NSG 533/ NSG533 Exam 2 – Advanced Pharmacology Guide| Wilkes (Latest 2026/ 2027 Update) 100% Verified Questions & Answers | Grade A

NSG 533/ NSG533 Exam 2 – Advanced Pharmacology Guide| Wilkes (Latest 2026/ 2027 Update) 100% Verified Questions & Answers | Grade A What would you be concerned with regarding the first patient's use of Vicodin in terms of the dose acetaminophen? In elderly patients, it is recommended not to exceed 3,000mg per day of acetaminophen. 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. In addition, be sure to understand which non-opiod medications you would use for a patient with neuropathic pain. Gabapentin, pregabalin, transdermal lidocaine, TCAs. 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 classed should be used. For example, a patient with a true opiate allergy could receive fentanyl. 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. 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 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. 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. What could you use for prophylaxis of migraines? -beta-blockers if not contraindicated (or CCB) -low-dose TCAs (amitriptyline, venlafaxine) -antiepileptics (topiramate, valproic acid, divalproex sodium) What could you use in the treatment of acute migraine symptoms? mild to moderate: APAP, ASA or combination products w/ caffeine moderate to severe: triptans are 1st line What absolute contraindications would prevent you from using triptans? Hx of neurologic focality Stroke Poorly controlled HTN Unstable angina What triggers would you want to tell a patient to avoid to help prevent migraines (non pharmacologic interventions): -emotional stress -sleep excess or deficient -strong smells -alcohol -caffeine -fermented foods -nitrates -tobacco -MSG Know what are the "red flag symptoms" of headaches which signify the need for urgent medical care: -new onset sudden, severe pain -systemic signs (fever, weight loss, HTN) -focal neuro symptoms -papilledema (swelling of both optic discs in eyes d/t increased ICP -cough/ exertion triggered by HA -pregnancy or postpartum state -HIV -cancer patients -seizure activity Know the stepwise treatment algorithm for the treatment of chronic headaches/ migraines: 1. PMH, family hx, med hx 2. Assess info: triggers? Timing? 3. Develop POC: recommend pharmacotherapy that is financially feasible 4. Implement plan- log HA diary 5. Follow up- 4 weeks after starting new med If you had a patient w/ a hx of GERD and required a calcium supplement, what would be the best supplement to recommend? A patient w/ GERD is likely taking an antacid or something to decrease the acidity within the stomach. Calcium citrate does not require an acidic environment for absorption. Understand the use of bisphosphonates and counseling points when giving bisphosphonates (alendronate, risedronate and ibandronate): Follow specific instructions to avoid GI side effects Remain upright after taking If you had a male patient w/ osteoporosis, what could you recommend as a 1st line treatment? Bisphosphonates are considered 1st line therapy in male patients w/ osteoporosis. What medication would you recommend for a patient who has symptomatic hyperuricemia and is an over-producer and under excretor: Allopurinol is the medication of choice for symptomatic hyperuricemia and for over-producers and under excretors. What doses of calcium and vitamin D would you recommend for a patient based on their age? Men: 51-70: 1,000 mg calcium Woemn 51+/ Men 71+: 1,200mg calcium Men/ Women 50+: 800-1000 iu vitamin D Know current treatment guidelines of The American College of Rheumatology for the tx of OA: -lifestyle modifications -PT -heat/ cold therapy -oral NSAIDs, topical NSAIDs on superficial joints -APAP -tramadol -duloxetine Know which herbal/ OTC product is commonly used in the tx of OA Glucosamine and chondroitin Know all about tramadol; how it works, daily dose limits, interactions and side effects: -centrally acting synthetic opioid -weak SSRI/ SNRI -can cause dizzinesss, vertigo, N/V, lethargy -seizures reported; dose related, more so with TCAs and other SSRIs -risk for SEROTONIN SYNDROME -Max 200mg/ day Understand when you would initiate prophylaxis therapy in a patient w. gout (you would not typically recommend prophylaxis for a patient experiencing symptoms for the first time): -patients with 2 or more flares/ year -radiographic evidence attributable to gout -or one subcutaneous tophi are candidates for prophylaxis treatment What meds could you recommend for prophylaxis? Allopurinol is generally well tolerated, effective and affordable and treats overproduction of uric acid and underexcretion of uric acid. Febuxostat was found to be less effective in people with CVD. Probenecid acid increases excretion of uric acid. What meds would you recommend in the tx of acute symptoms of gout? -NSAIDs -cholchicine -glucocorticoids Colchicine works well if given w/in the first 24 hours of attack. What if a patient has gout and chronic kidney disease (which gout treatment would you want to avoid in this case): -avoid NSAIDS in chronic kidney disease -those with peptic ulcers -those taking anticoagulants What non-pharmacological interventions could you recommend to help a patient avoid gout attacks (what triggers should they avoid)? -life style modifications: weight loss, smoking + alcohol cessation -lower BP by following DASH diet -increase non-sugary fluid intake If a physician said a patient's community acquired pneumonia was caused by a virulent pathogen, what is the physician saying about the pathogen? More virulent pathogens will cause more severe disease What are risk factors for aspiration pneumonia? -dysphagia -change in oropharyngeal bacterial colonization -GERD -lowered host defense -oropharyngeal colonization can be from poor oral care, dental disease, tube feedings and medications -GERD creates lowered mucosal and cilia production, altered cough reflex and promotion of gram-negative bacilli colonization What microorganisms would you expect to cause CAP? S. pneumoniae is the predominant microorganism associated w/ CAP -other common organisms: haemophilus influenzae, mycoplasma pneumoniae, mortadella catarrhalis If the patient w/ CAP has comorbidities, what would an appropriate treatment regimen include? Beta-lactam or cephalosporin in combination w/ either a macrolide or doxycycline If opting for monotherapy, current reccomendations are a fluoroquinolone such as levofloxacin 750 mg daily, moxifloxacin 400 mg daily or gemifloxacin 320 mg daily If you chose monotherapy w/ a fluoroquinolone, what counseling points would you want to give regarding the use of antacids in a patient also taking a fluoroquinolone? Antacids may cause decreased effects of antibiotics, separate meds by at least 2 hours. Know how a gram stain works and what it tells us about the organism Gram stain gives rapid information that can be applied immediately and determines bacterial morphologic characteristics Know which organisms are a part of your "normal GI flora" stomach: lactobacillus, streptococcus sp small intestine: lactobacillus, streptococcus enterococcus, enterococcus, enterobacteriaceae, diphtheroids ileum: enterobacteriaceaea, enterococcus, peptostreptococcus, bacteroides, clostridium If the first patient had acute pyelonephritis, how would you change your selection of antibiotic, if at all? For complicated UTIs (pyelonephritis), usually fluoroquinolone is prescribed for a 7-14 day course of treatment What could you give if the patient was pregnant (what should you avoid)? Avoid fluoroquinolones, B-lactams are generally considered 1st line treatments What lab test would you order and monitor to determine if treatment for a UTI was required? Urine culture Which of the medication options for the second patient carries the highest risk of causing c. diff? Clindamycin Also, fluoroquinolones, cephalosporins, carbapenems and penicillins are most associated w/ c. diff If the patient was diagnosed w/ methicillin-sensitive staphylococcus aureus (MSSA) and had a penicillin allergy, how would this change your recommendation, if at all? Cefezolin Know about acute bacterial rhinosinusitis (ABRS)- common causes (bacterial pathogens) and treatment. ABX should target S. pneumoniae and H. influenzae Standard dose amoxicillin or amoxicillin clavulanate Know about serious side effects associated w/ the use of tetracyclines -Avoid use in pregnancy and children (tooth discoloration) -N/V/D -Photosensitivity Know the treatment guidelines for otitis media Most cases of AOM do not require abx, except in children younger than 2 ABX should be reserved for those likely to benefit Our second patient, Jimmy Chipwood had a mild cause of CAP MRSA. What oral antibiotics could you recommend? Dicloxacillin or cephalexin w/ cover s. aureus But if CAP MRSA is suspected, oral abx include -clindamycin, doxycycline or trimethoprim- sulfamethazole (TMP/ SMX) What if the patient had a penicillin allergy (there is another class of antibiotics, other than penicillins, that you would want to avoid in a patient w/ a penicillin allergy)? doxycyline or trimethoprim-sulfamethazole for (ca) MRSA and SEVERE PCN allergy MILD non-immunologic pcn allergies may receive B-lactam abx. Non-IgE reactions like Stevens-Johnson syndrome, toxic epidermal necrolysis or interstitial nephritis should avoid offending agents. What common pathogens would you expect to cause Jimmy's infection (skin/ soft tissue infection)? Furuncles (boils) and larger furuncles (carbuncles) are commonly caused by staphylococci. Those furuncles and carbuncles w/ purulent drainage w/ s/s of infection (fever) should be treated w/ an agent that will cover s. aureus (dicloxacillin or cephalexin) What treatment could you recommend if Jimmy's infection was methicillin susceptible staphylococcus aureus? MSSA coverage- dicloxacillin