Advanced Pharmacology - Wilkes
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,1. What would you be concerned with regarding the first patient's use of
Vicodin in terms of the dose acetaminophen?
Answer:
In elderly patients, it is recommended not to exceed 3,000 mg per day of
acetaminophen.
Rationale:
Older adults have increased risk of hepatotoxicity from acetaminophen, especially
with chronic use or liver impairment. Since Vicodin contains both hydrocodone
and acetaminophen, the total daily dose from all sources should be monitored
closely to avoid accidental overdose.
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2. What medication could you recommend for a diabetic patient in pain that
could also be used to help treat depression?
Answer:
SNRIs such as duloxetine or venlafaxine have been successfully used in diabetic
peripheral neuropathy.
Rationale:
Both duloxetine and venlafaxine can help not only with the neuropathic pain of
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, diabetes but also with comorbid depression, thus addressing two aspects of the
patient's health with a single agent.
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3. In addition, be sure to understand which non-opioid medications you
would use for a patient with neuropathic pain:
Answer:
Gabapentin, pregabalin, transdermal lidocaine, and TCAs.
Rationale:
These are first-line, evidence-based non-opioid medications that can effectively
treat neuropathic pain syndromes, each with specific indications and monitoring
parameters.
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4. If a patient has a true allergy to morphine, what opioid, if any, could you
try instead?
Answer:
When a true allergy is present, use an agent from another opioid class, such as
fentanyl.
Rationale:
Fentanyl is a synthetic opioid with a different structure from morphine and is less
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