NSG 533
EXAM 2
Advanced Pharmacology
Actual Questions with Verified Answers
Wilkes University
Pass the Exam with Confidence
What You Will Get:
➢100 Exam Questions w/ Answers
➢Expert Rationales included.
➢Exam 2 Comprehensive Study Guide
,Table of Contents
NSG 533 Exam 2 ................................................................................ 2
NSG 533 Exam 2 ............................................................................. 40
NSG 533 Exam 2 Study Guide ................................................. 69
NSG 533 Exam 2
1. What would you be concerned with regarding the first patient's use of Vicodin in
terms of the dose of acetaminophen?
A) The patient may develop renal toxicity from acetaminophen overdose.
B) In elderly patients, it is recommended not to exceed >3,000 mg per day of
acetaminophen.
C) Acetaminophen causes significant gastrointestinal bleeding in elderly patients.
D) Vicodin contains no acetaminophen, so there is no concern.
Correct Answer: B
Rationale: Vicodin is a combination medication containing hydrocodone and
acetaminophen. In elderly patients, the recommended maximum daily dose of
acetaminophen is 3,000 mg to reduce the risk of hepatotoxicity. Many patients may
unknowingly exceed this limit by taking multiple medications containing acetaminophen
(APAP). The FDA has set a maximum daily dose of 4,000 mg for the general population, but
geriatric patients and those with liver disease should not exceed 3,000 mg/day.
Acetaminophen does not cause significant GI bleeding (that's NSAIDs), and Vicodin
definitely contains acetaminophen.
,---
2. What medication could you recommend for a diabetic patient in pain that could
also be used to help treat depression?
A) Gabapentin
B) Duloxetine or venlafaxine
C) Tramadol
D) Amitriptyline
Correct Answer: B
Rationale: SNRIs (Serotonin-Norepinephrine Reuptake Inhibitors), specifically duloxetine
and venlafaxine, are dual-purpose medications. They are FDA-approved for the treatment of
diabetic peripheral neuropathic pain and are also effective antidepressants. Duloxetine is
particularly beneficial because it addresses both the neuropathic pain common in diabetes
and comorbid depression. Gabapentin treats neuropathic pain but is not an antidepressant.
Tramadol is an opioid analgesic with weak SSRI/SNRI properties but is not indicated for
depression. Amitriptyline is a TCA that can treat both conditions but is not the best answer
here as the question specifically asks about SNRIs.
---
3. In addition, be sure to understand which non-opioid medications you would use for a
patient with neuropathic pain. (Select All That Apply)
A) Gabapentin
B) Pregabalin
C) Transdermal lidocaine
,D) Tricyclic antidepressants (TCAs)
E) Acetaminophen
Correct Answers: A, B, C, D
Rationale: Neuropathic pain arises from damage to the nervous system and responds
poorly to traditional analgesics like acetaminophen and NSAIDs. First-line non-opioid
treatments for neuropathic pain include: Gabapentin and pregabalin (calcium channel
alpha-2-delta ligands that modulate neurotransmitter release), transdermal lidocaine (local
anesthetic that blocks sodium channels and nerve conduction), and TCAs such as
amitriptyline and nortriptyline (which inhibit reuptake of serotonin and norepinephrine,
modulating pain pathways). Acetaminophen is effective for nociceptive pain (inflammatory,
somatic) but has minimal efficacy for neuropathic pain.
---
4. If a patient has a true allergy to morphine, what opioid, if any, could you try
instead?
A) No opioid can be used if the patient has a true morphine allergy.
B) An agent from another opiate class should be used.
C) Only synthetic opioids like fentanyl can be used.
D) Hydromorphone is the safest alternative because it is structurally identical to morphine.
Correct Answer: B
Rationale: True opioid allergies are rare; most reported "allergies" are actually adverse
effects (nausea, itching, sedation). When a true allergy is present, an agent from a different
opiate class should be selected. Morphine is a phenanthrene derivative. Alternative classes
include: phenylpiperidines (fentanyl, meperidine), diphenylheptanes (methadone), or
benzomorphans. Hydromorphone is also a phenanthrene derivative and structurally
,similar to morphine, so it would NOT be a safe alternative. The key principle is to select
from a different structural class to minimize cross-reactivity risk.
---
5. Know the common side effects which opioids can cause: (Select All That Apply)
A) Excessive sedation
B) Constipation
C) Nausea and vomiting
D) Gastroparesis
E) Vertigo
F) Respiratory depression
G) CNS depression
Correct Answers: A, B, C, D, E, F, G
Rationale: Opioids produce numerous side effects through mu-receptor activation:
Excessive sedation (reduce dose by 25% if problematic); Constipation (most common and
persistent side effect—treat prophylactically with senna, dulcolax, or stool softeners);
Nausea/vomiting (often transient; treat with hydroxyzine or diphenhydramine);
Gastroparesis (delayed gastric emptying due to decreased GI motility); Vertigo (due to
vestibular effects); Respiratory depression (dose-dependent depression of medullary
respiratory centers—most serious adverse effect); CNS depression (sedation, confusion,
euphoria). Constipation is the only side effect that does NOT diminish with tolerance
development.
---
,6. Know the WHO pain treatment algorithm. A patient presents with moderate pain
rated 6/10. According to the WHO analgesic ladder, what is the appropriate
treatment?
A) Non-opioid analgesic scheduled around the clock (ATC)
B) Add opioid to scheduled non-opioid ATC
C) Switch to high-dose opioid ATC
D) Non-pharmacologic interventions only
Correct Answer: B
Rationale: The WHO three-step analgesic ladder guides pain management: Step 1 (Mild
pain 1-3/10): Non-opioid analgesic (acetaminophen, NSAID) scheduled ATC. Step 2
(Moderate pain 4-6/10): Add a "weak" opioid (e.g., codeine, tramadol, hydrocodone) to the
scheduled non-opioid. Step 3 (Severe pain 7-10/10): Switch to a "strong" opioid (morphine,
oxycodone, fentanyl) ATC, with non-opioid adjuncts continued. For moderate pain (6/10),
the correct step is to add an opioid to the baseline non-opioid regimen. Adjuvant
medications (antidepressants, anticonvulsants) can be added at any step for neuropathic
pain.
---
7. Understand when you would use acetaminophen versus an NSAID or an NSAID
instead of acetaminophen. Which statement is CORRECT?
A) NSAIDs are first-line for low back pain and osteoarthritis.
B) Acetaminophen is the drug of choice for inflammatory pain such as rheumatoid arthritis.
C) NSAIDs work best on inflammatory pain or pain mediated by prostaglandins, while
acetaminophen is first-line for mild to moderate pain and low back pain.
D) Acetaminophen carries a higher risk of gastrointestinal bleeding than NSAIDs.
,Correct Answer: C
Rationale: NSAIDs inhibit COX-1 and COX-2 enzymes, reducing prostaglandin synthesis.
They are most effective for inflammatory pain (rheumatoid arthritis, menstrual cramps,
post-surgical pain) and bony metastasis. However, NSAIDs carry increased risks of GI
bleeding, renal dysfunction, and cardiovascular events. Acetaminophen (APAP) is a good
first-line agent for mild to moderate pain and is considered first-line for low back pain and
osteoarthritis per current guidelines. APAP hepatotoxicity occurs primarily in patients with
liver injury, chronic alcohol use, or overdose. APAP has minimal anti-inflammatory activity
and virtually no GI bleeding risk.
---
8. What class of prophylaxis for migraines should be avoided in asthmatics?
A) Calcium channel blockers
B) Beta-blockers
C) Tricyclic antidepressants
D) Antiepileptics
Correct Answer: B
Rationale: Beta-blockers (propranolol, metoprolol, timolol) are commonly used for
migraine prophylaxis and are considered first-line agents. However, non-selective beta-
blockers can cause bronchoconstriction by blocking beta-2 receptors in the lungs, which
mediate bronchodilation. This poses a significant risk to patients with asthma or COPD. If
beta-blockers are absolutely necessary, cardioselective agents (metoprolol, atenolol) may
be considered with caution, but generally beta-blockers should be avoided in asthmatic
patients. Alternative prophylactic options for asthmatics include CCBs (verapamil), TCAs, or
antiepileptics (topiramate, valproic acid).
,---
9. What could you use for prophylaxis of migraines? (Select All That Apply)
A) Beta-blockers (if not contraindicated)
B) Calcium channel blockers
C) Low-dose TCAs (amitriptyline, venlafaxine)
D) Antiepileptics (topiramate, valproic acid, divalproex sodium)
Correct Answers: A, B, C, D
Rationale: Migraine prophylaxis is indicated when patients have ≥4 migraine days/month,
significant disability, or frequent acute medication use. Effective prophylactic agents
include: Beta-blockers (propranolol, metoprolol, timolol)—first-line; Calcium channel
blockers (verapamil, flunarizine)—alternative first-line; Low-dose TCAs (amitriptyline,
nortriptyline) and SNRIs (venlafaxine)—especially useful with comorbid
depression/anxiety; Antiepileptics (topiramate, valproic acid/divalproex sodium)—FDA-
approved for migraine prevention. OnabotulinumtoxinA (Botox) is approved for chronic
migraine (≥15 headache days/month). CGRP antagonists (erenumab, rimegepant) are
newer options.
---
10. What could you use in the treatment of acute migraine symptoms?
A) For mild to moderate: APAP, ASA, or combination products with caffeine; for moderate to
severe: triptans
B) Opioids are first-line for all migraine severities
C) NSAIDs should be avoided in acute migraine treatment
, D) Only rest in a dark room is recommended
Correct Answer: A
Rationale: Acute migraine treatment is stratified by severity: Mild to moderate migraines:
Acetaminophen (APAP), aspirin (ASA), or combination products with caffeine (Excedrin)
are first-line. These are most effective when taken at migraine onset. Moderate to severe
migraines: Triptans (sumatriptan, rizatriptan, eletriptan) are first-line. They are serotonin
5-HT1B/1D receptor agonists that cause vasoconstriction and inhibit neurogenic
inflammation. Triptans should be taken at the first sign of migraine for maximum efficacy.
Opioids are NOT first-line and should be reserved for refractory cases due to risk of
medication-overuse headache. NSAIDs (naproxen, ibuprofen) are actually commonly used.
Rest in a dark room is adjunctive, not standalone treatment.
---
11. What absolute contraindications would prevent you from using triptans? (Select
All That Apply)
A) History of neurologic focality
B) Stroke
C) Poorly controlled hypertension
D) Unstable angina
Correct Answers: A, B, C, D
Rationale: Triptans are potent vasoconstrictors and must be used cautiously. Absolute
contraindications include: History of neurologic focality or hemiplegic migraine (risk of
stroke mimics/worsening); Ischemic or hemorrhagic stroke (risk of recurrent
cerebrovascular event); Poorly controlled hypertension (triptans can further elevate BP,
risking hypertensive crisis); Unstable angina, myocardial infarction, or significant
EXAM 2
Advanced Pharmacology
Actual Questions with Verified Answers
Wilkes University
Pass the Exam with Confidence
What You Will Get:
➢100 Exam Questions w/ Answers
➢Expert Rationales included.
➢Exam 2 Comprehensive Study Guide
,Table of Contents
NSG 533 Exam 2 ................................................................................ 2
NSG 533 Exam 2 ............................................................................. 40
NSG 533 Exam 2 Study Guide ................................................. 69
NSG 533 Exam 2
1. What would you be concerned with regarding the first patient's use of Vicodin in
terms of the dose of acetaminophen?
A) The patient may develop renal toxicity from acetaminophen overdose.
B) In elderly patients, it is recommended not to exceed >3,000 mg per day of
acetaminophen.
C) Acetaminophen causes significant gastrointestinal bleeding in elderly patients.
D) Vicodin contains no acetaminophen, so there is no concern.
Correct Answer: B
Rationale: Vicodin is a combination medication containing hydrocodone and
acetaminophen. In elderly patients, the recommended maximum daily dose of
acetaminophen is 3,000 mg to reduce the risk of hepatotoxicity. Many patients may
unknowingly exceed this limit by taking multiple medications containing acetaminophen
(APAP). The FDA has set a maximum daily dose of 4,000 mg for the general population, but
geriatric patients and those with liver disease should not exceed 3,000 mg/day.
Acetaminophen does not cause significant GI bleeding (that's NSAIDs), and Vicodin
definitely contains acetaminophen.
,---
2. What medication could you recommend for a diabetic patient in pain that could
also be used to help treat depression?
A) Gabapentin
B) Duloxetine or venlafaxine
C) Tramadol
D) Amitriptyline
Correct Answer: B
Rationale: SNRIs (Serotonin-Norepinephrine Reuptake Inhibitors), specifically duloxetine
and venlafaxine, are dual-purpose medications. They are FDA-approved for the treatment of
diabetic peripheral neuropathic pain and are also effective antidepressants. Duloxetine is
particularly beneficial because it addresses both the neuropathic pain common in diabetes
and comorbid depression. Gabapentin treats neuropathic pain but is not an antidepressant.
Tramadol is an opioid analgesic with weak SSRI/SNRI properties but is not indicated for
depression. Amitriptyline is a TCA that can treat both conditions but is not the best answer
here as the question specifically asks about SNRIs.
---
3. In addition, be sure to understand which non-opioid medications you would use for a
patient with neuropathic pain. (Select All That Apply)
A) Gabapentin
B) Pregabalin
C) Transdermal lidocaine
,D) Tricyclic antidepressants (TCAs)
E) Acetaminophen
Correct Answers: A, B, C, D
Rationale: Neuropathic pain arises from damage to the nervous system and responds
poorly to traditional analgesics like acetaminophen and NSAIDs. First-line non-opioid
treatments for neuropathic pain include: Gabapentin and pregabalin (calcium channel
alpha-2-delta ligands that modulate neurotransmitter release), transdermal lidocaine (local
anesthetic that blocks sodium channels and nerve conduction), and TCAs such as
amitriptyline and nortriptyline (which inhibit reuptake of serotonin and norepinephrine,
modulating pain pathways). Acetaminophen is effective for nociceptive pain (inflammatory,
somatic) but has minimal efficacy for neuropathic pain.
---
4. If a patient has a true allergy to morphine, what opioid, if any, could you try
instead?
A) No opioid can be used if the patient has a true morphine allergy.
B) An agent from another opiate class should be used.
C) Only synthetic opioids like fentanyl can be used.
D) Hydromorphone is the safest alternative because it is structurally identical to morphine.
Correct Answer: B
Rationale: True opioid allergies are rare; most reported "allergies" are actually adverse
effects (nausea, itching, sedation). When a true allergy is present, an agent from a different
opiate class should be selected. Morphine is a phenanthrene derivative. Alternative classes
include: phenylpiperidines (fentanyl, meperidine), diphenylheptanes (methadone), or
benzomorphans. Hydromorphone is also a phenanthrene derivative and structurally
,similar to morphine, so it would NOT be a safe alternative. The key principle is to select
from a different structural class to minimize cross-reactivity risk.
---
5. Know the common side effects which opioids can cause: (Select All That Apply)
A) Excessive sedation
B) Constipation
C) Nausea and vomiting
D) Gastroparesis
E) Vertigo
F) Respiratory depression
G) CNS depression
Correct Answers: A, B, C, D, E, F, G
Rationale: Opioids produce numerous side effects through mu-receptor activation:
Excessive sedation (reduce dose by 25% if problematic); Constipation (most common and
persistent side effect—treat prophylactically with senna, dulcolax, or stool softeners);
Nausea/vomiting (often transient; treat with hydroxyzine or diphenhydramine);
Gastroparesis (delayed gastric emptying due to decreased GI motility); Vertigo (due to
vestibular effects); Respiratory depression (dose-dependent depression of medullary
respiratory centers—most serious adverse effect); CNS depression (sedation, confusion,
euphoria). Constipation is the only side effect that does NOT diminish with tolerance
development.
---
,6. Know the WHO pain treatment algorithm. A patient presents with moderate pain
rated 6/10. According to the WHO analgesic ladder, what is the appropriate
treatment?
A) Non-opioid analgesic scheduled around the clock (ATC)
B) Add opioid to scheduled non-opioid ATC
C) Switch to high-dose opioid ATC
D) Non-pharmacologic interventions only
Correct Answer: B
Rationale: The WHO three-step analgesic ladder guides pain management: Step 1 (Mild
pain 1-3/10): Non-opioid analgesic (acetaminophen, NSAID) scheduled ATC. Step 2
(Moderate pain 4-6/10): Add a "weak" opioid (e.g., codeine, tramadol, hydrocodone) to the
scheduled non-opioid. Step 3 (Severe pain 7-10/10): Switch to a "strong" opioid (morphine,
oxycodone, fentanyl) ATC, with non-opioid adjuncts continued. For moderate pain (6/10),
the correct step is to add an opioid to the baseline non-opioid regimen. Adjuvant
medications (antidepressants, anticonvulsants) can be added at any step for neuropathic
pain.
---
7. Understand when you would use acetaminophen versus an NSAID or an NSAID
instead of acetaminophen. Which statement is CORRECT?
A) NSAIDs are first-line for low back pain and osteoarthritis.
B) Acetaminophen is the drug of choice for inflammatory pain such as rheumatoid arthritis.
C) NSAIDs work best on inflammatory pain or pain mediated by prostaglandins, while
acetaminophen is first-line for mild to moderate pain and low back pain.
D) Acetaminophen carries a higher risk of gastrointestinal bleeding than NSAIDs.
,Correct Answer: C
Rationale: NSAIDs inhibit COX-1 and COX-2 enzymes, reducing prostaglandin synthesis.
They are most effective for inflammatory pain (rheumatoid arthritis, menstrual cramps,
post-surgical pain) and bony metastasis. However, NSAIDs carry increased risks of GI
bleeding, renal dysfunction, and cardiovascular events. Acetaminophen (APAP) is a good
first-line agent for mild to moderate pain and is considered first-line for low back pain and
osteoarthritis per current guidelines. APAP hepatotoxicity occurs primarily in patients with
liver injury, chronic alcohol use, or overdose. APAP has minimal anti-inflammatory activity
and virtually no GI bleeding risk.
---
8. What class of prophylaxis for migraines should be avoided in asthmatics?
A) Calcium channel blockers
B) Beta-blockers
C) Tricyclic antidepressants
D) Antiepileptics
Correct Answer: B
Rationale: Beta-blockers (propranolol, metoprolol, timolol) are commonly used for
migraine prophylaxis and are considered first-line agents. However, non-selective beta-
blockers can cause bronchoconstriction by blocking beta-2 receptors in the lungs, which
mediate bronchodilation. This poses a significant risk to patients with asthma or COPD. If
beta-blockers are absolutely necessary, cardioselective agents (metoprolol, atenolol) may
be considered with caution, but generally beta-blockers should be avoided in asthmatic
patients. Alternative prophylactic options for asthmatics include CCBs (verapamil), TCAs, or
antiepileptics (topiramate, valproic acid).
,---
9. What could you use for prophylaxis of migraines? (Select All That Apply)
A) Beta-blockers (if not contraindicated)
B) Calcium channel blockers
C) Low-dose TCAs (amitriptyline, venlafaxine)
D) Antiepileptics (topiramate, valproic acid, divalproex sodium)
Correct Answers: A, B, C, D
Rationale: Migraine prophylaxis is indicated when patients have ≥4 migraine days/month,
significant disability, or frequent acute medication use. Effective prophylactic agents
include: Beta-blockers (propranolol, metoprolol, timolol)—first-line; Calcium channel
blockers (verapamil, flunarizine)—alternative first-line; Low-dose TCAs (amitriptyline,
nortriptyline) and SNRIs (venlafaxine)—especially useful with comorbid
depression/anxiety; Antiepileptics (topiramate, valproic acid/divalproex sodium)—FDA-
approved for migraine prevention. OnabotulinumtoxinA (Botox) is approved for chronic
migraine (≥15 headache days/month). CGRP antagonists (erenumab, rimegepant) are
newer options.
---
10. What could you use in the treatment of acute migraine symptoms?
A) For mild to moderate: APAP, ASA, or combination products with caffeine; for moderate to
severe: triptans
B) Opioids are first-line for all migraine severities
C) NSAIDs should be avoided in acute migraine treatment
, D) Only rest in a dark room is recommended
Correct Answer: A
Rationale: Acute migraine treatment is stratified by severity: Mild to moderate migraines:
Acetaminophen (APAP), aspirin (ASA), or combination products with caffeine (Excedrin)
are first-line. These are most effective when taken at migraine onset. Moderate to severe
migraines: Triptans (sumatriptan, rizatriptan, eletriptan) are first-line. They are serotonin
5-HT1B/1D receptor agonists that cause vasoconstriction and inhibit neurogenic
inflammation. Triptans should be taken at the first sign of migraine for maximum efficacy.
Opioids are NOT first-line and should be reserved for refractory cases due to risk of
medication-overuse headache. NSAIDs (naproxen, ibuprofen) are actually commonly used.
Rest in a dark room is adjunctive, not standalone treatment.
---
11. What absolute contraindications would prevent you from using triptans? (Select
All That Apply)
A) History of neurologic focality
B) Stroke
C) Poorly controlled hypertension
D) Unstable angina
Correct Answers: A, B, C, D
Rationale: Triptans are potent vasoconstrictors and must be used cautiously. Absolute
contraindications include: History of neurologic focality or hemiplegic migraine (risk of
stroke mimics/worsening); Ischemic or hemorrhagic stroke (risk of recurrent
cerebrovascular event); Poorly controlled hypertension (triptans can further elevate BP,
risking hypertensive crisis); Unstable angina, myocardial infarction, or significant
