HIMT1350-Pharmacotherapy- Chapter 19-26

After a serious gastrointestinal bleed, Alina, who has rheumatoid arthritis, and her doctor discuss options for continued NSAID therapy. He suggests that she take a drug that combines an NSAID with another drug that will protect the gastric mucosa. What agent combines diclofenac with misoprostol?

Arthrotec

Jenny has severe depression characterized by extreme fatigue, lethargy, and psychomotor retardation. Which heterocyclic antidepressant would be most effective with these symptoms?

bupropion

Jaxson has generalized anxiety disorder and his anger often causes serious interpersonal problems. What anxiolytic might be helpful?

buspirone

Chiara has poorly controlled pain from diabetic neuropathy. What serotonin norepinephrine reuptake inhibitor might be given as an adjuvant?

duloxetine

Myra is taking a bisphosphonate for treatment of osteoporosis. She should take the bisphosphonate with a ____.

full glass of water, at least 30 minutes before her first food of the day

Ursula has seizures that are bilaterally symmetrical and without local onset. These seizures are ____.

generalized

Kassidy's seizures are well-controlled with carbamazepine. However, what food should she avoid?

grapefruit

Jai has become psychologically dependent on marijuana. What term is applicable when only psychological dependence is involved?

habituation

Ashley has insomnia and her doctor gives her medication to produce sleep. This type of medication is called a(n) ____.

hypnotic

Alyssia is taking an agent that acts directly to inhibit bone reabsorption. What is an example of such an agent?

ibandronate

Roderick's terrified parents rush their 18 month-old son to the emergency room after he has a seizure that lasts about a minute. An investigation reveals Roderick has had a febrile seizure. What is the treatment of choice?

identifcation of and treatment for the cause of the fever

Hasan has long QT syndrome and experiences episodes of rapid, chaotic heart beats. He is having surgery and discusses pain control with his surgeon. Which analgesic is itself associated with sometimes fatal QT prolongation and should therefore be avoided?

methadone

Thelma has restless leg syndrome that has disrupted her sleep and left her drowsy during the day. What medication might be helpful?

pramipexole

Stan expresses his anxiety about his upcoming surgery at his pre-operative appointment. His doctor tells him that he will be given medication to calm him prior to the surgery. This type of medication is called a(n) ____.

sedative

Jim has been taking a carbidopa-levodopa agent for almost two years and is experiencing wearing off. What medication might be useful?

selegiline

Felicity has poorly controlled migraines and the resulting pain is not responsive to standard analgesic protocols. Her physician suggests the use of sumatriptan when she has an acute migraine. What is the mechanism of action for this drug?

seroronin receptor agonist

Kody takes a broad-spectrum anticonvulsant, which is likely to be ____.

valproic acid

Billie, an active 72-year-old, becomes concerned about the risk of osteoporosis after a close friend suffers an osteoporosis-related spinal fracture. She asks her doctor about estrogen replacement. What is the current consensus on estrogen for osteoporosis prevention?

Estrogen should only be used if Billie is unable to take other medications and the potential benefits outweigh the risks.

Kolby is a long distance truck driver, and despite taking regular breaks and stretching, he often experiences painful muscle spasms. Would taking a muscle relaxant be an appropriate solution for Kolby?

No. Muscle relaxants can cause confusion and sedation.

Your 73-year-old grandmother, who rarely drinks alcohol and has no history of drug abuse, is reluctant to take opioid analgesics following her hip surgery. Should she be concerned about addiction?

Probably not. The majority of people stop taking opioids when their pain stops

Lata is preparing a report on the abuse of ADHD medications in school settings, and is particularly interested in medications formulated in ways that reduce the risk of abuse. What prodrug should she include?

Vyvanse

While helping her friend move into a third floor walk-up, Elisabeth experiences painful muscle spasms in her back. Her doctor prescribes a centrally acting muscle relaxant. This medication is most likely ____.

diazepam

Nathan loves running long distances and often describes his runner's high. The phenomenon of runner's high is associated with the body's production of ____.

endorphins

Fifteen-year-old Adan has major depressive disorder. Which antidepressant is recommended for treating major depressive disorder in adolescents?

escitalopram

Brittany has absence seizures. What is the drug of choice for managing this type of seizure?

ethosuximide

Caitlin strained her back and her doctor prescribes a centrally-acting muscle relaxant during the initial checkup. After the pain subsides, her doctor is likely to prescribe ____.

exercise

Trevor has just been diagnosed with Parkinson's and his doctor prescribes a single agent that alters dopamine release and has anticholinergic effects. The efficacy of the drug tends to wane rather quickly. What drug is it likely to be?

amantadine

Landen has peripheral neuropathy from cancer chemotherapy. After his pain is not well controlled with just analgesics, his physician suggests the use of a tricyclic antidepressant as an adjuvant. What drug might he be given?

amitriptyline

Ellis is having surgery and a neuromuscular blocking agent has been administered. What else must also be administered?

analgesics and sedatives

Marianne, 62 years of age, is discussing osteoporosis prevention with her doctor, with concerns about the action of estrogen replacement on breast and uterine tissue. Marianne might be interested in selective estrogen-receptor modifiers (SERMs) because they have an estrogen ____.

antagonist effect on breast and uterine tissue

Spencer is taking a tricyclic antidepressant and complains of a dry mouth, drowsiness, and urinary retention. What property of tricyclics accounts for these side effects?

anticholinergic

Kristian has generalized epilepsy that is not as well-controlled in his opinion. He wonders if he should be switched to a second-generation anticonvulsant. How are second-generation anticonvulsants typically used in the management of epilepsy?

as adjuvants

Adrian's mother and father have personal and family histories of drug addiction. Therefore, Adrian's mother asks whether there are any nonstimulant medications that can be used to treat his ADHD. What drug might be suggested?

atomoxetine

Roxie is feeling exhausted by the constant demands of work, school, and her family. What is the only over-the-counter drug proven to be safe and effective in fighting fatigue?

caffeine

Newborn Giana has sleep apnea. The medication of choice is ____.

caffeine citrate

Carla, 67 years of age, has a history of breast cancer and thromboembolic disorders, and cannot take hormone replacement or selective estrogen-receptor modifier therapy to treat her osteoporosis. What hormonal agent might be effective?

calcitonin-salmon

After hearing about another opioid-associated overdose death, your friend wonders why nothing is being done about this issue. You can inform your friend about the market withdrawal of propoxyphene due to its association with overdose deaths and ____.

cardiac abnormalities

Seven-year-old Grant's family and physician are considering pharmacologic treatment of his ADHD with one of the amphetamine/methylphenidate formulations. Accordingly, it is particularly important that the physician screen for personal and family history of ____.

cardiovascular disease

Halle is taking an antipsychotic that may cause her to experience extrapyramidal side effects because it blocks dopamine receptors and unbalances cholinergic activities. What antipsychotic might she be taking?

chlorpromazine

Franklin is taking an antipsychotic that acts by blocking serotonin receptors and transiently blocking dopamine receptors. What antipsychotic might he be taking?

clozapine

Zara has a morphine pump to help post-surgical control pain. What side effect occurs in more than 50% of patients on morphine and often requires treatment?

constipation

Marsha is preparing a report on the health effects of alcohol use. She has covered alcohol poisoning and alcoholism. In her section on positive effects, Marsha discusses the inverse association between alcohol consumption and ____.

coronary heart disease

Trent's new job requires shift rotation. He has just moved from the 8 A.M. to 4 P.M. shift to the 12 midnight to 8 A.M. shift. What medication might help with the transition?

modafinil

Collin was given an opioid analgesic to help control the pain from a broken nose, broken teeth, and facial lacerations he suffered in a fall. He soon becomes disoriented and violently sick to his stomach. What drug might he be given to reverse the effects of the opioid?

naloxone

Tom is a chronic alcoholic who is in recovery. What medication might he be given that would decrease his craving for alcohol?

naltrexone

For years, the only medication Jayla has taken to help with her severe knee pain is an NSAID. She has just been diagnosed with cancer and is to be treated with, among other agents, methotrexate. What is the potential interaction between the methotrexate and the NSAID?

potentiation and increased risk of methotrexate toxicity

Thaddeus has shooting, shock-like pain from shingles (herpes zoster). What Schedule V second-generation anticonvulsant might be used as an adjuvant?

pregabalin

Rajesh, an active and fit young adult, injures his shoulder in a weekend baseball game. His doctor tells him to take an NSAID and reminds him of the acronym RICE. What does the R indicate?

rest

Alice has experienced a number of fractures due to Paget's disease of the bone. What agent is indicated for treatment of this disease?

risedronate

Felipe has just been diagnosed with Alzheimer's and is terrified about what will happen to him. What cholinesterase inhibitor may delay symptoms?

rivastigmine

Alex, 34 years of age, was recently diagnosed with Parkinson's. What medication might he be prescribed as a "levodopa-sparing" strategy?

ropinirole

Heather has Parkinson's disease and her symptoms are very poorly controlled in the morning. What dopamine agonist might be helpful?

rotigotine

The labels of non-selective NSAIDs must indicate that they ____.

should be used in strict accordance with label directions

Kyla has seizures in which the onset is limited to one cerebral hemisphere and involve no loss of consciousness. This type of seizure is called ____.

simple partial

Which of the following is considered to be a neurologic emergency?

status epilepticus

Prior to orthopedic surgery, Azalea meets with the anesthesiologist who, when explaining the medications that will be used, mentions that one will paralyze all of her muscles, including her diaphragm. What agent has this effect?

succinylcholine

The Black Box warning that must be included on all antidepressants notes the increased risk of ____.

suicidal thinking and behavior in children and adolescents

Clarissa has partial seizures. What is the most likely cause of her seizures?

temporal lobe lesion

Adam is astounded when he is diagnosed with osteoporosis, which he has always thought of as a women's disease. What agent can be prescribed that will increase GI calcium absorption and renal tubular reabsorption of calcium?

teriparatide

Arleen is being treated for chronic pain and finds that she is needing higher doses of the pain medication to control her pain. This phenomenon is known as ____.

tolerance

Rosetta has seizures that are characterized by an abrupt loss of consciousness, falling, with extension of trunk and extremities, followed by alternating contractions and relaxation of the muscles. These are classified as ____.

tonic-clonic

Cody openly and honestly discusses his history of addiction with his surgeon prior to surgery and asks what pain medications will have less potential for abuse. What centrally acting synthetic analog of codeine might the surgeon select?

tramadol

Epilepsy is defined as the recurrence of ____.

unprovoked seizures

Jillian is taking an antidepressant that inhibits the reuptake of both serotonin and norepinephrine. This medication is most likely to be ____.

venlafaxine

Cayden is using a diclofenac patch for pain from his recent knee injury. How does the patch compare to oral medications?

Concentrations in joint tissues are higher with the patch.

Casey recalls that her grandfather used a barbiturate to help him sleep. She asks her doctor about the use of barbiturates for insomnia and is told that they are rarely used for that purpose due to their side effects. What side-effect is of particular concern?

CNS depression

Lincoln has rheumatoid arthritis and a history of gastrointestinal bleeds. What characteristic of COX-2 inhibitors is important for Lincoln?

COX-2 inhibitors decrease production of the prostaglandin that is good for the heart, but not the one that is harmful.

Marlee has heard that COX-2 inhibitors are less likely to cause GI bleeds than are NSAIDs. What property of COX-2 inhibitors makes them less likely to cause GI bleeds?

COX-2 inhibitors do not inhibit platelet aggregation.

Darlene's breast cancer has spread to her bones, causing terrible, unrelenting pain. She meets with the palliative care team to discuss pain control during the last weeks of her life, and is concerned because she has heard that doctors often withhold adequate doses of pain medication for fear of dependence or abuse. What is their philosophy likely to be?

Dependence is irrelevant for dying patients and should not be a consideration.

Francesca attends doctor's appointments with her mother, who is in her late 80s. Her mother is taking NSAIDs for arthritis pain and Francesca asks what might indicate that her mother was having a GI bleed as a result. What should the doctor tell Francesca?

Even serious GI bleeds may be silent in the elderly and have no warning signs.

Arthur experiences status epilepticus and his terrified patients rush him to the hospital. What is the treatment of choice?

IV lorazepam administered slowly and simultaneous loading with IV phenytoin or fosphenytoin

Levi wonders why acetaminophen is used so frequently if it has little anti-inflammatory effect. Why is this?

It has fewer adverse effects than the salicylates.

Andie is taking an antidepressant and has been told that there are a number of foods and herbal preparations she must avoid because of potentially dangerous side effects. What type of antidepressant is she likely to be taking?

MAOI

Pauline is taking an antidepressant that is typically reserved for refractory or atypical depression or those associated with panic disorder or phobias. She is most likely taking a(n) ____.

MAOI

Martina is providing medication education and, when she mentions possible interactions of the medication with alcohol, the patient acknowledges heavy alcohol binges nearly every weekend. What should Martina do?

Make the appropriate referral.

Jeremy has painful muscle spasms associated with rheumatoid arthritis. He knows that his friend Tanya, who has multiple sclerosis, has experienced relief from her muscle spasms with dantrolene. Is dantrolene also appropriate for Jeremy?

No. Dantrolene is not indicated for muscle spasms associated with rheumatic conditions.

Lizzy has severe chronic pain following an automobile accident and her pain specialist gives her a coanalgesic to help control her pain. What class of drugs is often used as coanalgesics?

NSAIDs

Naya has absence seizures. Is carbamazepine likely to help her?

No, because carbamazepine is known to worsen absence and myoclonic seizures.

Jane has sensorimotor neurologic disorder characterized by a distressing urge to move the legs, often accompanied by a marked sense of discomfort in the legs. She likely has ____.

RLS

Maeve has Parkinson's with marked bradykinesia which has not been well-controlled with medications typically prescribed for mild Parkinson's. What medication might help her?

Sinemet

Jorja uses a synthetic cannabinoid with effects similar to, but sometimes stronger and more unpredictable than those of marijuana. What is she most likely using?

Spice

Rachel is being treated for opioid addiction with a medication that combines both a pure opioid agonist and a partial opioid agonist. What is it?

Suboxone

Just as Kendall is experiencing relief from painful muscle spasms with methocarbamol, her spring allergies hit full force and she cannot stop sneezing. Should this be of additional concern?

Yes, because the effects of muscle relaxants can be potentiated by antihistamines.

Maggie, aged 77, occasionally takes diphenhydramine to help her sleep. Is there any reason for concern?

Yes. Because of her age, she may be more prone to side effects like confusion.

John wakes up in a hospital to find that he had been in an accident that required major surgery to pin his legs back together. He is told that he has a patient controlled analgesia pump with morphine, which he recognizes as a pure opiate agonist. Is he likely to be able to achieve good pain control?

Yes. Morphine does not have a ceiling to its analgesic effects.

A celebrity with no history of substance abuse or bizarre behavior is found driving in circles around a fountain at three o'clock in the morning. His publicist releases a statement attributing the behavior to a prescription benzodiazepine sleep medication. Is this plausible?

Yes. Use of these medications has been associated with the occurrence of complex behaviors while asleep.

Zelina has just been diagnosed with generalized seizures and the decision has been made to start treating her with anticonvulsants. What is likely the first choice of treatment?

a single first generation anticonvulsant

Bryce is taking modafinil for narcolepsy. It is particularly important to caution him ____.

about the need to ensure he gets adequately restorative sleep

Sybil has been taking high doses of aspirin for arthritis, and is having increasingly serious adverse effects. What medication might her health care provider suggest that has analgesic effects but very limited anti-inflammatory effects and would also allow a reduction of the aspirin dose?

acetaminophen

Vonda is concerned about the safety of over-the-counter medications for children. She knows that one particular drug has been associated with liver toxicity and that the manufacturers of this drug have voluntarily reduced the concentration used in children's formulations. What is this drug?

acetaminophen

Wade is using a synthetic drug that is similar to amphetamine but is associated with more prolonged, severe, and possibly permanent mental disorders. What is he likely to be using?

bath salts

Dina has osteoporosis. What factor is most effective in determining her risk of fracture?

bone mineral density

Delbert has cerebral palsy and experiences painful muscle contractions. What peripherally-acting muscle relaxant may help him?

dantrolene

Tanya has multiple sclerosis and sometimes experiences painful muscle spasms. What muscle relaxant is indicated for the spasms associated with her condition?

dantrolene

Patrick, who has bipolar disorder, has a history of serious suicide attempts. What mood stabilizer is successful in reducing suicide rates in persons with bipolar disorder?

lithium

Morris, 73 years of age, has been having severe anxiety following the death of his wife. What benzodiazepine is considered to be preferable for older adults because of its relatively short half-life and inactive metabolites?

lorazepam

Kerri is the primary caregiver for her mother, who has moderate Alzheimer's dementia and appears to be deteriorating. What medication has been approved for patients whose dementia has progressed to the moderate or severe stages?

memantine

Layne has absence seizures. Such seizures may be described as ____.

nonconvulsive generalized seizures

Clarissa is being treated with oxcarbazepine, a second-generation oral anticonvulsant indicated for the treatment of ____.

partial seizures

Lyndon usually avoids the use of benzodiazepines but his insomnia is playing havoc with his life. His doctor prescribes a melatonin receptor agonist. How should Lyndon take this medication?

within 30 minutes of going to bed with a high fat meal or snack