NURS 615 PHARM EXAM 1 |
Questions and Answers Graded
A+ | 2023/2024 MARYVILLE
What is off label prescribing? – Correct Answer – Off label use is
the prescription of drugs for un approved indication or age group
dosage of route of administration. Both prescription and otc drugs
can be used in off label ways. However, most studies focus on
prescription drugs. Off label use is legal unless it violates ethical
or safety guidelines. There can be health risks or differences in
legal liability.
What factors place an infant and child at risk when prescribing
medications? – Correct Answer – In general, there is a lack of
safety studies related to medications and the pediatric population.
Adverse drug reactions are most common in this age group.
Children are not just small adults they metabolize drugs differently
than adults.
What adverse drug reactions (ADRs) are the elderly at risk of
developing? – Correct Answer – Physiological changes in elderly
adults affect mainly how medications are metabolized by the
kidney and liver. Hepatic blood flow nearly decreases by 1/2 or 40
% in older adults, and some degree of chronic kidney disease is
present in nearly ½ of older adults. The median renal blood flow
decreases by ½ by the time the patient is 80 years old. Although
individual rates vary and 1/3 of older adults maintain normal renal
function. Heart failure affects more than 40% of persons older
than 80 years. This further reduces the function of aging kidneys
and liver. Aging decreases first pass clearance in the liver and a
number of common drugs like warfarin, benzodiazepines, and
opiates require much lower diseases in older adults. Distribution
of drugs to body compartments is changed by the decrease in the
ratio of lean body weight to body fat. Levels of serum proteins
which bind to many drugs decrease in older adults because of
malnutrition and dietary changes that are common for both
intentional and unintentional reasons. Drug metabolism can be
affected by drug abuse like alcohol. Up to 10 % of older adults are
heavy or problem drinkers.
What are the ADRS related to special populations? – Correct
Answer – These can be related to genetics, age, gender, drug
interactions, and medical conditions.
Type 1 hypersensitivity – Correct Answer – immediate is a
reaction provoked by reexposure to a specific type of antigen or
allergen. Symptoms include mild irritation to anaphylactic shock.
Cytotoxic hypersensitivity the antibodies produce an immune
response that binds to antigens (allergens) at the surface of the
cell. Antigens can be either intrinsic (apart of the body)or extrinsic
(outside of the body). ABO blood incompatibility where the blood
cells have a different antigen on them. B cell proliferation will take
place, and antibodies to foreign blood types are produced. IgG
and IgM bind to these antigens to form complexes that activate
the pathway of the complement activation to eliminate cells
presenting as foreign antigens. That is mediators of acute
inflammation are generated at the site and membranes attack
cause cell lysis and death. This reaction takes hours to a day. –
Correct Answer – Type 2 hypersensitivity
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NURS 615 Pharm Exam 1
Questions and Answers
Maryville Latest 2023
Identify drug metabolism and the role of isoenzymes in the p450
system – Correct Answer – CYPs are the are the major enzymes
involved in drug metabolism accounting for about 75% of the total
metabolism.
Naturally occurring compounds may induce or inhibit CYP activity.
- Correct Answer – For example, bioactive compounds found in
grapefruit juice and some other fruit juices including dihydroxy
forgotten and parasitin A have been found to inhibit CYP3a4
mediated metabolism of certain medications leading to increased
bioavailability and the strong possibility of overdosing.
What does grapefruit have to do with CYP? – Correct Answer –
Grapefruit is an inhibitor and will decrease the metabolism of
drugs by the cyp enzymes
When 2 drugs are both metabolized by the p450 system the drug
should be – Correct Answer – administered at separate times to
prevent the metabolism of one drug resulting in toxic effects of the
other drug. (because it would have less protein to bind too, thus
more free floating drug)
What is the efficacy of a drug? – Correct Answer – Efficacy is the
maximum response achievable from a drug. Effectiveness refers
to the ability of the drug to produce a beneficial effect.
On the drug concentration curve what is the first sign of a
therapeutic effect? – Correct Answer – The onset of action
What is the purpose of a peak and trough level? – Correct
Answer – To determine if the drug is in therapeutic range.
Describe the purpose of blood brain barrier – Correct Answer –
The BBB is a highly selective permeability barrier that separates
the circulating blood from the brain and extracellular fluid in the
CNS. The BBB is formed by brain endothelial cells which are
connected by tight junctions with an extremely high electrical
resistivity of at least 0.1 micron. The BBB allows the passage of
water, some gases, and lipid soluble molecules by passive
diffusion as well as the selective transport molecules such as
glucose and amino acids that are crucial to neuro function.
Describe the purpose of the fetal placental barrier – Correct
Answer – the so-called placental barrier impedes certain
chemicals although it allows most fat soluble chemicals to cross.
Drugs that are more water soluble and that possess a higher
molecular weight tend not to cross the placental barrier. In
addition, if a drug binds to a large molecule, such as a bloodborne protein like albumin, it is even less likely to come into
contact with fetus.
How will renal insufficiency affect drug elimination? – Correct
Answer – The kidney is the primary organ of excretion for most
drugs. General theme of metabolism is to produce drug
metabolites that are more water soluble and more easily removed
by the kidneys. The rate at which the drug is excreted by the
kidneys depends on several factors. Renal blood flow influences
the glomerular filtration rate (GFR) which is how much plasma is
filtered per minute by the glomerulus.
Renal excretion of drugs is typically well-characterized, what is
variable is the – Correct Answer – level of renal function the
patient.
It is common to monitor renal function in patients by the clinical
setting and to adjust dosages based on renal function. This is
typically assessed by the – Correct Answer – serum creatinine.
Patients with poor renal function may have higher levels of drugs
secondary to – Correct Answer – decreased excretion of
metabolites.
What is off-label prescribing? – Correct Answer – Off-label use is
the use of pharmaceutical drugs for an unapproved indication or
an unapproved age group, dosage or route of administration.
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NUR 615 Pharm Exam 1 Study
Guide Latest 2023/2024
What is pharmacokinetics? – Correct Answer – The study of drug
movement throughout the body
What is pharmacotherapeutics? – Correct Answer –
Pharmacotherapeutics is the clinical purpose or indication for
giving a drug
What is a drug’s half-life? – Correct Answer – The time period
over which concentration will decrease by half
What is a drug’s onset of action? – Correct Answer – The
duration of time it takes for a drug to start taking effect. Depends
on route of administration.
What is peak of action? – Correct Answer – The time it takes for a
drug to be at its strongest in the body.
What is the duration of action? – Correct Answer – The length of
time a drug is effective in the body.
What is first pass metabolism? – Correct Answer – Although a
first-pass effect can occur in a variety of tissues, including the
intestines and uterus, it is most observed with the liver. Drug
absorbed from the gastrointestinal tract travels immediately to the
liver through the hepatic portal vein. Hepatic first pass occurs
when the drug absorbed from the gastrointestinal tract is
metabolized by enzymes within the liver to such an extent that
most of the active agent does not exit the liver, thus, not reaching
systemic circulation.
What is a steady state? – Correct Answer – Intake of a drug is in
dynamic equilibrium with elimination.
What factors affect drug absorption? – Correct Answer – Route of
administration, solubility of drug, effects of pH and ionization,
blood flow to area
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Nurs 615 exam 1 | Questions
and 100% Correct Answers
Rated A+
- The point in time on the drug concentration curve that indicates
the first sign of a therapeutic effect is the: - Minimum adverse effect level
- Peak of action
- Onset of action
- Therapeutic range – Correct Answer – 3. Onset of action
- Phenytoin requires that a trough level be drawn. Peak and
trough levels are done: - When the drug has a wide therapeutic range
- When the drug will be administered for a short time only
- When there is a high correlation between the dose and
saturation of receptor sites - To determine if a drug is in the therapeutic range
- Correct Answer – 4. To determine if a drug is in the
therapeutic range
- A laboratory result indicates that the peak level for a drug is
above the minimum toxic concentration. This means that the: - Concentration will produce therapeutic effects
- Concentration will produce an adverse response
- Time between doses must be shortened
- Duration of action of the drug is too long – Correct Answer –
- Concentration will produce an adverse response
- Drugs that are receptor agonists may demonstrate what
property? - Irreversible binding to the drug receptor site
- Upregulation with chronic use
- Desensitization or downregulation with continuous use
- Inverse relationship between drug concentration and drug
action – Correct Answer – 3. Desensitization or
downregulation with continuous use - Drugs that are receptor antagonists, such as beta blockers,
may cause: - Downregulation of the drug receptor
- An exaggerated response if abruptly discontinued
- Partial blockade of the effects of agonist drugs
- An exaggerated response to competitive drug agonists –
Correct Answer – 2. An exaggerated response if abruptly
discontinued - Factors that affect gastric drug absorption include:
- Liver enzyme activity
- Protein-binding properties of the drug molecule
- Lipid solubility of the drug
- Ability to chew and swallow – Correct Answer – 3. Lipid
solubility of the drug - Drugs administered via IV:
- Need to be lipid soluble in order to be easily absorbed
- Begin distribution into the body immediately
- Are easily absorbed if they are nonionized
- May use pinocytosis to be absorbed – Correct Answer – 2.
Begin distribution into the body immediately - When a medication is added to a regimen for a synergistic
effect, the combined effect of the drugs is: - The sum of the effects of each drug individually
- Greater than the sum of the effects of each drug individually
- Less than the effect of each drug individually
- Not predictable, as it varies with each individual – Correct
Answer – 2. Greater than the sum of the effects of each drug
individually - Which of the following statements about bioavailability is true?
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