ADVANCED PHARMACOLOGY NSG 533
EXAM QUESTIONS AND ANSWERS
What could you use in the treatment of acute
migraine symptoms?
mild to moderate: APAP, ASA or combination
products w/ caffeine
moderate to severe: triptans are 1st line
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.
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.
In addition, be sure to understand which non-
opiod medications you would use for a patient
with neuropathic pain.
Gabapentin, pregabalin, transdermal lidocaine,
TCAs.
If a patient has a true allergy to morphine, what
opioid, if any, could you try instead?
True opioid allergies are rare. When a true allergy
is present, an agent from another opiate classed
should be used. For example, a patient with a true
opiate allergy could receive fentanyl.
Know the common side effects which opioids can
cause:
Excessive sedation (reduce dose by 25%),
constipation (senna, dulcolax, N/V (hydroxyzine/
diphenhydramine), gastroparesis, vertigo, resp.
depression, CNS irritability.
, Know the WHO pain treatment algorithm:
Mild pain (1-3) non-opioid analgesic scheduled
ATC
Moderate pain (4-6) Add opioid to scheduled non-
opioid ATC
Severe pain (7-10) Switch to high dose opioid,
ATC
Understand when you would use acetaminophen
versus an NSAID or an NSAID instead of
acetaminopehn
NSAIDs work best on inflammatory pain or pain
mediated by prostaglandins (RA, menstrual and
post-surgical pain) and bony metastasis. NSAIDS
come with increased GIB risk and renal
impairment.
EXAM QUESTIONS AND ANSWERS
What could you use in the treatment of acute
migraine symptoms?
mild to moderate: APAP, ASA or combination
products w/ caffeine
moderate to severe: triptans are 1st line
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.
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.
In addition, be sure to understand which non-
opiod medications you would use for a patient
with neuropathic pain.
Gabapentin, pregabalin, transdermal lidocaine,
TCAs.
If a patient has a true allergy to morphine, what
opioid, if any, could you try instead?
True opioid allergies are rare. When a true allergy
is present, an agent from another opiate classed
should be used. For example, a patient with a true
opiate allergy could receive fentanyl.
Know the common side effects which opioids can
cause:
Excessive sedation (reduce dose by 25%),
constipation (senna, dulcolax, N/V (hydroxyzine/
diphenhydramine), gastroparesis, vertigo, resp.
depression, CNS irritability.
, Know the WHO pain treatment algorithm:
Mild pain (1-3) non-opioid analgesic scheduled
ATC
Moderate pain (4-6) Add opioid to scheduled non-
opioid ATC
Severe pain (7-10) Switch to high dose opioid,
ATC
Understand when you would use acetaminophen
versus an NSAID or an NSAID instead of
acetaminopehn
NSAIDs work best on inflammatory pain or pain
mediated by prostaglandins (RA, menstrual and
post-surgical pain) and bony metastasis. NSAIDS
come with increased GIB risk and renal
impairment.
