Week 4 -Midterm Review

Question 1

Most appropriate treatment approach for OA - pharmalogical

Answer 1

• Topical NSAIDS
• Oral NSAIDS
• Tylenol
• US guided glucocorticoid injection
• Duloxetine
• Tramadol

Question 2

Most appropriate treatment regimen for OA - non-pharmacological

Answer 2

• Exercise
• Balance exercises
• Weight loss
• Self-efficacy /self-management

Question 3

Complications of untreated gout

Answer 3

• Tophi
• Joint damage
• Kidney stones & damage from crystal deposition

Question 4

Patient education for colchicine

Answer 4

• Stop medication and inform the MD if GI symptoms including nausea, vomiting, diarrhea, or abdominal pain occur

Question 5

Adverse effects of colchicine for gout

Answer 5

• GI side effects (N&V, D, abdo pain)
• GI toxicity
• Leukopenia
• Granulocytopenia
• Pancytopenia
• thrombocytopenia

Question 6

What condition can be developed with long term use of allopurinol?

Answer 6

• Hypersensitivity syndrome includes rash, fever, eosinophilia, decreased liver and kidney function

Question 7

What drugs interact with allopurinol?

Answer 7

• Warfarin
• Theophylline
• ampicillin

Question 8

What should be co-administered with febuxostat?

Answer 8

• Colchicine or indomethacin to prevent gout attacks during the first 6 months of treatment

Question 9

Black Box Warning for NSAIDS

Answer 9

• Increase risk of MI, stroke, other thrombolytic events
• Increase risk of dangers GI effects including bleeding and perforated ulceration

Question 10

Drug interactions for NSAIDS

Answer 10

• Aspirin interacts with many other medications

Question 11

NSAIDS mechanism of action

Answer 11

• 1st gen – inhibit Cox-1 and cox-2 enzymes (adverse effects
• 2nd gen- selectively inhibits cox-2 enzymes– produces analgesic and anti-inflammatory effects

Question 12

Therapeutic action of NSAIDS

Answer 12

• Reduces inflammation and provides pain relief

Question 13

Patient teaching for DMARDS

Answer 13

• Notifying about risk of infection
• Avoid communicable disease people
• Report s/s of infection to provider or evidence of bruising, bleeding, fatigue, fever, pallor, HF symptoms – SOB, orthopnea, fatigue

Question 14

What baseline data/diagnostics are needed for all DMARDs

Answer 14

• Complete history and physical
• CBC with WBC diff
• s/s of infection
• TB and hepatitis
• Malignancies (skin exam)
• Rule out pregnancy
• Check ALT, AST, serum creat
• Chest x-ray
• Pulmonary status
• GI status

Question 15

Therapeutic response of methotrexate

Answer 15

• Decreases immune reaction

Question 16

Patient education for alendronate for osteoporosis

Answer 16

First line of treatment for osteoporosis

• Swallow tablet whole with a full glass of water while sitting or standing upright and remain upright for a minimum of 30 minutes
• Intake of food prevents absorption should take in the morning before taking anything except water do not take calcium, antacids, Iron, mg, coffee or juice for at least 30 minutes afterwards.

Question 17

Which dietary supplement can interfere with absorption of ibandronate?

Answer 17

• Multivitamin with minerals
• Do not take with Mg, Ca or Fe

Question 18

Adverse effects of densumaub

Answer 18

• Hypercalcemia
• Serious infections
• Skin reactions
• Osteonecrosis of the jaw

Question 19

Raloxifene can cause…..

Answer 19

• Can cause DVT, PE, Stroke

Question 20

Which RA drugs have highest risk vs which ones are the safest during pregnancy?

Answer 20

Safest
- NSAIDS
- Corticosteroids
- DMARDs (Sulfasalazine, Hydroxychloroquine)

Highest risk
- Methotrexate
- Leflunomide
- Biologics (rituximab and abatacept)

Question 21

PRESCRIPTION WRITING:

Hydrocodone/Acetaminophen
- indication
- common doses
- directions for use

Answer 21

Indication
- moderate to severe pain

Common dose
– 2.5/325mg or 5/300 or 500mg

Directions for use
– 1 to 2 tablets every 4 to 6 hours as needed. May be taken with food or milk to minimize GI irritation.

Question 22

PRESCRIPTION WRITING:

Lisinopril
- indication
- common doses
- directions for use

Answer 22

Indication
– hypertension, HF, MI, persistent albuminuria

Common dose
– 10mg PO daily (10-40mg up to max 80)

Directions for use
– take with/without food

Question 23

PRESCRIPTION WRITING:

Amlodipine
- indication
- common doses
- directions for use

Answer 23

Indication
- Hypertension

Common dose
– 5mg PO daily (up to
10mg per day)

Directions for use
- May administer without regard to meals.

Question 24

PRESCRIPTION WRITING:

Colchicine
- indication
- common doses
- directions for use

Answer 24

Indication
– prevention and treatment of gout flares, Mediterranean fever, pseudogout, pericarditis

Common dose
– 0.6mg PO once or 2x per day (max 1.2mg per day)

Directions for use
- Take without regard to meals. Administer with food to minimize gastric irritation.