Download NURS 316 Exam: Pharmacology Basics & Drug Administration and more Exams Nursing in PDF only on Docsity!
NURS 316 Exam Questions With
Complete Solutions
any chemical that can affect living processes correct answer: drug study of drugs and their interactions with living systems correct answer: pharmacology study of drugs in humans correct answer: clinical pharmacology also known as pharmacotherapeutics; the use of drugs to diagnose, prevent, or treat disease or to prevent pregnancy correct answer: therapeutics what are the five branches of pharmacology? correct answer: pharmacognosy-origin; pharmacokinetics-movement; pharmacodynamics-effect; pharmacotherapeutics-use/purpose; toxicology why be concerned about how drugs work? correct answer: aids in memorization of uses, interactions, adverse effects and contraindications; evaluation of literature; patient-health professional relationship; peace of mind pharmacologic knowledge can be applied to: _____; nursing responsibilities: correct answer: patient care and patient education; Pre-administration assessment, Dosage and administration,
Evaluating and promoting therapeutic effects, Minimizing adverse effects, Minimizing drug interactions, Making "as needed" (pro re nata = PRN) decisions, Managing toxicity what is the nursing process in pharmacology? correct answer: pre-administration assessment, analysis and nursing diagnoses, planning, implementation, evaluation (AD PIE) what are the dug standards? correct answer: purity (uncontaminated); bioavailability (amount absorbed and transported to target site); potency (strength, power, measurable effects); efficacy (effectiveness, measurement difficult); safe and toxicity (adverse events and effects) unintended effect of a drug; occurring at normal dose; related to the pharmacological properties correct answer: side effect noxious and unintended effect of a drug; occurs at normal doses correct answer: adverse effect/reaction adverse reaction NOT consistent with applicable product information or characteristics of drug correct answer: unintended adverse reaction medical occurrence; temporally associated with use of a medicinal product, but not necessarily causally related, ex: drug interactions correct answer: adverse event
(NP, CRNA, Certified Nurse Midwives, Clinical Nurse Specialists); Controlled substances vary by state Chemical Name Generic Name Derived from chemical name Approved by FDA WILL NOT change Trade Name (Brand) Selected by Manufacturer Copyrighted - ® May potentially change correct answer: how do drugs get into the body? correct answer: prescribed dose, administered dose (medication errors, patient adherence); concentration of sites of action: pharmacokinetics (absorption, distribution, metabolism, excretion); intensity of responses: pharmacodynamics (drug-receptor interaction, patient's functional state, placebo effects) Movement from site of administration into the bloodstream Unless injected directly into the blood stream, drugs must be absorbed. Drug molecules travel across biological barriers (mostly layers of cells) correct answer: absorption rate of drug absorption are effected by: (5) correct answer: 1. Pharmaceutical preparation
- Membrane permeability of drug
- Surface area in contact with drug
- Blood flow to site of absorption
- Destruction of drug at or near site of absorption pharmaceutical preparation-determinants of rate of release are correct answer: Dosage forms Additives (Excipients) Manufacturing parameters Delayed-release preparations Sustained-release preparations dosage forms: correct answer: solutions (no delay, immediate release); capsules and tablets (delay-dissolution, followed by rapid release); creams, ointments, and suppositories (no delay, slow release additives (excipients) correct answer: Decrease rate of dissolution (Binders, lubricants, coating agents); Increase rate of dissolution (Disintegrants); Variable effects on rate of dissolution (Diluents, coloring agents, flavoring agents); Protect active drug manufacturing parameters correct answer: Tablet compression (Soft vs hard compression); Tablet shape (Round vs square, etc.); Tablet size (Small vs large) Example: Oral Medications (p.o.) Pills must dissolve/breakdown Most absorbed in small Intestine
Small intestines Lungs determinants of tissue blood flow correct answer: Physiology Low flow: eyes, stomach, lg intestines, rectum, SQ tissue High flow: sm intestines, lungs, muscle, buccal/nasal cavities; Pathology - Abscesses and Tumors Low regional blood flow (depending on location) Pus-filled pockets rather than internal blood vessels Solid tumors have limited blood supply; Pharmacology Some drugs are vasoconstrictors Some drugs are co-administered with vasoconstrictors Some drugs are vasodilators Determinants of drug destruction correct answer: Biochemistry: Liver - hepatic enzymes ("first pass" effect) Colon - intestinal flora Stomach - digestive enzymes and acids routes of drug administration correct answer: Enteral Oral (PO) Sublingual (SL) Rectal (PR) Gastric (PG)
Parenteral Intravenous (IV) Intra-arterial (IA) Subcutaneous (SC/SQ) Intradermal (ID) Transdermal Intramuscular (IM) Intraperitoneal (IP) Lungs Skin (Topical) Nose (Intranasal) Eye (Ophthalmic) Ear (Otic) Vagina (PV) Urethra (PU) Urinary Bladder Intrathecal Determinants of where drugs go correct answer: Organ blood flow Barriers to drug diffusion Adipose tissue Plasma protein binding Drug transport Ion trapping (pH partitioning) organ blood flow: high blood flow: correct answer: larger amounts of drug delivered per unit of time-> larger initial
Obese plasma protein binding correct answer: Some drugs are highly bound (> 90%) to plasma proteins (Ex: Coumadin® at 99%): Albumin, globulin, fibrinogen, clotting factors, others... Binding limits distribution out of vascular compartment, Need more drug initially, Increased time for drug to be removed; Risk of drug interactions... Displacement of a highly plasma-protein bound drug by another drug drug-drug interactions, Result of rapid increase in the availability of "free" (unbound) drug drug transport correct answer: Transport mechanisms may increase or decrease distribution to certain tissues Ex: Most diuretics are transported by proximal tubules -> delivery to site of action; Competition for transport may result in drug-drug interactions. Ex: Probenecid blocks transport (secretion) of diuretics into the proximal tubule-> markedly blunting diuretic effect ion trapping correct answer: Non-ionized vs ionized drugs: Ionization of drugs is pH dependent Acidic drugs ionize in alkaline media & vice-versa; When pH differs across membrane, drug molecules move to side where pH favors their ionization: Acidic drugs alkaline side Basic drugs acidic side; Used to distribute drugs into the urinary compartment to increase the urinary excretion of poisons:
Systemic administration of sodium bicarbonate (NaHCO3) for aspirin overdose alkalinization of the urine Systemic administration of ammonium chloride (NH4Cl) for amphetamine overdose acidification of the urine enzymatic alteration of a drug structure; most often takes place in liver by hepatic drug-metabolizing enzymes (performed by CYP450 system); metabolism doesn't always->smaller molecule correct answer: drug metabolism Drugs absorbed from GI tract (excluding SL and distal segment of rectum) must pass through_____ before they reach general circulation; Some drugs go through liver-> inferior vena cava (IVC) -> general circulation, Other drugs undergo extensive hepatic metabolism (first pass effect)-> diminished bioavailability; Enterohepatic recycling: Drug in the liver-> into the bile ->back into the duodenum (via bile duct) -> reabsorbed back into portal blood (Remains unchanged in system longer) correct answer: liver Fraction of drug that reaches systemic circulation after a particular route of administration; affected by: correct answer: bioavailability; first pass effect, solubility, instability therapeutic consequences of metabolism correct answer: Accelerated renal drug excretion Drug inactivation Increased therapeutic action Activation of prodrugs Increased toxicity
Toxic concentration Therapeutic range The objective of drug dosing is to maintain plasma drug levels within this range single-dose time course: Duration of effects is determined (largely) by the combination of ______. For drug levels above the minimum effective concentration, the therapeutic response will be maintained correct answer: metabolism and excretion Time required for amount of drug in the body to decrease by 50% Percentage vs. amount; example: Half-life = amount of time it takes for a 100mg dose to be reduced to 50mg Determines the dosing interval Important for many drug classes: antibiotics, anti-epileptics, etc. correct answer: half-life drug levels produced with repeated doses: process by which plateau drug levels are achieved; must factor in: correct answer: time to plateau, techniques for reducing fluctuations in drug levels, loading doses vs. maintenance doses, decline from plateau
study of what drugs do to the body and how they do it; Dose- response relationships Drug-receptor interactions Drug responses that do not involve receptors Interpatient variability in drug responses Therapeutic index correct answer: pharmacodynamics what is a dose-response relationship? What does it determine correct answer: Relationship between the size of an administered dose and the intensity of the response produced; The minimum amount of drug to be used The maximum response a drug can elicit How much to increase the dosage to produce the desired increase in response characteristic properties revealed in dose-response curves: maximal efficacy and relative potency (define both) correct answer: Maximal efficacy - The largest effect/response a drug can produce (height of the curve) Very high maximal efficacy is not always more desirable Relative Potency - The dosage of drug that must be given to elicit an effect receptor bindings usually reversible; Receptor activity is regulated by ______compounds Drug binds to a receptor -> Mimic or block the action of the endogenous regulatory molecules, and
The larger/greater the therapeutic index, the safer the drug The smaller/lesser the therapeutic index, the less safe the drug lithium consequences of drug-drug interactions correct answer: intensification of effects reduction of effects creation of a unique response Drugs can interact through four basic mechanisms: correct answer: 1. Direct chemical or physical interaction
- Pharmacokinetic interaction
- Pharmacodynamic interaction
- Combined toxicity direct chemical or physical interaction correct answer: NEVER combine drugs in the same container without establishing compatibility -*Most common in IV solution precipitate: do not administer pharmacokinetic interactions correct answer: changes that occur in the absorption, distribution, metabolism or biotransformation, and excretion of one or more drugs pharmacodynamic interactions correct answer: At the same receptor (Almost always inhibitory (antagonistic)); At separate sites (May be potentiative (morphine & diazepam), OR Inhibitory (HCTZ and spironolactone))
combined toxicity correct answer: Drugs with overlapping toxicities should not be used together Minimizing Adverse Drug-Drug Interactions correct answer: Minimize number of drugs a patient receives. Take a thorough drug history. Be aware of the possibility of illicit drug use. Adjust the dosage when metabolizing inducers are added or deleted. Adjust the timing of administration to minimize interference with absorption. Monitor for early signs of toxicity. Be especially vigilant when patient is taking a drug with a low therapeutic index. drug-food interactions: impact of food on drug absorption and drug metabolism correct answer: Drug Absorption : Decreased Rate and Extent of absorption (Milk and tetracycline Fiber and digoxin) Increased High-calorie meal and saquinavir; Drug metabolism : Grapefruit juice effect (not with other citrus fruits or juices): Inhibits metabolism (CYP 3A4), Dose dependent, and Raises the drugs' blood levels (Lovastatin, simvastatin, felodipine, etc.)
Severe reactions (potentially fatal; respiratory depression, anaphylaxis, hemorrhage, etc.); Most common in "book-end populations" Risk increased by severe illness correct answer: adverse drug reactions Side effect Toxicity Allergic reaction Idiosyncratic effect Paradoxical effect Iatrogenic disease Physical dependence Carcinogenic effect Teratogenic effect correct answer: terms related to adverse drug reactions Formal definition: Adverse drug reaction caused by excessive dosing May occur even with normal dosing Neutropenia (risk for infection) caused by anticancer medications correct answer: toxicity Immune response; Determined primarily by the degree of sensitization of the immune system rather than by drug dosage; Patient's sensitivity to a drug can change over time; Very few drugs cause severe allergic reactions Penicillins are the most common
NSAIDs and sulfonamides (diuretics, antibiotics, and oral hypoglycemic agents) correct answer: allergic reaction (hypersensitivity) An uncommon drug response resulting from a genetic predisposition Succinylcholine-induced paralysis Usually brief but may last for hours in genetically predisposed patients correct answer: idiosyncratic effect The opposite of the intended drug response For example, when using benzodiazepines for sedation to treat insomnia, excitement may occur instead (especially in children and older adults) correct answer: paradoxical effect Iatrogenic: Literally, "a disease produced by a physician"; also used to refer to a disease produced by drugs (for example, drugs for antipsychotic disorders can cause Parkinson's-like symptoms) Sometimes also called drug-induced disease Essentially identical to naturally occurring pathology correct answer: iatrogenic disease Develops during long-term use of certain drugs (opioids, alcohol, barbiturates, and amphetamines) A state in which the body has adapted to drug exposure in such a way that an abstinence syndrome will result if drug use is discontinued
