1. 1
NSAIDS
36. Various opiates may be used as all of the following except ?
Anti-inflammatories
37- Which of the following best describes prednisone pharmacological activity?
An anti-inflammatory agent
52- Which of the following is the mechanism of action of anti- inflammatory action of aspirin ?
Decreased synthesis of prostaglandins
57. Anti-inflammatory (NSAIDS) MOC ?
decrease prostaglandin
155. Type of prostaglandin that inhibited by aspirin?
Aspirin is non-selective and irreversibly inhibits both forms (but is weakly more selective for COX-1).
85. Aspirin antiplatlet mechanism ?
irreversibly inhibits prostaglandin H synthase (cyclooxygenase-1) in platelets and megakaryocytes, and thereby blocks the formation of
thromboxane A2 (TXA2; a potent vasoconstrictor and platelet aggregant).
15. Aspirin
Aspirin is a weak organic acid that irreversibly acetylates (and, thus, inactivates) Cyclooxygenase
40. The drug is most commonly used in the selective COX2 inhibitors ?
Celecoxib
58. rofecoxib is ?
selective cox2 inhibitor
42. Concerning COX-2 inhibitor, which is not true ?
combination with non-selective agents provide additional benefit
Q- Which of these medications used widely in community and it can cause hepatotoxicity ?
Answer : Paracetamol
Q- What is antidote for paracetamol ?
Answer: N-acetylcysteine
Q- Paracetamol dose in emergency department where can you find it?
Answer: All IV acetaminophen doses should be prepared in the pharmacy ER dose 650mg
439 -Patient with osteoarthritis suffering from pain ?
Acetaminophen
285 - Antidote for acetaminophen ?
Acetylcysteine (NAC)
138 -Hepatotoxicity of paracetamol due to ?
Glutathione depletion
358 -Antidote of morphine
Naloxone
744 –constipation SE of ? morphine
540 -Patient with ISHD coronary heart disease has injury and severe pain
morphine (the best for treat moderate to severe pain)
818 -Morphine convert to codeine ?
by dealkaylation
438 -Morphine causes respiratory depression by ?
Depression of respiratory center in brain
109- Convert codeine to morphine by ( give structure of two drug) ?
Answer: demethylation
515 -Fentanyl patch should avoid: Heat
556- patient used morphine 60mg twice daily he want to change fentanyl patch ?
Answer: .50mcg
565- morphine extra dose to decrease pain?
10mg
55- A 21-year-old patient went through respiratory depression after receiving anesthetic agent.
Which of the following agents will counteract post-anesthetic respiratory depression?
. morphine
Q- NSAID structures which one is less GIT ulcer ?
Answer: Ibuprofen appears to produce the least risk among older NSAIDS, whereas piroxicam and ketorolac are the worst. Newer
NSAIDS such as etodolac, meloxicam, and nabumetone are thought to cause less injury to the GI tract.
For the structure review question number 258
525-Analgesic considered as narcotic but dispensed normally ? Methadone
2. 2
526-Most group use OTC? – Adult
Q- What is the most common type of toxicity with elderly be at risk for it if they used NSAID high doses for a long time?
-Renal Toxicity
422- Most popular to cause acute kidney injury ? NSAID
Q- lowest adverse effects of NSAID structures? Ibuprofen
Q- NSAID ?
Indomethacin: more side effect in CNS
Piroxicam: more side effect in GIT
Q- NSAID has long duration of action ?
Piroxicam
21-A 45-year-old surgeon has developed symmetric early morning stiffiness in her hands. She has to do several fong surgical procedures in the next
few months. Which of the following non-steriodal anti-inflammatory agents (NSAIDS) has the longest duration of action?
piroxicam
85- Which of the following drugs causes water retention?
Indomethacin
4)A 4-week Infant is diagnosed with patent ductus arteriosis. The doctor wants to avoid performing surgery.
Which drug will be administered to avoid surgical closure?
Indomethacin (NSAIDS should be used within 14 day of birth)
CASES
53- Case patient has ductus arteriosus?
Answer Iv indomethacin Intravenous (IV) medication called indomethacin may help close a patent ductus arteriosus. Indomethacin is
related to aspirin and ibuprofen and works by stimulating the muscles inside the PDA to constrict, thereby closing the connection.
Q- What is first line agent for fever in 8 months pediatric patient?
Answer: Acetaminophen: 10 to 15 mg/kg/dose orally every 4 to 6 hours; MAX 75 mg/kg/day for infants and either 100 mg/kg/day or 1625
mg/day in children, whichever is less. (8 months=infant)
Ibuprofen: 5 to 10 mg/kg orally every 6 to 8 hours as needed, MAX 4 doses/day
The patient needs to be assessed by a specialist to rule out any infection.
SE
66- A 65-year-old woman is suffering from osteoarthritis. She complains of şevere pain and is prescribed naproxen 500 mg twice a day, Which of
the following adverse effects may be seen with long term use of naproxen ?
Renal failure
86- A 28-year-old woman who is 8 months pregnant is taking naproxen 500 mg twice daily for the past four weeks to treat severe backache. Which
of the following health issues at the time of birth puts the neonate at higher risk?
uncontrolled bleeding
Q- Drug cause GIT side effect? Answer: -naproxen
Q-Drug cause more peptic ulcer ? - ketorolac –
INTERACTION
677- Patients On Nexium And Has Severe Heart Pain + No Other Diseases
Answer: Continue Same Medication, Refer To Doctor, Add Cimetidine
Q-Patient with angina which one can worse his case?
Answer: Celecoxib
Q- Drug Disease interaction?
Answer: Celecoxib and cardiac toxicity
CYP2C9 (Carvedilol, celecoxib, glipizide, ibuprofen, Irbesartan, losartan) (celecoxib=angina)
3- aspirin NSAIDS > contraindicated with CHD
Q- Medication interaction with antihypertensive ? celecoxib
15- Which of the following drugs has both an anti-inflammatory and analgesic activity?
Ibuprofen
61- A 60-year-old man with 6-year history of myocardial infarction and gout. He presented to the clinic complain of severe pain in his first left
consistent with acute gout flare. He mentions that he can't colchicine. What is the most appropriate pharmacotherapy recommendation for his
acute flare-associated pain?
Ibuprofen
98- An 88-year-old frail woman with osteoarthritis has difficulty in walking and pain. She has no other medical history and has failed numerous aids
to help her with the pain. Which of the following drugs is the best recommendation?
Ibuprofen
5)A 73-year-old man is diagnosed with osteoarthritis of the knee.
Which of the following is the best initial therapy?
Acetaminophen
N.B:-
Acetaminophen should be used as first-line therapy for mild osteoarthritis. Nonsteroidal anti-inflammatory drugs are superior to acetaminophen for
treating moderate to severe osteoarthritis.
34- Which of the following drugs/substance would exacerbate the poisoning effects of acetaminophen?
Valproic acid (cause hepatic failure)
3. 3
19- Which detoxification pathway is active paracetamol toxicity?
CYP-450 dependent glutathione
. Ibuprofen dose: 3000mg
.paracetamol dose: 4g 24hr
. Voltaren emulgel: declofenac diethylamine
GOUT
. Indomethacin for : acute gaut
43. Allopurinol ?
Anti-inflammatory
. Allopurinol : prophylaxis of gout, uric acid & ca oxalate
. Allopurinol : ⬆ renal tubular reabsorption
Definition: inflammatory arthritis due to deposition of uric acid crystal in the joint
treatment strategy during acute attack
reduce inflammatory
o Colichicine ( may prevent precipitation of uric acid in joint)
o NSAIDs as indomethacine, …….
o Intra-articular steroid
treatment strategy In between attack (chronic)
1. allopurinol
decrease uric acid synthesis ( xanthine oxidase inh.)
2. Probencid ||||
increase uric acid excretion( prevent uric acid reabsorption)
N.B. probencid action is antagonized by salicylate
60-Which of the following is an alkaloid isolated from the autumn crocus plant and is useful in the treatment of the symptoms of gouty erthritis?
Colchicine
16- plant source use for acute gouty
Answer: Colchicine
Q. Case: Management of Acute gout attack in HF patient
Answer- colchicine
458 Which med treatment gout pain ?
Answer Nsaids as include over-the-counter options such as ibuprofen (Advil, Motrin IB, others) and naproxen sodium (Aleve), as well as
more-powerful prescription nsaids such as indomethacin (Indocin) or celecoxib (Celebrex).
Colchicine.(Colcrys, Mitigare), a type of pain reliever that effectively reduces gout pain.
Corticosteroids. Corticosteroid medications, such as the drug prednisone, may control gout inflammation and pain. Corticosteroids may
be in pill form, or they can be injected into your joint.
Corticosteroids are generally used only in people with gout who can't take either nsaids or colchicine. Side effects of corticosteroids may
include mood changes, increased blood sugar levels and elevated blood pressure.
Q.Which Diuretic Contraindicated In Gout?
Answer: Loop diuretics ( furosemide, torsemide, bumetanide) , Thiazide diuretics (-thiazide) ,Because all cause hyperuricemia
Q. What is use of Colchicine?
Answer Gout and Behçet's disease.
What is MOA Allopurinol ?
Answer: Allopurinol inhibits xanthine oxidase, the enzyme responsible for the conversion of hypoxanthine to xanthine to uric acid.
Allopurinol is metabolized to oxypurinol which is also an inhibitor of xanthine oxidase; allopurinol acts on purine catabolism, reducing the
production of uric acid without disrupting the biosynthesis of vital purines
18- Which of the following is the mechanism by which probenecid increases the duration of action of ampicillin when administered at the same
time? Inhibition of renal tubular secretion
SE
Q-Case with acute gout due to use
Answer: Furosemide
Q-allopurinol genetic is HALA_B will be make. side effect of
Answer: Severe cutaneous adverse reactions
HLA-B*58:01 allele is strongly associated with severe cutaneous adverse reactions (SCAR) during treatment with allopurinol if the
patient is positive for HLA-B*58:01 allele
side effect of allopurinol ?
Fever, sore throat, and headache with a severe blistering, peeling and red skin rash.
Q. What will happen if you give Allopurinol to a patient who is positive for HLA-B5801 variant allele?
Answer It will cause severe cutaneous drug reaction (SCDR)
468- Which is most likely to cause heartburn? -Kcl
