NR - 293 PHARMACOLOGY EXAM 2 :
UNITS 3 AND 4 MASTERY GUIDE 2025
What are analgesic drugs?
- answer-Pain killers that relieve pain without causing loss of consciousness.
What are the 2 different class of analgesics?
- answer-opioids analgesics and adjuvant analgesics
What factors changes a person's perception of pain?
- answer-Varies by attitude, environment, culture, ethnicity
Past experience, anxiety, past experience, gender, general mental health
A patient with bone cancer tells the nurse that he is in pain. The nurse knows that
bone pain is classified as which type of pain?
a. Somatic pain
b. Referred pain
c. Visceral pain
d. Neuropathic pain
- answer-a. Somatic pain, which includes bone pain, originates from the skeletal
muscles, ligaments, and joints. Referred pain occurs when visceral nerve fibers
synapse at a level in the spinal cord close to fibers that supply specific
subcutaneous tissues in the body. Visceral pain originates from organs and smooth
muscles. Neuropathic pain usually results from damage to peripheral or CNS nerve
fibers or injury, but may also be idiopathic.
What are adjuvant drugs?
- answer-Are drugs that assist primary drug in relieving pain such as NSAIDs,
antidepressants, antiepileptics, and corticosteriods
1|Page
,Describe the WHO three-step analgesic ladder
- answer-Step 1: nonopioids (with or without adjuvant medications) after the pain
has been identified and assessed. If pain persists or increases, treatment moves to
Step 2: opioids with or without nonopioids and with or without adjuvants. If pain
persists or increases, management then rises to
Step 3: opioids indicated for moderate to severe pain, administered with or without
nonopioids or adjuvant medications.
What is the opiod ceiling effect?
- answer-Drug reaches a maximum analgesic effect
Analgesia does not improve, even with higher doses
What are the 3 classifications of opiods?
- answer-Agonist, Agonists-antagonist, antagonist
why is meriperidine not recommend for long term use?
- answer-Accumulation of neurotoxic metabolite - normerperidine which causes
seisures
What is the mechanism of Agonist?
- answer-Bind to an opioid pain receptor in the brain
Cause an analgesic response (reduction of pain sensation)
What is the mechanism of Agonist-antagonist?
- answer-Bind to a pain receptor
Cause a weaker neurologic response than a full agonist
Exert their effect by binding in different degrees to kappa + mu opiod receptors
Not usually first like pain treatment
Used in OB patients to provide pain relief to mom without sedating fetus
What is the mechanism of antagonist?
- answer-Competes with and reverses effect of agonist and agonist-antagonist
drugs at receptor site
2|Page
,What are the indications for opiod analgesics?
- answer-Main use: to alleviate moderate to severe pain
Often given with adjuvant analgesic drugs to assist primary drugs with pain relief
Opioids are also used for:
Cough center suppression
Treatment of diarrhea-Imodium
Balanced anesthesia
What are the contraindications for opiod analgesics?
- answer-Known drug allergy
Severe asthma
Use with extreme caution in patients with:
Respiratory insufficiency
Elevated intracranial pressure
Morbid obesity or sleep apnea
Paralytic ileus
Pregnancy
A patient is recovering from an appendectomy. She also has asthma and allergies
to shellfish and iodine. To manage her postoperative pain, the physician has
prescribed patient-controlled analgesia (PCA) with hydromorphone (Dilaudid).
Which vital sign is of greatest concern?
Pulse
Blood pressure
Temperature
Respirations
- answer-Correct answer: D
Rationale: This patient has a history of asthma and allergies, and she will be
receiving a drug that can depress respirations.
3|Page
, Adverse effects of Opiod analgesics?
- answer-CNS depression
Leads to respiratory depression
Most serious adverse effect
Nausea and vomiting - irritation of GI tract stimulates chemoreceptors zone in
CNS.
Urinary retention
Diaphoresis and flushing
Pupil constriction (miosis)
Constipation - slows peristalsis and increase water absorption from intestinal
contents.
Itching
Strong affinity for mu receptors for rapid onset and produce euphoria which leads
to high addiction.
Cause histamine relaease -> itching, rash, hemodynamic changes, flushing and
orthostatic hyper tension
A patient who has metastasized bone cancer has been on transdermal fentanyl
patches for pain management for 3 months. He has been hospitalized for tests and
has told the nurse that his pain is becoming "unbearable." The nurse is reluctant to
give him the ordered pain medication because the nurse does not want the patient
to get addicted to the medication. The nurse's actions reflect
appropriate concern for the patient's best welfare.
appropriate caution for a patient who is already on a long-term opioid.
an uncaring attitude toward the patient.
a failure to manage the patient's pain properly.
- answer-Correct answer: D
Rationale: Patients with severe pain, including metastatic pain or bone pain, may
need higher and higher doses of analgesics. The nurse is responsible for ensuring
that the patient experiences adequate pain relief.
Opioid Analgesics:
Toxicity and Management of Overdose
- answer-Naloxone (Narcan) - bind to all receptor sites -> competive antagonists ->
binds to these site.
4|Page
UNITS 3 AND 4 MASTERY GUIDE 2025
What are analgesic drugs?
- answer-Pain killers that relieve pain without causing loss of consciousness.
What are the 2 different class of analgesics?
- answer-opioids analgesics and adjuvant analgesics
What factors changes a person's perception of pain?
- answer-Varies by attitude, environment, culture, ethnicity
Past experience, anxiety, past experience, gender, general mental health
A patient with bone cancer tells the nurse that he is in pain. The nurse knows that
bone pain is classified as which type of pain?
a. Somatic pain
b. Referred pain
c. Visceral pain
d. Neuropathic pain
- answer-a. Somatic pain, which includes bone pain, originates from the skeletal
muscles, ligaments, and joints. Referred pain occurs when visceral nerve fibers
synapse at a level in the spinal cord close to fibers that supply specific
subcutaneous tissues in the body. Visceral pain originates from organs and smooth
muscles. Neuropathic pain usually results from damage to peripheral or CNS nerve
fibers or injury, but may also be idiopathic.
What are adjuvant drugs?
- answer-Are drugs that assist primary drug in relieving pain such as NSAIDs,
antidepressants, antiepileptics, and corticosteriods
1|Page
,Describe the WHO three-step analgesic ladder
- answer-Step 1: nonopioids (with or without adjuvant medications) after the pain
has been identified and assessed. If pain persists or increases, treatment moves to
Step 2: opioids with or without nonopioids and with or without adjuvants. If pain
persists or increases, management then rises to
Step 3: opioids indicated for moderate to severe pain, administered with or without
nonopioids or adjuvant medications.
What is the opiod ceiling effect?
- answer-Drug reaches a maximum analgesic effect
Analgesia does not improve, even with higher doses
What are the 3 classifications of opiods?
- answer-Agonist, Agonists-antagonist, antagonist
why is meriperidine not recommend for long term use?
- answer-Accumulation of neurotoxic metabolite - normerperidine which causes
seisures
What is the mechanism of Agonist?
- answer-Bind to an opioid pain receptor in the brain
Cause an analgesic response (reduction of pain sensation)
What is the mechanism of Agonist-antagonist?
- answer-Bind to a pain receptor
Cause a weaker neurologic response than a full agonist
Exert their effect by binding in different degrees to kappa + mu opiod receptors
Not usually first like pain treatment
Used in OB patients to provide pain relief to mom without sedating fetus
What is the mechanism of antagonist?
- answer-Competes with and reverses effect of agonist and agonist-antagonist
drugs at receptor site
2|Page
,What are the indications for opiod analgesics?
- answer-Main use: to alleviate moderate to severe pain
Often given with adjuvant analgesic drugs to assist primary drugs with pain relief
Opioids are also used for:
Cough center suppression
Treatment of diarrhea-Imodium
Balanced anesthesia
What are the contraindications for opiod analgesics?
- answer-Known drug allergy
Severe asthma
Use with extreme caution in patients with:
Respiratory insufficiency
Elevated intracranial pressure
Morbid obesity or sleep apnea
Paralytic ileus
Pregnancy
A patient is recovering from an appendectomy. She also has asthma and allergies
to shellfish and iodine. To manage her postoperative pain, the physician has
prescribed patient-controlled analgesia (PCA) with hydromorphone (Dilaudid).
Which vital sign is of greatest concern?
Pulse
Blood pressure
Temperature
Respirations
- answer-Correct answer: D
Rationale: This patient has a history of asthma and allergies, and she will be
receiving a drug that can depress respirations.
3|Page
, Adverse effects of Opiod analgesics?
- answer-CNS depression
Leads to respiratory depression
Most serious adverse effect
Nausea and vomiting - irritation of GI tract stimulates chemoreceptors zone in
CNS.
Urinary retention
Diaphoresis and flushing
Pupil constriction (miosis)
Constipation - slows peristalsis and increase water absorption from intestinal
contents.
Itching
Strong affinity for mu receptors for rapid onset and produce euphoria which leads
to high addiction.
Cause histamine relaease -> itching, rash, hemodynamic changes, flushing and
orthostatic hyper tension
A patient who has metastasized bone cancer has been on transdermal fentanyl
patches for pain management for 3 months. He has been hospitalized for tests and
has told the nurse that his pain is becoming "unbearable." The nurse is reluctant to
give him the ordered pain medication because the nurse does not want the patient
to get addicted to the medication. The nurse's actions reflect
appropriate concern for the patient's best welfare.
appropriate caution for a patient who is already on a long-term opioid.
an uncaring attitude toward the patient.
a failure to manage the patient's pain properly.
- answer-Correct answer: D
Rationale: Patients with severe pain, including metastatic pain or bone pain, may
need higher and higher doses of analgesics. The nurse is responsible for ensuring
that the patient experiences adequate pain relief.
Opioid Analgesics:
Toxicity and Management of Overdose
- answer-Naloxone (Narcan) - bind to all receptor sites -> competive antagonists ->
binds to these site.
4|Page
