NSG./533:./Pharm./Exam./2
1. What. / would. / you. / be. / concerned. / with. / regarding. / the. / first. / patient's. / use. / of. / Vic
odin./in./terms./of./the./dose./acetaminophen?:./In./elderly./patients,./it./is./recommended./not./to./exc
eed./>3,000mg./per./day./of./acetaminophen.
2. What. / medication. / could. / you. / recommend. / for. / a. / diabetic. / patient. / in. / pain. / that.
/ could./also./be./used./to./help./treat./depression?:./SNRIs;./either./duloxetine./or./venlafaxine./have./been.
/successfully./used./in./diabetic./peripheral./neuropathy.
3. In. / addition,. / be. / sure. / to. / understand. / which. / non-
opiod. / medications. / you. / would. / use./for./a./patient./with./neuropathic./pain.:./Gabapentin,./preg
abalin,./transdermal./lidocaine,./TCAs.
4. If. / a. / patient. / has. / a. / true. / allergy. / to. / morphine,. / what. / opioid,. / if. / any,. / could. / you. /
try./instead?:./True./opioid./allergies./are./rare../When./a./true./allergy./is./present,./an./agent./from./another./opiate./clas
sed./should./be./used../For./example,./a./patient./with./a./true./opiate./allergy./could./receive./fentanyl.
5. Know./the./common./side./effects./which./opioids./can./cause::./Excessive./sedation./(reduce./
dose./by./25%),./constipation./(senna,./dulcolax,./N/V./(hydroxyzine/./diphenhydramine),./gastroparesis,./vertigo,./resp..
/depression,./CNS./irritability.
6. Know./the./WHO./pain./treatment./algorithm::./Mild./pain./(1-3)./non-
opioid./analgesic./scheduled./ATC
Moderate./pain./(4-6)./Add./opioid./to./scheduled./non-opioid./ATC
Severe./pain./(7-10)./Switch./to./high./dose./opioid,./ATC
7. Understand. / when. / you. / would. / use. / acetaminophen. / versus. / an. / NSAID. / or. / an./
NSAID./instead./of./acetaminopehn:./NSAIDs./work./best./on./inflammatory./pain./or./pain./mediated./by.
/prostaglandins./(RA,./menstrual./and./post-
surgical./pain)./and./bony./metastasis../NSAIDS./come./with./increased./GIB./risk./and./renal./impairment.
APAP./is./a./good./first./line./for./mild./to./moderate./pain./and./considered./the./first./line./in./low./back./pain./and./osteoarthritic
../APAP./hepatotoxicity./has./occured./in./those./w../liver./injury./or./chronic./drinkers.
8. What. / class. / of. / prophylaxis. / for. / migraines. / should. / be. / avoided. / in. / asthmatics?-
:./Beta./blockers./would./usually./be./a./medication./used./in./the./prophylaxis./of./migraines./but./this./would./not./be./the./best./
choice./in./an./asthmatic.
9. What./could./you./use./for./prophylaxis./of./migraines?:./-beta-
blockers./if./not./contraindicated./(or./CCB)
./ .
/
, NSG./533:./Pharm./Exam./2
-low-dose./TCAs./(amitriptyline,./venlafaxine)
-antiepileptics./(topiramate,./valproic./acid,./divalproex./sodium)
10. What./could./you./use./in./the./treatment./of./acute./migraine./symptoms?:./mild./to. /
moderate:./APAP,./ASA./or./combination./products./w/./catteine
moderate./to./severe:./triptans./are./1st./line
11. What. / absolute. / contraindications. / would. / prevent. / you. / from. / using. / triptans?:. / H
x./of./neurologic./focality
Stroke
Poorly./controlled./HTN
Unstable./angina
12. What. / triggers. / would. / you. / want. / to. / tell. / a. / patient. / to. / avoid. / to. / help. / preve
nt./migraines./(non-pharmacologic./interventions)::./-emotional./stress
-sleep./excess./or./deficient
-strong./smells
-alcohol
-catteine
-fermented. / foods
-nitrates
-tobacco
-MSG
./ .
/
1. What. / would. / you. / be. / concerned. / with. / regarding. / the. / first. / patient's. / use. / of. / Vic
odin./in./terms./of./the./dose./acetaminophen?:./In./elderly./patients,./it./is./recommended./not./to./exc
eed./>3,000mg./per./day./of./acetaminophen.
2. What. / medication. / could. / you. / recommend. / for. / a. / diabetic. / patient. / in. / pain. / that.
/ could./also./be./used./to./help./treat./depression?:./SNRIs;./either./duloxetine./or./venlafaxine./have./been.
/successfully./used./in./diabetic./peripheral./neuropathy.
3. In. / addition,. / be. / sure. / to. / understand. / which. / non-
opiod. / medications. / you. / would. / use./for./a./patient./with./neuropathic./pain.:./Gabapentin,./preg
abalin,./transdermal./lidocaine,./TCAs.
4. If. / a. / patient. / has. / a. / true. / allergy. / to. / morphine,. / what. / opioid,. / if. / any,. / could. / you. /
try./instead?:./True./opioid./allergies./are./rare../When./a./true./allergy./is./present,./an./agent./from./another./opiate./clas
sed./should./be./used../For./example,./a./patient./with./a./true./opiate./allergy./could./receive./fentanyl.
5. Know./the./common./side./effects./which./opioids./can./cause::./Excessive./sedation./(reduce./
dose./by./25%),./constipation./(senna,./dulcolax,./N/V./(hydroxyzine/./diphenhydramine),./gastroparesis,./vertigo,./resp..
/depression,./CNS./irritability.
6. Know./the./WHO./pain./treatment./algorithm::./Mild./pain./(1-3)./non-
opioid./analgesic./scheduled./ATC
Moderate./pain./(4-6)./Add./opioid./to./scheduled./non-opioid./ATC
Severe./pain./(7-10)./Switch./to./high./dose./opioid,./ATC
7. Understand. / when. / you. / would. / use. / acetaminophen. / versus. / an. / NSAID. / or. / an./
NSAID./instead./of./acetaminopehn:./NSAIDs./work./best./on./inflammatory./pain./or./pain./mediated./by.
/prostaglandins./(RA,./menstrual./and./post-
surgical./pain)./and./bony./metastasis../NSAIDS./come./with./increased./GIB./risk./and./renal./impairment.
APAP./is./a./good./first./line./for./mild./to./moderate./pain./and./considered./the./first./line./in./low./back./pain./and./osteoarthritic
../APAP./hepatotoxicity./has./occured./in./those./w../liver./injury./or./chronic./drinkers.
8. What. / class. / of. / prophylaxis. / for. / migraines. / should. / be. / avoided. / in. / asthmatics?-
:./Beta./blockers./would./usually./be./a./medication./used./in./the./prophylaxis./of./migraines./but./this./would./not./be./the./best./
choice./in./an./asthmatic.
9. What./could./you./use./for./prophylaxis./of./migraines?:./-beta-
blockers./if./not./contraindicated./(or./CCB)
./ .
/
, NSG./533:./Pharm./Exam./2
-low-dose./TCAs./(amitriptyline,./venlafaxine)
-antiepileptics./(topiramate,./valproic./acid,./divalproex./sodium)
10. What./could./you./use./in./the./treatment./of./acute./migraine./symptoms?:./mild./to. /
moderate:./APAP,./ASA./or./combination./products./w/./catteine
moderate./to./severe:./triptans./are./1st./line
11. What. / absolute. / contraindications. / would. / prevent. / you. / from. / using. / triptans?:. / H
x./of./neurologic./focality
Stroke
Poorly./controlled./HTN
Unstable./angina
12. What. / triggers. / would. / you. / want. / to. / tell. / a. / patient. / to. / avoid. / to. / help. / preve
nt./migraines./(non-pharmacologic./interventions)::./-emotional./stress
-sleep./excess./or./deficient
-strong./smells
-alcohol
-catteine
-fermented. / foods
-nitrates
-tobacco
-MSG
./ .
/
