The Mechanism Of Acetaminophen Discussion

The Mechanism Of Acetaminophen Discussion
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The Mechanism Of Acetaminophen Discussion
1. 11. Which of the following best describes the mechanism of acetaminophen?
A. Central inhibition of cyclooxygenase (COX) activation
B. Inhibition of lipoxygenase activation
C. Activation of lipoxygenase central a2 receptors
D. Activation of GABA receptors
2. You are consulted on a patient with a history of chronic back pain who is now
on the first postoperative day from a L4-L5 fusion surgery. He tells you that he
has a “high tolerance” to opioids and his pain is currently 8/10 when he moves,
so you decide to start him on a multimodal regimen for pain control. His medical
history is significant for chronic kidney disease and depression. He is currently
taking ciprofloxacin per his surgical team. Which of the following medications
should not be included as part of a multimodal regimen?
A. Ketamine
B. Hydromorphone
C. Tizanidine
D. Tylenol
3. Which of the following agents or drugs is most likely to have a similar
mechanism of action to ketamine?
A. Sevoflurane
B. Nitrous oxide
C. Midazolam
D. Clonidine
4. A 60-year-old man with bilateral radicular pain in his legs presents 4 weeks
after implantation of a spinal cord stimulator (SCS) with dual percutaneous
leads. He had reported greater than 50% pain relief with his SCS trial and also
reports feeling well after implantation of his SCS. He has therefore greatly
increased his daily activity. He now complains of paresthesias in his lower
abdominal region and worsening pain in his legs. His neurologic exam is
unremarkable. There is no pain on palpation of his lower back. His incision site
is clean, dry, and intact and he is afebrile. Which of the following most likely
explains this presentation?
A. Epidural abscess
B. Migration of leads
C. Disc herniation
D. Infection of the SCS leads
5. Which of the following areas is targeted by SCSs?
A. Dorsal columns
B. Lateral corticospinal tract
C. Botzinger complex
D. Peripheral nerves
The Mechanism Of Acetaminophen Discussion
6. A patient with a history of unresectable pancreatic cancer presents to your
office because his current pain control regimen, Tylenol and hydromorphone (2-
4 mg every 4 h as needed), is no longer sufficient. He reports that when he
began this regimen 6 months ago, his pain was under good control and he could
remain active. However, now he reports worsening back pain that limits his
ability to walk. He asks whether it would be reasonable to increase his dose of
hydromorphone at this time. Which of the following phenomena best describes
this situation?
A. Opioid-induced hyperalgesia (OIH)
B. Pseudotolerance
C. Drug-seeking behavior
D. Addiction
7. 17. A patient with a history of prostate cancer with metastases to his spine
causing back pain presents to your office. You have been managing his opioid
prescriptions for over a year, and during that time he has required increasing
doses of hydromorphone to treat his back pain. He currently takes 8-10 mg of
dilaudid every 3 hours. When questioned about his pain, he describes a diffuse
pain that affects his arms and legs. His back pain is also present. Which of the
following receptors or family of receptors is thought to be involved in this
phenomenon?
A. GABA-A
B. NMDA
C. GABA-B
D. Dopamine-2
8. In the perioperative period, patients maintained on Suboxone will most likely
experience which of the following?
A. Increased postoperative opioid requirements
B. Increased sensitivity to opioids
C. Withdrawal symptoms within 24 hours of discontinuing Suboxone
D. Increased risk of postoperative delirium
9. Which of the following effects would be likely to occur after parenteral
injection of Suboxone in a patient actively taking heroin?
A. Respiratory depression
B. Withdrawal
C. Euphoria
D. Miosis
10. A 76-year-old man with pancreatic cancer and chronic abdominal pain admits to
his pain specialist that he has been giving his son, who has chronic back pain,
some of his oxycodone pills. Which of the following terms best characterizes
this situation?
A. Abuse
B. Misuse
C. Pseudoaddiction
D. Addiction
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