NSG 533 (NSG533) Advanced
Pharmacology Exam 2 | Questions
and Answers Graded A+ | Latest
2024
When are NSAIDs indicated and is one NSAID better / safer than another in a given patient?
Useful for mild to moderate pain that are mediated by prostaglandins (RA, menstrual cramps, and postsurgical pain). Works well for pain associated with bone metastasis. Will dose escalation provide greater benefits (i.e. Is there a ceiling effect)? Higher doses produce no greater efficacy than moderate doses.
What is the mechanism of acetaminophen?
Blocks prostaglandin synthesis in the CNS and block pain impulses in the periphery. 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)?
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.
What would you be concerned with regarding the first patient's use of Vicodin in terms of the dose Acetaminophen?
In elderly patients, it is recommended not to exceed 3,000mg per day of Acetaminophen.
How does spectrum of use differ from NSAIDS? 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
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
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?
Snris; either Duloxetine or venlafaxine have been successfully used in diabetic peripheral neuropathy.* Postherpetic Neuralgia (PHN)
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
Gabapentin, pregabalin, transdermal lidocaine, or tcas. (pg 580).
Fibromyalgia treatment
Duloxetine 30mg daily up to 60mg. Pregabalin 75mg TID up to 300mg-450mg
What is the mechanism of opioids and common adverse effects?
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
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