Chapter 9: Musculoskeletal Drugs 1. Drugs used to treat osteoarthritis reduce pain and inflammation by inhibiting the production of ________. a. estradiol b. osteoblasts c. progesterone d. prostaglandins Answer: d. prostaglandins Correct Feedback: Drugs used to treat osteoporosis include those that reduce pain and inflammation by inhibiting the production of prostaglandins. a. estradiol Incorrect Feedback: Estradiol is a female sex hormone that is used to treat osteoporosis, not osteoarthritis. b. osteoblasts Incorrect Feedback: Drugs used to treat osteoarthritis do not inhibit the production of osteoblasts. c. progesterone Incorrect Feedback: Progesterone is a female hormone that stimulates the formation of new bone. It is not used to treat osteoarthritis. 2. NSAIDs (nonsteroidal anti-inflammatory drugs) are ________. a. less likely than aspirin to cause gastric irritation or ulcers b. less likely than ibuprofen to cause gastric irritation or ulcers c. more likely than aspirin to cause gastric irritation or ulcers d. more likely than ibuprofen to cause gastric irritation or ulcers Answer: a. less likely than aspirin to cause gastric irritation or ulcers Correct Feedback: NSAIDs have less of a tendency than does aspirin to cause gastric irritation or ulcers. b. less likely than ibuprofen to cause gastric irritation or ulcers Incorrect Feedback: The category of NSAIDs includes ibuprofen, so their effects would be the same. c. more likely than aspirin to cause gastric irritation or ulcers Incorrect Feedback: NSAIDS have less of tendency, not more, to cause gastric irritation or ulcers than aspirin. d. more likely than ibuprofen to cause gastric irritation or ulcers Incorrect Feedback: The category of NSAIDs includes ibuprofen, so their effects would be the same. 3. Natural corticosteroids are produced in the ________. a. cortex of the adrenal gland b. bone marrow c. medulla of the adrenal gland d. muscle tissue Answer: a. cortex of the adrenal gland Correct Feedback: Natural corticosteroids are produced in the cortex of the adrenal gland. b. bone marrow Incorrect Feedback: Natural corticosteroids are not produced in the bone marrow. c. medulla of the adrenal gland Incorrect Feedback: Natural corticosteroids are not produced in the medulla of the adrenal gland. d. muscle tissue Incorrect Feedback: Natural corticosteroids are not produced in the muscle tissue. 4. Because of the side effects associated with their prolonged oral use, these drugs are only prescribed to treat the acute symptoms of osteoarthritis for a limited time: ________. a. gold compound drugs b. NSAIDs c. corticosteroid drugs d. muscle relaxant drugs Answer: c. corticosteroid drugs Correct Feedback: Because of the side effects associated with prolonged oral use, corticosteroid drugs are only prescribed to treat acute symptoms of osteoarthritis for a limited time. a. gold compound drugs Incorrect Feedback: Gold compound drugs are not used to treat osteoarthritis. b. NSAIDs Incorrect Feedback: NSAIDs are used to treat osteoarthritis for extended periods of time. d. muscle relaxant drugs Incorrect Feedback: Muscle relaxant drugs are not used to treat osteoarthritis. 5. The normal balance between new bone deposition and bone resorption (breakdown) is maintained by all of the following EXCEPT ______. a. exercise and exposure to the sun b. the hormone calcitonin c. calcium and vitamin D in the diet d. all of the above Answer: d. all of the above Correct Feedback: Normal bone maintains a healthy balance (homeostasis) between new bone deposition and bone resorption (breakdown). This balance is maintained by hormones that control the amount of calcium in the blood (parathyroid hormone from the parathyroid glands and calcitonin hormone from the thyroid gland), calcium (in the diet), vitamin D (in the diet and from exposure to the sun), exercise, and—in women—by the hormones progesterone and estradiol from the ovaries. a. exercise and exposure to the sun Incorrect Feedback: The normal balance is maintained by exercise and exposure to the sun. b. the hormone calcitonin Incorrect Feedback: The normal balance is maintained by the hormone calcitonin. c. calcium and vitamin D in the diet Incorrect Feedback: The normal balance is maintained by calcium and vitamin D in the diet. 6. In patients with rheumatoid arthritis, the antibodies within their bodies target and destroy cartilage, connective tissue, and joints. Rheumatoid arthritis is ______. a. an autoimmune reaction triggered by a virus b. an allergic reaction triggered by histamine c. an inflammatory response caused by a bacterial infection d. an autoimmune response caused by a bacterial infection Answer: a. an autoimmune reaction triggered by a virus Correct Feedback: Rheumatoid arthritis is caused by an autoimmune reaction in which the body’s own antibodies target and destroy cartilage, connective tissue, and joints. Rheumatoid arthritis is thought to be triggered by a virus. b. an allergic reaction triggered by histamine Incorrect Feedback: Rheumatoid arthritis is not an allergic reaction. c. an inflammatory response caused by a bacterial infection Incorrect Feedback: Rheumatoid arthritis is not caused by a bacterial infection. d. an autoimmune response caused by a bacterial infection Incorrect Feedback: Rheumatoid arthritis is not caused by a bacterial infection. 7. Which of the following drugs has the most powerful anti-inflammatory effect? a. ibuprofen (Advil, Motrin) b. acetaminophen (Tylenol) c. hydrocortisone (Cortef, Solu-Cortef) d. zoledronic acid (Reclast, Zometa) Answer: c. hydrocortisone (Cortef, Solu-Cortef) Correct Feedback: Natural corticosteroids, produced in the cortex of the adrenal gland, have a powerful anti-inflammatory action. Corticosteroid drugs have this same anti-inflammatory effect. a. ibuprofen (Advil, Motrin) Incorrect Feedback: Ibuprofen has an anti-inflammatory effect, but not the most powerful anti-inflammatory effect. b. acetaminophen (Tylenol) Incorrect Feedback: Acetaminophen (Tylenol) does not have an antiinflammatory effect. d. zoledronic acid (Reclast, Zometa) Incorrect Feedback: This drug is a bone resorption inhibitor drug; it has no antiinflammatory effect. 8. Which of the following statements is TRUE concerning acetaminophen? a. It inhibits the action of prostaglandins. b. It is used to treat osteoarthritis. c. It is an NSAID. d. All of the above statements are true. Answer: b. It is used to treat osteoarthritis. Correct Feedback: Acetaminophen lacks the ability to inhibit the production of prostaglandins and has no anti-inflammatory action. However, the American College of Rheumatology recommends the use of acetaminophen to treat mild-tomoderate pain associated with osteoarthritis. a. It inhibits the action of prostaglandins. Incorrect Feedback: Acetaminophen lacks the ability to inhibit the production of prostaglandins. c. It is an NSAID. Incorrect Feedback: Acetaminophen is not an NSAID. d. All of the above statements are true. Incorrect Feedback: Only one of the statements is true. 9. All of the following drugs are skeletal muscle relaxant drugs EXCEPT______. a. Skelaxin b. Robaxin c. Flexeril d. Fosamax Answer: d. Fosamax Correct Feedback: Bone resorption inhibitor drugs inhibit osteoclasts and this decreases the rate at which bone is resorbed (broken down); these include alendronate (Fosamax). a. Skelaxin Incorrect Feedback: Skelaxin is a skeletal muscle relaxant drug. b. Robaxin Incorrect Feedback: Robaxin is a skeletal muscle relaxant drug. c. Flexeril Incorrect Feedback: Flexeril is a skeletal muscle relaxant drug. 10. Eugenia Wedridge is entering menopause and is experiencing hot flashes that are very uncomfortable. She asks her physician to give her a hormone replacement therapy drug. Her physician declines to prescribe this because long-term treatment with a hormone therapy drug throughout menopause increases the risk of ________. a. myocardial infarction b. stroke c. breast and endometrial cancer d. all of the above Answer: d. all of the above Correct Feedback: Hormone replacement therapy drugs can increase the risk of endometrial cancer, breast cancer, stroke, and myocardial infarction; this has limited the use of these drugs for the long-term treatment of osteoporosis in postmenopausal women. a. myocardial infarction Incorrect Feedback: This is true, but it is not the only correct answer. b. stroke Incorrect Feedback: This is true, but it is not the only correct answer. c. breast and endometrial cancer Incorrect Feedback: This is true, but it is not the only correct answer. 11. Ibuprofen belongs to what category of drugs? a. salicylate b. aspirin c. skeletal muscle relaxant drug d. NSAID Answer: d. NSAID Correct Feedback: The NSAID ibuprofen (Advil, Motrin) is used to treat the pain and inflammation of osteoarthritis and rheumatoid arthritis. a. salicylate Incorrect Feedback: Ibuprofen does not belong to the salicylate category of drugs. b. aspirin Incorrect Feedback: There is no aspirin category of drugs. c. skeletal muscle relaxant drug Incorrect Feedback: Ibuprofen does not belong to the skeletal muscle relaxant category of drugs. 12. Miacalcin, Fosamax, Aredia, and Zometa are all used to treat ______. a. muscle spasm b. osteoarthritis c. osteoporosis d. pain and inflammation Answer: c. osteoporosis Correct Feedback: Miacalcin is the drug form of the hormone calcitonin used to treat osteoporosis. Fosamax, Aredia, and Zometa are all bone resorption inhibitor drugs used to treat osteoporosis. a. muscle spasm Incorrect Feedback: These drugs are not used to treat muscle spasm. b. osteoarthritis Incorrect Feedback: These drugs are not used to treat osteoarthritis. d. pain and inflammation Incorrect Feedback: These drugs are not used to treat pain and inflammation. 13. William Ruckles has severe rheumatoid arthritis. His physician prescribed ______, an oral gold compound drug. a. auranofin (Ridaura) b. raloxifene (Evista) c. naproxen (Aleve, Naprosyn) d. capsaicin (Capsin, Zostrix) Answer: a. auranofin (Ridaura) Correct Feedback: Gold compound drugs are used to treat active rheumatoid arthritis, including auranofin (Ridaura). b. raloxifene (Evista) Incorrect Feedback: This selective estrogen receptor modulator (SERM) drug is not used to treat rheumatoid arthritis. c. naproxen (Aleve, Naprosyn) Incorrect Feedback: This NSAID is not used to treat rheumatoid arthritis. d. capsaicin (Capsin, Zostrix) Incorrect Feedback: Capsaicin is used topically, not orally. 14. The suffix –profen is common to generic ________. a. gold compound drugs b. nonsteroidal anti-inflammatory drugs c. monoclonal antibody drugs d. drugs used to treat fibromyalgia Answer: b. nonsteroidal anti-inflammatory drugs Correct Feedback: The suffix -profen is common to generic nonsteroidal antiinflammatory drugs. a. gold compound drugs Incorrect Feedback: The suffix –profen is not common to gold compound drugs. c. monoclonal antibody drugs Incorrect Feedback: The suffix –profen is not common to monoclonal antibody drugs. d. drugs used to treat fibromyalgia Incorrect Feedback: The suffix –profen is not common to drugs used to treat fibromyalgia. 15. Risk factors for osteoporosis include all of the following EXCEPT ________. a. lack of exercise b. Caucasian or Asian race c. a metabolic defect d. smoking and the use of alcohol Answer: c. a metabolic defect Correct Feedback: Risk factors for osteoporosis in both men and women include Caucasian or Asian race, slender build, smoking, alcohol use, and lack of exercise. Gout, not osteoporosis, is caused by a metabolic defect. a. lack of exercise Incorrect Feedback: Lack of exercise is a risk factor for osteoporosis. b. Caucasian or Asian race Incorrect Feedback: Caucasian or Asian race is a risk factor for osteoporosis. d. smoking and the use of alcohol Incorrect Feedback: Smoking and the use of alcohol are risk factors for osteoporosis. 16. All of the following are corticosteroid drugs that are used to treat osteoarthritis or rheumatoid arthritis EXCEPT __________. a. betamethasone (Celestone) and dexamethasone (Decadron) b. triamcinolone (Aristospan Intra-articular) and cortisone c. prednisone (Deltasone, Meticorten) and celecoxib (Celebrex) d. hydrocortisone (Cortef, Solu-Cortef) and prednisolone (Orapred, Prelone) Answer: c. prednisone (Deltasone, Meticorten) and celecoxib (Celebrex) Correct Feedback: Prednisone (Deltasone, Meticorten) is a corticosteroid drug, but celecoxib (Celebrex) is a COX-2 inhibitor drug. a. betamethasone (Celestone) and dexamethasone (Decadron) Incorrect Feedback: These are corticosteroid drugs. b. triamcinolone (Aristospan Intra-articular) and cortisone Incorrect Feedback: These are corticosteroid drugs. d. hydrocortisone (Cortef, Solu-Cortef) and prednisolone (Orapred, Prelone) Incorrect Feedback: These drugs are corticosteroid drugs. 17. Which of the following statements is FALSE? a. Hyaluronic acid is secreted by the synovial membrane of a joint. b. The drug hyaluronic acid (Hyalgan, Synvisc) is derived from chili pepper plants. c. Another form of the drug hyaluronic acid (Hylaform, Restylane) is a filler that is injected under the skin to minimize wrinkles. d. The drug hyaluronic acid is injected into the joints of patients who have osteoarthritis. Answer: b. The drug hyaluronic acid (Hyalgan, Synvisc) is derived from chili pepper plants. Correct Feedback: Hyaluronic acid (Hyalgan, Synvisc) is derived from the combs of chickens. a. Hyaluronic acid is secreted by the synovial membrane of a joint. Incorrect Feedback: This is a true statement. c. Another form of the drug hyaluronic acid (Hylaform, Restylane) is a filler that is injected under the skin to minimize wrinkles. Incorrect Feedback: This is a true statement. d. The drug hyaluronic acid is injected into the joints of patients who have osteoarthritis. Incorrect Feedback: This is a true statement. 18. All of the following are topical drugs used to treat the pain of osteoarthritis EXCEPT ______. a. Absorbine Power Gel b. capsaicin (Capsin, Zostrix) c. Ascriptin d. Icy Hot Answer: c. Ascriptin Correct Feedback: Ascriptin is a combination drug that contains aspirin, aluminum, calcium, and magnesium. It is used to treat the pain of osteoarthritis, but it is not a topical drug. a. Absorbine Power Gel Incorrect Feedback: This is a topical drug used to treat the pain of osteoarthritis. b. capsaicin (Capsin, Zostrix) Incorrect Feedback: This is a topical drug used to treat the pain of osteoarthritis. d. Icy Hot Incorrect Feedback: This is a topical drug used to treat the pain of osteoarthritis. 19. Osteoporosis is treated with all of the following types of drugs EXCEPT ________. a. SERM drugs b. NSAIDS c. bone resorption inhibitor drugs d. calcium supplements Answer: b. NSAIDS Correct Feedback: Osteoporosis is treated with bone resorption inhibitor drugs, selective estrogen receptor modulator (SERM) drugs, estrogen drugs, other hormone drugs, calcium supplements, and other drugs. NSAIDS are not used to treat osteoporosis. a. SERM drugs Incorrect Feedback: SERM drugs are used to treat osteoporosis. c. bone resorption inhibitor drugs Incorrect Feedback: Bone resorption inhibitor drugs are used to treat osteoporosis. d. calcium supplements Incorrect Feedback: Calcium supplements are used to treat osteoporosis. 20. Which two drugs are commonly prescribed for muscle spasm and low back pain? a. Lyrica and Novocain b. Indocin and Zyloprim c. Deltasone and Orapred d. Soma and Flexeril Answer: d. Soma and Flexeril Correct Feedback: Muscle relaxant drugs specifically relieve muscle spasm and stiffness, but cannot relieve pain or inflammation; these include carisoprodol (Soma) and cyclobenzaprine (Flexeril). a. Lyrica and Novocain Incorrect Feedback: These drugs are not used to treat muscle spasm. b. Indocin and Zyloprim Incorrect Feedback: These drugs are not used to treat muscle spasm. c. Deltasone and Orapred Incorrect Feedback: These drugs are not used to treat muscle spasm. 21. Bridget Maurer is taking a monoclonal antibody drug for her rheumatoid arthritis. That drug might include any one of the following drugs EXCEPT ______. a. abatacept (Orencia) and methotrexate (Rheumatrex Dose Pack) b. adalimumab (Humira) and etanercept (Enbrel) c. infliximab (Remicade) and rituximab (Rituxan) d. alemtuzumab (Campath) and etanercept (Enbrel) Answer: a. abatacept (Orencia) and methotrexate (Rheumatrex Dose Pack) Correct Feedback: Abatacept inhibits T lymphocytes that attack joint tissues. Methotrexate is a chemotherapy drug used to treat many different types of cancer; its exact action in treating rheumatoid arthritis is not known. b. adalimumab (Humira) and etanercept (Enbrel) Incorrect Feedback: These are monoclonal antibody drugs. c. infliximab (Remicade) and rituximab (Rituxan) Incorrect Feedback: These are monoclonal antibody drugs. d. alemtuzumab (Campath) and etanercept (Enbrel) Incorrect Feedback: These are monoclonal antibody drugs. 22. Which of these drugs is NOT used for synovial fluid replacement? a. Sandimmune b. Hyalgan c. Synvisc d. hyaluronic acid Answer: a. Sandimmune Correct Feedback: Immunosuppressant drugs suppress the immune system in patients with active, uncontrolled rheumatoid arthritis and include cyclosporine (Neoral, Gengraf, Sandimmune). b. Hyalgan Incorrect Feedback: This drug is used for synovial fluid replacement. c. Synvisc Incorrect Feedback: This drug is used for synovial fluid replacement. d. hyaluronic acid Incorrect Feedback: This drug is used for synovial fluid replacement. 23. Which bone resorption inhibitor drug must be given intravenously? a. ibandronate (Boniva) b. alendronate (Fosamax) c. zoledronic acid (Reclast, Zometa) d. raloxifene (Evista) Answer: c. zoledronic acid (Reclast, Zometa) Correct Feedback: Zoledronic acid is now approved to treat osteoporosis in postmenopausal women with a single dose just once a year, but that dose can only be given intravenously, which necessitates a visit to the doctor’s office or clinic. a. ibandronate (Boniva) Incorrect Feedback: Boniva is given orally. b. alendronate (Fosamax) Incorrect Feedback: Fosamax is given orally. d. raloxifene (Evista) Incorrect Feedback: Evista is not a bone resorption inhibitor drug. 24. All of the following drugs are used to treat osteoarthritis EXCEPT ________. a. muscle relaxant drugs b. salicylate drugs and acetaminophen c. NSAID and COX-2 inhibitor drugs d. corticosteroid drugs Answer: a. muscle relaxant drugs Correct Feedback: Drugs used to treat osteoarthritis include drugs that reduce pain and inflammation by inhibiting the production of prostaglandins. These drugs include salicylates (such as aspirin), acetaminophen, nonsteroidal antiinflammatory drugs (NSAIDs), and COX-2 inhibitor drugs. In addition, corticosteroid drugs can be used. Muscle relaxant drugs are not used to treat osteoarthritis. b. salicylate drugs and acetaminophen Incorrect Feedback: Salicylate drugs and acetaminophen are used to treat osteoarthritis. c. NSAID and COX-2 inhibitor drugs Incorrect Feedback: NSAID and COX-2 inhibitor drugs are used to treat osteoarthritis. d. corticosteroid drugs Incorrect Feedback: Corticosteroid drugs can be used to treat osteoarthritis. 25. All of the following are trade name nonsteroidal anti-inflammatory drugs EXCEPT _______. a. Daypro and Advil b. Aleve and Clinoril c. Voltaren and Motrin d. Feldene and Flexeril Answer: d. Feldene and Flexeril Correct Feedback: Piroxicam (Feldene) is a nonsteroidal anti-inflammatory drug, but cyclobenzaprine (Flexeril) is a muscle relaxant drug a. Daypro and Advil Incorrect Feedback: These are nonsteroidal anti-inflammatory drugs. b. Aleve and Clinoril Incorrect Feedback: These are nonsteroidal anti-inflammatory drugs. c. Voltaren and Motrin Incorrect Feedback: These are nonsteroidal anti-inflammatory drugs. 26. Muscle relaxant drugs specifically relieve muscle ________. a. inflammation and loss of function b. pain and inflammation c. spasms and stiffness d. inflammation and swelling Answer: c. spasms and stiffness Correct Feedback: Muscle relaxant drugs specifically relieve muscle spasm and stiffness, but cannot relieve pain or inflammation. a. inflammation and loss of function Incorrect Feedback: Muscle relaxant drugs do not relieve inflammation and loss of function. b. pain and inflammation Incorrect Feedback: Muscle relaxant drugs do not relieve pain and inflammation. d. inflammation and swelling Incorrect Feedback: Muscle relaxants do not relieve inflammation and swelling. 27. Which of the following drugs is NOT used to treat fibromyalgia? a. The anticonvulsant drug pregabalin (Lyrica) b. The chemotherapy drug methotrexate (Rheumatrex Dose Pack) c. The local anesthetic drug lidocaine (Xylocaine) d. The muscle relaxant drug cyclobenzaprine (Flexeril) Answer: b. The chemotherapy drug methotrexate (Rheumatrex Dose Pack) Correct Feedback: The drugs used to treat fibromyalgia include the muscle relaxant drug cyclobenzaprine, a local anesthetic drug (lidocaine, procaine) injected into the trigger points, or an anticonvulsant drug (pregabalin). Methotrexate (Rheumatrex Dose Pack) is a chemotherapy drug used to treat rheumatoid arthritis and different types of cancer. a. The anticonvulsant drug pregabalin (Lyrica) Incorrect Feedback: This drug is used to treat fibromyalgia. c. The local anesthetic drug lidocaine (Xylocaine) Incorrect Feedback: This drug is used to treat fibromyalgia. d. The muscle relaxant drug cyclobenzaprine (Flexeril) Incorrect Feedback: This drug is used to treat fibromyalgia. 28. Drugs used to treat gout and gouty arthritis ________. a. decrease the excretion of uric acid b. inhibit enzymes that produce uric acid in the blood c. increase the excretion of uric acid d. b and c Answer: d. b and c Correct Feedback: Drugs used to treat gout and gouty arthritis act either by increasing the excretion of uric acid in the urine or by inhibiting enzymes that produce uric acid in the blood. a. decrease the excretion of uric acid Incorrect Feedback: Drugs used to treat gout and gouty arthritis increase the excretion of uric acid. b. inhibit enzymes that produce uric acid in the blood Incorrect Feedback: This is true, but it is not the only correct answer. c. increase the excretion of uric acid Incorrect Feedback: This is true, but it is not the only correct answer. 29. ________ is also known as degenerative joint disease. a. fibromyalgia b. gouty arthritis c. osteoarthritis d. osteoporosis Answer: c. osteoarthritis Correct Feedback: Osteoarthritis, also known as degenerative joint disease, occurs when cumulative damage (“wear and tear”) causes degeneration of the cartilage pad and erosion of the bone ends inside a joint. a. fibromyalgia Incorrect Feedback: Fibromyalgia is not known as degenerative joint disease. b. gouty arthritis Incorrect Feedback: Gouty arthritis is not known as degenerative joint disease. d. osteoporosis Incorrect Feedback: Osteoporosis is not known as degenerative joint disease. 30. Drugs used to treat osteoarthritis include those that reduce pain and inflammation. Which of the following classes of drugs are NOT used to reduce the pain and inflammation of osteoarthritis? a. COX-2 inhibitor drugs b. gold compound drugs c. NSAIDs d. salicylate drugs Answer: b. gold compound drugs Correct Feedback: Gold compound drugs are used to treat rheumatoid arthritis, not osteoarthritis. Drugs used to treat osteoarthritis include salicylates (such as aspirin), acetaminophen, nonsteroidal anti-inflammatory drugs (NSAIDs), and COX-2 inhibitor drugs. In addition, corticosteroid drugs can be used. a. COX-2 inhibitor drugs Incorrect Feedback: COX-2 inhibitor drugs are used to reduce the pain and inflammation of osteoarthritis. c. NSAIDs Incorrect Feedback: NSAIDs are used to reduce the pain and inflammation of osteoarthritis. d. salicylate drugs Incorrect Feedback: Salicylate drugs are used to reduce the pain and inflammation of osteoarthritis. 31. Gold compound drugs inhibit _______ that attack the joints. a. macrophages from the muscles b. macrophages from the immune system c. osteoclasts from the bone d. natural corticosteroids from the adrenal gland Answer: b. macrophages from the immune system Correct Feedback: Gold compound drugs are used to treat active rheumatoid arthritis. These drugs inhibit macrophages from the immune system that attack the joints. a. macrophages from the muscles Incorrect Feedback: Macrophages do not come from the muscles. c. osteoclasts from the bone Incorrect Feedback: Gold compounds do not inhibit osteoclasts. d. natural corticosteroids from the adrenal gland Incorrect Feedback: Gold compound drugs do not inhibit natural corticosteroids from the adrenal gland. 32. Only _______ drugs can reverse the cartilage and bone damage that has already occurred in the joints of patients with osteoarthritis. a. corticosteroid drugs b. COX-2 inhibitor drugs and NSAIDs c. monoclonal antibody drugs d. There are no drugs that can reverse the cartilage and bone damage of osteoarthritis once it has occurred. Answer: d. There are no drugs that can reverse the cartilage and bone damage of osteoarthritis once it has occurred. Correct Feedback: Drugs used to treat osteoarthritis include drugs that reduce pain and inflammation by inhibiting the production of prostaglandins. None of these drugs, however, can reverse the cartilage and bone damage that has already occurred in the joint. a. corticosteroid drugs Incorrect Feedback: Corticosteroid drugs cannot reverse the cartilage and bone damage that has occurred in the joints due to osteoarthritis. b. COX-2 inhibitor drugs and NSAIDs Incorrect Feedback: COX-2 inhibitor drugs and NSAIDs cannot reverse the cartilage and bone damage that has occurred in the joints due to osteoarthritis. c. monoclonal antibody drugs Incorrect Feedback: Monoclonal antibody drugs cannot reverse the cartilage and bone damage that has occurred in the joints due to osteoarthritis. 33. The cause of fibromyalgia is ______. a. overproduction of prostaglandins b. muscle spasms in the neck, back, and hips c. wear and tear on the joints d. unknown Answer: d. unknown Correct Feedback: The cause of fibromyalgia is unknown. a. overproduction of prostaglandins Incorrect Feedback: Prostaglandins cause pain and inflammation, but they are not the cause of fibromyalgia. b. muscle spasms in the neck, back, and hips Incorrect Feedback: Muscle spasms are not the cause of fibromyalgia. c. wear and tear on the joints Incorrect Feedback: Wear and tear on the joints is a symptom of osteoarthritis, not fibromyalgia. 34. Mature bone is a hard, unchanging substance. Answer: False Feedback: Most people think of bone as a hard, unchanging substance when, in fact, it is not. Although mature bone is hard, it is also a living tissue that undergoes change. Each year, about 10 percent of the entire bony skeleton is rebuilt. 35. Some of the hormone replacement drugs used to treat menopause are also indicated for the prevention of osteoporosis. Answer: True Feedback: When estradiol levels naturally decline during menopause, the rate of bone resorption (breakdown) accelerates. Hormone replacement drugs are used to treat the symptoms of menopause, and some of the drugs are also indicated for the prevention of osteoporosis in postmenopausal women. 36. Because acetaminophen has no anti-inflammatory action, it is not recommended to treat the pain associated with osteoarthritis. Answer: False Feedback: The American College of Rheumatology recommends the use of acetaminophen to treat mild-to-moderate pain associated with osteoarthritis because it is the drug of choice for treating musculoskeletal pain in older patients and it has fewer side effects than NSAIDs, even though it cannot treat the inflammation associated with osteoarthritis. 37. NSAIDs are structurally similar enough to aspirin that some patients who are allergic to aspirin should not take NSAIDs. Answer: True Feedback: NSAIDs are structurally similar enough to aspirin that some patients who are allergic to aspirin should not take NSAIDs. 38. Drugs that are derivatives of hyaluronic acid are injected into the joints of patients with osteoarthritis to improve the viscosity and lubricating quality of the synovial fluid. Answer: True Feedback: Hyaluronic acid (Hyalgan, Synvisc) derivatives are injected into the joints of patients with osteoarthritis to improve the viscosity and lubricating quality of the synovial fluid. . 39. Rheumatoid arthritis is treated with many of the same drugs used to treat gouty arthritis. Answer: False Feedback: Rheumatoid arthritis is treated with many of the same drugs used to treat osteoarthritis. 40. COX-2 inhibitor drugs also belong to the larger drug category of NSAIDs. Answer: True Feedback: COX-2 inhibitor drugs also belong to the larger category of NSAIDs. 41. Corticosteroid drugs for acute episodes of osteoarthritis are only given as intraarticular injections into specific joints. Answer: False Feedback: Oral corticosteroid drugs are only prescribed to treat acute symptoms for a limited time. Some corticosteroid drugs (betamethasone, dexamethasone, methylprednisolone, triamcinolone) can also be injected directly into a joint affected by osteoarthritis (intra-articular administration) to relieve inflammation. 42. Two types of bone cells are constantly at work: Osteoclasts deposit new bone and osteoblasts break down and remove areas of old or damaged bone. Answer: False Feedback: Two types of bone cells are constantly at work: Osteoblasts deposit new bone and osteoclasts break down and remove areas of old or damaged bone. 43. Calcitonin-salmon is the drug form of the hormone calcitonin. This hormone takes excess calcium in the bone and moves it into the blood. Answer: False Feedback: Calcitonin-salmon is the drug form of the hormone calcitonin; it takes excess calcium in the blood and deposits it in the bones. 44. Muscle relaxant drugs are useful in treating the pain and inflammation of osteoarthritis and other conditions of the bones and muscles, such as bursitis, tendonitis, and muscle sprains. Answer: False Feedback: Muscle relaxant drugs specifically relieve muscle spasm and stiffness, but cannot relieve pain or inflammation. 45. Some corticosteroid drugs can be injected directly into a joint affected by osteoarthritis to relieve inflammation. They can also be injected into the soft tissue near the joint to relieve bursitis and tendonitis. Answer: True Feedback: Some corticosteroid drugs (betamethasone, dexamethasone, methylprednisolone, triamcinolone) can also be injected directly into a joint affected by osteoarthritis (intra-articular administration) to relieve inflammation. They can also be injected into the soft tissue near the joint to relieve bursitis and tendinitis. 46. The topical drug capsaicin is a natural substance derived from chili pepper plants; it makes the skin and joint less sensitive to pain by diminishing sensory nerve signals. Answer: True Feedback: Capsaicin is a natural substance derived from chili pepper plants; it makes the skin and joint less sensitive to pain by diminishing sensory nerve signals. 47. The drug potassium citrate (Polycitra-K, Urocit-K) increases the pH of the urine to help prevent the formation of uric acid stones in the kidneys in patients who have osteoporosis. Answer: False Feedback: This drug increases the pH of the urine to help prevent the formation of uric acid stones in the kidneys in patients who have gout: potassium citrate (Polycitra-K, Urocit-K). Patients with osteoporosis do not form uric acid stones in the kidneys. 48. The hormone drug calcitonin-salmon (Miacalcin), which is used to treat fibromyalgia, is actually derived from salmon fish. Answer: False Feedback: Calcitonin-salmon is the drug form of the hormone calcitonin; it takes excess calcium in the blood and deposits it in the bones. It is used to treat osteoporosis. Calcitonin-salmon (Miacalcin) is actually derived from salmon fish. 49. The NSAID diclofenac (Voltaren) was the first prescription topical skin gel approved by the FDA for treating the pain of osteoarthritis. Answer: True Feedback: The NSAID diclofenac (Voltaren) is available as a topical gel to treat the pain of osteoarthritis. It was the first prescription topical skin gel approved by the FDA for treating the pain of osteoarthritis. 50. Leflunomide (Arava), which is used to treat rheumatoid arthritis, is not recommended for patients with decreased liver function because it has a very long half-life. Answer: True Feedback: Leflunomide (Arava) has a very long half-life. Traces of the drug can still be found in the body six months after the last dose. This drug is not recommended for patients who have decreased liver function and cannot metabolize the drug normally, as this prolongs the half-life even more and can result in toxic levels of the drug. 51. The muscle relaxant drug diazepam (Valium) is also used to treat anxiety and neurosis, to prevent epileptic seizures, and to treat patients who are undergoing alcohol detoxification. Answer: True Feedback: Diazepam (Valium) belongs to the benzodiazepine class of antianxiety drugs, a different class of drugs from the other muscle relaxant drugs. Diazepam is best known for its use in treating anxiety and neurosis. It is also used to prevent epileptic seizures and to treat agitation and tremor in patients who are undergoing detoxification from alcohol. 52. In both women and men, the hormones calcitonin, progesterone, and estradiol help prevent osteoporosis. Answer: False Feedback: A healthy balance between new bone deposition and bone resorption (breakdown) is maintained by parathyroid hormone from the parathyroid glands and calcitonin hormone from the thyroid gland, calcium (in the diet), vitamin D (in the diet and from exposure to the sun), exercise, and—in women—by the hormones progesterone and estradiol from the ovaries. 53. Indomethacin (Indocin), an older drug used to treat osteoarthritis, is also given intravenously to newborn infants to close a persistent patent ductus arteriosus heart defect, an abnormality in the fetal circulation. Answer: True Feedback: Besides its use in treating osteoporosis, indomethacin (Indocin) has an unusual use: It is given intravenously to newborn infants to close a persistent patent ductus arteriosus, a part of the fetal circulation that normally closes after birth. 54. The first bone resorption inhibitor drug approved for the treatment of osteoporosis and the one that has the outline of a bone on its tablet is the trade name drug Boniva. Answer: False Feedback: Alendronate (Fosamax) was the first bone resorption inhibitor drug approved for the treatment of osteoporosis. It is taken orally each week. It has a unique bone-shaped indentation on the tablet to remind patients that it is used to improve bone density. 55. A drug class used to treat osteoporosis is called SERM. The abbreviation SERM stands for __________ drugs. Answer: selective estrogen receptor modulator Feedback: Selective estrogen receptor modulator (SERM) drugs bind to estradiol receptors on cells and stimulate the receptors in the same way that estradiol does. These drugs are used to prevent and treat osteoporosis. 56. The antacid Tums, which uses calcium to neutralize stomach acid, has advertised that it has a secondary therapeutic effect of calcium supplementation in women. This implies that it would be helpful in preventing _______. Answer: osteoporosis Feedback: The antacid Tums, which uses calcium to neutralize stomach acid, has advertised that it has a secondary therapeutic effect of calcium supplementation for women, implying that it would be helpful in preventing osteoporosis. 57. Aspirin, or __________ acid (ASA), is the most well-known drug in the salicylate class. Answer: acetylsalicylic Feedback: Aspirin, or acetylsalicylic acid (ASA), is the most wellknown drug in the salicylate class. 58. The abbreviation NSAID stands for _______. Answer: nonsteroidal anti-inflammatory drug Feedback: Nonsteroidal anti-inflammatory drugs (NSAIDs) inhibit the production of prostaglandins to produce an analgesic effect and anti-inflammatory effect. 59. Acetaminophen is not used to treat rheumatoid arthritis because it is not effective against __________. Answer: inflammation Feedback: Acetaminophen is not used to treat rheumatoid arthritis because it is not effective against inflammation. 60. COX-2 inhibitor drugs selectively inhibit the COX-2 enzyme. This enzyme decreases the production of __________ that causes the pain and inflammation of osteoarthritis. Answer: prostaglandins Feedback: COX-2 inhibitor drugs, which also belong to the larger category of NSAIDs, selectively inhibit cyclooxygenase-2 (COX-2), an enzyme that decreases the production of prostaglandins that cause the pain and inflammation of osteoarthritis. 61. The category of _________ drugs used to treat osteoarthritis includes aspirin, one of the oldest drugs known to man. Answer: salicylate Feedback: Salicylate drugs used to treat osteoarthritis include aspirin, one of the oldest drugs known to man. 62. 1. allopurinol (Zyloprim) A. bone resorption inhibitor drug 2. aurothioglucose (Solganal) B. corticosteroid drug 3. celecoxib (Celebrex) C. COX-2 inhibitor drug 4. cyclobenzaprine (Flexeril) D. estrogen drug 5. dexamethasone (Decadron) E. gold compound drug 6. diflunisal (Dolobid) F. gout drug 7. estropipate (Ogen, Ortho-Est) G. muscle relaxant drug 8. ibandronate (Boniva) H. NSAID 9. ibuprofen (Advil, Motrin) I. salicylate drug 10. raloxifene (Evista) J. SERM drug Answer: F Answer: E Answer: C Answer: G Answer: B Answer: I Answer: D Answer: A Answer: H Answer: J Feedback: These drugs and their categories are found throughout the chapter. 63. Explain why osteoporosis is common in postmenopausal women. Answer: Osteoporosis is more common in women than men, and most common in postmenopausal women. In postmenopausal women, decreasing levels of progesterone no longer stimulate new bone formation, while decreasing levels of estradiol allow osteoclasts to increase the breakdown of bone. 64. Salicylate drugs, such as aspirin, are irritating to the stomach. Describe two precautions that some drug companies have taken to reduce this irritation. Answer: Because salicylate drugs, such as aspirin, are irritating to the stomach, and long-term therapy with these drugs has been shown to cause gastric ulcers, some drug companies take precautions to reduce this irritation. Ecotrin is manufactured as an enteric-coated tablet that does not dissolve in the stomach; it dissolves only when it comes in contact with the higher pH environment of the duodenum. Aspirin can also be combined with an antacid drug. 65. Explain how prostaglandins play a role in causing the pain and inflammation of osteoarthritis and rheumatoid arthritis. Answer: Prostaglandins play a role in causing the pain and inflammation of osteoarthritis and rheumatoid arthritis. When body tissue is damaged, cells are destroyed, and the cell contents spill into the interstitial fluid. There, the enzyme cyclooxygenase (COX-2) converts these contents into prostaglandins. The prostaglandins then stimulate the pain receptors in that area. The greater the amount of tissue damage, the more prostaglandins are produced and the greater the sensation of pain. The joints have a large number of pain receptors and damage to the joints can cause chronic, severe pain. Test Bank for Understanding Pharmacology for Health Professionals Susan M. Turley 9780135145708, 9780133911268
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