NSG 533: Advanced Pharmacology Exam 2
Review / NSG 533 (NSG533) Advanced
Pharmacology Exam 2 | Questions and
Answers Graded A+ | Wilkes
1. When are NSAIDs indicated? Do higher doses provide greater benefits (is
there a ceiling effect)?
• ---Answer---: NSAIDs are indicated for mild to moderate pain,
particularly pain mediated by prostaglandins. This includes conditions like
rheumatoid arthritis (RA), menstrual cramps, and postsurgical pain. They
also work well for pain associated with bone metastasis. Yes, there is a
ceiling effect.
• ------Rationale------: NSAIDs work by inhibiting COX enzymes, which
reduces prostaglandin synthesis. Prostaglandins are key mediators of
inflammation and pain. Once the COX enzymes are fully inhibited by a
moderate dose, higher doses do not provide greater analgesic efficacy but
significantly increase the risk of adverse effects (GI, renal, cardiovascular).
2. What is the mechanism of action of acetaminophen (Tylenol)?
• ---Answer---: Acetaminophen is believed to work by blocking
prostaglandin synthesis primarily in the central nervous system (CNS) and
may also block pain impulses in the periphery.
• ------Rationale------: Unlike NSAIDs, acetaminophen has very weak
effects on COX enzymes in the periphery, which is why it lacks significant
, anti-inflammatory properties. Its primary analgesic and antipyretic effects
are considered central.
3. When is acetaminophen (APAP) indicated, and what are the major
precautions, including maximum daily doses?
• ---Answer---: APAP is used for mild to moderate pain (first-line for
osteoarthritis and low back pain) and as an antipyretic (fever reducer). Key
precautions are hepatotoxicity and interactions with warfarin.
• ------Rationale------:
• Dosing: Maximum dose for the general population is 4,000 mg/day.
The maximum dose for the elderly is recommended at 3,000 mg/day.
Doses must be reduced by 50-75% in patients with renal or hepatic
dysfunction.
• Hepatotoxicity: Risk is high with excessive use, especially in patients
with chronic alcohol use or pre-existing liver disease. It's crucial to
account for APAP from all sources (including combination products
like Vicodin/Percocet).
• Warfarin Interaction: Doses >2,000 mg/day can increase the INR by
inhibiting warfarin metabolism, raising bleeding risk.
4. What would you be concerned with regarding an elderly patient’s use of
Vicodin?
• ---Answer---: The primary concern is the total daily dose of
acetaminophen.
• ------Rationale------: Vicodin is a combination of hydrocodone and
acetaminophen. Elderly patients are more susceptible to hepatotoxicity and
have a lower recommended maximum daily dose of acetaminophen (3,000
mg). It is critical to ensure their total intake from all sources does not
exceed this limit to prevent accidental overdose and liver injury.
Review / NSG 533 (NSG533) Advanced
Pharmacology Exam 2 | Questions and
Answers Graded A+ | Wilkes
1. When are NSAIDs indicated? Do higher doses provide greater benefits (is
there a ceiling effect)?
• ---Answer---: NSAIDs are indicated for mild to moderate pain,
particularly pain mediated by prostaglandins. This includes conditions like
rheumatoid arthritis (RA), menstrual cramps, and postsurgical pain. They
also work well for pain associated with bone metastasis. Yes, there is a
ceiling effect.
• ------Rationale------: NSAIDs work by inhibiting COX enzymes, which
reduces prostaglandin synthesis. Prostaglandins are key mediators of
inflammation and pain. Once the COX enzymes are fully inhibited by a
moderate dose, higher doses do not provide greater analgesic efficacy but
significantly increase the risk of adverse effects (GI, renal, cardiovascular).
2. What is the mechanism of action of acetaminophen (Tylenol)?
• ---Answer---: Acetaminophen is believed to work by blocking
prostaglandin synthesis primarily in the central nervous system (CNS) and
may also block pain impulses in the periphery.
• ------Rationale------: Unlike NSAIDs, acetaminophen has very weak
effects on COX enzymes in the periphery, which is why it lacks significant
, anti-inflammatory properties. Its primary analgesic and antipyretic effects
are considered central.
3. When is acetaminophen (APAP) indicated, and what are the major
precautions, including maximum daily doses?
• ---Answer---: APAP is used for mild to moderate pain (first-line for
osteoarthritis and low back pain) and as an antipyretic (fever reducer). Key
precautions are hepatotoxicity and interactions with warfarin.
• ------Rationale------:
• Dosing: Maximum dose for the general population is 4,000 mg/day.
The maximum dose for the elderly is recommended at 3,000 mg/day.
Doses must be reduced by 50-75% in patients with renal or hepatic
dysfunction.
• Hepatotoxicity: Risk is high with excessive use, especially in patients
with chronic alcohol use or pre-existing liver disease. It's crucial to
account for APAP from all sources (including combination products
like Vicodin/Percocet).
• Warfarin Interaction: Doses >2,000 mg/day can increase the INR by
inhibiting warfarin metabolism, raising bleeding risk.
4. What would you be concerned with regarding an elderly patient’s use of
Vicodin?
• ---Answer---: The primary concern is the total daily dose of
acetaminophen.
• ------Rationale------: Vicodin is a combination of hydrocodone and
acetaminophen. Elderly patients are more susceptible to hepatotoxicity and
have a lower recommended maximum daily dose of acetaminophen (3,000
mg). It is critical to ensure their total intake from all sources does not
exceed this limit to prevent accidental overdose and liver injury.
