentration in the stomach lumen vs blood should increase absorption B. Infliximab should be given orally only with a drug that buffers or reduces gut H+ concentration C. Infliximab is absorbed across lipid bilayer via amino acid transporters. D. Large functional proteins used as drugs are given parenterally (I.V., I.M., S.C.) E. The gut pH does not affect the structure of infliximab
D. functional proteins have to be injected and will not survive the gut environment
The main advantage of ketorolac over aspirin is that ketorolac A. Can be obtained as an over the counter agent B. Does not prolong the bleeding time C. Is not associated with gastro-intestinal toxicity D. Is available in a parenteral formulation E. Is less likely to cause acute renal failure
D. is available in a parenteral formulation
A 46-year-old male develops a skin rash after walking his dog through an area of poison oak. His rash consists of small liquid filled eruptions. His doctor prescribes prednisone, an oral glucocorticoid. Why was prednisone used in this patient? A. to increase gene expression of endogenous glucocorticoids B. to increase the gene expression of cyclooxygenase 2 C. to increase the enzyme activity of phospholipase A2 D. to reduce gene expression pro-inflammatory proteins E. to reduce the probability of opportunistic infections
D. to reduce gene expression pro-inflammatory proteins
A 32 year old woman complains to her family doctor of mild to moderate pain in all of her joints, a swollen right knee, and stiffness every morning. These symptoms have been occurring with increasing severity for the past week. She has swelling in 3,4,5 proximal interphalangeal joints bilaterally. Joint deformity 3, 4 bilaterally is visible with ulnar deviation bilaterally. She has decreased grip strength, L>R. She also has decreased range of motion in her shoulders, hips and knees. Blood tests are positive for serum rheumatoid factor. Her personal medical history indicates a history of GI bleeding from peptic ulcer disease and has no significant cardiovascular issues. Which of the following medications would most likely be used chronically to stop the progression of bone erosion in this patient? A. Acetaminophen B. Aspirin C. Celecoxib D. Dexamethasone E. Methotrexate
E Methotrexate, a folic acid analog, inhibits dihydrofolate reductase preventing the addition of methyl groups to purines and amino acids. DNA synthesis is inhibited in fast growing immune cells. Dexamethasone could be used as a short term bridge therapy—long term use would cause to many metabolic side effects. DMARDs like MTX are used to stop the progression of bone erosion in patients with rheumatoid arthritis.
A 32 year old woman complains to her family doctor of mild to moderate pain in all of her joints, a swollen right knee, and stiffness every morning. These symptoms have been occurring with increasing severity for the past week. She has swelling in 3,4,5 proximal interphalangeal joints bilaterally. Joint deformity 3, 4 bilaterally is visible with ulnar deviation bilaterally. She has decreased grip strength, L>R. She also has decreased range of motion in her shoulders, hips and knees. Blood tests are positive for serum rheumatoid factor. Her personal medical history indicates a history of GI bleeding from peptic ulcer disease and has no significant cardiovascular issues. The patient informs you that she wishes to become pregnant. What type of therapy would you use in this situation? A. Continue leflunomide therapy B. Continue Methotrexate therapy C. Lower the dose of methotrexate and add infliximab D. Lower the dose of leflunomide and add infliximab E. Restrict DMARD therapy to a glucocorticoid if necessary at all
E Symptoms of rheumatoid arthritis can go into remission temporarily when woman are pregnant. Most DMARDs are category X and should not be used except for glucocorticoids.
Which of the following contraindicate the use of glucocorticoids? If all (A-D) do, answer E! A. Diabetes B. Heart disease C. Infection D. Peptic ulcer E. All of the above
E. All of the above. High doses for longer than two weeks can result in iatrogenic Cushing's syndrome. Symptoms include changes in fat redistribution (round-puffy "moon" face, truncal obesity , spindly limbs, hump on back) acne, insomnia, increased appetite, many metabolic effects (protein breakdown, glucose production, increased insulin requirement, weight gain), structural consequences (osteoporosis, muscle loss, skin thinning with striae and bruising). Other notable effects include peptic ulcers, increased infections, CNS changes (acute psychosis, depression), eye (cataracts and increased intraocular pressure—dangerous in patients with glaucoma), growth retardation in children, and adrenal suppression Contraindicated Peptic ulcer disease Hypertension with heart disease Certain infections Varicella TB Psychoses Diabetes Osteoporosis Glaucoma
A 60-year-old male with a history of gastric ulcers develops rheumatoid arthritis. His physician would like to begin therapy with aspirin. To avoid the recurrence of gastric ulcers in this patient, the physician should advise him to A. Take aspirin between meals B. Take aspirin at night with a glass of wine C. Take aspirin as a suppository D. Take ibuprofen instead E. Take misoprostol with aspirin
E. Aspirin, an irreversible-COX-1 and-2-inhibitor, can prevent the cytoprotective prostaglandins from being made. Misoprostol, a PGE1 analog can be used to augment the aspirin induced endogenous production of PGE1 in the gut. Proton pump inhibitors are now more favored as a mechanism to reduce gut erosion.
Which process can lead to toxic products of acetaminophen (Tylenol)? A. Conjugation with glucuronide B. Conjugation with sulfate C. Conjugation with glutathione D. Induction of CytP450 by acetaminophen E. Metabolism of acetaminophen by CytP450
E. CYP 2E1 metabolizes approximately 5% of ingested Tylenol and converts it into a free radical that if not rapidly conjugated to glutathione can bind to important enzymes and lead to liver cell death.
Which of the following NSAIDs (A-D) causes irreversible inhibition of platelet aggregation? (If none of them does, answer E!) A. Ibuprofen B. Celecoxib C. Naproxen D. Sodium salicylate E. None of the above
E. Only aspirin is the irreversible COX 1 and 2 inhibitor the rest are reversible. Celocoxib is reversible and selective for COX 2, which is not involved in TXA2 production.
A 65-year-old women is on a medication that decreases symptoms and slows the progression of erosive changes produced by her rheumatoid arthritis (RA). However, she is complaining of symptoms of diarrhea, stomatitis, dermatitis and her lab values indicate hematologic abnormalities. She no longer wishes to take the medication. Which drug is she currently using to treat her RA? A. Celecoxib B. Indomethacin C. Etanercept D. Infliximab E. Parenteral gold (aurothiomalate)
E. Parenteral gold is associated with all of these side effects.
A 50-year-old man complains that he has attacks of excruciating pain in his big toe. Examination of the foot shows that the third metatarsophalangeal joint is swollen, hot, red, and tender. Laboratory finding include a serum uric acid level of 20 mg/dl (3.5 to 8.0 mg/dl is the normal range for an adult). Which of the following could be used to increase uric acid secretion in this patient? A. Allopurinol B. Celecoxib C. Colchicine D. Indomethacin E. Sulfinpyrazone
E. Sulfinpyrazone and probenecid are both used to increase excretion of uric acid in patients with severe chronic gout.
Which of the following (A-D) constitutes a relative contraindication of corticosteroid treatment? If all of (A_D) are contraindications, answer E! A. Viral infection B. Osteoporosis C. Diabetes D. Glaucoma E. All of the above (A-D) are relative contraindications of glucocorticoid treatment
E. corticosteroids are an immunosuppressant that has many important metabolic effects and associated toxicities if used for extended periods.
