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Pharm Exam 2
| Question | Answer |
|---|---|
| pharmacokinetics | process of drug movement throughout the body necessary to achieve drug action |
| process of pharmacokinetics includes: | absorption, distribution, metabolism and excretion |
| pharmacodynamics | what the drug does to the body as a drug moves throughout the body |
| drug absorption | drug movement from GI tract into blood stream |
| what factors affect bioavailability? | drug form, route of administration, gastric, change in liver metabolism, and administration with food and other drugs |
| what can affect drug absorption? | blood flow, pain, stress, hunger, fasting,food and pH |
| what kind of drugs have a high risk of drug-to-drug interaction and cause toxicity? | high- protein binding drugs |
| lower albumin levels can be due to: | malnourishment. and anorexia |
| What is the primary site of metabolism? | liver |
| drug metabolism | process by which the body chemically changes drugs into a form that can be excreted |
| the drug Warfarins is used as a ____ | blood thinner |
| drug distribution | movement of drugs from circulation to body tissues |
| influencing factors of drug distribution | protein binding, free drugs, and the blood-brain barrier |
| drug absorption methods | passive transport: diffusion or facilitated diffusion |
| half-life | drug half-life (t½) is the time it takes for the amount of drug in the body to be reduced by half |
| what affects the half-life of a drug? | the amount of drug administered, the amount of drug remaining in the body from previous doses, metabolism, and elimination |
| drug distribution | diistribution is drug movement from the blood to the tissues and into the cells. |
| what three major factors determine drug distribution? | blood flow to tissues, the ability of a drug to exit the vascular system, and the ability of a drug to enter cells |
| protien-binding | as drugs are distributed in the plasma, many bind with plasma proteins |
| highly protein-bound drugs | drugs that are more than 90% bound to protein |
| weakly protein-bound drugs | drugs that are less than 10% bound to protein |
| blood-brain barrier | Blood vessels in the brain have a special endothelial lining where the cells are pressed tightly together |
| The liver metabolizes drugs into which component for renal excretion? | Water-soluble substance |
| Only _____ of the 12 closely related cytochrome P450 enzyme families metabolize drugs. | 3 |
| Which factors decrease drug metabolism? | malnutrition, kidney disease, cardiovascular disease |
| glomerular filtration | Moves drugs from Blood to urine |
| Passive tubular reabsorption | Lipid-soluble drugs move back into the blood |
| Active tubular secretion | "Pumps" for organic acids and bases move drugs from blood to urine |
| which organ accounts for most drug excretion, thereby limiting the duration of action of many drugs? | Kidneys |
| Drugs are excreted by which routes? | Feces,Lungs,Breast milk |
| Which route of drug administration is most likely to be reversible? | Oral |
| Which route of drug administration delivers drugs directly to the tissue where they exert their actions? | inhalation |
| Which factors may affect drug absorption? | Surface area, Lipid solubility,Rate of dissolution |
| Which conditions decrease blood flow to tissues, thereby reducing the effectiveness of drug therapy? | Abscess Solid Tumor |
| The nurse knows that warfarin is 99% protein-bound, whereas bupropion is 84% protein bound. If both of these drugs are administered concurrently, which events could occur? | Warfarin could displace bupropion from its binding site.Bupropion could accumulate to toxic levels. |
| To safely administer drugs, nurses must understand that only certain drugs can cross the blood-brain barrier (BBB), including those that are highly lipid-soluble and of low molecular weight. Which drug can cross the BBB? | Diazepam |
| Drug Inactivation | Conversion of procaine into para-aminobenzoic acid (PABA) |
| Increased therapeutic action | Conversion of codeine into morphine |
| Increased Toxicity | Conversion of acetaminophen into metabolite - |
| Increased renal excretion | Conversion of lipid-soluble drugs into water-soluble drugs |
| Which routes of administration can be used to avoid the first-pass effect? | Topical, Intranasal, Intravenous, inhalation |
| Which factors alter drug metabolism in older adults? | Decreased liver mass, Decreased hepatic blood flow |
| Kidney stones and urinary obstruction alter which pharmacokinetic principle? | Excretion |
| Drugs with which property are excreted in breast milk? | Lipid soluble |
| Certain drugs must undergo which process before enterohepatic recirculation can occur? | Glucuronidation |
| Which statement is accurate regarding the graph? | Meperdinehas greater efficacy than pentazocine |
| If the body eliminates a drug more slowly than the drug enters the body, which conditions can occur? | toxic concentration, Increased side effects |
| Cell membrane–embedded enzymes | Binding site is on cell surface. |
| Ligand-gated ion channels | Cell membrane channel opens, and ions flow into and out of the cells. |
| G protein–coupled receptor systems | take three steps to activate this receptor response. |
| Transcription factors | Activation of receptors through this family regulates protein synthesis. |
| Which type of drug can mimic or block the actions of receptors? | Partial agonists |
| Which term describes the most likely cause of orthostatic hypotension that occurs in a patient who is taking six different drugs? | Drug-drug interaction |
| Which drug may cause toxicity when taken with grapefruit juice? | Cyclosporine |
| Patients may experience reduced effectiveness of which drugs when taken with St. John’s wort? | Digoxin Warfarin Oral contraceptives |
| Which patients are more vulnerable to adverse effects? | Pediatric patients Older adult patients Patients with chronic illness |
| Side effect | Results from decreased drug clearance |
| Toxic effect | Usually requires prior exposure |
| Dose-related adverse effect | Genetically determined abnormal response to a drug |
| Nurses understand patients taking which narrow therapeutic index (TI) drugs require close monitoring of blood levels to adjust dosing? | Digoxin Lithium Warfarin Phenytoin |
| A patient is prescribed an increased dose of a drug to improve control of their blood pressure. A week later, there is no change in the patient’s blood pressure (BP). Which phase of the dose-response curve might this reflect? | Phase 3 |
| When providing care for a person who has stopped taking a drug with a half-life of 4 hours, how long will it take for 94% of the drug to leave the body? | 16 hours |
| Which drug best meets the criteria for a selective drug? | Which drug best meets the criteria for a selective drug? |
| Which types of drugs work through physical or chemical reactions rather than through receptor binding? | Antacids Hormones Saline laxatives Chelating agents |
| Which common symptoms may indicate a drug-drug interaction in a patient taking multiple drugs? | Nausea Heartburn Headache Lightheadedness |
| Additive drug interaction | Administering a diuretic and beta blocker for hypertension |
| Synergistic | Using two cytotoxic drugs to treat cancer at lower doses than if given alone |
| Potentiation | Adding a bacterial enzyme inhibitor to an antibiotic |
| Antagonistic | Giving naloxone to block harmful effects of morphine overdose |
| Which drug(s) classes interact adversely with cheeses? | Tetracyclineso Fluoroquinoloneso Monoamine oxidase (MAO) inhibitors |
| Which of the four receptor families regulates protein synthesis? | Transcription factors |
| Nurses understand that to provide for patient safety with respect to drug administration, they should take which actions? | Teach patients about the side effects of drugs they take Teach the patient in an environment conducive to learning Provide education in a manner appropriate to the patient’s cognitive abilities |
| After administering lorazepam to an older adult patient with restlessness and crying, the patient becomes hostile and aggressive and has angry outbursts and psychomotor agitation. Which type of adverse drug effect is the patient experiencing? | Paradoxical reaction |
| The nurse is preparing to infuse the 0900 dose of gentamycin 80 mg intravenously (IV) over 1 hour to a patient for an infection. At which time would the nurse obtain an ordered blood sample to determine the peak drug level? | 1100 |
| Which action enables drugs to exert their effects on the body? | Interacting with receptors, inhibiting the action of a specific enzyme, and altering metabolic chemical responses |
| Which drugs will the. nurse administer to a patient in need of an immediate drug response? | A loading dose |
| What factor influences the absorption of oral medications? | Pain, pH of the stomach, form of drug preparation, and presence of food in the stomach |
| Which condition increases the risk for drug toxicity in a patient being treated with a highly protein-bound drug? | Liver cirrhosis. kidney disease, and nutritional deficiency |
| Which time frame would a nurse select for a blood sample to be drawn from a patient to obtain a trough level? | Just before the administration of the next dose |
| Which effect will the nurse suspect when a patient receiving pain medication more than 24 hours states, "This medication is not helping my pain like it did yesterday"? | Tachyphylaxis |
| Which interpretation will guide the nurse's care of a patient when administering medication with a half-life of 12 hours> | This medication will be 50% eliminated in 12 hours, so the dosing will be spread out. |
| Which process occurs when a drug is aborbed in the mouth and then found in trace amounts in the urine and cerebrospinal fluid 12 hours later? | Pharmacokinetics |
| Which instruction would the nurse include when teaching a patient about the administration of sulfonamide? | "Stay out of the sun when possible, and use sunscreen when you are outside." |
| Which instruction will the nurse give to a patient prescribed ciprofloxacin for bronchitis to prevent antagonistic effects? | "Avoid taking the drug with milk." |
| Phases of pharmacokinetics in order | Absorption, Distribution, Biotransformation, Excretion |
| Which type of effect occurs when a psychological benefit is obtained from a compound that may not have a drug effect? | Placebo |
| Which intervention will the nurse implement when caring for a patient who is receiving a drug with a narrow therapeutic index? | Monitor the patient's plasma drug level periodically. |
| Which action would the nurse consider when administering two highly protein-bound drugs to a patient? | Asses the patient frequently for the risk. of drug-drug interactions. |
| What is your priority nursing action based on your interaction with Lois and Jim in relation to their herbal remedies? | Assess their knowledge on the herbal remedies and potential side effects and interactions. |
| Which herb may interfere with Lois's current treatment for osteopenia? | St. John's wort |
| Lois and Jim ask which potential drug-drug interaction may happen with taking garlic, Ginkgo biloba, and aspirin together? | Anticoagulation |
| What health promotion strategy will you discuss with Lois and Jim while they are taking St. John's wort? | Use sunscreen daily. |
| which common over-the-counter medication may pose a significant drug-drug adverse reaction if taken with St. John's wort? | Robitussin DM (dextromethorphan) |
| ou know that which herb may cause an additive effect when taken with insulin? | Ginseng |
| Which lab values will need to be monitored while Jim is taking antilipemic medications and using complementary medications concurrently? | Liver enzymes |
| which potential drug-drug interaction is most likely to cause a serious complication? | Ginkgo biloba, aspirin, Garlic |
| which definition of dietary supplements is true as described by the Dietary Supplement Health and. Education Act (DSGEA)? | Meant to supplement the diet Labeled properly as supplements |
| Which patient taking a.n herbal remedy may develop edema, have a blood pressure of 140/100 mm Hg and. have a potassium level of 2.5 mEq/L? | Patient with bronchitis who is taking licorice |
| Which information provided by a hypertensive patient taking garlic supplements would be concerning to the nurse? | Breastfeeding a 3-month old baby Having dental work done next month |
| Which herbal product interferes with the action of anticoagulants? | Chamomile |
| Which drug in the patient's health record would case the nurse to counsel the patient to avoid Ginko biloba for memory imporvement? | Warfarin |
| Which herbal supplement would the nurse suspect that a patient is taking if the nurse learn that the patient, who has depression and was admitted with serotonin syndrome, is taking an herbal supplement along with the antidepressant sertraline? | St. John's wort |
| Which route of administration would a nurse expect if a patient reports using herbs to make an liniment? | Topical |
| Which information would the nurse include. when teaching a community group about the use of herbal supplements? | Refrain from herbal remedies when pregnant Discontinue the product if side effects occur Report all herbal supplement use to the health care provider Take the herbal supplement exactly as directed on the label |
| Which action would the nurse take after learning that a patient takes five herbal supplements daily? | Instruct the patient to list all of the supplements for the health care provider |
| Which factor would cause a substance to be considered a dietary supplement, according to the Dietary Supplement Health and Education Act (DSHEA) of 1994? | Labeled as a dietary supplement Given orally as a tablet, capsule, powder, softgel, gelcap, or liquid Contains vitamins, herbs, and amino acids |
| Which herbal preparation involves adding the supplement to alcohol. or vinegar to be used topically? | Liniment |
| Which herb may be helpful in treating Alzheimer's disease? | Ginkgo |
| Four organizations award a seal of approval to supplements based on fee-based tests of which characteristic of an herbal product? | Purity, Identity, Potency, Dissolution, Labeling accuracy |
| Which factors increase the incidence of older adults experiencing adverse drug effects (ADEs) from drug therapy? | Polypharmacy Cognitive impairment Kidney dysfunction |
| Anticholinergics | Bladder flow obstruction |
| Nonsteroidal antiinflammatory drugs (NSAIDs) | Clotting disorders |
| Opioids | Falls |
| Hypertension | |
| Which considerations would the nurse use to promote drug adherence in older adults? | Recommend simple drug regimens Recommend keeping a drug list in purse or wallet Ask the pharmacy to provide containers that are easy to open |
| An 18-month-old patient has been started on chemotherapy. Which means are used to adjust the drug dosages? | Therapeutic response Plasma drug concentrations |
| Which family-centered education techniques would the nurse use when teaching the parents of a 12-month-old infant how to administer oral antibiotics? | Have parent soothe the 12-month-old patient Use an oral syringe to administer the drug Allow the 12-month-old patient to suck on a pacifier |
| Lesson Assessment Performance 57.1% CORRECT Keep it up! Let's review your results Overview Incorrect Correct Question 1 of 7 Identify the physiologic differences in body systems and organs of pediatric patients by labeling the diagram. 32154 |
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