Nsg 533 Advanced Pharmacology Exam 2
1. pain: cthe cmost ccommon csymptom cprompting cpatients cto cvisit
cprimary ccare cproviders. cMore cthan c80% cof cpatients cwho cvisit
cphysicians creport cpain. cOften cremains cunder ctreated.
2.nociceptive cpain: cpain cfrom ca cnormal cprocess cthat cresults cin cnoxious
cstimuli cbeing cperceived cas cpainful. cExplained cby congoing ctissue cinjury.
thermal, cmechanical cand cchemical cnociceptors cthat cengage
c"withdrawal" creflex cfollowed cby cinflammatory cresponse cto cprotect
cinjured ctissue
3. functional cpain: cpain csensitivity cdue cto can cabnormal cprocessing cor
cfunction cof cthe ccentral cnervous csystem cin cresponse cto cnormal cstimuli
4. neruopathic cpain: cPain ccaused cby clesions cor cother cdamage cto
cthe cnervous csystem.
5. Diabetic cperipheral cneuropathy: cprogressive cdeterioration cof cnerve
cfunction cthat cresults cin closs cof csensory cperception
6. acute cpain: cis cpain cthat coccurs cas ca cresult cof cinjury cor csurgery,
cunder c3 cmonths. cPoorly ctreated cacute cpain ccan ccause cpsychological
cstress cand ccompromise cthe cimmune csystem. cSomatic cacute cpain cis
can cinjury cto cskin, cbone, cjoint, cmuscle cand cconnective ctissue. cVisceral
cpain cinvolves cinjury cto cnerves con cinternal corgans. cTreat caggressively.
cExamples: ccut chand, cmenstrual ccramps.
7. chronic cpain: ccan cbe cintermittent cor cpersistent, cmore cthan c3 cmonths.
cMain caffects cinclude ca) ceffects con cphysical cfunction cb) cpsychological
cchanges cc) csocial cconse- cquences cand cd) csocietal cconsequences.
cUsually cinvolving clife cthreatening cdiseases csuch cas ccancers, caids,
cprogressive cneurological cdiseases, cend cstage corgan cfailure, cdementia.
cManagement cshould cbe cmultimodal cwith ccognitive cinterventions,
cphysi- ccal cmanipulations, cpharmacological cagents, csurgical
1 c/
,cinterventions, cand cregional cor cspinal canesthesia.
8. chronic cmalignant cpain: cPainn cis cassociated cwith ca cprogressive clife-
threatening cdisease clike ccancer, caids, cneurologic cdiseases, cend cstage
corgan cfailure, cand cdemen- ctia. cGoal cis cpain calleviation cand cprevention.
cDependence cor caddiction cis cnot ca cconcern. cPain cnot cassociated cwith clife
cthreatening cdisease cand clasting cmore cthan c6 cmonths cbeyond cthe
chealing cperiod cis creferred cto cas c"chronic cnonmalignant cpain."
9. What care csome cnon-pharmacological capproaches cto cpain?: cimagery,
cdistrac- ction, crelaxation, cpsychotherapy, cbiofeedback, ccognitive
cbehavioral ctherapy, csupport cgroups, cand cspiritual ccounseling. cPhysical
ctherapy, cheat, ccold, cwater, cultrasound, cTENS, cmassage cand
ctherapeutic cexercise.
10.WHO c3 cstep canalgesic cladder: c* c1- cnonopioid
* 2 c- copioid cfor cmild cto cmoderate cpain
* 3 c- copioid cfor cmoderate cto csevere cpain
2 c/
, 11.WHO cfirst cstep cpain cladder: cmild cpain/nonopioid canalgesics csuch cas
cNSAIDS cor cacetaminophen cw/ cor cw/out cadjuvants c(such cas cpregablin)
c.. c"soreness." cMed cexamples: capap c1000mg cq c6hrs, cibu600mg cq6 chrs
12.NSAIDs: cNon-steroidal canti-inflammatory cdrugs. cassociated cwith
cseveral cclinical- cly csignificant ccontraindications cand cdrug cinteractions.
cNSAIDS care cequally ceffective cin canalgesia, cantipyretic cand canti-
inflammatory ceffects. cChoice cshould cinclude cSTEPS c(simplicity,
ctolerability, cevidence, cprice, csafety). cIf cpatient cfails ctherapy cwith can
cagent cfrom cone cclass cof cNSAIDs, cuse cof can cagent cfrom canother cclass
cis creasonable.
13.COX2 cinhibitors: cCelecoxib c(Celebrex) cselective cagents c(celecoxib)
chave cideal cindication cin cpatients cwith chigh crisk cfor cGI cbleed, chigh
cintolerance cof cnon-selective cNSAIDS, cor ctreatment cfailure cwith cnon-
selective cagents. cNSAIDs care cof cminimal cvalue cin cneuropathic cpain.
cNSAIDs cproduce ca cflat cdose cresponse ccurve c(celling ceffect) cwith chigher
cdoses cproviding cno cgreater cefficacy cthan cmoderate cdoses.
14.Acetaminophen: cTylenol. cblocks cPG csynthesis cin cCNS, cinhibits
cperipheral cpain cimpulses. cAPAP cdoes cnot cinterfere cwith cCOX c1 cor cCOX2
cand cthus chas cno canti-inflam- cmatory cbenefits.
15.WHO cpain cladder cstep c2: cmoderate cpain: cweak copioids c(hydrocodone,
ccodeine, ctramadol) cw/ cor cw/out cnonopioid canalgesics cw/ cor cw/out
cadjuvants c"every ctime cI cdo csomething, cit churts" cmed cexamples:
capa325mg c+ ccod c60mg cq4 chrs
16.WHO cpain cladder cstep c3: csevere cand cpersistent cpain, cpotent copioids
c(morphine, ctapentadol, coxycodone, chydromorphone, cfentanyl, cw/ cor
cw/out cnon-opioid canalgesics cand cwith cor cwithout cadjuvants c"no cmatter
cwhat cI cdo cit churts, ctheres ca cbone csticking cout cof cmy cskin!" cExamples;
cmorphine c10mg cq4 chrs, chydromorphone c4mg cq4 chr
17.What cis cthe cmechanism cof cNSAIDs cand cprecautions cto cuse?: cNSAIDS
care ceither cnonselective c(inhibit ccox c1 cand ccox c2) cor cselective c(inhibit
ccox c2). cCox c2 cinhi- cbition cis cresponsible cfor canti-inflammatory ceffects.
c- cCox c1 ccontributes cto cincreased cGI cand crenal ctoxicity cassoc cwith
cnonselective cNSAIDS. cUse cwith ccaution cin cpatients cwith cdyspepsia,
cpeptic culcers, cbleeding, cand cpatients ctaking ccorticosteroids. cNephro-
ctoxicity ccan coccur cin cthe celderly. cA cboxed cwarning cis cnow crequired cfor
cprescription cnonselective cNSAIDs cand cCelecoxib cdue cto cthe cincrease
crisk cof ccardiovascular cevents cand cGI cbleeding. cGenerally cpts
cprescribed cNSAIDS cwill cneed cPPI's.
18.Managment cfor cNSAID crisks: cPts cmore cpre-disposed cto cGI ctoxicity cif
3 c/
1. pain: cthe cmost ccommon csymptom cprompting cpatients cto cvisit
cprimary ccare cproviders. cMore cthan c80% cof cpatients cwho cvisit
cphysicians creport cpain. cOften cremains cunder ctreated.
2.nociceptive cpain: cpain cfrom ca cnormal cprocess cthat cresults cin cnoxious
cstimuli cbeing cperceived cas cpainful. cExplained cby congoing ctissue cinjury.
thermal, cmechanical cand cchemical cnociceptors cthat cengage
c"withdrawal" creflex cfollowed cby cinflammatory cresponse cto cprotect
cinjured ctissue
3. functional cpain: cpain csensitivity cdue cto can cabnormal cprocessing cor
cfunction cof cthe ccentral cnervous csystem cin cresponse cto cnormal cstimuli
4. neruopathic cpain: cPain ccaused cby clesions cor cother cdamage cto
cthe cnervous csystem.
5. Diabetic cperipheral cneuropathy: cprogressive cdeterioration cof cnerve
cfunction cthat cresults cin closs cof csensory cperception
6. acute cpain: cis cpain cthat coccurs cas ca cresult cof cinjury cor csurgery,
cunder c3 cmonths. cPoorly ctreated cacute cpain ccan ccause cpsychological
cstress cand ccompromise cthe cimmune csystem. cSomatic cacute cpain cis
can cinjury cto cskin, cbone, cjoint, cmuscle cand cconnective ctissue. cVisceral
cpain cinvolves cinjury cto cnerves con cinternal corgans. cTreat caggressively.
cExamples: ccut chand, cmenstrual ccramps.
7. chronic cpain: ccan cbe cintermittent cor cpersistent, cmore cthan c3 cmonths.
cMain caffects cinclude ca) ceffects con cphysical cfunction cb) cpsychological
cchanges cc) csocial cconse- cquences cand cd) csocietal cconsequences.
cUsually cinvolving clife cthreatening cdiseases csuch cas ccancers, caids,
cprogressive cneurological cdiseases, cend cstage corgan cfailure, cdementia.
cManagement cshould cbe cmultimodal cwith ccognitive cinterventions,
cphysi- ccal cmanipulations, cpharmacological cagents, csurgical
1 c/
,cinterventions, cand cregional cor cspinal canesthesia.
8. chronic cmalignant cpain: cPainn cis cassociated cwith ca cprogressive clife-
threatening cdisease clike ccancer, caids, cneurologic cdiseases, cend cstage
corgan cfailure, cand cdemen- ctia. cGoal cis cpain calleviation cand cprevention.
cDependence cor caddiction cis cnot ca cconcern. cPain cnot cassociated cwith clife
cthreatening cdisease cand clasting cmore cthan c6 cmonths cbeyond cthe
chealing cperiod cis creferred cto cas c"chronic cnonmalignant cpain."
9. What care csome cnon-pharmacological capproaches cto cpain?: cimagery,
cdistrac- ction, crelaxation, cpsychotherapy, cbiofeedback, ccognitive
cbehavioral ctherapy, csupport cgroups, cand cspiritual ccounseling. cPhysical
ctherapy, cheat, ccold, cwater, cultrasound, cTENS, cmassage cand
ctherapeutic cexercise.
10.WHO c3 cstep canalgesic cladder: c* c1- cnonopioid
* 2 c- copioid cfor cmild cto cmoderate cpain
* 3 c- copioid cfor cmoderate cto csevere cpain
2 c/
, 11.WHO cfirst cstep cpain cladder: cmild cpain/nonopioid canalgesics csuch cas
cNSAIDS cor cacetaminophen cw/ cor cw/out cadjuvants c(such cas cpregablin)
c.. c"soreness." cMed cexamples: capap c1000mg cq c6hrs, cibu600mg cq6 chrs
12.NSAIDs: cNon-steroidal canti-inflammatory cdrugs. cassociated cwith
cseveral cclinical- cly csignificant ccontraindications cand cdrug cinteractions.
cNSAIDS care cequally ceffective cin canalgesia, cantipyretic cand canti-
inflammatory ceffects. cChoice cshould cinclude cSTEPS c(simplicity,
ctolerability, cevidence, cprice, csafety). cIf cpatient cfails ctherapy cwith can
cagent cfrom cone cclass cof cNSAIDs, cuse cof can cagent cfrom canother cclass
cis creasonable.
13.COX2 cinhibitors: cCelecoxib c(Celebrex) cselective cagents c(celecoxib)
chave cideal cindication cin cpatients cwith chigh crisk cfor cGI cbleed, chigh
cintolerance cof cnon-selective cNSAIDS, cor ctreatment cfailure cwith cnon-
selective cagents. cNSAIDs care cof cminimal cvalue cin cneuropathic cpain.
cNSAIDs cproduce ca cflat cdose cresponse ccurve c(celling ceffect) cwith chigher
cdoses cproviding cno cgreater cefficacy cthan cmoderate cdoses.
14.Acetaminophen: cTylenol. cblocks cPG csynthesis cin cCNS, cinhibits
cperipheral cpain cimpulses. cAPAP cdoes cnot cinterfere cwith cCOX c1 cor cCOX2
cand cthus chas cno canti-inflam- cmatory cbenefits.
15.WHO cpain cladder cstep c2: cmoderate cpain: cweak copioids c(hydrocodone,
ccodeine, ctramadol) cw/ cor cw/out cnonopioid canalgesics cw/ cor cw/out
cadjuvants c"every ctime cI cdo csomething, cit churts" cmed cexamples:
capa325mg c+ ccod c60mg cq4 chrs
16.WHO cpain cladder cstep c3: csevere cand cpersistent cpain, cpotent copioids
c(morphine, ctapentadol, coxycodone, chydromorphone, cfentanyl, cw/ cor
cw/out cnon-opioid canalgesics cand cwith cor cwithout cadjuvants c"no cmatter
cwhat cI cdo cit churts, ctheres ca cbone csticking cout cof cmy cskin!" cExamples;
cmorphine c10mg cq4 chrs, chydromorphone c4mg cq4 chr
17.What cis cthe cmechanism cof cNSAIDs cand cprecautions cto cuse?: cNSAIDS
care ceither cnonselective c(inhibit ccox c1 cand ccox c2) cor cselective c(inhibit
ccox c2). cCox c2 cinhi- cbition cis cresponsible cfor canti-inflammatory ceffects.
c- cCox c1 ccontributes cto cincreased cGI cand crenal ctoxicity cassoc cwith
cnonselective cNSAIDS. cUse cwith ccaution cin cpatients cwith cdyspepsia,
cpeptic culcers, cbleeding, cand cpatients ctaking ccorticosteroids. cNephro-
ctoxicity ccan coccur cin cthe celderly. cA cboxed cwarning cis cnow crequired cfor
cprescription cnonselective cNSAIDs cand cCelecoxib cdue cto cthe cincrease
crisk cof ccardiovascular cevents cand cGI cbleeding. cGenerally cpts
cprescribed cNSAIDS cwill cneed cPPI's.
18.Managment cfor cNSAID crisks: cPts cmore cpre-disposed cto cGI ctoxicity cif
3 c/
