NSG 533 Advanced Pharmacology Exam (2026) Exam
Questions & Answers | Latest Already Graded A+
UPDATE |2026!! STUDY GUIDE EXAM Advanced
Pharmacology NSG 533
pain
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.
nociceptive pain
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
functional pain
Answer---; pain sensitivity due to an abnormal processing or function of the central nervous system in
response to normal stimuli
Diabetic peripheral neuropathy
Answer---; progressive deterioration of nerve function that results in loss of sensory perception
acute pain
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: cut hand, menstrual cramps.
chronic pain
Answer---; can be intermittent or persistent, more than 3 months. Main affects include a) effects 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.
What are some non-pharmacological approaches to pain?
Answer---; imagery, distraction, relaxation, psychotherapy, biofeedback, cognitive behavioral
therapy, support groups, and spiritual counseling. Physical therapy, heat, cold, water, ultrasound, TENS,
massage and therapeutic exercise.
WHO 3 step analgesic ladder
Answer---; * 1- nonopioid
* 2 - opioid for mild to moderate pain
* 3 - opioid for moderate to severe pain
WHO first step pain ladder
Answer---; mild pain/nonopioid analgesics such as NSAIDS or acetaminophen w/ or w/out adjuvants
(such as pregablin) .. "soreness." Med examples: apap 1000mg q 6hrs, ibu600mg q6 hrs
NSAIDs
Answer---; Non-steroidal anti-inflammatory drugs. associated with several clinically significant
contraindications and drug interactions. NSAIDS are equally effective in analgesia, antipyretic and anti-
inflammatory effects. 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.
COX2 inhibitors
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 effect) with higher doses providing no greater efficacy than moderate doses.
Acetaminophen
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.
WHO pain ladder step 2
Answer---; 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
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
What is the mechanism of NSAIDs and precautions to use?
Answer---; 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.
Managment for NSAID risks
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 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
Answer---; 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)
Answer---; 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?
Answer---; 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?
Answer---; 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)?
Answer---; 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
Questions & Answers | Latest Already Graded A+
UPDATE |2026!! STUDY GUIDE EXAM Advanced
Pharmacology NSG 533
pain
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.
nociceptive pain
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
functional pain
Answer---; pain sensitivity due to an abnormal processing or function of the central nervous system in
response to normal stimuli
Diabetic peripheral neuropathy
Answer---; progressive deterioration of nerve function that results in loss of sensory perception
acute pain
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: cut hand, menstrual cramps.
chronic pain
Answer---; can be intermittent or persistent, more than 3 months. Main affects include a) effects 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.
What are some non-pharmacological approaches to pain?
Answer---; imagery, distraction, relaxation, psychotherapy, biofeedback, cognitive behavioral
therapy, support groups, and spiritual counseling. Physical therapy, heat, cold, water, ultrasound, TENS,
massage and therapeutic exercise.
WHO 3 step analgesic ladder
Answer---; * 1- nonopioid
* 2 - opioid for mild to moderate pain
* 3 - opioid for moderate to severe pain
WHO first step pain ladder
Answer---; mild pain/nonopioid analgesics such as NSAIDS or acetaminophen w/ or w/out adjuvants
(such as pregablin) .. "soreness." Med examples: apap 1000mg q 6hrs, ibu600mg q6 hrs
NSAIDs
Answer---; Non-steroidal anti-inflammatory drugs. associated with several clinically significant
contraindications and drug interactions. NSAIDS are equally effective in analgesia, antipyretic and anti-
inflammatory effects. 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.
COX2 inhibitors
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 effect) with higher doses providing no greater efficacy than moderate doses.
Acetaminophen
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.
WHO pain ladder step 2
Answer---; 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
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
What is the mechanism of NSAIDs and precautions to use?
Answer---; 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.
Managment for NSAID risks
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 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
Answer---; 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)
Answer---; 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?
Answer---; 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?
Answer---; 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)?
Answer---; 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
