Osmosisia Pharmacy News

1. Which of the following statements about analgesic use among women and men is most accurate?
Men are more likely than women to use prescription and over-the-counter analgesics
Men are more likely than women to use prescription analgesics, but women use more over-the-counter analgesics
Women are more likely than men to use prescription analgesics, but men use more over-the-counter analgesics
Women are more likely than men to use prescription and over-the-counter analgesics
2. Which of the following statements about sex-based differences in response to analgesics is most accurate?
Men appear to have a better response to kappa opioids, such as nalbuphine
Increased binding to albumin reduces the free fraction of morphine during pregnancy
Women tend to recover faster from general anesthesia compared with men
Plasma levels of analgesics are an excellent surrogate for brain concentrations and analgesic efficacy
3. Which of the following statements about previous research into sex-based differences in the use of analgesics is most accurate?
Men were less likely to report pain to female vs male attendants in one study
Women clearly prefer to report pain to women vs men
In a study of patient-controlled analgesia, women used more morphine compared with men
Paramedics were more likely to treat women with an isolated extremity injury with opioids in one study
4. Which of the following statements about sex-based differences in adverse events of analgesics is most accurate?
Nausea and vomiting following opioid administration are more common among men
Respiratory depression following opioid administration is more common among men
Mouse models have suggested that women are at higher risk for liver damage after acetaminophen administration
Women may be more aware of adverse events related to analgesics compared with men

Answers:

Which of the following statements about analgesic use among women and men is most accurate?
Answer: Women are more likely than men to use prescription and over-the-counter analgesics
Previous research has found that women are more likely than men to use both prescription and over-the-counter analgesic medications.
Which of the following statements about sex-based differences in response to analgesics is most accurate?
Answer: Women tend to recover faster from general anesthesia compared with men
Kappa opioids appear to be more effective among women compared with men. During pregnancy, there is less binding of morphine to albumin, promoting higher free fractions of morphine. Plasma concentrations of analgesics are a poor surrogate for analgesic efficacy.
Which of the following statements about previous research into sex-based differences in the use of analgesics is most accurate?
Answer: Men were less likely to report pain to female vs male attendants in one study
A previous study demonstrated that men were more likely to report pain to a female vs male attendant, whereas the opposite was true for female subjects with pain. In another study, men were more likely than women to use patient-controlled analgesia with morphine, and other research has demonstrated that paramedics were more likely to administer opioids to men vs women.
Which of the following statements about sex-based differences Viagra in adverse events of analgesics is most accurate?
Answer: Women may be more aware of adverse events related to analgesics compared with men
Adverse events associated with the use of opioids, such as nausea/vomiting and respiratory depression, may be more common among women compared with men. Mouse models have suggested that men may be at higher risk for liver damage following administration of acetaminophen.

1. Which of the following agents is the most recent to receive approval from the US Food and Drug Administration (FDA) for treatment of adults with ADHD?
Lisdexamfetamine (LDX)
Atomoxetine
Osmotic-release oral methylphenidate (OROS-MPH)
Dexmethylphenidate
2. ABT-089 exerts its action by binding to and altering the action of which of the following receptors?
Dopaminic receptors
Nicotinic receptors
Noradrenergic receptors
Cholinergic receptors
3. A study that examined the effects of atomoxetine (ATX) on adults with ADHD and comorbid social anxiety disorder found which of the following?
Compared with subjects receiving placebo (PBO), both ADHD and social anxiety symptoms improved significantly more for subjects receiving ATX
Compared with subjects receiving PBO, social anxiety symptoms but not ADHD symptoms improved significantly more for subjects receiving ATX
Compared with subjects receiving PBO, ADHD symptoms but not social anxiety symptoms improved significantly more for subjects receiving ATX
Compared with subjects receiving PBO, neither improvements in ADHD symptoms nor social anxiety reached significance for subjects receiving ATX
4. A national random dialing telephone survey found a prevalence of 5.9% in 6000 adults in the United States. What percentage of these self-identified adults with ADHD were receiving treatment?
10%
15%
25%
40%
5. Longitudinal studies have found that ADHD has an effect that far outlasts the childhood years. All of the following are consequences of ADHD in adulthood except:
ADHD in adulthood makes for difficulties with social relationships
Hyperactivity in childhood does not impair social relationships in adulthood
Hyperactivity in adulthood makes for poor social relationships
ADHD in adulthood improves negotiation skills, regardless of difficulties with social relationships

Answers:

Which of the following agents is the most recent to receive approval from the US Food and Drug Administration (FDA) for treatment of adults with ADHD?
Answer: Osmotic-release oral methylphenidate (OROS-MPH)
OROS-MPH is the most recent agent approved for use in adults with ADHD, having received FDA approval in July 2008.
ABT-089 exerts its action by binding to and altering the action of which of the following receptors?
Answer: Nicotinic receptors
ABT-089 is an (alpha 4, beta 2) neuronal nicotinic receptor (NNR) partial agonist.
A study that examined the effects of atomoxetine (ATX) on adults with ADHD and comorbid social anxiety disorder found which of the following?
Answer: Compared with subjects receiving placebo (PBO), both ADHD and social anxiety symptoms improved significantly more for subjects receiving ATX
In a study reported by Durell and colleagues, the mean change from baseline on the Conners’ Adult ADHD Rating Scale (CAARS) was significantly greater in the ATX group (in regard to reduction in ADHD symptoms) than the mean change in the PBO group. In addition, subjects within the ATX group experienced statistically significant reductions social anxiety symptoms (as measured by the Liebowitz Social Anxiety Scale) when compared with subjects in the PBO group.
A national random dialing telephone survey found a prevalence of 5.9% in 6000 adults in the United States. What percentage of these self-identified adults with ADHD were receiving treatment?
Answer: 25%
In this national survey of 6000 adults over age 18, 5.9% of respondents reported being diagnosed with ADHD (with 66.1% being diagnosed during childhood), and of these, 25% currently were receiving pharmacologic treatment. Of the individuals screened who did not report a diagnosis of ADHD, 11.3% screened positive for ADHD by the ASRS-v1.1, and 2.8% to 6.9% screened positive using the Barkley screener (depending on the criteria used).
Longitudinal studies have found that ADHD has an effect that far outlasts the childhood years. All of the following are consequences of ADHD in adulthood except:
Answer: ADHD in adulthood improves negotiation skills, regardless of difficulties with social relationships
Results from a study by Moya and colleagues indicate that ADHD in adulthood was associated with difficulties in social relationships (particularly intimate partner relationships and negotiation skills). By contrast, adults who had been classified as hyperactive in childhood (but not having current difficulties with hyperactivity) appeared to have positive social relationships (eg, good negotiation skills and partner relationships) when compared with those who had never been hyperactive (the 2 were similar). But those who met criteria for a diagnostic level of hyperactive behavior (ADHD) at age 27 appeared to be at risk for relationship problems.

January 13, 2009 — The addition of the diet drug orlistat (Xenical, Roche Laboratories, Inc; alli, GlaxoSmithKline) to caloric restriction failed to enhance weight loss or improve hepatic outcomes over diet alone in patients with nonalcoholic steatohepatitis, according to the results of a study reported in the January issue of Hepatology. However, moderate weight loss was associated with improved hepatic outcomes.

Body weight loss of 5% or more during 9 months achieved improvements in insulin resistance and steatosis, and body weight loss of 9% or more during that period achieved improved hepatic histologic changes as well. In fact, the 40% of patients who completed the trial and achieved moderate weight loss irrespective of whether they were taking orlistat exhibited significant improvements in serum aminotransferase levels, insulin resistance, and specific adipocytokines, as well as hepatic steatosis, ballooning, lobular inflammation, and total nonalcoholic fatty liver disease activity score.

“Our study is the first to prospectively define the amount of weight loss necessary to show histopathologic improvement in the active features of steatohepatitis: steatosis, ballooning, and inflammation,” write Stephen A. Harrison, MD, from the Brooke Army Medical Center, Fort Sam Houston, Texas, and colleagues. The study authors note that improvement in hepatocellular ballooning is particularly important, because ballooning is a feature of cellular injury that is independently associated with progression of fibrosis.

The study enrolled 50 overweight patients (body mass index ≥ 27) with biopsy-proven nonalcoholic steatohepatitis. Participants were randomly assigned to a diet restricted to 1400 Kcal/day plus vitamin E, 800 U daily, with or without orlistat 120 mg three times a day, for 36 weeks. Liver biopsies were obtained as part of enrollment criteria and again at 36 weeks. Twenty-three patients in the orlistat group and 18 in the diet/vitamin E group completed the study.

After 9 months, no significant difference in weight loss was observed between the 2 groups: a mean of 8.3% body weight loss with orlistat compared with a mean of 6.0% in the diet/vitamin E group. Similar improvements were seen in both groups for serum aminotransferase levels, hepatic steatosis, inflammation, ballooning, and nonalcoholic fatty liver disease activity scores.

Study limitations include the absence of a placebo group, the participants may not have been fully blinded to their treatment because of gastrointestinal adverse effects of orlistat, and relatively small size of the study. In addition, the length of the study was too short to allow adequate evaluation of weight loss maintenance over time, and the short follow-up meant that potential long-term fibrosis response to the early weight loss could not be assessed.

“Although this preliminary study does not show a weight loss advantage with the use of orlistat, it does show that moderate weight loss, attainable by approximately 40% of the subjects who completed this trial, is associated with significant improvements in serum aminotransferases, insulin resistance, and specific adipocytokines as well as hepatic steatosis, ballooning, lobular inflammation, and the total NAS,” the authors conclude.

1. A patient complains of sensitivity of the posterior auditory canal during your ear examination. No other part of the canal is as sensitive. The next test to consider would be:
Imaging to rule out an acoustic neuroma
Politzer’s test
Audiology testing
Serology for herpes virus
2. Which of the following conditions is most likely to produce visible pulsations of the nasal arteries?
Frontal lobe meningioma
Hyperthyroidism
Thoracic aortic aneurysm
Tricuspid regurgitation
3. Breath that smells like fresh-baked bread suggests:
Yellow fever
Typhoid fever
Chloroform ingestion
Turpentine ingestion
4. Which of the following causes of gingivitis would be extremely unusual in an edentulous patient?
Acute monocytic leukemia
Phenytoin effect
Wegener’s granulomatosis
Vitamin C deficiency
5. Pale purple discoloration along the gum line near the teeth suggests:
Zinc poisoning
Copper poisoning
Pemphigus vulgaris
Lichen planus

Answers:

A patient complains of sensitivity of the posterior auditory canal during your ear examination. No other part of the canal is as sensitive. The next test to consider would be:
Answer: Imaging to rule out an acoustic neuroma
Increased sensitivity of the posterior auditory canal (Hitselberger’s sign) suggests an acoustic neuroma. Politzer’s test employs a tuning fork and is used to check the function of the eustachian tube if a patient has unilateral hearing loss. If the patient appears to have hearing loss, then the next step would be audiology testing, typically with a trained audiologist. A unilateral painful rash with vesicles on the lower ear suggests herpes zoster of the geniculate ganglion (Ramsay Hunt syndrome).
Which of the following conditions is most likely to produce visible pulsations of the nasal arteries?
Answer: Thoracic aortic aneurysm
Pulsation of the nasal arteries is increased in thoracic aortic aneurysm (Bozzolo’s sign). Fine tremor of the tongue suggests hyperthyroidism. Movement of the ear lobe coincident with the pulse suggests tricuspid insufficiency (Paul Dudley White’s winking ear lobe sign). Frontal lobe meningioma does not cause pulsation of the nasal arteries.
Breath that smells like fresh-baked bread suggests:
Answer: Typhoid fever
Breath that smells like fresh-baked bread suggests typhoid fever. Yellow fever is associated with breath that smells like fresh meat; chloroform ingestion with apples; and turpentine ingestion with violets.
Which of the following causes of gingivitis would be extremely unusual in an edentulous patient?
Answer: Vitamin C deficiency
Vitamin C deficiency is a cause of gingivitis but almost always only in people with teeth. Gingivitis can be associated with phenytoin, Wegener’s granulomatosis, or acute monocytic leukemia whether a person has teeth or not.
Pale purple discoloration along the gum line near the teeth suggests:
Answer: Copper poisoning
Pale purple discoloration along the gum line near the teeth suggests copper poisoning (Corrigan’s sign). Zinc poisoning does not. Lichen planus and pemphigus cause mucosal bulla around the mouth.