NSG 533 Exam 2 Advanced Pharmacology | Wilkes
University 2026/2027 | 150 Verified Q&A with
Rationales | Grade A+ Study Guide | Instant PDF
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,Q1. 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.
Q2. 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.
,Q3. 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.
Q4. 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), diphenylmethanes (methadone), and morphinans
(butorphanol).
Q5. Which cytochrome P450 enzyme is primarily responsible for the metabolism of warfarin,
phenytoin, and certain NSAIDs?
, A) CYP3A4
B) CYP2D6
C) CYP2C9
D) CYP1A2
Correct Answer: C
Rationale: CYP2C9 is the primary enzyme responsible for metabolizing warfarin, phenytoin, and
some NSAIDs. Genetic variations in CYP2C9 can significantly alter drug clearance, leading to
increased risk of bleeding with warfarin or toxicity with phenytoin. CYP3A4 metabolizes statins
and calcium channel blockers, while CYP2D6 metabolizes codeine and many antidepressants.
Q6. A patient is started on a drug with a half-life of 24 hours. Approximately how long will it take
to reach steady state?
A) 24 hours
B) 48 hours
C) 96 to 120 hours
D) 240 hours
Correct Answer: C
Rationale: Steady state is typically reached after approximately 4 to 5 half-lives. For a drug with
a 24-hour half-life, steady state would be achieved in roughly 96 to 120 hours (4 x 24 = 96; 5 x 24
= 120).
Q7. Which of the following drugs follows zero-order elimination kinetics?
A) Penicillin
B) Ethanol
C) Aspirin (low dose)
D) Morphine
Correct Answer: B
Rationale: Zero-order kinetics means a constant amount of drug is eliminated per unit of time,
regardless of plasma concentration. Ethanol is a classic example. Most drugs follow first-order
kinetics, where a constant fraction of the drug is eliminated per unit of time.
University 2026/2027 | 150 Verified Q&A with
Rationales | Grade A+ Study Guide | Instant PDF
Download
,Q1. 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.
Q2. 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.
,Q3. 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.
Q4. 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), diphenylmethanes (methadone), and morphinans
(butorphanol).
Q5. Which cytochrome P450 enzyme is primarily responsible for the metabolism of warfarin,
phenytoin, and certain NSAIDs?
, A) CYP3A4
B) CYP2D6
C) CYP2C9
D) CYP1A2
Correct Answer: C
Rationale: CYP2C9 is the primary enzyme responsible for metabolizing warfarin, phenytoin, and
some NSAIDs. Genetic variations in CYP2C9 can significantly alter drug clearance, leading to
increased risk of bleeding with warfarin or toxicity with phenytoin. CYP3A4 metabolizes statins
and calcium channel blockers, while CYP2D6 metabolizes codeine and many antidepressants.
Q6. A patient is started on a drug with a half-life of 24 hours. Approximately how long will it take
to reach steady state?
A) 24 hours
B) 48 hours
C) 96 to 120 hours
D) 240 hours
Correct Answer: C
Rationale: Steady state is typically reached after approximately 4 to 5 half-lives. For a drug with
a 24-hour half-life, steady state would be achieved in roughly 96 to 120 hours (4 x 24 = 96; 5 x 24
= 120).
Q7. Which of the following drugs follows zero-order elimination kinetics?
A) Penicillin
B) Ethanol
C) Aspirin (low dose)
D) Morphine
Correct Answer: B
Rationale: Zero-order kinetics means a constant amount of drug is eliminated per unit of time,
regardless of plasma concentration. Ethanol is a classic example. Most drugs follow first-order
kinetics, where a constant fraction of the drug is eliminated per unit of time.
