NSG 533 ADVANCED PHARMACOLOGY EXAM 2 /NSG 533
Advanced Pharmacology Exam 2(Module 5 PAIN and
Headaches) ACTUAL EXAM 100 QUESTION AND CORRECT
DETAILED ANSWERS WITH RATIONALES RATED AGRADE.
When is APAP indicated and are there precautions / restrictions /
limitations to use or in dosing (you MUST know maximum daily doses in
general population and older adults)? - ANSWER-Apap does NOT have
anti-inflammatory properties. It is used for mild to moderate pain and
as an antipyretic. - Considered first line for low back pain and
osteoarthritis. Causes a hypoprothrombinemic response to warfarin in
patients receiving 2000 mg/day. Hepatotoxicity has been reported with
excessive use especially in patients with hepatitis or chronic alcohol use.
- All providers and patients should be aware of the maximum daily
doses of APAP and be conscious of the fact APAP can be found in many
products in combination with other medications.... -Max dose for
patients with normal renal + hepatic function if 4000mg/day -Max dose
for elderly is 3000mg/ day. Reduce dose 50% to 75% in patients with
renal or hepatic dysfunction.
*Practice question: What would you be concerned with regarding the
first patient's use of Vicodin in terms of the dose Acetaminophen? -
ANSWER-In elderly patients, it is recommended not to exceed 3,000mg
per day of Acetaminophen.
How does spectrum of use differ from NSAIDs? - ANSWER-Also used as
an antipyretic
,What is meant by an adjuvant analgesic and when would they be
appropriate? Provide examples of medications in this class - ANSWER-
Adjuvant analgesics are drugs that have indications other pain but are
useful as monotherapy or in combination with other drugs. Examples:
diabetic neuropathy, post hepatic neuralgia, fibromyalgia.... Common
adjuvants are antiepileptic drugs, antidepressants, antiarrhythmic
drugs, local anesthetics, capsaicin, NMDA antagonists, clonidine, and
muscle relaxants.
Diabetic peripheral neuropathy treatment - ANSWER-Duloxetine
(Cymbalta) 60mg daily; Pregabalin (Lyrica) 50mg TID or 100mg TID.
Practice question: What medication could you recommend for a
diabetic patient in pain that could also be used to help treat
depression? - ANSWER-SNRIs; either Duloxetine or venlafaxine have
been successfully used in diabetic peripheral neuropathy.*
Postherpetic Neuralgia (PHN) - ANSWER-Gabapentin (Neurotonin)
300mg TID up to 3600mg; Pregabalin 75mg BID or 50mg TID. May be
increased to 100mg TID; Lidocaine (Lidoderm Patch) up to 3 patiches
over site. 12 hours on, 12 hours off.
Practice question: In addition, be sure to understand which non-opioid
medications you would use for a patient with neuropathic pain -
ANSWER-Gabapentin, pregabalin, transdermal lidocaine, or TCAs. (pg
580).
, Fibromyalgia treatment - ANSWER-Duloxetine 30mg daily up to 60mg.
Pregabalin 75mg TID up to 300mg-450mg
What is the mechanism of opioids and common adverse effects? -
ANSWER-Stimulate opioid receptors in the CNS. Pure agonists like
Morphine bind to receptors to produce analgesia that increase with
dose without ceiling effect. They *block* pain, not treat the cause of
pain. The opioids exert their analgesic efficacy by stimulating opioid
receptors Mu (μ), kappa (κ), and delta (δ)
u receptor - ANSWER-(Mu (μ) produces the effects of analgesia. - The
μ2-receptor is also associated with other effects such as "sedation,
reduced blood pressure, itching, nausea, euphoria, decreased
respiration, miosis (constricted pupils) and decreased bowel motility
often leading to constipation"
Opioid side effects and management - ANSWER-Common adverse
effects include sedation, nausea, and constipation. Sedation and nausea
are common when starting therapy and increasing doses. Constipation
is managed by stimulant laxatives like senna or bisacodyl and stool
softeners like docusate sodium. Tolerance to respiratory depression
develops rapidly with repeated doses. If serious, give Naloxone. Opioids
can be rotated to achieve a better balance of analgesia and treatment-
limiting adverse effects
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