NSGvj533:vjPharmvjExamvj2
1. Whatv j wouldv j youv j bev j concernedv j withv j regardingv j thev j firstv j patient'sv j usev j ofv j Vic
odinvjinvjtermsvjofvjthevjdosevjacetaminophen?:vjInvjelderlyvjpatients,vjitvjisvjrecommendedvjnotvjtovjexcee
d
>3,000mgvjpervjdayvjofvjacetaminophen.
2. Whatv j medicationv j couldv j youv j recommendv j forv j av j diabeticv j patientv j inv j painv j thatv
j couldvjalsovjbevjusedvjtovjhelpvjtreatvjdepression?:vjSNRIs;vjeithervjduloxetinevjorvjvenlafaxinevjhavevjbee
nvjsuccessfullyvjusedvjinvjdiabeticvjperipheralvjneuropathy.
3. Inv j addition,v j bev j surev j tov j understandv j whichv j non-
opiodv j medicationsv j youv j wouldvjusevjforvjavjpatientvjwithvjneuropathicvjpain.:vjGabapentin,vjpr
egabalin,vjtransdermalvjlidocaine,vjTCAs.
4. Ifv j av j patientv j hasv j av j truev j allergyv j tov j morphine,v j whatv j opioid,v j ifv j any,v j couldv j yo
uv j tryvjinstead?:vjTruevjopioidvjallergiesvjarevjrare.vjWhenvjavjtruevjallergyvjisvjpresent,vjanvjagentvjfromvjanothervjopiatevjc
lassedvjshouldvjbevjused.vjForvjexample,vjavjpatientvjwithvjavjtruevjopiatevjallergyvjcouldvjreceivevjfentanyl.
5. Knowvjthevjcommonvjsidevjeffectsvjwhichvjopioidsvjcanvjcause::vjExcessivevjsedationvj(reduc
evjdosevjbyvj25%),vjconstipationvj(senna,vjdulcolax,vjN/Vvj(hydroxyzine/vjdiphenhydramine),vjgastroparesis,vjvertigo,vjres
p.vjdepression,vjCNSvjirritability.
6. KnowvjthevjWHOvjpainvjtreatmentvjalgorithm::vjMildvjpainvj(1-3)vjnon-
opioidvjanalgesicvjscheduledvjATC
Moderatevjpainvj(4-6)vjAddvjopioidvjtovjscheduledvjnon-opioidvjATC
Severevjpainvj(7-10)vjSwitchvjtovjhighvjdosevjopioid,vjATC
7. Understandv j whenv j youv j wouldv j usev j acetaminophenv j versusv j anv j NSAIDv j orv j anvjN
SAIDvjinsteadvjofvjacetaminopehn:vjNSAIDsvjworkvjbestvjonvjinflammatoryvjpainvjorvjpainvjmediatedvjbyvjpros
taglandinsvj(RA,vjmenstrualvjandvjpost-
surgicalvjpain)vjandvjbonyvjmetastasis.vjNSAIDSvjcomevjwithvjincreasedvjGIBvjriskvjandvjrenalvjimpairment.
APAPvjisvjavjgoodvjfirstvjlinevjforvjmildvjtovjmoderatevjpainvjandvjconsideredvjthevjfirstvjlinevjinvjlowvjbackvjpainvjandvjosteoarthritic.vjAPAP
vjhepatotoxicityvjhasvjoccuredvjinvjthosevjw.vjlivervjinjuryvjorvjchronicvjdrinkers.
8. Whatvjclassvjofvjprophylaxisvjforvjmigrainesvjshouldvjbevjavoidedvjinvjasthmatics?:vjBetavj
blockersvjwouldvjusuallyvjbevjavjmedicationvjusedvjinvjthevjprophylaxisvjofvjmigrainesvjbutvjthisvjwouldvjnotvjbevjthevjbestvjchoic
evjinvjanvjasthmatic.
9. Whatvjcouldvjyouvjusevjforvjprophylaxisvjofvjmigraines?:vj-beta-
vj v
j
, NSGvj533:vjPharmvjExamvj2
blockersvjifvjnotvjcontraindicatedvj(orvjCCB)
vj v
j
1. Whatv j wouldv j youv j bev j concernedv j withv j regardingv j thev j firstv j patient'sv j usev j ofv j Vic
odinvjinvjtermsvjofvjthevjdosevjacetaminophen?:vjInvjelderlyvjpatients,vjitvjisvjrecommendedvjnotvjtovjexcee
d
>3,000mgvjpervjdayvjofvjacetaminophen.
2. Whatv j medicationv j couldv j youv j recommendv j forv j av j diabeticv j patientv j inv j painv j thatv
j couldvjalsovjbevjusedvjtovjhelpvjtreatvjdepression?:vjSNRIs;vjeithervjduloxetinevjorvjvenlafaxinevjhavevjbee
nvjsuccessfullyvjusedvjinvjdiabeticvjperipheralvjneuropathy.
3. Inv j addition,v j bev j surev j tov j understandv j whichv j non-
opiodv j medicationsv j youv j wouldvjusevjforvjavjpatientvjwithvjneuropathicvjpain.:vjGabapentin,vjpr
egabalin,vjtransdermalvjlidocaine,vjTCAs.
4. Ifv j av j patientv j hasv j av j truev j allergyv j tov j morphine,v j whatv j opioid,v j ifv j any,v j couldv j yo
uv j tryvjinstead?:vjTruevjopioidvjallergiesvjarevjrare.vjWhenvjavjtruevjallergyvjisvjpresent,vjanvjagentvjfromvjanothervjopiatevjc
lassedvjshouldvjbevjused.vjForvjexample,vjavjpatientvjwithvjavjtruevjopiatevjallergyvjcouldvjreceivevjfentanyl.
5. Knowvjthevjcommonvjsidevjeffectsvjwhichvjopioidsvjcanvjcause::vjExcessivevjsedationvj(reduc
evjdosevjbyvj25%),vjconstipationvj(senna,vjdulcolax,vjN/Vvj(hydroxyzine/vjdiphenhydramine),vjgastroparesis,vjvertigo,vjres
p.vjdepression,vjCNSvjirritability.
6. KnowvjthevjWHOvjpainvjtreatmentvjalgorithm::vjMildvjpainvj(1-3)vjnon-
opioidvjanalgesicvjscheduledvjATC
Moderatevjpainvj(4-6)vjAddvjopioidvjtovjscheduledvjnon-opioidvjATC
Severevjpainvj(7-10)vjSwitchvjtovjhighvjdosevjopioid,vjATC
7. Understandv j whenv j youv j wouldv j usev j acetaminophenv j versusv j anv j NSAIDv j orv j anvjN
SAIDvjinsteadvjofvjacetaminopehn:vjNSAIDsvjworkvjbestvjonvjinflammatoryvjpainvjorvjpainvjmediatedvjbyvjpros
taglandinsvj(RA,vjmenstrualvjandvjpost-
surgicalvjpain)vjandvjbonyvjmetastasis.vjNSAIDSvjcomevjwithvjincreasedvjGIBvjriskvjandvjrenalvjimpairment.
APAPvjisvjavjgoodvjfirstvjlinevjforvjmildvjtovjmoderatevjpainvjandvjconsideredvjthevjfirstvjlinevjinvjlowvjbackvjpainvjandvjosteoarthritic.vjAPAP
vjhepatotoxicityvjhasvjoccuredvjinvjthosevjw.vjlivervjinjuryvjorvjchronicvjdrinkers.
8. Whatvjclassvjofvjprophylaxisvjforvjmigrainesvjshouldvjbevjavoidedvjinvjasthmatics?:vjBetavj
blockersvjwouldvjusuallyvjbevjavjmedicationvjusedvjinvjthevjprophylaxisvjofvjmigrainesvjbutvjthisvjwouldvjnotvjbevjthevjbestvjchoic
evjinvjanvjasthmatic.
9. Whatvjcouldvjyouvjusevjforvjprophylaxisvjofvjmigraines?:vj-beta-
vj v
j
, NSGvj533:vjPharmvjExamvj2
blockersvjifvjnotvjcontraindicatedvj(orvjCCB)
vj v
j
