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NSG 533 ADVANCED PHARMACOLOGY
EXAM 2|| ALL QUESTIONS AND 100%
Diabetic peripheral neuropathy
CORRECT ANSWERS ALREADY GRADED
progressive deterioration of nerve function that results in loss of sensory perception
A+||LATEST AND COMPLETE UPDATE 2024-
2025 WITH VERIFIED SOLUTIONS|| ASSURED
PASS!!!! acute pain
pain is pain that occurs as a result of injury or surgery, under 3 months. Poorly treated
the most common symptom prompting patients to visit primary care providers. acute pain can cause psychological stress and compromise the immune system.
More than 80% of patients who visit physicians report pain. Often remains under Somatic acute pain is an injury to skin, bone, joint, muscle and connective tissue.
treated. Visceral pain involves injury to nerves on internal organs. Treat aggressively.
Examples: cut hand, menstrual cramps.
nociceptive pain
chronic pain
pain from a normal process that results in noxious stimuli being perceived as
painful. Explained by ongoing tissue injury. can be intermittent or persistent, more than 3 months. Main affects include a)
effects on physical function b) psychological changes c) social consequences and
thermal, mechanical and chemical nociceptors that engage "withdrawal" reflex
d) societal consequences. Usually involving life threatening diseases such as
followed by inflammatory response to protect injured tissue
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.
functional pain
pain sensitivity due to an abnormal processing or function of the central nervous
system in response to normal stimuli
chronic malignant pain
Painn is associated with a progressive life-threatening disease like cancer, aids,
neurologic diseases, end stage organ failure, and dementia. Goal is pain alleviation
neruopathic pain 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
Pain caused by lesions or other damage to the nervous system.
is referred to as "chronic nonmalignant pain."
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COX2 inhibitors
What are some non-pharmacological approaches to pain? Celecoxib (Celebrex) selective agents (celecoxib) have ideal indication in patients
with high risk for GI bleed, high intolerance of non-selective NSAIDS, or
imagery, distraction, relaxation, psychotherapy, biofeedback, cognitive behavioral
treatment failure with non-selective agents. NSAIDs are of minimal value in
therapy, support groups, and spiritual counseling. Physical therapy, heat, cold,
neuropathic pain. NSAIDs produce a flat dose response curve (celling effect) with
water, ultrasound, TENS, massage and therapeutic exercise.
higher doses providing no greater efficacy than moderate doses.
WHO 3 step analgesic ladder
Acetaminophen
* 1- nonopioid
Tylenol. blocks PG synthesis in CNS, inhibits peripheral pain impulses. APAP does
* 2 - opioid for mild to moderate pain not interfere with COX 1 or COX2 and thus has no anti-inflammatory benefits.
* 3 - opioid for moderate to severe pain
WHO pain ladder step 2
WHO first step pain ladder moderate pain: weak opioids (hydrocodone, codeine, tramadol) w/ or w/out
mild pain/nonopioid analgesics such as NSAIDS or acetaminophen w/ or w/out nonopioid analgesics w/ or w/out adjuvants "every time I do something, it hurts"
adjuvants (such as pregablin) .. "soreness." Med examples: apap 1000mg q 6hrs, med examples: apa325mg + cod 60mg q4 hrs
ibu600mg q6 hrs
WHO pain ladder step 3
NSAIDs severe and persistent pain, potent opioids (morphine, tapentadol, oxycodone,
Non-steroidal anti-inflammatory drugs. associated with several clinically hydromorphone, fentanyl, w/ or w/out non-opioid analgesics and with or without
significant contraindications and drug interactions. NSAIDS are equally effective adjuvants "no matter what I do it hurts, theres a bone sticking out of my skin!"
in analgesia, antipyretic and anti-inflammatory effects. Choice should include Examples; morphine 10mg q4 hrs, hydromorphone 4mg q4 hr
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.
What is the mechanism of NSAIDs and precautions to use?
NSG 533 ADVANCED PHARMACOLOGY
EXAM 2|| ALL QUESTIONS AND 100%
Diabetic peripheral neuropathy
CORRECT ANSWERS ALREADY GRADED
progressive deterioration of nerve function that results in loss of sensory perception
A+||LATEST AND COMPLETE UPDATE 2024-
2025 WITH VERIFIED SOLUTIONS|| ASSURED
PASS!!!! acute pain
pain is pain that occurs as a result of injury or surgery, under 3 months. Poorly treated
the most common symptom prompting patients to visit primary care providers. acute pain can cause psychological stress and compromise the immune system.
More than 80% of patients who visit physicians report pain. Often remains under Somatic acute pain is an injury to skin, bone, joint, muscle and connective tissue.
treated. Visceral pain involves injury to nerves on internal organs. Treat aggressively.
Examples: cut hand, menstrual cramps.
nociceptive pain
chronic pain
pain from a normal process that results in noxious stimuli being perceived as
painful. Explained by ongoing tissue injury. can be intermittent or persistent, more than 3 months. Main affects include a)
effects on physical function b) psychological changes c) social consequences and
thermal, mechanical and chemical nociceptors that engage "withdrawal" reflex
d) societal consequences. Usually involving life threatening diseases such as
followed by inflammatory response to protect injured tissue
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.
functional pain
pain sensitivity due to an abnormal processing or function of the central nervous
system in response to normal stimuli
chronic malignant pain
Painn is associated with a progressive life-threatening disease like cancer, aids,
neurologic diseases, end stage organ failure, and dementia. Goal is pain alleviation
neruopathic pain 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
Pain caused by lesions or other damage to the nervous system.
is referred to as "chronic nonmalignant pain."
, 3|Page 4|Page
COX2 inhibitors
What are some non-pharmacological approaches to pain? Celecoxib (Celebrex) selective agents (celecoxib) have ideal indication in patients
with high risk for GI bleed, high intolerance of non-selective NSAIDS, or
imagery, distraction, relaxation, psychotherapy, biofeedback, cognitive behavioral
treatment failure with non-selective agents. NSAIDs are of minimal value in
therapy, support groups, and spiritual counseling. Physical therapy, heat, cold,
neuropathic pain. NSAIDs produce a flat dose response curve (celling effect) with
water, ultrasound, TENS, massage and therapeutic exercise.
higher doses providing no greater efficacy than moderate doses.
WHO 3 step analgesic ladder
Acetaminophen
* 1- nonopioid
Tylenol. blocks PG synthesis in CNS, inhibits peripheral pain impulses. APAP does
* 2 - opioid for mild to moderate pain not interfere with COX 1 or COX2 and thus has no anti-inflammatory benefits.
* 3 - opioid for moderate to severe pain
WHO pain ladder step 2
WHO first step pain ladder moderate pain: weak opioids (hydrocodone, codeine, tramadol) w/ or w/out
mild pain/nonopioid analgesics such as NSAIDS or acetaminophen w/ or w/out nonopioid analgesics w/ or w/out adjuvants "every time I do something, it hurts"
adjuvants (such as pregablin) .. "soreness." Med examples: apap 1000mg q 6hrs, med examples: apa325mg + cod 60mg q4 hrs
ibu600mg q6 hrs
WHO pain ladder step 3
NSAIDs severe and persistent pain, potent opioids (morphine, tapentadol, oxycodone,
Non-steroidal anti-inflammatory drugs. associated with several clinically hydromorphone, fentanyl, w/ or w/out non-opioid analgesics and with or without
significant contraindications and drug interactions. NSAIDS are equally effective adjuvants "no matter what I do it hurts, theres a bone sticking out of my skin!"
in analgesia, antipyretic and anti-inflammatory effects. Choice should include Examples; morphine 10mg q4 hrs, hydromorphone 4mg q4 hr
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.
What is the mechanism of NSAIDs and precautions to use?
