Answer Key for PHAR 408 Exam I

Matching:

1:  H;          2:  B, J, K;      3:  E;      4:  A;   
5:  G, I;       6:  C;            7:  D;      8:  F; 

True or False:

9:  F;          10:  F; 

Multiple Choice:

11:  b or e;    12:  b;           13:  c;      14:  a;      
15:  b;         16:  c;           17:  b;      18:  a; 
19:  c;         20:  c;           21:  b;      22:  c; 
23:  a;         24:  d;           25:  b;      26:  c; 
27:  c;         28:  c; 

Short Answer:

29:  Hydroxyurea
30:  Induction of fetal hemoglobin, and corresponding reduction in sickle hemoglobin 
     ( can get into a more complex discussion of how it induces HbF, but that is not 
     required).
31:  (1). Doesn't work for all individuals; 
     (2). Potential long-term toxicity; 
     (3). Induction of HbF is limited to a relatively small percentage of total Hb; 
     (4). A variety of side effects; 
     (5). Very high doses may be required for some individuals 
          ( corelated with (2), (3), (4) ).

Explanation:

(1).  For question 13, the question asks about treatment of the patient's acute 
          gout attack ( not about preventive therapy). Indomethacin is very effective 
          for the treatment of acute gout due to its antiinflammatory effect. Although 
          colchicine is used for acute therapy, the onset of the attack was more than 
          24 hours ago and colchicine loses efficacy as time since onset increases. 
          Allopurinol and probenecid are used to prevent acute attacks but are ineffective 
          in treating the attack once it begins. 
          ( This is clearly outlined in the treatment algorithm and it was discussed in 
          class and the recitation.)
(2).  For question 16, the patient clearly needs a NSAID, however, she has a history 
          of peptic ulcer disease. To minimize the risk of recurrence of ulcer disease, 
          a COX-2 selective ( or COX-1 sparing ) agent should be selected. Refocoxib is 
          the only agent that fits that criterion. Neither naproxen nor ibuprofen spare 
          COX-1. Steroids are generally reserved for patients who fail an adequate trial 
          of NSAIDs.