NSG 533 Exam 2 Advanced Pharmacology
Wilkes Questions and Answers
1. What would you be concerned with regarding the first patient's use
of Vicodin in terms of the dose acetaminophen?
ANS In elderly patients, it is recommended not to exceed
>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?
ANS 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.
ANS Gabapentin, pregabalin, transdermal lidocaine, TCAs.
4. If a patient has a true allergy to morphine, what opioid, if any,
could you try instead?
ANS True opioid allergies are rare. When a true allergy is present, an agent from another opiate
classed 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
1/
17
,ANS 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
ANS 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
ANS 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?
ANS 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?
2/
17
, ANS -beta-blockers if not contraindicated (or CCB)
-low-dose TCAs (amitriptyline, venlafaxine)
-antiepileptics (topiramate, valproic acid, divalproex sodium)
10. What could you use in the treatment of acute migraine
symptoms?
ANS mild to moderate
APAP, ASA or combination products w/ caffeine
moderate to severe
triptans are 1st line
11. What absolute contraindications would prevent you from using
triptans?
ANS Hx of neurologic focality
Stroke
Poorly controlled HTN
Unstable angina
3/
17
Wilkes Questions and Answers
1. What would you be concerned with regarding the first patient's use
of Vicodin in terms of the dose acetaminophen?
ANS In elderly patients, it is recommended not to exceed
>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?
ANS 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.
ANS Gabapentin, pregabalin, transdermal lidocaine, TCAs.
4. If a patient has a true allergy to morphine, what opioid, if any,
could you try instead?
ANS True opioid allergies are rare. When a true allergy is present, an agent from another opiate
classed 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
1/
17
,ANS 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
ANS 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
ANS 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?
ANS 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?
2/
17
, ANS -beta-blockers if not contraindicated (or CCB)
-low-dose TCAs (amitriptyline, venlafaxine)
-antiepileptics (topiramate, valproic acid, divalproex sodium)
10. What could you use in the treatment of acute migraine
symptoms?
ANS mild to moderate
APAP, ASA or combination products w/ caffeine
moderate to severe
triptans are 1st line
11. What absolute contraindications would prevent you from using
triptans?
ANS Hx of neurologic focality
Stroke
Poorly controlled HTN
Unstable angina
3/
17
