Applied Pharmacology for the Dental Hygienist 7th Edition by Elena Bablenis Haveles - Test Bank

Applied Pharmacology for the Dental Hygienist 7th Edition by Elena Bablenis Haveles – Test Bank

 

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Chapter 05: Nonopioid (Nonnarcotic) Analgesics

Haveles: Applied Pharmacology for the Dental Hygienist, 7th Edition

 

MULTIPLE CHOICE

 

1. Pain:

a.	brings people to the dental office.
b.	keeps people from the dental office.
c.	can be effectively treated with inactive pills (placebos).
d.	does all of the above.

 

 

ANS:  D

Correct: All of the above choices are correct.

Incorrect choices: Pain is often the issue that brings the patient to the dental office. Conversely, pain can be the factor that keeps the patient from seeking dental care at the appropriate time. Because many patients respond when given a placebo, the inclusion of a placebo is required for any acceptable analgesic clinical trials.

 

REF:   Introduction | p. 46                          OBJ:   1

 

2. The pain threshold varies greatly in individuals because of different perceptions of pain.

a.	Both parts of the statements are true.
b.	Both parts of the statements are false.
c.	The first part of the statement is true; the second part is false.
d.	The first part of the statement is false; the second part is true.

 

 

ANS:  C

Correct: The pain threshold does vary greatly in individuals. However, this variation is because of widely different reactions to pain.

Incorrect choices: The two components of pain are perception and reaction. Perception is the physical component of pain and involves the message of pain that is carried through the nerves eventually to the cortex. Reaction is the psychological component of pain and involves the patient’s emotional response to pain. Although individuals are surprisingly uniform in their perception of pain, they vary greatly in their reaction to it.

 

REF:   Pain | p. 46      OBJ:   1

 

3. Which of the following raises the pain threshold?

a.	Emotional instability
b.	Sympathy
c.	Sleep
d.	Both a and c
e.	Both b and c

 

 

ANS:  E

Correct: The pain threshold is raised by sleep, sympathy, activities, and analgesics.

Incorrect choices: A decrease in the pain threshold (a greater reaction to pain) has been said to be associated with emotional instability, anxiety, fatigue, youth, certain nationalities, women, and fear and apprehension. Analgesic therapy must be selected for the individual. A level of discomfort that may not require drug treatment in one person may demand extreme therapy in another.

 

REF:   Pain | p. 46      OBJ:   1

 

4. Synonyms for nonopioid analgesics include:

a.	narcotic.
b.	central.
c.	antipyretic.
d.	strong.

 

 

ANS:  C

Correct: Nonopioid analgesics are also called nonnarcotic, peripheral, mild, and antipyretic.

Incorrect choices: Opioid analgesics are called narcotic, central, or strong analgesics.

 

REF:   Classification | pp. 46-47                 OBJ:   1

 

5. Pain relief by nonopioid analgesics is mediated via action:

a.	at the central nervous system (CNS).
b.	at the peripheral nervous system.
c.	both centrally and peripherally.
d.	None of the above are correct.

 

 

ANS:  B

Correct: Nonopioid analgesics act primarily at the peripheral nerve endings, although their antipyretic effect is mediated centrally.

Incorrect choices: The analgesic agents can be divided into two groups, the nonopioids, also called the nonnarcotic, peripheral, mild, and anti-pyretic agents, and the opioids, also called the narcotic, central, or strong analgesics. Opioids act primarily within the central nervous system (CNS).

 

REF:   Classification | p. 47                        OBJ:   1

 

6. The action of nonopioid analgesics is related to their ability to inhibit:

a.	the CNS.
b.	prostaglandin synthesis.
c.	release of epinephrine.
d.	release of acetylcholine.

 

 

ANS:  B

Correct: Nonopioid analgesics work by inhibiting prostaglandin synthesis.

Incorrect choices: The opioids affect the response to pain by depressing the CNS.

 

REF:   Classification | p. 47                        OBJ:   1

 

7. Which of the following choices has antiinflammatory, antipyretic, analgesic and antiplatelet action?

a.	Acetaminophen
b.	Codeine
c.	Aspirin
d.	Hydrocodone

 

 

ANS:  C

Correct: Aspirin and nonsteroidal antiinflammatory drugs (NSAIDs) have antiinflammatory, antipyretic, analgesic, and antiplatelet actions.

Incorrect choices: Acetaminophen has antipyretic and analgesic action. Hydrocodone has analgesic action.

 

REF:   Salicylates (Mechanism of Action) | p. 48                          OBJ:   2

 

8. Prostaglandins sensitize pain receptors to:

a.	diflunisal.
b.	salsalate.
c.	bradykinin.
d.	ketoprofen.

 

 

ANS:  C

Correct: Prostaglandins, which are lipids that are synthesized locally by inflammatory stimuli, can sensitize the pain receptors to substances such as bradykinin. Prostaglandins can also lower the pain threshold to painful stimuli, cause inflammation and fever, and affect vascular tone and permeability, which results in edema. Therefore a reduction in prostaglandin results in a reduction in pain.

Incorrect choices: Diflunisal and salsalate are both salicylates, and ketoprofen is an NSAID.

 

REF:   Salicylates (Mechanism of Action) | p. 48                          OBJ:   2

 

9. Which of the following statements is true concerning the pharmacokinetics of aspirin?

a.	Plain, unbuffered aspirin produces its peak effect on an empty stomach in 15 minutes.
b.	Buffered aspirin has a slower peak of aspirin than plain aspirin.
c.	The half-life of unhydrolyzed aspirin is approximately 90 minutes.
d.	Aspirin exhibits zero-order kinetics.

 

 

ANS:  D

Correct: Aspirin exhibits zero-order kinetics, meaning that a constant amount rather than a constant percentage of the drug is metabolized per hour.

Incorrect choices: Plain, unbuffered aspirin produces its peak effect on an empty stomach in 30 minutes. The buffered tablet reaches its peak in approximately 20 minutes. Buffered aspirin preparations have a somewhat quicker peak of action and attain higher blood levels because buffering facilitates dispersion and dissolution. The half-life of unhydrolyzed aspirin is approximately 15 minutes.

 

REF:   Salicylates (Pharmacokinetics) | p. 49                                OBJ:   2

 

10. The ability of aspirin to reduce fever results from its inhibition of prostaglandin synthesis in the:

a.	medulla.
b.	hypothalamus.
c.	pons.
d.	cerebellum.

 

 

ANS:  B

Correct: Hypothalamic prostaglandin synthesis is caused by elevated blood levels of leukocyte pyrogens induced by inflammation. Increased hypothalamic prostaglandin levels produce increased body temperature. The inhibition of hypothalamic prostaglandin synthesis results in a return to a more normal body temperature.

Incorrect choices: Aspirin inhibits prostaglandin synthesis in the hypothalamus.

 

REF:   Salicylates (Pharmacologic Effects) | p. 49                        OBJ:   2

 

11. Prostacyclin _____ aggregation of platelets and thromboxane A₂ ____ aggregation of platelets.

a.	stimulates; stimulates
b.	stimulates; inhibits
c.	inhibits; stimulates
d.	inhibits; inhibits

 

 

ANS:  C

Correct: Depending on the dose, aspirin can inhibit either prostacyclin or thromboxane A₂. Further studies are needed to determine aspirin’s usefulness and dose in preventing clotting events in different patient populations.

Incorrect choices: Prostacyclin inhibits aggregation of platelets and thromboxane A₂ stimulates aggregation of platelets.

 

REF:   Salicylates (Pharmacologic Effects) | p. 49                        OBJ:   2

 

12. Which of the following is the most common side effect from aspirin?

a.	Gastrointestinal effects
b.	Bleeding
c.	Hepatic and renal effects
d.	Hypersensitivity

 

 

ANS:  A

Correct: Gastrointestinal effects may be simple dyspepsia, nausea, vomiting, or gastric bleeding. These adverse effects result from direct gastric irritation and inhibition of prostaglandins. Because prostaglandins are responsible for inhibition of gastric acid secretion and stimulation of the cytoprotective mucus in the stomach, aspirin counteracts these effects.

Incorrect choices: Aspirin’s most frequent side effect is related to the gastrointestinal tract.

 

REF:   Salicylates (Adverse Reactions) | p. 49                              OBJ:   2

 

13. Which of the following statements is true regarding aspirin and the clotting mechanism?

a.	Aspirin reversibly interferes with the clotting mechanism by reducing platelet adhesiveness.
b.	Replacement of all of the affected platelets is required to produce normal clotting.
c.	With lower doses of aspirin,  days should elapse to obtain normal clotting.
d.	Aspirin stimulates production of prothrombin.

 

 

ANS:  C

Correct:  days should elapse to obtain normal clotting with lower doses of aspirin. With large doses of aspirin, the half-life is prolonged.

Incorrect choices: Aspirin irreversibly interferes with the clotting mechanism by reducing platelet adhesiveness. Replacement of all of the affected platelets is not required to produce normal clotting. After approximately 20% of the platelets have been replaced with newly formed platelets, clotting will return to normal by approximately 36 hours. Aspirin inhibits the production of prothrombin, resulting in hypoprothrombinemia.

 

REF:   Salicylates (Adverse Reactions) | p. 50                              OBJ:   2

 

14. Aspirin can be used most safely in patients who:

a.	have arthritis.
b.	have gout.
c.	have ulcers.
d.	are pregnant.

 

 

ANS:  A

Correct: Aspirin is commonly used in patients to relieve the pain and inflammation of rheumatoid arthritis.

Incorrect choices: Small doses of aspirin can produce uric acid retention and exacerbate gout. Aspirin may exacerbate preexisting ulcers. Aspirin abuse, or high dose use at near term, can be detrimental to the fetus or the newborn.

 

REF:   Salicylates (Uses) | p. 51                  OBJ:   2

 

15. Which of the following is the best to use in pediatric patients for both its analgesic and antipyretic action?

a.	Aspirin
b.	Acetaminophen
c.	NSAIDs
d.	Codeine

 

 

ANS:  B

Correct: Acetaminophen is used in place of aspirin for pediatric patients for both its analgesic and antiinflammatory action.

Incorrect choices: In children and adolescents with either chickenpox or influenza, the use of aspirin has been epidemiologically associated with Reye syndrome.

 

REF:   Salicylates (Adverse Reactions) | p. 50                              OBJ:   2

 

16. The incidence of true aspirin allergy is:

a.	approximately 10%.
b.	between 2% and 5%.
c.	less than 1%.
d.	unknown; it has not ever been recorded.

 

 

ANS:  C

Correct: Many patients with “allergy to aspirin” in their charts, on questioning, actually have stomach problems rather than a true allergy. In the patient’s chart, differentiating aspirin’s adverse reactions from its hypersensitivity reactions is important. Patients with true aspirin hypersensitivity cannot be given any of the NSAIDs because of some cross-hypersensitivity. Allergic reactions can vary from rash, wheezing, urticaria, and angioneurotic edema to anaphylactic shock.

Incorrect choices: The incidence of true aspirin allergy is less than 1% (0.2% to 0.4%).

 

REF:   Salicylates (Adverse Reactions) | p. 50                              OBJ:   2

 

17. Which of the following drugs can be substituted for aspirin in patients displaying the aspirin hypersensitivity triad?

a.	Ibuprofen
b.	Naproxen
c.	Codeine
d.	Piroxicam

 

 

ANS:  C

Correct: Codeine is not a NSAID. Patients displaying the aspirin hypersensitivity triad show cross-hypersensitivity between aspirin and other agents, including the NSAIDs, and they should not be given any NSAIDs.

Incorrect choices: Ibuprofen, naproxen, and piroxicam are all NSAIDs.

 

REF:   Salicylates (Adverse Reactions) | p. 50                              OBJ:   2

 

18. All of the following are characteristics of aspirin toxicity (salicylism) except:

a.	dimness of vision.
b.	hyperthermia.
c.	electrolyte imbalance.
d.	hepatic necrosis.
e.	tinnitus.

 

 

ANS:  D

Correct: Hepatic necrosis is a characteristic of acetaminophen toxicity and is rarely seen with aspirin use. The toxic metabolite of acetaminophen that contributes to hepatic necrosis is N-acetyl-p-benzoquinone. The Food and Drug Administration (FDA) has recommended tighter dose controls and warnings with acetaminophen use in the hopes of preventing even more cases of accidental liver toxicity.

Incorrect choices: All the other choices are characteristics of aspirin toxicity.

 

REF:   Salicylates (Toxicity) | p. 50             OBJ:   2

 

19. A drug interaction between aspirin and _____ can result in significant bleeding.

a.	probenecid
b.	warfarin
c.	methotrexate
d.	sulfonylureas

 

 

ANS:  B

Correct: The drug interaction between aspirin and warfarin can result in bleeding. Warfarin is an oral anticoagulant that is highly protein bound to plasma protein–binding sites. If aspirin is administered to a patient taking warfarin, it can displace the warfarin from its binding sites, increasing its anticoagulant effect.

Incorrect choices: Aspirin interferes with probenecid’s uricosuric effect and has been reported to precipitate an acute attack of gout. Aspirin can displace methotrexate from its plasma protein–binding sites and can also interfere with its clearance. This results in an increased serum concentration and methotrexate toxicity such as bone marrow depression. Higher doses of salicylates may produce a hypoglycemic effect.

 

REF:   Salicylates (Drug Interactions) | p. 51                                OBJ:   2

 

20. What is the usual adult dosage of aspirin for the treatment of pain or fever?

a.	250 mg every 4 hours
b.	3 to 6 g per day
c.	650 mg every 4 hours
d.	800 mg every 4 hours
e.	160 mg per day

 

 

ANS:  C

Correct: Two 325-mg tablets every 4 hours.

Incorrect choices: Aspirin doses are generally measured on a per tablet basis (325 mg = 5 g). The dose for arthritis is 3 to 6 g per day, and the dose for prevention of myocardial infarction is one half tablet daily.

 

REF:   Salicylates (Doses and Preparations) | p. 51                       OBJ:   2

 

21. A person should _____ aspirin if he or she suspects he or she may be having a heart attack provided there is not an aspirin allergy, hypersensitivity, or another contraindication.

a.	completely avoid
b.	chew one low dose
c.	take the maximum daily recommended dose of 4,000 mg of
d.	take 325 to 650 mg every 4 hours of

 

 

ANS:  B

Correct: Patients should call 9-1-1 first and wait for their instructions before taking the aspirin tablet. The aspirin tablet can be administered once the emergency responder is present, in the ambulance, or in the emergency room.

Incorrect choices: Patients experiencing a myocardial infarction are usually advised by emergency responders to chew one low dose aspirin at the onset of symptoms.

 

REF:   Salicylates (Uses) | p. 51                  OBJ:   2

 

22. Caffeine is often combined with aspirin because caffeine potentiates the analgesic effect of aspirin and other analgesics.

a.	Both parts of the statement are true.
b.	Both parts of the statement are false.
c.	The first part of the statement is true; the second part is false.
d.	The first part of the statement is false; the second part is true.

 

 

ANS:  A

Correct: The addition of 130 mg of caffeine is equivalent to increasing the dose of the analgesic by one third or more. The caffeine in most proprietary aspirin preparations is at an active level for a single dose.

Incorrect choices: Most proprietary aspirin preparations contain caffeine, and caffeine does significantly potentiate the analgesic effect of aspirin and other analgesics.

 

REF:   Salicylates (Doses and Preparations) | p. 52                       OBJ:   2

 

23. Which of the following agents would be least useful in alleviating fever?

a.	Piroxicam
b.	Acetaminophen
c.	Diflunisal
d.	Probenecid
e.	Aspirin

 

 

ANS:  C

Correct: Diflunisal (Dolobid) is a nonacetylated salicylic acid classified as a nonsteroidal antiinflammatory drug (NSAID). It is as effective as the other NSAIDs in the treatment of pain, but is the least useful in alleviating fever.

Incorrect choices: Diflunisal does not have clinically useful antipyretic activity.

 

REF:   Salicylates (Diflunisal) | p. 52          OBJ:   2

 

24. Which of the following is true concerning NSAIDs?

a.	Many authors agree that the NSAIDs are the most useful drug group for the treatment of dental pain.
b.	Unlike aspirin, NSAIDs do not inhibit the enzyme cyclooxygenase (COX).
c.	Most NSAIDs reach a peak blood level in approximately 20 minutes.
d.	NSAIDs do not have a significant antiinflammatory effect.

 

 

ANS:  A

Correct: Many authors agree that the NSAIDs are the most useful drug group for the treatment of dental pain.

Incorrect choices: Similar to aspirin, NSAIDs inhibit the enzyme COX (prostaglandin synthase), resulting in a reduction in the formation of prostaglandin precursors and thromboxanes from arachidonic acid. All of the currently available NSAIDs inhibit both COX I and COX II. COX I is a widely distributed constitutive enzyme responsible for all the adverse reactions of the NSAIDs such as stomach problems, reduced renal function, fluid retention, and reduced platelet adhesiveness. COX II is an inducible enzyme that is synthesized only when inflammation occurs.

 

REF:   Nonsteroidal Antiinflammatory Drugs | p. 52                     OBJ:   3

 

25. Adverse cardiovascular effects are thought to be least likely to occur with the use of which of the following nonsteroidal antiinflammatory drugs (NSAIDs)?

a.	Celecoxib (Celebrex)
b.	Naproxen (Naprosyn)
c.	Diclofenac (Voltaren)
d.	Ketoprofen (Orudis)

 

 

ANS:  B

Correct: Naproxen (Naprosyn) and naproxen sodium OTC (Aleve) are propionic acid derivatives. They have slightly longer half-lives than ibuprofen and can be dosed on an 8- to 12-hour schedule. Aleve is dosed 220 mg every 8 to 12 hours not to exceed two tablets in the 8 to 12 hour time period. Their pharmacologic effects, adverse reactions, and efficacy are similar to those of ibuprofen.

Incorrect choices: Higher doses of celecoxib (Celebrex) are associated with increased risk of adverse cardiovascular effects. Celecoxib has been associated with cholestatic jaundice, which may be related to sulfonamide allergy. The risk is highest with diclofenac (Voltaren) and lowest with naproxen (Naprosyn).

 

REF:   Nonsteroidal Antiinflammatory Drugs (Cardiovascular Effects) | p. 53

OBJ:   3

 

26. Which of the following statements is true concerning adverse reactions of NSAIDs?

a.	NSAIDs will decrease acid secretion in the stomach.
b.	Tolerance develops to the use of NSAIDs.
c.	NSAIDs irreversibly inhibit platelet aggregation because they inhibit thromboxane A2 production.
d.	NSAIDs have precipitated renal insufficiency.

 

 

ANS:  D

Correct: All NSAIDs, including celecoxib, inhibit renal prostaglandins, decrease renal blood flow, cause fluid retention, and may cause hypertension and renal failure in some patients, especially the elderly. The NSAIDs have little effect on the patient with normal kidney function; however, with renal disease, decreases in both renal blood flow and glomerular filtration rate can occur.

Incorrect choices: Prostaglandin inhibitors, such as NSAIDs, can interfere with the normal protective mechanisms in the stomach and increase acid secretion, causing symptoms or even an ulceration or perforation. These agents are not addicting, tolerance does not develop, and no withdrawal syndrome can be induced. NSAIDs reversibly inhibit platelet aggregation because they inhibit thromboxane A₂ production. In contrast to aspirin, their effect remains only as long as the drug is present in the blood: 1 day for ibuprofen, 4 days for naproxen, and 2 weeks for oxaprozin.

 

REF:   Nonsteroidal Antiinflammatory Drugs (Renal Effects) | pp. 53-54

OBJ:   3

 

27. Which of the following NSAIDs is designated U.S. Food and Drug Administration (FDA) pregnancy category B?

a.	Naproxen (Naprosyn)
b.	Diflunisal (Dolobid)
c.	Tolmetin (Tolectin)
d.	Mefanamic acid (Ponstel)

 

 

ANS:  A

Correct: Fenoprofen, ibuprofen, and naproxen have not been shown to be teratogenic in animal studies and are designated FDA pregnancy category B.

Incorrect choices: NSAIDs administered late in pregnancy can prolong gestation, delay parturition, and produce dystocia or premature closing of ductus arteriosus. Diflunisal, tolmetin, and mefenamic acid have been shown to be teratogenic in animals and are designated FDA category C.

 

REF:   Nonsteroidal Antiinflammatory Drugs (Pregnancy and Nursing Considerations) | p. 54

OBJ:   3

 

28. Which of the following NSAIDs is the drug of choice for treating a nursing woman?

a.	Naproxen
b.	Diflunisal
c.	Ibuprofen
d.	Fenoprofen

 

 

ANS:  C

Correct: Ibuprofen is the drug of choice for treating a nursing woman.

Incorrect choices: Fenoprofen and mefenamic acid are present in small quantities in breast milk. Small amounts of both naproxen and diflunisal are excreted in breast milk.

 

REF:   Nonsteroidal Antiinflammatory Drugs (Pregnancy and Nursing Considerations) | p. 54

OBJ:   3

 

29. Which of the following agents is known to have a drug interaction with lithium?

a.	Aspirin
b.	Naproxen
c.	Acetaminophen
d.	Oxycodone

 

 

ANS:  B

Correct: NSAIDs such as naproxen are known to increase serum levels of lithium.

Incorrect choices: Aspirin, acetaminophen, and oxycodone do not have this interaction with lithium.

 

REF:   Nonsteroidal Antiinflammatory Drugs (Naproxen Sodium) | p. 56

OBJ:   3

 

30. Dental pain is best managed with which of the following choices?

a.	Codeine 60 mg
b.	Ibuprofen 400 mg
c.	Acetaminophen 650 mg
d.	Aspirin 650 mg
e.	Placebo

 

 

ANS:  B

Correct: In usual prescription doses, NSAIDs can be shown to be statistically significantly better than codeine alone, aspirin, acetaminophen, or placebo.

Incorrect choices: Usual analgesic doses of NSAIDs have been shown to be as effective as 650 mg of aspirin or acetaminophen plus 60 mg of codeine and even as effective as the intermediate-strength opioid combinations.

 

REF:   Nonsteroidal Antiinflammatory Drugs (Ibuprofen) | p. 55   OBJ:   3

 

31. Which of the following NSAIDs is considered the drug of choice for management of dental pain when a NSAID is indicated?

a.	Naproxen
b.	Naproxen sodium
c.	Ibuprofen
d.	Diflunisal

 

 

ANS:  C

Correct: Ibuprofen is considered the drug of choice for management of dental pain when a NSAID is indicated.

Incorrect choices: Naproxen and naproxen sodium are propionic acid NSAIDs that have slightly longer half-lives than ibuprofen and can be administered on an 8- to 12-hour schedule. Other NSAIDs, such as fenoprofen, ketorolac, or diflunisal, may be used for patients who do not respond to either ibuprofen or naproxen sodium.

 

REF:   Nonsteroidal Antiinflammatory Drugs (Ibuprofen) | p. 55   OBJ:   3

 

32. Oral administration with _____ is indicated only as continuation to intravenous (IV) or intramuscular (IM) therapy.

a.	fenoprofen
b.	ketorolac
c.	naproxen sodium
d.	diflunisal

 

 

ANS:  B

Correct: Ketorolac is an NSAID indicated for the short-term management of moderately severe acute pain that requires analgesia at the opioid level. It is contraindicated as a prophylactic analgesic before any major surgery when hemostasis is critical because of the increased risk of bleeding.

Incorrect choices: Oral administration with ketorolac is indicated only as continuation to IV or IM therapy. Ketorolac is a newer NSAID; it is equivalent in efficacy to the other NSAIDs; however, unlike other NSAIDs, it is available parenterally.

 

REF:   Nonsteroidal Antiinflammatory Drugs (Other Nonsteroidal Antiinflammatory Drugs) | p. 56

OBJ:   3

 

33. Which of the following statements is true of COX II?

a.	It is a widely distributed constitutive enzyme.
b.	It is responsible for the adverse reactions of the NSAIDs.
c.	It is synthesized only when inflammation occurs.
d.	It is not an enzyme.

 

 

ANS:  C

Correct: COX II is an inducible enzyme that is only synthesized when inflammation occurs.

Incorrect choices: COX I is a widely distributed constitutive enzyme responsible for the adverse reactions of the NSAIDs such as stomach problems, reduced renal function, fluid retention, and reduced platelet adhesiveness.

 

REF:   Nonsteroidal Antiinflammatory Drugs (Mechanism of Action) | p. 52

OBJ:   3

 

34. Which of the following choices is currently the most popular COX II–specific agent on the market?

a.	Celecoxib
b.	Rofecoxib
c.	Valdecoxib
d.	Indomethacin

 

 

ANS:  A

Correct: Celecoxib is currently the most popular COX II–specific agent; it is indicated for arthritis.

Incorrect choices: Rofecoxib and valdecoxib were removed from the U.S. market in 2005 as a result of a high incidence of cardiovascular events associated with these two drugs. Indomethacin is a COX I–specific medication.

 

REF:   Nonsteroidal Antiinflammatory Drugs (Cyclo-Oxygenase II-Specific Agents) | p. 56

OBJ:   3

 

35. Which of the following statements is true regarding the pharmacokinetics of acetaminophen?

a.	Acetaminophen is slowly and incompletely absorbed from the gastrointestinal tract.
b.	Acetaminophen is excreted with a half-life of 8 to 12 hours.
c.	When large doses of acetaminophen are ingested, an intermediate metabolite is produced that is thought to be hepatotoxic.
d.	Acetaminophen is less potent and efficacious than aspirin.

 

 

ANS:  C

Correct: An intermediate metabolite is produced when large doses of acetaminophen are ingested that is thought to be hepatotoxic and possibly nephrotoxic.

Incorrect choices: Acetaminophen is rapidly and completely absorbed from the gastrointestinal tract, achieving a peak plasma level in 1 to 3 hours. After therapeutic doses, it is excreted with a half-life of 1 to 4 hours. Acetaminophen and aspirin are equally efficacious and equally potent.

 

REF:   Acetaminophen (Pharmacokinetics) | p. 56                        OBJ:   4

 

36. Acetaminophen does not possess any of these clinically significant _____ effects: (1) antipyretic, (2) antiinflammatory, (3) analgesic.

a.	1, 2, 3
b.	1 and 2
c.	1 and 3
d.	1
e.	2

 

 

ANS:  E

Correct: Acetaminophen this thought to produce analgesia by elevating the pain threshold. Its potential mechanism of action may involve inhibiting the nitric oxide pathway, which is mediated by a variety of neurotransmitter receptors. Its antipyretic effects may be the result of inhibition of endogenous pyrogens on the heat-regulating centers of the brain by blocking the formation and release of prostaglandins in the central nervous system.

Incorrect choices: Acetaminophen does have clinically significant antipyretic and analgesic effects; however, it does not possess any clinically significant antiinflammatory effect.

 

REF:   Acetaminophen (Pharmacologic Effects) | p. 56                 OBJ:   4

 

37. Which of the following is true regarding these pharmacologic effects of therapeutic doses of acetaminophen?

(1)  No effect on the cardiovascular system

(2)  Does not produce gastric bleeding

(3)  Does not affect platelet adhesiveness

(4)  Does not affect uric acid excretion

a.	1, 2, 3, 4
b.	1, 2, 3
c.	2, 3, 4
d.	1 only

 

 

ANS:  A

Correct: All of the above are true regarding the pharmacologic effects of therapeutic doses of acetaminophen.

Incorrect choices: Therapeutic doses of acetaminophen have no effect on the cardiovascular or respiratory system. In contrast to aspirin, acetaminophen does not produce gastric bleeding or affect platelet adhesiveness or uric acid excretion.

 

REF:   Acetaminophen (Pharmacologic Effects) | p. 56                 OBJ:   4

 

38. An acute overdose with acetaminophen may damage the:

a.	eyes.
b.	liver.
c.	spleen.
d.	kidney.

 

 

ANS:  B

Correct: Acute overdose of acetaminophen can lead to the generation of a toxic metabolite that can cause hepatic necrosis and lead to death.

Incorrect choices: Acetaminophen does not damage the eyes or the spleen but can damage the kidney upon chronic administration.

 

REF:   Acetaminophen (Hepatic Effects) | p. 57                            OBJ:   4

 

39. Who is most likely to experience the most cases of accidental overdose with acetaminophen?

a.	Infants
b.	Children
c.	Young adults
d.	Older adults

 

 

ANS:  B

Correct: In children, the acute ingestion of 250 mg/kg poses a high risk for liver damage and the acute ingestion of 350 mg/kg can cause severe hepatotoxicity if not immediately treated.

Incorrect choices: Children experience more cases of accidental overdose with acetaminophen, which occurs because the wrong dose form is used (e.g., infant drops are given to older children or adult doses are given to children). Infant drops are concentrated, and doses for toddlers to 11-year-old children are not the same as doses for infants. Parents may give the infant liquid to the older child and pour it in the measuring cup, not realizing that they have overdosed their child.

 

REF:   Acetaminophen (Hepatic Effects) | p. 57                            OBJ:   4

 

40. Alcohol consumption stimulates the breakdown of acetaminophen, thereby decreasing the toxic potential of acetaminophen use.

a.	Both parts of the statement are true.
b.	Both parts of the statement are false.
c.	The first part of the statement is true; the second part is false.
d.	The first part of the statement is false; the second part is true.

 

 

ANS:  C

Correct: Depending on the amount of alcoholic beverages consumed, the maximum dose of acetaminophen varies. The normal maximum dose of acetaminophen (4 g) may be used in patients who usually do not drink alcohol. The dose should be restricted to 2 g if a patient is a moderate drinker (less than three alcohol beverages daily).

Incorrect choices: Alcohol stimulates the oxidizing enzymes that metabolize acetaminophen to its toxic metabolite. In this way, it increases acetaminophen toxicity.

 

REF:   Acetaminophen (Hepatic Effects) | p. 57                            OBJ:   4

 

41. The Food and Drug Administration (FDA) recently issued a safety announcement regarding the risk of three rare, but potentially fatal, skin reactions associated with:

a.	aspirin and salicylates.
b.	NSAIDs.
c.	acetaminophen.
d.	colchicine.

 

 

ANS:  C

Correct: This warning advised that anyone with a skin reaction, such as rash or blister, while taking acetaminophen stop taking it and seek immediate medical care. It was made based upon a review of the medical literature and reports of adverse reactions to the FDA.

Incorrect choices: In August of 2013, the FDA issued a safety announcement regarding acetaminophen because of the risk of Stevens-Johnson syndrome, toxic epidermal necrolysis, and acute generalized exanthematous pustulosis.

 

REF:   Acetaminophen (Skin Reactions) | p. 57                            OBJ:   4

 

42. Which of the following agents is intended to treat an acute attack of gout?

a.	Probenecid
b.	Codeine
c.	Colchicine
d.	Acetaminophen
e.	Both a and c

 

 

ANS:  C

Correct: Colchicine is used for acute attacks of gout.

Incorrect choices: Probenecid is used in prevention of a gout attack. Codeine and acetaminophen are not recommended for treating gout.

 

REF:   Drugs Used to Treat Gout | p. 58      OBJ:   5

 

43. Which of the following agents is a xanthine oxidase inhibitor?

a.	Colchicine
b.	Ibuprofen
c.	Allopurinol
d.	Probenecid

 

 

ANS:  C

Correct: Allopurinol is the only drug listed that inhibits xanthine oxidase.

Incorrect choices: Colchicine appears to inhibit the chemotactic property of leukocytosis and interfere with the inflammatory response to urate crystals. Ibuprofen is a nonsteroidal antiinflammatory. Probenecid blocks the tubular reabsorption of filtered urate, prevents formation of new urate crystals called tophi, and mobilizes those present.

 

REF:   Drugs Used to Treat Gout (Allopurinol) | p. 58                  OBJ:   5

 

MULTIPLE RESPONSE

 

1. Low-dose aspirin therapy is recommended for which of the following? (Select all that apply.)

a.	People who have had heart bypass surgery
b.	Men aged 45 to 79 with no history of heart disease
c.	Women aged 55 to 79 with no history of heart disease
d.	A person with gastroesophageal reflux disease (GERD)

 

 

ANS:  A, B, C

Correct: Clinical trials have shown that daily use of aspirin as a secondary preventive measure can reduce all-cause mortality by 18% and myocardial infarctions by 30% in persons with known cardiovascular disease. Aspirin can also be used as preventive therapy in persons who have not experienced a heart attack or stroke but are at increased risk for these events.

Incorrect choices: Salicylates may exacerbate preexisting conditions such as ulcers, gastritis, hiatal hernia, or GERD. Aspirin can be of benefit to persons that have already had a stroke, heart attack, angina, peripheral vascular disease, or in persons that have had angioplasty or bypass surgery. The U.S. Preventative Service Task Force recommends that men with no history of heart disease or stroke, aged 45 to 79 years of age take low-dose aspirin each day to prevent a myocardial infarction and women with no history of heart attack or stroke, aged 55 to 79 take low-dose aspirin each day to prevent a stroke. The benefit of aspirin therapy must outweigh the risk of many adverse effects associated with aspirin therapy, especially gastrointestinal bleeding.

 

REF:   Salicylates (Uses) | p. 51                  OBJ:   2

 

2. NSAIDs carry “black box warnings” for which of the following types of events? (Select all that apply.)

a.	Respiratory
b.	Gastrointestinal
c.	Cardiovascular
d.	Endocrine

 

 

ANS:  B, C

Correct: Gastrointestinal and cardiovascular. The Food and Drug Administration (FDA) requires that a black box be placed around serious adverse and even fatal effects with certain drugs. It is the strongest warning possible.

Incorrect choices: All NSAIDs may cause an increased risk of serious cardiovascular (CV) thrombotic events, myocardial infarction, and stroke, which all may be fatal. All NSAIDs increase the risk for serious gastrointestinal events including bleeding, ulceration, and perforation of the stomach or intestine, which may be fatal.

 

REF:   Nonsteroidal Antiinflammatory Drugs (Contraindications and Cautions) | p. 54

OBJ:   3

 

TRUE/FALSE

 

1. Two components of pain include perception and reaction.

 

ANS:  T

Correct: Perception and reaction are two distinct components of pain.

 

REF:   Pain | p. 46      OBJ:   1

 

2. Raising the pain threshold increases one’s reaction to pain.

 

ANS:  F

Correct: Lowering the pain threshold increases one reaction to pain.

 

REF:   Pain | p. 46      OBJ:   1

 

3. Salicylates’ mechanism of action involves inhibiting prostaglandin synthesis.

 

ANS:  T

Correct: Salicylates inhibit the COX enzyme, which produces prostaglandins.

 

REF:   Salicylates (Mechanism of Action) | p. 48                          OBJ:   2

 

4. Aspirin should not be given to children until they are 18 years of age.

 

ANS:  T

Correct: Administration of aspirin to children with either chickenpox or influenza has been associated with Reye syndrome, which can be fatal.

 

REF:   Box 5-3: Patient Instructions for Use of Aspirin | p. 51       OBJ:   2

 

5. Salicylism is a toxic effect from acetaminophen.

 

ANS:  F

Correct: Acetaminophen is not a salicylate and does not cause salicylism.

 

REF:   Salicylates (Toxicity) | pp. 50-51 | Acetaminophen | p. 56   OBJ:   2

 

6. Probenecid and allopurinol both inhibit the synthesis of uric acid.

 

ANS:  F

Correct: Allopurinol inhibits the synthesis of uric acid, but probenecid increases the excretion of uric acid.

 

REF:   Drugs Used to Treat Gout (Allopurinol) | p. 58 | Drugs Used to Treat Gout (Probenecid) | p. 58

OBJ:   5