Nurs 615 Pharm Exam 1 – Maryville Latest 2023 (100% Correct Answers)

Nurs 615 Pharm Exam 1 – Maryville Latest 2023 (100%
Correct Answers)
How does hypoalbuminemia affect the process of prescribing? – correct answer
✅Low albumin = more free drug (bc the drug can’t bind to albumin aka protein) =
increased adverse effects
What is a Black Box Warning: – correct answer ✅is considered a contraindication
to administer that drug.
What is the drugs half-life? – correct answer ✅Half-life specifically means the
amount of time it takes for an administered drug to be halfway cleared from the
system.
Peak of action: – correct answer ✅the time between drug administration and
maximum concentration of drug in the blood stream. Best therapeutic effect.
Duration of action: – correct answer ✅the time between onset of action and
metabolism of drug below the minimum needed for an effect. The length of time
you have the drug in your system.
According to the WHO what is the first step in the prescribing process? – correct
answer ✅The first step is to define the patient’s problem

Nurs 615 Pharm Exam 1 – Maryville Latest 2023 (100%
Correct Answers)
The second step is to – correct answer ✅specify the therapeutic objective
The third step is to – correct answer ✅choose which drug or treatment is needed.
Step 4 of the WHO approach: – correct answer ✅Start the treatment
Step 5 of the WHO approach: – correct answer ✅Educate the patient
Step 6 of the WHO approach: – correct answer ✅Monitor the treatment
Phase 1 of drug development: – correct answer ✅The drug is tested on healthy
volunteers
Phase 2 of drug development: – correct answer ✅trials with people who have the
disease for which the drug is thought to be effective
Phase 3 of drug development: – correct answer ✅Large numbers of patients in
medical research centers receive the drug in phase 3. This larger sampling
provides information about infrequent or rare adverse effects. The FFA will
approve a new drug application if phase 3 studies are satisfactory.

Nurs 615 Pharm Exam 1 – Maryville Latest 2023 (100%
Correct Answers)
Phase 4 of drug development: – correct answer ✅This phase is voluntary and
involves postmarket surveillance of the drug’s therapeutic effects at the
completion of phase 3. The pharmaceutical company receives reports from
doctors and other health care professionals about the therapeutic results and
adverse effects of the drug. Some medications, for example, have been found to
be toxic and have been removed from the market after their initial release.
Explain first pass metabolism – correct answer ✅much of the drug is lost in the
absorption process. The liver metabolizes many drugs, thus reduces the
bioavailabilty of the drug.
What is the fasted route of absorption: – correct answer ✅The fastest route of
absorption is inhalation, and not as mistakenly considered the IV administration.
Why does the GI tract take longer to absorb? – correct answer ✅The GI tract is
lined with epithelial cells; drugs must permeate through these cells in order to be
absorbed into the circulatory system.
What is One particular cellular barrier that may prevent absorption of a given
drug? – correct answer ✅the cell membrane. Cell membranes are essentially lipid
bilayers which form a semipermeable membrane. Pure lipid bilayers are generally

How does hypoalbuminemia affect the process of prescribing?

Low albumin = more free drug (bc the drug can’t bind to albumin aka protein) = increased adverse effects

What is a Black Box Warning:

is considered a contraindication to administer that drug.

What is the drugs half-life?

Half-life specifically means the amount of time it takes for an administered drug to be halfway cleared from the system.

Peak of action:

the time between drug administration and maximum concentration of drug in the blood stream. Best therapeutic effect.

Duration of action:

the time between onset of action and metabolism of drug below the minimum needed for an effect. The length of time you have the drug in your system.

According to the WHO what is the first step in the prescribing process?

The first step is to define the patient’s problem

The second step is to

specify the therapeutic objective

The third step is to

choose which drug or treatment is needed.

Step 4 of the WHO approach:

Start the treatment

Step 5 of the WHO approach:

Educate the patient

Step 6 of the WHO approach:

Monitor the treatment

Phase 1 of drug development:

The drug is tested on healthy volunteers

Phase 2 of drug development:

trials with people who have the disease for which the drug is thought to be effective

Phase 3 of drug development:

Large numbers of patients in medical research centers receive the drug in phase 3. This larger sampling provides information about infrequent or rare adverse effects. The FFA will approve a new drug application if phase 3 studies are satisfactory.

Phase 4 of drug development:

This phase is voluntary and involves postmarket surveillance of the drug’s therapeutic effects at the completion of phase 3. The pharmaceutical company receives reports from doctors and other health care professionals about the therapeutic results and adverse effects of the drug. Some medications, for example, have been found to be toxic and have been removed from the market after their initial release.

Explain first pass metabolism

much of the drug is lost in the absorption process. The liver metabolizes many drugs, thus reduces the bioavailabilty of the drug.

What is the fasted route of absorption:

The fastest route of absorption is inhalation, and not as mistakenly considered the IV administration.

Why does the GI tract take longer to absorb?

The GI tract is lined with epithelial cells; drugs must permeate through these cells in order to be absorbed into the circulatory system.

What is One particular cellular barrier that may prevent absorption of a given drug?

the cell membrane. Cell membranes are essentially lipid bilayers which form a semipermeable membrane. Pure lipid bilayers are generally permeable only to small and uncharged solutes, hence whether or not a molecule is ionized will affect its absorption, since ionic molecules are charged.

What is solubility?

Solubility favors charged species, permeability favors neutral species. Some molecules have special exchange proteins and channels to facilitate movement from the lumen into the circulation.

Why does absorption occur at a slower rate for oral, IM, SQ routes?

Absorption occurs at a slower rate because the complex membrane systems of GI mucosal layers, muscle, and skin delay drug passage.

The ability of a drug to cross a cell membrane depends on:

whether the drug is water or lipid (fat) soluble. Lipid-soluble drugs easily cross through cell membranes; water-soluble drugs can’t. Lipid-soluble drugs can also cross the blood-brain barrier and enter the brain.

As a drug travels through the body, it comes in contact with?

proteins such as the plasma protein albumin. The drug can remain free or bind to the protein. The portion of a drug that’s bound to a protein is inactive and can’t exert a therapeutic effect. Only the free, or unbound, portion remains active. A drug is said to be highly protein-bound if more than 80% of the drug is bound to protein.

Identify drug metabolism and the role of isoenzymes in the p450 system

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.

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?

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

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?

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?

The onset of action

What is the purpose of a peak and trough level?

To determine if the drug is in therapeutic range.

Describe the purpose of blood brain barrier

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

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 blood-borne protein like albumin, it is even less likely to come into contact with fetus.

How will renal insufficiency affect drug elimination?

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

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

serum creatinine.

Patients with poor renal function may have higher levels of drugs secondary to

decreased excretion of metabolites.

What is off-label prescribing?

Off-label use is the use of pharmaceutical drugs for an unapproved indication or an unapproved age group, dosage or route of administration.

What factors place an infant and child at risk when prescribing medication?

In general, there is a lack of safety and efficacy studies in the pediatric population most medications are studied in adult populations which because of age-related differences and medication metabolism and mechanisms of action don’t necessarily apply to pediatric populations. Children are not just small adults. Adverse drug reactions are most common in this age group. Kids do not have a fully mature liver and renal function, and are at higher risk for toxicity and adverse drug effects.

In kids, meds should be

weight based. Kids do not have a fully mature liver and renal function, and are at higher risk for toxicity and adverse drug effects.

What ADRs are the elderly at risk of developing?

Physiologic changes in older adults increase the risk of harm for medication metabolized by the liver and kidneys.

In the elderly, Hepatic blood flow decreases by

nearly one-half or 40% in older adults.

some degree of chronic kidney disease is present in X of older adult

50%

Furthermore, the median renal blood flow decreases by X by the time the patient reaches 80 years of age, and x

x of older adults maintain normal kidney function/50%, 1/3. Although, the normal individual rate of decline varies and one-third of older adults maintain normal renal function.

Heart failure, which affects more than forty percent of persons older than 80 years, can

further reduce the function of the aging kidneys and liver.

Other factors influence pharmacokinetics in older adults include

aging decreases first-pass clearance in the liver, and a number of commonly prescribed medications like warfarin, benzos, and opiates require much lower doses in older adults. Distribution of drugs to body compartments has changed by the decrease in the ratio of lean body weight to body fat. Levels of serum protein, which bind many drugs, decrease in older adults because of malnutrition and dietary changes that are common for both intentional and unintentional regions. Drug metabolism can be affected by substance abuse including alcohol, up to ten percent of older adults are heavy or problem drinkers. Polypharmacy.

What are the adverse drug reactions related to special populations?

These can come into the categories of genetics, age, gender, drug interactions, and medical conditions.

Type 1 hypersensitivity or immediate hypersensitivity is an

allergic reaction provoked by re-exposure to a specific type of antigen, referred to as an allergen. Symptoms vary from mild irritation to sudden death from anaphylactic shock, called type 1 anaphylactic shock.

In type 2 hypersensitivity or cytotoxic hypersensitivity,

the antibodies produced in the immune response bind to antigens of the patients on cell surfaces. The antigens recognized in the way may either be intrinsic (a self-antigen, part of the patient’s cells) or extrinsic (absorbed onto the cells during exposure to some foreign pathogens possibly as part of an infection with a pathogen).

An example of type 2 hypersensitivity is the

ABO blood incompatibility where the red blood cells have different antigens causing them to be recognized different. B-cell proliferation will take place in antibodies until foreign blood types are produced. IgG and IgM antibodies bind to these antigens to form complexes that activate the classical pathway of the complement activation to eliminate cells presenting foreign antigens. that is mediators of acute inflammation are generated at the site and the membrane attack of complexes cause cell lysis and death. This reaction takes between hours to a day.

Type-3 hypersensitivity occurs when

there is an accumulation of immune complexes or antigen-antibody complexes that may not have been adequately cleared by innate immune cells, giving rise to an inflammatory response and attraction of leukocytes. Such reactions progress into the point of disease producing immune-complex diseases. The reaction can take hours, days, or even weeks to develop depending on whether or not there is immunologic memory of the precipitating antigen. Typically, clinical features emerged a week following initial antigen challenge from the deposited immune complexes that can precipitate the inflammatory response. Type 4 hypersensitivity is often called delayed-type hypersensitivity, as a reaction take 2-3 days to develop. unlike other types it is not antibody-mediated but rather cell mediated response.

Which medications interact with St. John’s Wort?

SSRI antidepressants, warfarin, and birth control It is also known to decrease the efficacy of HIV medications, cholesterol medications, as well as transplant medications

Which medications interact with St. John’s Wort?

St. John’s Wort is a medicinal herb with antidepressant activity and potent anti-inflammatory properties. St. John’s wort has interactions with medications such as SSRI antidepressants, warfarin, and birth control. Combining St. John’s Wort and SSRI antidepressants, could lead to an increased serotonin level causing serotonin syndrome. Combining estrogen containing oral contraceptives with St. John’s Wort can lead to a decreased efficacy of the contraceptive and eventually unplanned pregnancies. It is also known to decrease the efficacy of HIV medications, cholesterol medications, as well as transplant medications. It should be noted however that traditional SSRI antidepressants such as fluoxetine carry similar contraindications. Use nonjudgmental approach so they tell u what herbs they take. Tricyclics and SJW can increase the risk for serotonin syndrome.

How does doxazosin work?

It is an alpha-1 adrenergic receptor blocker that inhibits the binding of norepinephrine released from sympathetic nerve terminals to the alpha 1 receptors in the membrane of vascular smooth muscle cells. the primary effect of this inhibition is relaxed vascular smooth muscle tone or vasodilation, which decreases peripheral vascular resistance leading to decrease blood pressure. is used to treat high blood pressure and urinary retention associated with benign prostatic hyperplasia (BPH). Doxazosin also shows potential for treatment of benign prostatic hyperplasia and erectile dysfunction. Doxazosin has shown some efficacy in in treating chronic epididymitis. Adverse effects include orthostatic hypotension and reflex tachycardia.

Alpha blockers end in “zosin” are mostly used for

BPH and sometimes HTN. Adverse effects of orthostatic hypotension. They block the effects of catecholamines at the alpha 1 receptors in vascular smooth muscle and also smooth muscle of the bladder neck and prostate

How does doxazosin work?

–pharm made easy: Most adrenergics produce their effects by stimulating alpha receptors and beta receptors. These drugs mimic the action of norepinephrine and epinephrine.

Doxazosin

relaxes your veins and arteries so that blood can more easily pass through them. It also relaxes the muscles in the prostate and bladder neck, making it easier to urinate.

What is the action of effective beta-blockers?

Beta-blockers are a class of drugs that are particularly used for the management of cardiac arrhythmias, protecting the heart from a second attack after first heart attack, which is called secondary prevention.

Betablockers – first choice for HTN?

They have been used in hypertension but no longer our treatment of first choice

Beta-blockers block the action of

endogenous catecholamines, epinephrine, and norepinephrine on adrenergic beta receptors of the sympathetic nervous system, which mediates the flight or fight response. Some block all activation of beta adrenergic receptors and others are selective.

The three types of beta receptors what are they?

They are known designated beta-1, beta-2, and beta-3 receptors.

Beta-1 adrenergic receptors are located mainly in the

heart and kidneys.

Beta-2 are located in the

lungs, GI tract, liver, uterus, vascular smooth muscle and skeletal muscle.

Beta-3 adrenergic receptors are located in

fat cells.

Beta receptors are found on cells of the

heart muscles, smooth muscles, airways, arteries, kidneys, and other tissues that are part of the sympathetic nervous system and lead to stress responses especially when they are simulated by epinephrine.

Beta 1 receptors effect

chronotropy, inotropy, dromotropy, renin release and lypolysis.

Beta-blockers interfere with

binding of the receptor to epinephrine and other stress hormones and weaken the effects of stress hormones.

There are two types of beta-blockers;

there are non-selective agents, adn selective agents

Nonselctive agents

bined to both beta-1 and beta-2 receptors, those include propranolol and carvedilol, although carvedilol has additional alpha blocking activity which can cause vasodilation of the peripheral vasculature, and labetalol as well.

Beta 1 selective agents, also known as cardio selective, they have

ionotropic effects as well as reducing with muscle tone these include atenolol, esmolol, and metoprolol.

beta blocker treatments:

: tx of cardiac D/Os, HF, anxiety, migraine, tachy r/y hyperthyroidism. Work by latching on the BB rec. site and prevent those sites from the catecholamines being able to latch onto those sites

Beta-adrenergic blockers, the most widely used adrenergic blockers, work by:

preventing stimulation of the sympathetic nervous system by inhibiting the action of catecholamines at beta-adrenergic receptors.

Pharmacokinetics of Beta-adrenergic blockers

they are usually absorbed rapidly and well from the GI tract and are somewhat protein-bound. Food doesn’t inhibit—and may even enhance—their absorption. Some betaadrenergic blockers are absorbed more completely than others. Beta-adrenergic blockers have widespread effects in the body because they produce their blocking action not only at adrenergic nerve endings but also in the adrenal medulla.

What are the adverse effects of beta-blockers? (16)

hypotension, bradycardia, peripheral vascular insufficiency, atrioventricular block, heart failure, fatigue, bronchospasm, diarrhea or constipation, nausea and vomiting, abdominal discomfort, anorexia, flatulence, rash, fever with sore throat, spasm of the lower neck, respiratory distress as an allergic response.

Adverse effects associated with beta-2 adrenergic receptor antagonists’ activity will include

bronchospasm, peripheral vasoconstriction, alteration of glucose and lipid metabolism, specifically hyperlipidemia, impaired insulin release. These are less common with the beta 1 selective or cardio selective agents but receptor selectivity diminishes at higher doses.

Beta blockade especially the beta 1 receptor at the macula densa inhibits

renin release thus decreasing the release of aldosterone this cause hyponatremia and hyperkalemia.

Beta 1 selected blockers can increase

plasma lipid levels and glucose levels and diabetics they may also interfere with oral hypoglycemics.

In general, beta blockers should be avoided in

diabetics.

Beta blockers are also contraindicated in patients with

asthma

Beta-blockers should be avoided in patients with a history of

cocaine use or cocaine induced tachycardia.

adverse drug reactions associated with use of beta-blockers include (22)

nausea, diarrhea, bronchospasm, dyspnea, cold extremities, exacerbation of Raynaud’s, syndrome, bradycardia, hypotension, heart failure, heart block, fatigue, dizziness, alopecia, abnormal vision, hallucinations, insomnia, nightmares, sexual dysfunction, erectile dysfunction, and or alteration of glucose and lipid metabolism

What effect will result with rapid withdrawal of a beta-blocker?

You can see a coronary artery spasm that will result in MI, this is most often seen in patients with coronary artery disease. Don’t stop, must wean, may have W/D and rebound, could have W/D and coronary artery spasm resulting in MI.

What patient teaching should be provided when prescribing clonidine or any centrally acting adrenergic blocker?

DO NOT MISS ANY DOSES, high rick of stroke due to HTN if stopped abruptly.

What patient teaching should be provided when prescribing clonidine or any centrally acting adrenergic blocker?

Clonidine treats high blood pressure by stimulating alpha 2 receptors in the brain, which decrease peripheral vascular resistance lowering blood pressure. The risk of rebound hypertension is increased in alpha agonist, so it’s important that you do not miss any doses. Usually used when others are not controlling. If stopped can result in rebound HTN urgency, concern for CVA

What are the adverse effects of a beta 1 selective blocker?

Serious side effects that are advised to be reported immediately include symptoms of bradycardia, which is a resting heart rates lower than 60 beats per minute, symptoms of dizziness, fainting, and unusual fatigue, bluish discoloration of the fingers and toes, numbness tingling swelling of the hands and feet, sexual dysfunction, erectile dysfunction, hair loss, mental or mood changes, depression, trouble breathing, cough, dyslipidemia, and increased thirst.

What is a cholinergic blockers?

An anticholinergic agent is a substance that blocks the neurotransmitter acetylcholine in the central and peripheral nervous system.

What effect is produced of cholinergic blockers?

Anticholinergics inhibit parasympathetic nerve impulses by selectively blocking the binding of neurotransmitter acetylcholine to its receptor and nerve cells. The nerve fibers in the parasympathetic system are responsible for the involuntary movement of smooth muscles present in the GI tract, urinary tract, and lungs.

Anticholinergics are divided into three categories in accordance with their specific target in the central and

or peripheral nervous system, this includes/ antimuscarinic agents, ganglionic blockers, and neuromuscular blockers.

Anticholinergic drugs are used to treat a variety of conditions, such as

GI disorders like gastritis, diarrhea, pylorospasm, diverticulitis, ulcerative colitis, nausea and vomiting; genitourinary disorders cystitis, urethritis, prostatitis; respiratory disorders like asthma, chronic bronchitis, COPD, sinus bradycardia due to hypersensitive vagus nerve, insomnia although usually only for a short term basis, dizziness including vertigo, motion sickness related symptoms.

Anticholinergics side effects:

decrease saliva production and most produce some level of sedation, both being advantageous for surgery procedures. For many of these effects cholinergic analogues produce the opposite effect so it would be helpful for you to go through and note make another chart with the cholinergic receptors and what happens when you block them and you simulate them and all the different organ systems.

Anticholinergics produce muscarinic blockade against acetylcholine. Muscarinic receptors are all over the body. The goal of administration is to compete with

acetylcholine at those receptor sites to keep acetylcholine from acting on them (gets in the way). Side effects: can’t pee, can’t see, can’t spit, can’t shit

Cholinergic blockers are often used to treat

GI disorders and complications.

All cholinergic blockers are used to treat

spastic or hyperactive conditions of the GI and urinary tracts because they relax muscles and decrease GI secretions. These drugs may be used to relax the bladder and to treat urinary incontinence. The quaternary ammonium and amine compounds such as propantheline are the drugs of choice for these conditions because they cause fewer adverse reactions than belladonna alkaloids. •

What are Belladonna alkaloids?

This is used with morphine to treat biliary colic (pain caused by stones in the bile duct). •

Cholinergic blocking drugs are given by injection before such diagnostic procedures as endoscopy and sigmoidoscopy to

relax the GI smooth muscle.

Who gives the ARNP authority to practice and prescribe medications?

It’s the state board of nursing in your respective state

Carvedilol is what type of blocker and what is its brand name?

alpha and beta blockers which is sold in the brand name Coreg,

Coreg is a

it is a beta-blocker used in the treatment of mild to severe heart congestive heart failure, left ventricular dysfunction following heart attack people in people who are otherwise stable, and high blood pressure.

How does Coreg work?

It primarily works by vasodilation of the peripheral vasculature, thereby decreasing the workload of the heart. It is a non-selective beta-blocker and also an alpha 1 blocker, belongs to the third generation of beta-blockers. It is particularly useful in African Americans. The starting dose is 6.25 to 25 milligrams, by mouth, twice a day, and should be administered with food to prevent postural hypertension.

What race does Coreg work best for?

African Americans

Coreg Prescription info:

The starting dose is 6.25 to 25 milligrams, by mouth, twice a day, and should be administered with food to prevent postural hypertension.

Phases of Drug Development