AUTACOIDS AND RELATED DRUGS

1. Long action analgesic and anti-inflammatory drug? NSAID has

more enterogenic effect? ( Piroxicam )

2. MOA of anti-inflammatory ? ( Decrease prostaglandin )

3. Most likely drug causes Peptic ulcer? Piroxicam Or Ketorolac Or

Indomethacin

4. Bioavailability of Diclofenac injection in muscle ----- 100%

5. Antidote of Paracetamol? N-Acetyl Cysteine

6. Dr prescribes Chlorpheniramine for driver but the pharmacist discover problem?

the error occur and drug won't reach Pt

7.In pediatric analgesic for tooth growth pain, what is contra-indicated and affect
on the brain? Aspirin
8. Pregnant woman take Naproxen "NSAID", what harm could to baby?
Uncontrolled bleeding

9.What is the last choice for pregnant with osteoarthritis? What cause congenital
problems last 3 months? Aspirin

10.Disease causes damage to brain and liver when children use aspirin?
Reye’s disease

11. Aspirin dose with Ticagrelor ?

initial loading dose 325 mg , then maintain dose 75 – 100 mg/day

12. Early symptoms of aspirin poisoning are? ringing in the ear &
blurred vision

13. OTC for child with fever? Paracetamol + ibuprofen

14.anti-inflammatory and analgesic ? ibuprofen

15. Maximum daily dose of ibuprofen OTC ? 1200 mg/day ,

Maximum dose : 3200

16. Pt suffered from acute migraine attack combined with aura. Now suffers from
migraine should take? Ibuprofen 400 four times daily

17.Pt suffered before from migraine attack with aura, he needs drug as
prophylaxis?

Topiramate 25 mg twice

18. How to take ibuprofen? What is the best counselling for ibuprofen ?

Take it with food and milk

19. Which analgesic should be used by injection for patient suffer from pain in his
leg after football? Diclofenac1(), Ketorolac (2)
20. Analgesic is considered as narcotic but is dispensed normally?
Ketorolac

21. Best analgesic for geriatric with back pain , high LDL , diabetes?
Paracetamol

22.Prophylaxis and prevention of Migraine ? propranolol , timolol ,

Topiramate , valporic acid , amitriptyline

23. Levocetrizine can be used after? Over 6 months

24. MOA of Cetirizine ? H1 blocker

25. Phenothiazine drug has anti-histamine effect? Promethazine ( used in ttt of

nausea and vomiting)

26. Dose of allopurinol ? 100:200 mg/day

( CrCl 10-20 ; 200mg/day ) , ( CrCl 3-10 or less than 3 ; 100 mg/day )

Maximum dose; 800 mg/day , allopurinol is anti-gout & anti-
inflammatory & xanthine oxidase inhibitor & decrease uric acid synthesis

27.. Probenecid ? is Uricosuric that increase excretion of uric acid in urine,

reduce concentration of uric acid in blood
28. Probenecid alters …… to prevent penicillin excretion? renal tubular
secretion

29. Paracetamol in pregnancy? Oral & rectal is category B - IV

is category C

30. Pt with diabetes and HTN and heart disease, take insulin and lisinopril and
celecoxib >> started taking diphenhydramine "anti-histamine" since two weeks,
what is your intervention? stop celecoxib

31. Celecoxib causes ? Cardio-toxicity

32. Side effects of Diphenhydramine ? Drowsiness

33. Drug is contra-indicated with ischemic heart disease with Dyslipidemia ?

celecoxib

34. Most common used in the selective COX-2 inhibitors ? Celecoxib

35. Neonate with ductus arteriosis Dr want to avoid surgery, what medication?
NSAID given for ductus arteriosus ? Which NSAID that works well in RA but it
causes GIT disturbance and is the one used in the closure of Patent Ductus
Arteriosus (PDA)? indomethacin

Note:Intravenous (IV) indomethacin or IV ibuprofen is used to treat patent

ductus arteriosus (PDA) in the neonate and in premature infants

36. Drug is not allowed in kidney failure? For acute gout attack? TTT of
gout attack in 24 hours? indomethacin

Note: The best NSAIDs to use with gout are: ibuprofen 800 mg TID and
Indomethacin 25 to 50 mg QID

37. Indomethacin causes? Diarrhea

38. Drug causes sodium and water retention ? Indomethacin(2) &

Minoxidil (1)

39. Risk of NSAID ? renal dysfunction

40. Best way to use NSAIDs? after meals

41. Proton pump inhibitor as Omeprazole can be used as single drug in? gastritis
as side effect of NSAID

42. other drugs can be used in TTT of NSAID gastritis or NSAID inducer ulcer?

H2 blocker - Sucralfate - ("PPI(1) is most effective" )

Prostaglandin analogue( misoprotol), gastric mucous barrier is prophylaxis, can’t

treat the ulcer

43. Side effects of NSAIDs in 3 trimesters in fetus? increase the risk of

premature ductal closure

44. NSAID permanently inhibits thromboxane A2? decrease

prostaglandins ? Aspirin

45. Rofecoxib is ? COX-2 selective non-steroidal anti-inflammatory drug

(NSAID)

46. Interleukin 1 inhibitor ? Anakinra ( TTT of rheumatoid arthritis)

47. Which metal is used in ttt of rheumatoid arthritis ? Gold

48. Pt with Rheumatoid arthritis takes methotrexate & ibuprofen & losec, but no
effect so next step use…? Leflunomide

49. Drug and Dose for infant with mild fever? Paracetamol 1 g / day

(NB: Maximum daily dose for children 1 g …. Maximum daily dose

for adult is 4 g)

50. TTT for baby 1 month suffers from mild fever? Paracetamol nasal metered
dose 15 mg / kg

51. Car driver wants anti-histamine? Desloratadine

52. Paracetamol is hepatotoxic due to its action on? Glutathione

53. Drug increases Paracetamol toxicity? Which of the following if used for long
term can increase acetaminophen toxicity? Drug worsen case of paracetamol
overdose?
ethanol (alcohol )

54. Which is indicator for a toxicity of a drug? Necrosis of liver by Paracetamol

55. Cyproheptadine ? ( anti-histamine ) ( 5-HT antagonist & H1

anti-histamine )

56. Cetirizine "zyrtec" ? H1 blocker

57. Rofecoxib is ? COX-2 selective non-steroidal anti-inflammatory drug

(NSAID)

58. Mizolastine ? Non-sedating antihistamine

59. FA is a 55 year old women with rheumatoid arthritis. On diagnosis 1 year ago
FA had an titer of 1:64 signs and symptoms of inflammation in the joints of both
hands, and about 45 minutes of morning stiffness. She began therapy with
methotrexate, and she is presently receiving 15 mg every week, folic acid 2mg/day,
ibuprofen 800 mg 3 times /day, and omeprazole 20 mg/day. At today’s clinic visit,
FA reports a recurrence of her symptoms. Radiographic evaluation of her hand
joints shows progression of joint space narrowing and bone erosion. Which one of
the following is the best next step in therapy for FA?

a.administer etanercept(Enbrel)

b. switch to hydroxychloroquine

c. add prednisone bridge therapy

d. change to leflunomide

NB:

Osteoporosis……Alendronate Na

Osteoporosis+ Methotrexate……..Leflunomide
Osteoarthritis……..Etanercept

Osteoarthritis+ Methotrexate……..Etanercept is the first choice, if not exist choose

Leflunomide

60. A pregnant women in 35 weeks and before 7 days from labor she suffers from
severe headache …what is the DOC for her? Acetaminophen

61. WF is an 85 year old man who presents to his physician with pain from hip
OA. He also has hypertension, CAD and BPH. For his OA, WF has been taking
acetaminophen 650mg 3 times/day. WF reports that acetaminophen helps, but he
still experiences pain that limits his ability to walk. Which one of the following is
the best next step in analgesic therapy for WF?

a.change the analgesic to celecoxib

b.add hydrocodone

c.change the analgesic to ibuprofen

d.add glucosamine

62. Side effect of NSAID in 3rd trimester on fetus?

Increase the risk of premature ductal closure

63. if driver has fever and take another road to the city is due to? Dipheniramine

64. exposure to NSAIDs after 30 weeks gestation is associated with an increased

risk of premature closure of the fetal ductus arteriosus

65. Pt with epigastric pain worsens during and after food . he had peptic ulcer
disease before 3 years and he smokes 50 cigarette per day and drinks coffee.
Recently, he took NSAID. He is married to 2 wives. What is his diagnosis?
NSAIDs induced ulcer
66. rheumatoid arthritis patient is on methotrexate, was initially diagnosed with
low risk of deterioration, then he developed deterioration and become moderate,
what should you do?

a.stay on methotrexate b.add hydroxychloroquine

c.change to abatacept d.add abatacept and adalimumab

67. concerning COX-2 inhibitor , which is not true?

a. they have lower risk gastric adverse reaction than non-selective agents

b. good evidence about their effectiveness in OA

c. cardiac toxicity is a recent concern of this class of drugs

d. usually administered once or twice daily

e. combination with non.-selective agents provide additional benefit

68. maintaining crohns :-

a-etanarcept
b-inflixmab
c-ustekinumab

67. case scenario about female patient have GOUT was weak & dizzy & fatigue
and another problems like she can’t raise her hand and having some blood
disorders like agrnaulocytosis and leucopenia and type of anemia which anti gout
are probably to cause this Side effects :
a- allopurinol
b- colchicine
c- probencid

68. Histamine autorecepteor: H3

69. Pt had renal transplant and has chronic gout best treatment is?
allopurinol

Note:
1- Allopurinol+ Febuxostat chronic gout
2-NSAID (Indomethacin and Ibuprofen) 1st choice for Acute gout(CI: Renal-
Hepatic-Cardiac problems)
3-Colchicine 2nd choice acute gout (CI: hepatic and renal failure)
4-Intra-articular Corticosteroid for acute gout with CI NSAID or Colchicine

70. A drug that has high risk for thrombosis and MI? celecoxib (others option
was also nsaid)

71. histamine not secreted from? adipose tissue

72. drug used in IBD(Inflammatory bowel disease) remission:-infliximab

73. case about person who will visit a friend who has a dog and the patient has
allergy from dogs and ask about otc drug for this?
Cetirizine 10 mg from the first day of visit

74. which elevates first at acetaminophen over dose?

a-ALT b-AST
Note: Acetaminophen metabolite (NAPQI responsible for depleting the Glutathione
precursor of the liverToxicity

75. which of the following can affect driving motorcycle? diphenhydramine

76. Pt with HTN and hypothyroidism has allergic rhinitis advise him with:
a. pseudoephedrine b. Decongestant c. cetirizine

77. All irreversible except:

A. Malathion B. Echothiophate C. parathion D. piperzidine

78. antiphlogistic: Act by cooling by evaporation

79. Monoclonal Antibodies used in rheumatoid arthritis?

a. omalizumab b. adalimumab(1st ) c. Basiliximab
d. rituximab(2nd)
(both b and d are true but if one answer so b )
80. For acute gout attack which NSAID is CI?
a. Indomethacin b. Colchicine
c. Allopurinol d. Aspirin decrease uric acid excretion
Note: The best NSAIDs to use with gout are: ibuprofen 800 mg TID and
Indomethacin 25 to 50 mg QID

81. which is contraindicated in liver impairment?

a. leflunomide b. vinblastine c. atomoxetine

82. Patient with gout history present to ER with gouty attack, which NSAID is
contraindicated?
a. Acetylsalicylic acid b. Sulindac c. Ibuprofen

83. When patient take prophylaxis therapy for gout:

a. more than One attack per year b. Association with Kidney stones
c. Urate excretion 500 mg d. Blood urea > level 10mg/dl

Note: consider for Prophylaxis if:

1.blood urea>10mg/dl(normal<6mg/dl)
2. Urate excretion>1000mg/24hrs
3.more than two attacks/year
4. Associated with Kidney stones

84. Aspirin differ from other NSAIDS?

a. has cardio beneficial effect b. irreversible COX inhibitor Non-Selective
c. can't stop arthritis progression d. Used in Kawasaki disease
Kawasaki: is an inflammatory disease affecting the blood vessels for kids<5yrs
usually, treated with gamma globulin +Aspirin (from the rare cases to use aspirin
in children as its associated with Reye’s syndrome)

85. Aspirin overdose symptoms are all of the following except?

a. Hypothermia (actually aspirin cause fever)
b. Metabolic acidosis
c. Respiratory depression
d. convulsions
Aspirin Poisoning signs are:
* Common
- ringing in the ears
- tachypnea , that causes respiratory alkalosis
- Nausea, vomiting
- Metabolic acidosis (because of the tachypnea)
*Severe
- Pulmonary Edema
- Hyperthermia
- Neurological effects: come, seizures, cerebral edema
- Renal failure

86. NSAIDS contraindicated with sulfa sensitivity? Selective COX 2 inhibitor?

a. Celecoxib b. Ibuprofen c. naproxen d. indomethacin

87. Paracetamol:
a) small risk of Reyes syndrome b) great anti-inflammatory
c) inhibit PG in CNS d) no platelet action
e) selective COX-3 inhibitor

88. Azathioprine SE not dose related?

a. bone marrow depression b. hepatotoxicity2nd
c. Infection 1st c. Pancreatitis

89. All are DMARDs except:

a. prednisolone b. methotrexate c. hydroxychloroquine d. Leflunomide

90. Patient take DMARDs and after 2 weeks have eye problem which drug
cause that?
a. Sulfasalazine b. hydroxyquine c. Chloroquine

91. A child took peanut butter and he’s allergic to peanut; he developed
rashes and urticarial. What type of allergic reaction is this?
a. Type 1 b. Type 2 c. Type 3 d. Type 4

Allergy Involved Mechanism Example

Type immunity type
Type 1 IgE quick inflammatory response Allergies -hay
upon subsequent exposure fever
Type 2 IgG - IgM binding of IgG and IgM Hemolytic
antibodies to antigens on cell transfusion
surfaces. This induces events reactions.
that leads to cell death. hemolytic
disease of
newborns
Type 3 Antigen- formation of antigen-antibody Serum sickness
Antibody complexes that settle on tissues rheumatoid
complexes and organs. In an attempt to arthritis
remove these complexes,
underlying tissue is also
damaged.
Type 4 T-Cells delayed reactions to antigens Tuberculin
associated with cells. reactions,
chronic asthma,
and contact
dermatitis

92. Acetaminophen (paracetamol) which is true you can choose more than one
true statement.
a. Acetaminophen has a great anti-inflammatory
b. inhibit PG in CNS
c. It has no risk in Reyes disease for kids with viral fever
d. irreversible cox3 inhibitor
e. No platelet action

93. Not a monoclonal antibody?

a. infliximab b. etanercept c. adalimumab d. certolizumab

94. NSAIDs is contraindicated with?

a. ACEI b. B-blockers c. Diuretics d. all

NOTE: NSAID not CI with B2 agonist

NSAID CI with: ACEI B-blocker Ca blocker Diuretics Digoxin Li

methotrexate Warfarin SSRI
NSAIDS are CI in Hypertension due to effect on Renal system (Na +water
retention) (ACEI-Diuretics-Bb)
In Asthma they produce Bronchoconstriction so take Montelukast 2 hours before
the needed NSAID

95. H1-antagonist: Fexofenadine, Cetirizine, Desloratadine,etc

96. second generation antihistamines?
fexofenadine, desloratadine, loratadine, levocetirizine, cetirizine

97. osteoarthritis therapy?

cold packs, hot packs, isometric exercises

98. Evista is also called?

a. alendronate b. etidronate c. ibandronate d. raloxifene

99. The anti-inflammatory effect of NSAIDs is due to their ability to

a. inhibit prostaglandin synthesis
b. inhibit the stimulation of the chemoreceptor trigger zone
c. reset the hypothalamic "set point"

100. Meclizine dose for motion sickness lasts for: 12-24hrs

Note: 12.5-50mg 1 hour before travel and then every 24-Hour PRN

101. All are risk factors for osteoporosis except:

a- cigarette smoking b. high body mass
c. glucosteroid treatment d. late menopause

102. Patient with renal insufficiency has gout at joints of one toe. Primary
treatment would include:
a. colchicine b. NSAIDs c. cortisone injection at the joint of the toe

103. some drugs have active enantiomers, which the following doesn’t have?
a. Enalapril b. Desloratadine c. fexofenadine

104. Which one has more sedative effects: DiphenhydramineorChlorpheniramine

105. NSAID has CNS side effects:
a. celecoxib
b. sulindac
c. nabumetone
d. mefenamic acid

106. what is the physiological antagonist of histamine

a) Cromolyn sodium.
b) Epinephrine
c) Cinnarizine
d) Nedocromil

107. Which of the following is true?

A. Aspirin used as anti inflammatory, antipyretic, and as a prophylaxis for
secondary MI
B-paracetamol is used as an analgesic, antipyretic, and as an antiplatelet in small
concentrations
C-diclofenac is used as analgesic,antipyretic, used as antiplatelet in small
concentrations

108. question about a traveler who has allergy and Hyperthyrodism,what otc
medicine he can take?

Cetrizine at the same day

109. which of the following can affect disturbed coordination and dizziness :
diphenhydramine

110. diphenhydramine belongs to which group :

Antihistamine

111. Infliximab used in rheumatoid arthritis with:

a- methotrexate
b- aspirin
112.Which of the following NSAIDs may decrease the rate of excretion of lithium?
Ibuprofen

113. Which NSAID is more selective to cox-2 more than cox-1:

Celecoxib

114. Study acetyl salicylic acid(aspirin) full mechanism of action as an

analgesic-irreversible cox inhibitor and cardio protective “cox2”. how?
Acetyl salicylic acid (aspirin)characterized by :
1) cardio protective action
2) Prophylaxis in MI
3) Cause Reyes Disease in kids
4) antiplatelet action
5) Analgesic
6) antipyretic
7) anti-inflammatory action
8) Irreversible Cox inhibitor

All of the above.

115. ahmad is allergic to dogs and cats,he will travel to his friend who has a
dog ,he csme to the pharmacy and talled u that he is also hyperthyrodism. What
OTC can he take:
a. Psuedoephidrine
b. clarinase (loratidine &pseudoephidrine)
c.cetirizine before the visit

116. Acetaminophen is converted to its metabolite by which reaction ?

a. Glutathione conjugation
b. Glucuronidation
c. Carboxylation
d. phosphorylation
NOTE:** glutathione detoxifies the toxic metabolite of paracetamol
**paracetamol metabolism by GLUCURONIDATION (main),sulfonation,
oxidation

117. Ibuprofen increases bleeding effect of aspirin by?

COX 1 inhibitor

118. Paracetamol dose in emergency department where can you find it?
ER dose 650mg

119. Hepatotoxicity of paracetamol due to ? Glutathione depletion

120. Skeletal muscle relaxant? Baclofen

121. Example of pathological toxicity ? Hepatic necrosis from acetaminophine

122. Patient take adlimumab for rheumatoids and he knew it may cause
malignancy what to
do?
tell him about benefits of drug versus risks

123. chemical composition of acetaminophen the

C8H9NO2

124. Peanut immediate allergic reaction?

IgE

125. NSAIDs cause

peptic ulcer

126. ibuprofen with paracetamol

bleeding

127. Which of the following contraindicated with Celebrex ?

NASID

128. Prefer for CV patient ?

Naproxen

129.