1. Mr. Holloway presents to your clinic with a significantly swollen, painful big toe and you diagnose him with gout. Of the following options which would
... [Show More] be the best treatment for Mr. Holloway? a. A cetaminophen with codeine b. Low-dose colchicine c. High-dose colchicine d. High-dose aspirin Low-dose colchicine. Low-dose colchicine is 1.2 mg followed by 0.6 mg one hour later or 1.8 mg total. High-dose colchicine is 1.2 mg followed by 0.6 mg Q4 to Q6 hours or 4.8 mg total. The difference between the two is low-dose is as effective as high-dose with a lower side effect profile. 2. Patient education when prescribing colchicine includes? a. Moderate amounts of alcohol are safe with colchicine b. Colchicine may be constipating c. Colchicine always causes some degree of diarrhea d. Mild muscle weakness is normal Colchicine always causes some degree of diarrhea 3. You have a patient who is taking allopurinol to prevent gout. What labs will you monitor for this patient on allopurinol? a. Blood glucose b. Complete blood count c. BUN, creatinine, and creatinine clearance d. C-reactive protein BUN, creatinine, and creatinine clearance 4. Mr. Thompson has just started taking febuxostat (Uloric) to treat his gout and he needs to be educated on what to expect. a. Feuxostat may cause severe diarrhea b. He will need frequent CBC monitoring c. He should consume a high-calcium diet d. Gout may worsen with therapy Gout may worsen with therapy 5. Ms. Jensen has been on prednisone for 6 months. Patients who have been on prednisone for some time should be assessed for what? a. Iron deficiency anemia b. Renal dysfunction c. Osteoporosis d. Gout Osteoporosis. Prednisone can also worsen diabetic control and you must educate your patients to report any tarry black stools or abdominal pain. 6. When you place a patient on prednisone and the total dose exceeds 1 gram, what additional drug should you prescribe? a. Naproxen, an NSAID for joint pain b. Omeprazole, a proton-pump inhibitor to prevent PUD c. Metformin, a biguanide to prevent diabetes d. Furosemide, a diuretic to treat fluid retention Omeprazole 7. Janet has fractured her ankle and you give her a prescription for Vicodin (acetaminophen +hydrocodone). What education should you provide before they leave your clinic? a. Okay to double dose if the pain is severe b. Patient should not take any other medications that contain acetaminophen c. Vicodin is not habit forming d. Vicodin may cause loose stools and therefore increase fiber intake Patient should not take any other medications that contain acetaminophen. When you do have a patient who has pain, always start with NSAIDs if they are not contraindicated in your patient. That way if their pain is not controlled you can prescribe a medication that is stronger. My pain is a 3 on the pain scale, can I get a prescription for Dilaudid? Umm, NO! 8. Margaret has been on 60 mg of prednisone for 10 days for her severe asthma exacerbation. Since she is breathing much better it is time to discontinue the medication. What should you know when discontinuing this drug? a. Prednisone can be abruptly discontinued with no adverse effects b. Substitute the prednisone with another anti-inflammatory such as ibuprofen c. Develop a tapering schedule to slowly wean Margaret off the prednisone d. Transition patient onto an inhaled corticosteroid Develop a tapering schedule because tapering helps to avoid both recurrent activity of the underlying disease process and possible cortisol deficiency resulting from the hypothalamic-pituitary-adrenal axis (HPA) suppression during the period of steroid therapy. 9. Patients who are currently on or will start chronic corticosteroid therapy should be monitored for what? a. Stool culture b. Vitamin B12 c. Serum glucose d. Folate levels Serum glucose. FYI: remember steroid therapy will raise glucose levels even in your nondiabetic patients. 10. Patients with rheumatoid arthritis who are on a chronic low-dose prednisone will need co-treatment with which medications to prevent further adverse effects? a. Vitamin D b. Calcium supplementation c. A bisphosphonate d. All of the above All of the above. FYI: long term steroid therapy can contribute to weakened bones. 11. What is the FDA Black Box Warning for ALL nonsteroidal anti-inflammatory drugs (NSAIDS)? a. Increased risk of developing systemic arthritis with prolonged use b. Risk of life-threatening rashes, including Stevens-Johnson c. Potential for causing life-threatening gastrointestinal bleeds d. Potential for transient changes in serum glucose levels Potential for causing life-threatening gastrointestinal bleeds (and ulceration and perforation of the stomach or intestines). NSAIDs can also increase the risk of cardiovascular thrombotic events, MI, and stroke, especially with extended use. Elderly patients are at greater risk and can happen without any warning symptoms. So EDUCATE, EDUCATE, EDUCATE! 12. If you are getting ready to prescribe an NSAID, a complete drug history should be conducted as NSAIDs interact with which drug? a. Diphenhydramine (an antihistamine) b. Combined oral contraceptives c. Warfarin (anticoagulant) d. Omeprazole (proton-pump inhibitor) Warfarin. NSAIDs work by inhibiting the cox enzymes. Strathman says to get familiar with the “cox pathway” and how blocking one part of the cox pathway can lead to build up of other different products. NSAIDs stimulate platelet aggregation by the formation of thromboxane-A2 leading to the formation of blood clots. See attachment. [Show Less]