Pharmacology Questions

1. Describe the three major types of pain and give an example of each. (Chapter 7)

2. The most commonly used drugs for pain management are the non-steroidal anti-inflammatory drugs and the opioids. Describe the mechanism of action of each group of drugs. Give an example of each. What type(s) of pain would each be useful for? (Chapter 7)

3. What are the advantages/disadvantages of using: (Chapter 7)
a. morphine
b. meperidine
c. methadone
d. butorphanol

4. What is Narcan used for? (Chapter 7)

5. Why are muscle relaxants sometimes used as analgesics? How do they work? Give an example of a muscle relaxant used as an analgesic. (Chapter 7)

6. Read the following case study on these questions.
a. What drug therapy would you prescribe and why? What dose would you prescribe?
b. List one or two adverse reactions for the selected agent that would cause you to change therapy.
c. What would be the choice for second-line therapy?

SN is a 52-year-old man with chronic nonmalignant pain of the nociceptive type. Most of his discomfort comes from degenerative osteoarthritis of the thoracic spine. He is a carpenter, and morning stiffness, joint pain, and occasional numbness of the hands makes working difficult at times.

Diagnosis: Osteoarthritis

7. Read the following case study and answer the following questions. You may have to consult a drug guide or another chapter in the book to answer these questions.

JD, a 15-year-old boy, receives severe burns while escaping from a building fire. The burns are extensive, including first and second degree burns covering much of his body and a local, full-thickness burn on his right forearm. He reaches the emergency room in severe pain, and is treated with IV morphine in increasing quantities until he reports that the pain has subsided. The dose of morphine is then maintained. The next day, he receives a skin graft covering the region of his full-thickness burn. During the operation the anesthesiologist provides a continuous IV infusion of remifentanil, with a bolus dose of morphine added 15 minutes before the end of the operation, and for 4 days thereafter. JD receives IV morphine through a patient-controlled analgesia device. As the burns heal, the morphine dose is tapered and eventually replaced with an oral codeine/acetaminophen combination tablet. Three months later, JD reports severe loss of sensation to touch in the area of the skin graft. He also describes a persistent tingling sensation in this area, with occasional bursts of sharp, knife-like pain. After referral to a pain clinic, JD is prescribed oral gabapentin, which partially reduces his symptoms. However, he reports to the pain clinic again two months later, still in severe pain. At this time, amitryptiline is added to the gabapentin, and the pain is further relieved. Three years later, JD’s lingering pain has resolved and no longer requires medication, but the lack of forearm sensation persists.

a. What was the rationale for the sequence of medications used during the skin graft operation?
b. Why was morphine tapered gradually and replaced with a combination of codeine/acetaminophen?
c. What was the rationale for using gabapentin and amitryptiline to treat JD’s chronic pain? What would be appropriate doses for this patient?

8. For each of the major groups of antibiotics describe the: (Chapter 8)
a. mechanism of action
b. spectrum of activity
c. some clinical uses
d. common side effects

The groups of antibiotics are:
I. aminoglycosides
II. beta-lactam/beta-lactamase inhibitor combinations
III. cephalosporins
IV. macrolides
V. penicillins
VI. fluoroquinolones
VII. sulfonamides
VIII. tetracyclines

9. Read the following case study and answer the questions.
A 25 year old married female client presents to your walk-in clinic for the first time complaining of a sore throat. She has tested positive for group A streptococcus of the oropharyngeal area. She also has a low grade fever. The sensitivity report is not yet available.
a. What questions are important to ask this patient prior to prescribing any drugs?
b. What drug or drugs would you recommend for this patient and why? What would be appropriate doses?
c. If the client developed diarrhea, how would you differentiate the diarrhea from pseudomembranous colitis? Assuming pseudomembranous colitis, what interventions would you implement to manage the diarrhea?
d. Why is it important to ensure completion of the antibiotic therapy? What two infectious sequela may occur with inadequate therapy against group A streptococcus?
e. What client education would be appropriate?

10. Describe the two proposed hypotheses of the migraine headache. (Chapter 38 & article)

11. What are the common symptoms of migraine? (Chapter 38 & article)

12. There are many groups of drugs used for the treatment of migraine headache. Read all of them and be able to: (Chapter 38 & article)
a. Describe mechanism of action
b. give an example
c. list common side effects

13. Describe the causes and symptoms of the various types of bacterial skin infections discussed in chapter 14. Give the drug therapy of choice and a second line of defense for treatment of this infection.

14. Read the case study on p. 171 and answer questions 2, 8, and 9. (Chapter 14)

15. What are the causes and symptoms of acne vulgaris? How do comedolytic drugs improve the symptoms of acne vulgaris? (Chapter 16)

16. What are the causes and symptoms of rosacea? (Chapter 16)

17. Read the following case study on p. 192 and answer questions 2, 5 and 6. (Chapter 16)

18. What is otitis media? Give causes and symptoms of otitis media. (Chapter 18)
19. Why are children prone to getting otitis media? Does drug therapy of otitis media differ in children as compared to adults? If so, how? (article)

20. Mrs. Thomas brings 30 month old Mark to the pediatrician’s office because he has been “irritable and feverish since last night.” Further history reveals that Mark also had a runny nose and cough for two days, and that his appetite and fluid intake have decreased since the fever started. He is otherwise healthy, this is the first episodic illness. You observe him pulling at ears. He has a temperature of 102. Degrees F, pulse 100x/minute, respiration rate 35x/minute, nasal congestion with clear discharge, tympanic membranes red and bulging bilaterally, pharynx slightly red without exudates, difficulty vocalizing. Chest clear, abdomen soft without hepatosplenomegali (HSM)and no meningeal sign.
a. What is the diagnosis?
b. What drug therapy would you prescribe and at what dose?
c. What parent education would be important?

21. What is otitis externa? Give causes and symptoms of otitis externa. (Chapter 18)

22. Read the case study on p. 226 and answer questions 2, 6 & 8. (Chapter 18)