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Chapter 36: NSAIDs, Acetaminophen, & Drugs Used in Rheumatoid Arthritis & Gout

In individuals who need antiplatelet therapy after percutaneous coronary intervention (PCI, stenting), aspirin is the NSAID of choice. Among NSAIDs, aspirin is unique because it

(A) Irreversibly inhibits its target enzyme

(B) Prevents episodes of gouty arthritis with long-term use

(C) Reduces fever

(D) Increases the risk of colon cancer

(E) Selectively inhibits the COX-2 enzyme

Aspirin differs from other NSAIDs by irreversibly inhibiting cyclooxygenase. Other NSAIDs also reduce fever. The answer is A.

A mother comes in very worried with her 2-year-old daughter who has had a cough and fever for the last three days. You order labs and can rule out serious infection. You decide to treat the fever. Which of the following is an analgesic and antipyretic drug that lacks an anti-inflammatory action?

(A) Acetaminophen

(B) Celecoxib

(C) Colchicine

(D) Indomethacin

(E) Probenecid

Acetaminophen is the only drug that fits this description. Indomethacin is a nonselective COX inhibitor and celecoxib is a COX-2 inhibitor; both have analgesic, antipyretic, and anti-inflammatory effects. Colchicine is a drug used for gout that also has an anti-inflammatory action. Probenecid is a uricosuric drug that promotes the excretion of uric acid. The answer is A.

A 16-year-old girl was brought to the emergency department by her parents who found her with an empty pill bottle. She was confused and reported hearing ringing in her ears; her respiratory rate was 28 breaths per minute. You order labs and her arterial blood reveals a pH of 7.2 (normal 7.4). Which of the following drugs did she most likely take?

(A) Acetaminophen

(B) Allopurinol

(C) Aspirin

(D) Colchicine

(E) Probenecid

Salicylate intoxication is associated with metabolic acidosis, dehydration, and hyperthermia. If these problems are not corrected, coma and death ensue. The answer is C.

Which of the following drugs is most likely to increase the risk of toxicity of methotrexate, a weak acid that is primarily cleared in the urine?

(A) Acetaminophen

(B) Allopurinol

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