NSG 533 ADVANCED
PHARMACOLOGY ACTUAL
EXAM + QUESTIONS AND
CORRECT ANSWERS 2025/2026
LATEST UPDATE GRADED A+ .
,1. pain 🗸🗸 CORRECT ANSWER the most common symptom prompting patients to visit primary care providers. More than 80% of patients who visit physicians report
pain. Often remains under treated.
2. nociceptive pain 🗸🗸 CORRECT ANSWER pain from a normal process that results in noxious stimuli being perceived as painful. Explained by ongoing
tissue injury.
thermal, mechanical and chemical nociceptors that engage "withdrawal" reflex followed by inflammatory response to protect injured tissue
3. functional pain 🗸🗸 CORRECT ANSWER pain sensitivity due to an abnormal processing or function of the central nervous system in
response to normal stimuli
4. neruopathic pain 🗸🗸 CORRECT ANSWER Pain caused by lesions or other damage to the nervous system.
5. Diabetic peripheral neuropathy 🗸🗸 CORRECT ANSWER progressive deterioration of nerve function that results in loss of sensory perception
6. acute pain 🗸🗸 CORRECT ANSWER is pain that occurs as a result of injury or surgery, under 3 months. Poorly treated acute pain can cause psychological stress and
compromise the immune system. Somatic acute pain is an injury to skin, bone, joint, muscle and connective tissue. Visceral pain involves injury to nerves on internal organs.
Treat aggressively. Examples 🗸🗸 CORRECT ANSWER cut hand, menstrual cramps.
7. chronic pain 🗸🗸 CORRECT ANSWER can be intermittent or persistent, more than 3 months. Main attects include a) ettects on
physical function b) psychological changes c) social consequences and d) societal consequences. Usually involving life threatening diseases such as cancers, aids, progressive
neurological diseases, end stage organ failure, dementia. Management should be multimodal with cognitive interventions, physical manipulations, pharmacological agents,
surgical interventions, and regional or spinal anesthesia.
8. chronic malignant pain 🗸🗸 CORRECT ANSWER Painn is associated with a progressive life-threatening disease like cancer, aids,
neurologic diseases, end stage organ failure, and dementia. Goal is pain alleviation and prevention. Dependence or addiction is not a concern. Pain not associated with life
threatening disease and lasting more than 6 months beyond the healing period is referred to as "chronic nonmalignant pain."
9. What are some non-pharmacological approaches to pain? 🗸🗸 CORRECT ANSWER imagery, distraction, re-
laxation, psychotherapy, biofeedback, cognitive behavioral therapy, support groups, and spiritual counseling. Physical therapy, heat, cold, water, ultrasound, TENS, massage and
therapeutic exercise.
10. WHO 3 step analgesic ladder 🗸🗸 CORRECT ANSWER * 1- nonopioid
* 2 - opioid for mild to moderate pain
* 3 - opioid for moderate to severe pain
11. WHO first step pain ladder 🗸🗸 CORRECT ANSWER mild pain/nonopioid analgesics such as NSAIDS or acetaminophen w/ or w/out adjuvants
(such as pregablin) .. "soreness." Med examples 🗸🗸 CORRECT ANSWER apap 1000mg q 6hrs, ibu600mg q6 hrs
, 12. NSAIDs 🗸🗸 CORRECT ANSWER Non-steroidal anti-inflammatory drugs. associated with several clinically significant contraindications and drug interactions.
NSAIDS are equally ettective in analgesia, antipyretic and anti-inflammatory ettects. Choice should include STEPS (simplicity, tolerability, evidence, price, safety). If patient fails
therapy with an agent from one class of NSAIDs, use of an agent from another class is reasonable.
13. COX2 inhibitors 🗸🗸 CORRECT ANSWER Celecoxib (Celebrex) selective agents (celecoxib) have ideal indication in patients with high
risk for GI bleed, high intolerance of non-selective NSAIDS, or treatment failure with non-selective agents. NSAIDs are of minimal value in neuropathic pain. NSAIDs produce
a flat dose response curve (celling ettect) with higher doses providing no greater eflcacy than moderate doses.
14. Acetaminophen 🗸🗸 CORRECT ANSWER Tylenol. blocks PG synthesis in CNS, inhibits peripheral pain impulses. APAP does not
interfere with COX 1 or COX2 and thus has no anti-inflammatory benefits.
15. WHO pain ladder step 2 🗸🗸 CORRECT ANSWER moderate pain 🗸🗸 CORRECT ANSWER weak opioids (hydrocodone, codeine, tramadol) w/ or
w/out nonopioid analgesics w/ or w/out adjuvants "every time I do something, it hurts" med examples 🗸🗸 CORRECT ANSWER apa325mg + cod 60mg q4 hrs
16. WHO pain ladder step 3 🗸🗸 CORRECT ANSWER severe and persistent pain, potent opioids (morphine, tapentadol, oxycodone,
hydromorphone, fentanyl, w/ or w/out non-opioid analgesics and with or without adjuvants "no matter what I do it hurts, theres a bone sticking out of my skin!" Examples;
morphine 10mg q4 hrs, hydromorphone 4mg q4 hr
17. What is the mechanism of NSAIDs and precautions to use? 🗸🗸 CORRECT ANSWER NSAIDS are either
nonselective (inhibit cox 1 and cox 2) or selective (inhibit cox 2). Cox 2 inhibition is responsible for anti-inflammatory ettects. - Cox 1 contributes to increased GI and renal
toxicity assoc with nonselective NSAIDS. Use with caution in patients with dyspepsia, peptic ulcers, bleeding, and patients taking corticosteroids. Nephrotoxicity can occur in the
elderly. A boxed warning is now required for prescription nonselective NSAIDs and Celecoxib due to the increase risk of cardiovascular events and GI bleeding. Generally pts
prescribed NSAIDS will need PPI's.
18. Managment for NSAID risks 🗸🗸 CORRECT ANSWER Pts more pre-disposed to GI toxicity if pre-existing ulcer or dyspepsia,
H Pylori infection, older age, and some concurrent medications increase risk. Management options for GI side ettects include taking with food or milk, Switch to ditterent NSAID
better safety profile, COX2 selective agent (celecoxib) and/or gastroprotection (H2RA, PPI, misoprostol
19. Celecoxib 🗸🗸 CORRECT ANSWER is recommended for patients at increased risk of gastrointestinal bleeding / ulcer who require a
NSAID -Side ettects can also include htn, and worsening asthma symptoms.
20. Tordol (Ketorolac) 🗸🗸 CORRECT ANSWER 40mg, max 5 days.. huge bleeding risk beyond that!
21. When are NSAIDs indicated and is one NSAID better / safer than another in a given patient? 🗸🗸 CORRECT ANSWER
Useful for mild to moderate pain that are mediated by prostaglandins (RA, menstrual cramps,
PHARMACOLOGY ACTUAL
EXAM + QUESTIONS AND
CORRECT ANSWERS 2025/2026
LATEST UPDATE GRADED A+ .
,1. pain 🗸🗸 CORRECT ANSWER the most common symptom prompting patients to visit primary care providers. More than 80% of patients who visit physicians report
pain. Often remains under treated.
2. nociceptive pain 🗸🗸 CORRECT ANSWER pain from a normal process that results in noxious stimuli being perceived as painful. Explained by ongoing
tissue injury.
thermal, mechanical and chemical nociceptors that engage "withdrawal" reflex followed by inflammatory response to protect injured tissue
3. functional pain 🗸🗸 CORRECT ANSWER pain sensitivity due to an abnormal processing or function of the central nervous system in
response to normal stimuli
4. neruopathic pain 🗸🗸 CORRECT ANSWER Pain caused by lesions or other damage to the nervous system.
5. Diabetic peripheral neuropathy 🗸🗸 CORRECT ANSWER progressive deterioration of nerve function that results in loss of sensory perception
6. acute pain 🗸🗸 CORRECT ANSWER is pain that occurs as a result of injury or surgery, under 3 months. Poorly treated acute pain can cause psychological stress and
compromise the immune system. Somatic acute pain is an injury to skin, bone, joint, muscle and connective tissue. Visceral pain involves injury to nerves on internal organs.
Treat aggressively. Examples 🗸🗸 CORRECT ANSWER cut hand, menstrual cramps.
7. chronic pain 🗸🗸 CORRECT ANSWER can be intermittent or persistent, more than 3 months. Main attects include a) ettects on
physical function b) psychological changes c) social consequences and d) societal consequences. Usually involving life threatening diseases such as cancers, aids, progressive
neurological diseases, end stage organ failure, dementia. Management should be multimodal with cognitive interventions, physical manipulations, pharmacological agents,
surgical interventions, and regional or spinal anesthesia.
8. chronic malignant pain 🗸🗸 CORRECT ANSWER Painn is associated with a progressive life-threatening disease like cancer, aids,
neurologic diseases, end stage organ failure, and dementia. Goal is pain alleviation and prevention. Dependence or addiction is not a concern. Pain not associated with life
threatening disease and lasting more than 6 months beyond the healing period is referred to as "chronic nonmalignant pain."
9. What are some non-pharmacological approaches to pain? 🗸🗸 CORRECT ANSWER imagery, distraction, re-
laxation, psychotherapy, biofeedback, cognitive behavioral therapy, support groups, and spiritual counseling. Physical therapy, heat, cold, water, ultrasound, TENS, massage and
therapeutic exercise.
10. WHO 3 step analgesic ladder 🗸🗸 CORRECT ANSWER * 1- nonopioid
* 2 - opioid for mild to moderate pain
* 3 - opioid for moderate to severe pain
11. WHO first step pain ladder 🗸🗸 CORRECT ANSWER mild pain/nonopioid analgesics such as NSAIDS or acetaminophen w/ or w/out adjuvants
(such as pregablin) .. "soreness." Med examples 🗸🗸 CORRECT ANSWER apap 1000mg q 6hrs, ibu600mg q6 hrs
, 12. NSAIDs 🗸🗸 CORRECT ANSWER Non-steroidal anti-inflammatory drugs. associated with several clinically significant contraindications and drug interactions.
NSAIDS are equally ettective in analgesia, antipyretic and anti-inflammatory ettects. Choice should include STEPS (simplicity, tolerability, evidence, price, safety). If patient fails
therapy with an agent from one class of NSAIDs, use of an agent from another class is reasonable.
13. COX2 inhibitors 🗸🗸 CORRECT ANSWER Celecoxib (Celebrex) selective agents (celecoxib) have ideal indication in patients with high
risk for GI bleed, high intolerance of non-selective NSAIDS, or treatment failure with non-selective agents. NSAIDs are of minimal value in neuropathic pain. NSAIDs produce
a flat dose response curve (celling ettect) with higher doses providing no greater eflcacy than moderate doses.
14. Acetaminophen 🗸🗸 CORRECT ANSWER Tylenol. blocks PG synthesis in CNS, inhibits peripheral pain impulses. APAP does not
interfere with COX 1 or COX2 and thus has no anti-inflammatory benefits.
15. WHO pain ladder step 2 🗸🗸 CORRECT ANSWER moderate pain 🗸🗸 CORRECT ANSWER weak opioids (hydrocodone, codeine, tramadol) w/ or
w/out nonopioid analgesics w/ or w/out adjuvants "every time I do something, it hurts" med examples 🗸🗸 CORRECT ANSWER apa325mg + cod 60mg q4 hrs
16. WHO pain ladder step 3 🗸🗸 CORRECT ANSWER severe and persistent pain, potent opioids (morphine, tapentadol, oxycodone,
hydromorphone, fentanyl, w/ or w/out non-opioid analgesics and with or without adjuvants "no matter what I do it hurts, theres a bone sticking out of my skin!" Examples;
morphine 10mg q4 hrs, hydromorphone 4mg q4 hr
17. What is the mechanism of NSAIDs and precautions to use? 🗸🗸 CORRECT ANSWER NSAIDS are either
nonselective (inhibit cox 1 and cox 2) or selective (inhibit cox 2). Cox 2 inhibition is responsible for anti-inflammatory ettects. - Cox 1 contributes to increased GI and renal
toxicity assoc with nonselective NSAIDS. Use with caution in patients with dyspepsia, peptic ulcers, bleeding, and patients taking corticosteroids. Nephrotoxicity can occur in the
elderly. A boxed warning is now required for prescription nonselective NSAIDs and Celecoxib due to the increase risk of cardiovascular events and GI bleeding. Generally pts
prescribed NSAIDS will need PPI's.
18. Managment for NSAID risks 🗸🗸 CORRECT ANSWER Pts more pre-disposed to GI toxicity if pre-existing ulcer or dyspepsia,
H Pylori infection, older age, and some concurrent medications increase risk. Management options for GI side ettects include taking with food or milk, Switch to ditterent NSAID
better safety profile, COX2 selective agent (celecoxib) and/or gastroprotection (H2RA, PPI, misoprostol
19. Celecoxib 🗸🗸 CORRECT ANSWER is recommended for patients at increased risk of gastrointestinal bleeding / ulcer who require a
NSAID -Side ettects can also include htn, and worsening asthma symptoms.
20. Tordol (Ketorolac) 🗸🗸 CORRECT ANSWER 40mg, max 5 days.. huge bleeding risk beyond that!
21. When are NSAIDs indicated and is one NSAID better / safer than another in a given patient? 🗸🗸 CORRECT ANSWER
Useful for mild to moderate pain that are mediated by prostaglandins (RA, menstrual cramps,
