NR565 Week 3 – Pain Management 2026 | Practice Questions
& Verified Answers | Advanced Pharmacology Review
What characterizes the second phase of withdrawal experienced by opioid
addicts after the acute onset of abstinence syndrome?
GI hyperactivity
Euphoria
Miosis
Respiratory depression
2nd phase of withdrwala after acute abstinence syndrome?
This second phase, which may persist for months, is characterized by
insomnia, irritability, and fatigue. Gastrointestinal hyperactivity and
premature ejaculation may also occur.
Adverse rxn for tramadol neurologic disorders? Seizures
Why is respiratory depression a significant concern in the case of fentanyl
overdose?
What is the drug classification of methadone? Opioid analgesic
What should the provider consider regarding opioid use during pregnancy?
a. Opioid use during pregnancy decreases the risk of withdrawal after
delivery
b. Opioid use during pregnancy increases the risk of congenital
heart defects
c. Opioid use during pregnancy is only safe in 3rd trimester
Why might the degree of pain relief achieved with codeine be lower than
with morphine, even at equivalent doses?
a. Codeine is classified under schedule 3
b. Codeine and nonopioid analgesics relieve pain by different
mechanisms
c. Codeine has a high potential for abuse
d. Codeine has a longer half-life than morphine
Adverse psych effects of marijuana: hallucinations, delusions, paranoia
,……………….……………….……………….……………….……………….
Acute Pain <3 months
• Acute pain occurs for less than three months and is often precipitated
by trauma, acute medical conditions, surgery, or treatment. Subacute
pain has a duration of 1-3 months. Acute pain is categorized as
referred pain, acute somatic pain, or acute visceral pain and is rated by
severity.
• Short-acting opioids should be used exclusively for the treatment of
acute pain in opioid naïve clients (as opposed to opioid-tolerant
clients). Titration to optimal therapeutic effects is faster, safer, and
easier with immediate-release opioids (as opposed to extended-release
opioids). Unintentional overdose may be more likely when opioid
therapy begins with long-acting opioids in opioid naïve clients.
Chronic Pain > 3 months
• Chronic pain persists beyond three months or the expected time of
healing.
• Agents used to manage chronic pain are often the same ones used to
manage acute pain. However, due to the extended duration of use and
increased potential for serious risks, including misuse and abuse,
addiction, overdose, and death, these agents must be judiciously used
to avoid harm. Chronic pain is ideally treated without opioids.
Essential Considerations for Safe Pain Management
1. Opioids are not first-line therapy
2. Establish goals for pain and function
3. Discuss risk and benefits
4. Use immediate-release opioids when starting
5. Use the lowest effective dose
6. Prescribe short durations for acute pain
7. Evaluate benefits and harms frequently
, 8. Use strategies to mitigate risk
9. Review PDMP data
10. Use urine drug testing
11. Avoid concurrent opioid and benzodiazepine prescribing
12. Offer treatment for opioid disorder
Acetaminophen reduces prostaglandin synthesis in the central
nervous system (CNS) to reduce pain and fever.
Overview of the Drug
Prototype: acetaminophen (Tylenol)
• Category: Cyclooxygenase Inhibitors (Drugs that Lack Anti-
inflammatory Actions)
• Primary Function: Acetaminophen reduces prostaglandin synthesis in
the CNS to reduce pain and fever.
• Unique Features: Acetaminophen is used more than any other
analgesic.
Mechanism of Action
• Acetaminophen reduces prostaglandin synthesis in the CNS to reduce
pain and fever. While acetaminophen is mostly transformed into safe
metabolites after metabolism, liver enzymes convert a small part into a
harmful substance. Normally, this dangerous byproduct is quickly
neutralized, but in cases of overdose, it accumulates and can severely
damage the liver due to depletion of protective glutathione.
Indications and Therapeutic Uses
• Pain Relief: Acetaminophen is used when mild pain relief is needed
across a range of indications.
• Fever: Acetaminophen can be used to reduce fever.
Side Effects and Adverse Reactions
Side Effect Description
Hypertension Daily use of acetaminophen has been tied to the development of this,
requiring ongoing monitoring.
Hepatotoxicity Overdose can cause this, although it is rare at therapeutic doses.
Rash If this appears, acetaminophen should be stopped immediately
as it could indicate serious effects, such as Stevens-Johnson Syndrome (SJS ),
acute generalized exanthematous pustulosis (AGEP), or toxic epidermal necroly
Precautions and Contraindications
Precautions
• Monitor for hepatic dysfunction.
• Caution with clients who consume three or more alcoholic drinks daily.
• Administering acetylcysteine (Mucomyst) for overdose can reduce liver
injury.
Contraindications
& Verified Answers | Advanced Pharmacology Review
What characterizes the second phase of withdrawal experienced by opioid
addicts after the acute onset of abstinence syndrome?
GI hyperactivity
Euphoria
Miosis
Respiratory depression
2nd phase of withdrwala after acute abstinence syndrome?
This second phase, which may persist for months, is characterized by
insomnia, irritability, and fatigue. Gastrointestinal hyperactivity and
premature ejaculation may also occur.
Adverse rxn for tramadol neurologic disorders? Seizures
Why is respiratory depression a significant concern in the case of fentanyl
overdose?
What is the drug classification of methadone? Opioid analgesic
What should the provider consider regarding opioid use during pregnancy?
a. Opioid use during pregnancy decreases the risk of withdrawal after
delivery
b. Opioid use during pregnancy increases the risk of congenital
heart defects
c. Opioid use during pregnancy is only safe in 3rd trimester
Why might the degree of pain relief achieved with codeine be lower than
with morphine, even at equivalent doses?
a. Codeine is classified under schedule 3
b. Codeine and nonopioid analgesics relieve pain by different
mechanisms
c. Codeine has a high potential for abuse
d. Codeine has a longer half-life than morphine
Adverse psych effects of marijuana: hallucinations, delusions, paranoia
,……………….……………….……………….……………….……………….
Acute Pain <3 months
• Acute pain occurs for less than three months and is often precipitated
by trauma, acute medical conditions, surgery, or treatment. Subacute
pain has a duration of 1-3 months. Acute pain is categorized as
referred pain, acute somatic pain, or acute visceral pain and is rated by
severity.
• Short-acting opioids should be used exclusively for the treatment of
acute pain in opioid naïve clients (as opposed to opioid-tolerant
clients). Titration to optimal therapeutic effects is faster, safer, and
easier with immediate-release opioids (as opposed to extended-release
opioids). Unintentional overdose may be more likely when opioid
therapy begins with long-acting opioids in opioid naïve clients.
Chronic Pain > 3 months
• Chronic pain persists beyond three months or the expected time of
healing.
• Agents used to manage chronic pain are often the same ones used to
manage acute pain. However, due to the extended duration of use and
increased potential for serious risks, including misuse and abuse,
addiction, overdose, and death, these agents must be judiciously used
to avoid harm. Chronic pain is ideally treated without opioids.
Essential Considerations for Safe Pain Management
1. Opioids are not first-line therapy
2. Establish goals for pain and function
3. Discuss risk and benefits
4. Use immediate-release opioids when starting
5. Use the lowest effective dose
6. Prescribe short durations for acute pain
7. Evaluate benefits and harms frequently
, 8. Use strategies to mitigate risk
9. Review PDMP data
10. Use urine drug testing
11. Avoid concurrent opioid and benzodiazepine prescribing
12. Offer treatment for opioid disorder
Acetaminophen reduces prostaglandin synthesis in the central
nervous system (CNS) to reduce pain and fever.
Overview of the Drug
Prototype: acetaminophen (Tylenol)
• Category: Cyclooxygenase Inhibitors (Drugs that Lack Anti-
inflammatory Actions)
• Primary Function: Acetaminophen reduces prostaglandin synthesis in
the CNS to reduce pain and fever.
• Unique Features: Acetaminophen is used more than any other
analgesic.
Mechanism of Action
• Acetaminophen reduces prostaglandin synthesis in the CNS to reduce
pain and fever. While acetaminophen is mostly transformed into safe
metabolites after metabolism, liver enzymes convert a small part into a
harmful substance. Normally, this dangerous byproduct is quickly
neutralized, but in cases of overdose, it accumulates and can severely
damage the liver due to depletion of protective glutathione.
Indications and Therapeutic Uses
• Pain Relief: Acetaminophen is used when mild pain relief is needed
across a range of indications.
• Fever: Acetaminophen can be used to reduce fever.
Side Effects and Adverse Reactions
Side Effect Description
Hypertension Daily use of acetaminophen has been tied to the development of this,
requiring ongoing monitoring.
Hepatotoxicity Overdose can cause this, although it is rare at therapeutic doses.
Rash If this appears, acetaminophen should be stopped immediately
as it could indicate serious effects, such as Stevens-Johnson Syndrome (SJS ),
acute generalized exanthematous pustulosis (AGEP), or toxic epidermal necroly
Precautions and Contraindications
Precautions
• Monitor for hepatic dysfunction.
• Caution with clients who consume three or more alcoholic drinks daily.
• Administering acetylcysteine (Mucomyst) for overdose can reduce liver
injury.
Contraindications
