NSG 533 (NSG533) Advanced Pharmacology
Exam 2 | Questions and Answers Graded A+ |
Wilkes
1. 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. NSAIDs have a ceiling effect: higher doses produce no greater
efficacy than moderate doses. Naproxen has the lowest cardiovascular risk of all
NSAIDs.
2. What is the mechanism of acetaminophen?
Blocks prostaglandin synthesis in the CNS and block pain impulses in the periphery.
3. When is APAP indicated and are there precautions / restrictions /
limitations to use or in dosing?
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.
Maximum Doses:
• 4000mg/day healthy adults
• 3000mg/day elderly
• Reduce dose 50% to 75% in renal or hepatic dysfunction
, All providers must be conscious that APAP is included in hundreds of combination
products.
4. What would you be concerned with regarding the first patient's use of
Vicodin in terms of acetaminophen dose?
In elderly patients, it is recommended not to exceed 3,000mg per day of
Acetaminophen.
5. How does acetaminophen spectrum of use differ from NSAIDS?
Acetaminophen has no anti-inflammatory activity, no GI risk, no cardiovascular
risk. Also used as an antipyretic.
6. What is meant by an adjuvant analgesic and when would they be
appropriate? Provide examples.
Adjuvant analgesics are drugs that have primary indications other than pain but
are useful as monotherapy or in combination with other drugs for pain. They are
the first line treatment for neuropathic pain syndromes.
Examples: antiepileptic drugs, antidepressants, antiarrhythmics, local anesthetics,
capsaicin, NMDA antagonists, clonidine, and muscle relaxants.
Indications: diabetic neuropathy, post herpetic neuralgia, fibromyalgia.
7. Diabetic peripheral neuropathy first line treatment
Duloxetine (Cymbalta) 60mg daily; Pregabalin (Lyrica) 50mg TID or 100mg TID.
8. Practice Question: What medication could you recommend for a diabetic
patient in pain that could also treat depression?
SNRIs; either Duloxetine or venlafaxine have been successfully used in diabetic
peripheral neuropathy.
9. Postherpetic Neuralgia (PHN) first line treatment
Gabapentin (Neurontin) 300mg TID up to 3600mg; Pregabalin 75mg BID or 50mg
TID. May be increased to 100mg TID. Lidocaine 5% patch: up to 3 patches over
site, 12 hours on, 12 hours off.
Exam 2 | Questions and Answers Graded A+ |
Wilkes
1. 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. NSAIDs have a ceiling effect: higher doses produce no greater
efficacy than moderate doses. Naproxen has the lowest cardiovascular risk of all
NSAIDs.
2. What is the mechanism of acetaminophen?
Blocks prostaglandin synthesis in the CNS and block pain impulses in the periphery.
3. When is APAP indicated and are there precautions / restrictions /
limitations to use or in dosing?
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.
Maximum Doses:
• 4000mg/day healthy adults
• 3000mg/day elderly
• Reduce dose 50% to 75% in renal or hepatic dysfunction
, All providers must be conscious that APAP is included in hundreds of combination
products.
4. What would you be concerned with regarding the first patient's use of
Vicodin in terms of acetaminophen dose?
In elderly patients, it is recommended not to exceed 3,000mg per day of
Acetaminophen.
5. How does acetaminophen spectrum of use differ from NSAIDS?
Acetaminophen has no anti-inflammatory activity, no GI risk, no cardiovascular
risk. Also used as an antipyretic.
6. What is meant by an adjuvant analgesic and when would they be
appropriate? Provide examples.
Adjuvant analgesics are drugs that have primary indications other than pain but
are useful as monotherapy or in combination with other drugs for pain. They are
the first line treatment for neuropathic pain syndromes.
Examples: antiepileptic drugs, antidepressants, antiarrhythmics, local anesthetics,
capsaicin, NMDA antagonists, clonidine, and muscle relaxants.
Indications: diabetic neuropathy, post herpetic neuralgia, fibromyalgia.
7. Diabetic peripheral neuropathy first line treatment
Duloxetine (Cymbalta) 60mg daily; Pregabalin (Lyrica) 50mg TID or 100mg TID.
8. Practice Question: What medication could you recommend for a diabetic
patient in pain that could also treat depression?
SNRIs; either Duloxetine or venlafaxine have been successfully used in diabetic
peripheral neuropathy.
9. Postherpetic Neuralgia (PHN) first line treatment
Gabapentin (Neurontin) 300mg TID up to 3600mg; Pregabalin 75mg BID or 50mg
TID. May be increased to 100mg TID. Lidocaine 5% patch: up to 3 patches over
site, 12 hours on, 12 hours off.
