NSG 533 ADVANCED PHARMACOLOGY
2 EXAM WITH ACTUAL CORRECT
QUESTIONS AND VERIFIED
DETAILED ANSWERS|FREQUENTLY
TESTED QUESTIONS AND
SOLUTIONS|NEWEST|GUARANTEED
PASS 2026/2027
COX2 inhibitors
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 effect) with
higher doses providing no greater efficacy than moderate doses.
Acetaminophen
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.
WHO pain ladder step 2
moderate pain: 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: apa325mg + cod 60mg q4 hrs
WHO pain ladder step 3
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,
there’s a bone sticking out of my skin!" Examples; morphine 10mg q4 hrs, hydromorphone 4mg q4 hr
What is the mechanism of NSAIDs and precautions to use?
NSAIDS are either nonselective (inhibit cox 1 and cox 2) or selective (inhibit cox 2). Cox 2 inhibition is
responsible for anti-inflammatory effects. - 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.
Management for NSAID risks
1|Page
, 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 effects include taking with
food or milk, Switch to different NSAID with better safety profile, COX2 selective agent (celecoxib)
and/or gastroprotection (H2RA, PPI, misoprostol
Celecoxib
is recommended for patients at increased risk of gastrointestinal bleeding / ulcer who require a NSAID -
Side effects can also include htn, and worsening asthma symptoms.
Tordol (Ketorolac)
40mg, max 5 days.. huge bleeding risk beyond that!
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 assoc with bone metastasis. Will dose escalation provide greater
benefits (i.e. is there a ceiling effect)? Higher doses produce no greater efficacy than moderate doses.
What is the mechanism of acetaminophen?
Blocks prostaglandin synthesis in the CNS and block pain impulses in the periphery.
When is APAP indicated and are there precautions / restrictions / limitations to use or in dosing (you
MUST know maximum daily doses in general population and older adults)?
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. - All providers and patients
should be aware of the maximum daily doses of APAP and be conscious of the fact APAP can be found in
many products in combination with other medications.... -Max dose for patients with normal renal +
hepatic function if 4000mg/day -Max dose for elderly is 3000mg/ day. Reduce dose 50% to 75% in
patients with renal or hepatic dysfunction.
*Practice question: 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.
How does spectrum of use differ from NSAIDs?
Also used as an antipyretic
What is meant by an adjuvant analgesic and when would they be appropriate? Provide examples of
medications in this class
Adjuvant analgesics are drugs that have indications other pain but are useful as monotherapy or in
combination with other drugs. Examples: diabetic neuropathy, post hepatic neuralgia, fibromyalgia....
2|Page
2 EXAM WITH ACTUAL CORRECT
QUESTIONS AND VERIFIED
DETAILED ANSWERS|FREQUENTLY
TESTED QUESTIONS AND
SOLUTIONS|NEWEST|GUARANTEED
PASS 2026/2027
COX2 inhibitors
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 effect) with
higher doses providing no greater efficacy than moderate doses.
Acetaminophen
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.
WHO pain ladder step 2
moderate pain: 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: apa325mg + cod 60mg q4 hrs
WHO pain ladder step 3
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,
there’s a bone sticking out of my skin!" Examples; morphine 10mg q4 hrs, hydromorphone 4mg q4 hr
What is the mechanism of NSAIDs and precautions to use?
NSAIDS are either nonselective (inhibit cox 1 and cox 2) or selective (inhibit cox 2). Cox 2 inhibition is
responsible for anti-inflammatory effects. - 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.
Management for NSAID risks
1|Page
, 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 effects include taking with
food or milk, Switch to different NSAID with better safety profile, COX2 selective agent (celecoxib)
and/or gastroprotection (H2RA, PPI, misoprostol
Celecoxib
is recommended for patients at increased risk of gastrointestinal bleeding / ulcer who require a NSAID -
Side effects can also include htn, and worsening asthma symptoms.
Tordol (Ketorolac)
40mg, max 5 days.. huge bleeding risk beyond that!
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 assoc with bone metastasis. Will dose escalation provide greater
benefits (i.e. is there a ceiling effect)? Higher doses produce no greater efficacy than moderate doses.
What is the mechanism of acetaminophen?
Blocks prostaglandin synthesis in the CNS and block pain impulses in the periphery.
When is APAP indicated and are there precautions / restrictions / limitations to use or in dosing (you
MUST know maximum daily doses in general population and older adults)?
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. - All providers and patients
should be aware of the maximum daily doses of APAP and be conscious of the fact APAP can be found in
many products in combination with other medications.... -Max dose for patients with normal renal +
hepatic function if 4000mg/day -Max dose for elderly is 3000mg/ day. Reduce dose 50% to 75% in
patients with renal or hepatic dysfunction.
*Practice question: 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.
How does spectrum of use differ from NSAIDs?
Also used as an antipyretic
What is meant by an adjuvant analgesic and when would they be appropriate? Provide examples of
medications in this class
Adjuvant analgesics are drugs that have indications other pain but are useful as monotherapy or in
combination with other drugs. Examples: diabetic neuropathy, post hepatic neuralgia, fibromyalgia....
2|Page
