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1. A man, 66 years of age, with a history of knee osteoarthritis (OA) is experiencing increasing pain at rest and with physical activity. He also has a history of depression and coronary artery disease. He currently takes sertraline 100 mg po daily, aspirin 81 mg po daily, pravastatin 20 mg po daily, and lisinopril 10 mg po daily. His primary care provider is considering NSAID therapy. Which risk factors may predispose this patient to gastrointestinal (GI) complications from the addition of nonsteroidal anti-inflammatory drug (NSAID) therapy?

A. Age and gender B. Age, history of OA, and pravastatin use C. Age, use of sertraline, and use of low-dose aspirin D. Age and use of low-dose aspirin

2. Based on a meta-analysis of observational studies, which one of the following NSAIDs has been associated with a higher risk of upper GI complications in comparison with other NSAIDs:

A. Ketorolac B. Naproxen C. Ibuprofen D. Celecoxib

3. Which one of the following is considered to be an important contributing factor to the development of NSAID-associated GI damage:

A. Direct toxic effect to GI tract after oral ingestion B. Increased growth of Gram-positive bacteria C. Prostaglandin deficiency caused by COX inhibition D. Gastric hypomotility

4. Which one of the following medications has not been shown to be effective for the prevention of NSAID-associated mucosal injury and ulcer formation:

A. High-dose famotidine B. Misoprostol C. Pantoprazole D. Sucralfate

5. Which one of the following statements about the use of gastroprotective strategies for the prevention of NSAID-associated GI complications is FALSE:

A. Proton pump inhibitors (PPIs) have been shown to be more effective than histamine-2-receptor antagonists (H2RAs) for healing ulcers in patients who are continued on NSAIDs B. Standard-dose H2RAs have been shown to decrease ulcer formation by more than 40% C. The dose of misoprostol found to be effective in clinical trials may limit its use in practice because of poor tolerability D. When compared with diclofenac plus omeprazole, celecoxib use was associated with a lower incidence of GI toxicity in patients with OA and rheumatoid arthritis (RA)

6. A woman, 57 years of age, was recently diagnosed with RA. She has been initiated on a disease-modifying antirheumatic drug, but requires more immediate pain relief. Her rheumatologist is recommending that she begin NSAID therapy. She has no other medical conditions and takes only acetaminophen, as needed, for headaches and a daily multivitamin. She is considered to be at low risk for cardiovascular events. Based on the guidelines for the prevention of NSAID-related ulcer complications, which one of the following statements is TRUE:

A. She is considered to be at high risk for GI complications and should be started on celecoxib plus a gastroprotective agent B. She is considered to be at moderate risk for GI complications and should be started on a traditional NSAID plus a gastroprotective agent C. She is considered to be at low risk for GI complications and should be started on a traditional NSAID alone D. Risk cannot be determined from the information available

7. A man, 68 years of age, with hip OA is considered to be at very high risk for NSAID-associated GI complications, but at low risk for cardiovascular events. Which one of the following regimens is MOST appropriate if this patient is started on NSAID therapy:

A. Traditional NSAID plus standard dose H2RA B. Traditional NSAID plus PPI C. COX-2 inhibitor alone D. COX-2 inhibitor plus PPI

8. Which one of the following statements regarding adherence to gastroprotective agents in the setting of NSAID use is TRUE:

A. Rates of adherence have been found to vary based on the presence of risk factors B. There is a direct relationship between adherence and the risk for upper GI complications C. It has been shown that patient adherence to these medications increases within the first year of treatment D. Assessment of prescriber trends has revealed consistent renewal of therapy, even after 2 years of NSAID use

9. Which one of the following statements about fixed-dose combination therapies is FALSE:

A. When compared with ibuprofen 800 mg 3 times daily, ibuprofen/famotidine 800/26.6 mg 3 times daily was associated with a statistically significantly lower rate of endoscopic gastric ulcers and upper GI ulcers B. Naproxen-esomeprazole magnesium and celecoxib had comparable improvements in pain and function from baseline and similar tolerability when studied in patients with symptomatic knee OA C. When compared with enteric-coated naproxen alone, naproxen-esomeprazole magnesium use was associated with a statistically significantly lower incidence of endoscopic ulceration after 6 months D. The cost of these formulations is similar to the cost associated with the use of both drugs as separate formulations

10. Which one of the following novel approaches to NSAID therapy may provide enhanced drug absorption and a quicker onset of analgesia:

A. Submicron NSAIDs B. Nitric oxide-release NSAIDs C. Hydrogen sulfide-releasing NSAIDs D. Phosphatidylcholine-linked NSAIDs