NSG533 / NSG 533 Exam 2 (Latest 2024 / 2025): Advanced Pharmacology | Questions and Verified Answers | 100% Correct | Grade A - Wilkes

Exam 2: NSG533 / NSG 533 (Latest 2024 / 2025) Advanced Pharmacology Review | Questions and Verified Answers | 100% Correct | Grade A - Wilkes Q: NSAID use Nonselective COX-1 and COX-2 inhibitors (COX-2 does anti-inflammation) Precaution: GI issues, renal toxicity, antiplatelet effect No NSAID is better than others- but vary from patient to patient Best for: RA, menstrual cramps, postsurgical pain, bony metastasis Flat-dose curve response: higher doses aren't more effective than moderate doses but do increase ADRs ADRS: sodium retention, platelet inhibition, GI irritation, hepatic dysfunction, renal insufficiency, CNS dysfunction Caution: Diuretics, lithium, warfarin, nephrotoxicity, low creatinine clearance, antihypertensives, reduced cardiac capacity Q: APAP Answer: Inhibit prostaglandin synthesis in CNS and block pain impulses in the periphery Indication: mild-moderate pain including low back pain and osteoarthritis Limits: hepatotoxicity don't go over 4000 mg/day, caution with alcohol use, binge drinking Renal dysfunction: 50-75% dose reduction and for those with excessive ETOH use Q: Adjunctive pain medications Answer: Fibromyalgia: Duloxetine Diabetic peripheral nerve pain (DPN): duloxetine, pregabalin (lyrica) Post-herpetic neuralgia (PHN) (shingles): gabapentin, pregabalin, lidocaine patch Q: Opioids Answer: Opioids act by stimulating opioid receptors in CNS ADRs: Sedation, hallucinations, constipation, nausea, vomiting, urinary retention, myoclonus, respiratory depression Q: Opioids ADR management Answer: Excessive sedation: reduce dose by 25% or change interval Constipation: docusate at bedtime or BID, senna, bisacodyl, miralax, methylnaltrexone, naloxegol N/V: prevention: hydroxyzine, diphenhydramine, treatment: prochlorperazine, ondansetron Gastroparesis: metoclopramide Vertigo: meclizine Urticaria/itching: hydroxyzine, diphenhydramine Respiratory depression: mild: reduce by 25%, moderate-severe: naloxone CNS irritability: d/c opioid, treat with benzo Patients with CYP450 may respond differently to opioids: drug unresponsiveness - elevated toxic serum levels Tolerance to respiratory depression develops quickly Q: Opioid allergy Answer: Cross-sensitivity is unlikely patient is truly allergic to one chemical class within the opioid family such as morphine-like agents they may try a different one such as meperidine-like or methadone-like agents Mixed agonist/antagonist agents are treated as if they are morphine-like agents Q: Opioid conversion Answer: Opioid potency is compared using a reference standard of 10 mg parenteral morphine Current total daily dose is calculated (for 24 hours including any rescue dosages) and the total of the new dosage form is determined using a ratio of equianalgesic doses Sustained-release options may decrease by 25% due to oversedation concern Methadone is more potent than once believed and may need to be reduced after calculation as well as for elderly Q: migraine with aura Answer: 1 or more of: visual, sensory, speech, language, motor, brainstem, retinal 2 or more of: at least one aura symptom that spreads over 5 minutes, individual aura symptoms 5-60 minutes, followed by headache within 60 minutes 2 o more attacks (ever) Q: chronic migraine Answer: Occur >15x or more days per month, for a 3-month period or longer, without the overuse of analgesic medications Q: Migraine without aura Answer: 2 or more of: unilateral pain, pulsating pain, mod-severe pain, pain interrupts/worsen with physical activity 1 or more of: nausea/vomiting, photo/phonophobia Duration: 4-72 hours 5 or more attacks (ever) Q: cluster headaches: Severe, intermittent, short in duration Often at night, unilateral, explosive, excruciating, suicide headache PNS overactivity: lacrimation, rhinorrhea, sweating, eyelid edema, flushing, miosis, ptosis, nasal congestion Excited, restless during attacks compared to migraine seekers for quiet and solitude