NUR 105 Final 3 - Answer Subjective information provided verbally...

NUR 105 Final 3

• What is the difference between subjective & objective data?

Answer Subjective

information provided verbally by the patient, family, or friends

Objective

information the nurse directly observes about the patient's health status

• · What are generic drugs?

Answer A generic drug is a medication created to be the same as an already marketed brand-name drug in dosage form, safety, strength, route of administration, quality, performance characteristics, and intended use. These similarities help to demonstrate bioequivalence, which means that a generic medicine works in the same way and provides the same clinical benefit as the brand- name medicine. In other words, you can take a generic medicine as an equal substitute for its brand-name counterpart.

• What is the first-pass effect?

Answer Some drugs are metabolized to an inactive form in liver and are excreted -> reduces amount of active drug available to exert a pharmacological effect

• · How can altered liver and kidney function affect drug

pharmacokinetics/pharmacodynamics?

Answer

• Liver/kidney dysfunction -> half life is prolonged and less drug is metabolized and eliminated

• What is a loading dose?

Answer 1 / 3

• Large initial dose

• Drug with long half life -> may not be acceptable to wait for a steady state -> loading dose ->

therapeutic effects can be obtained while a steady state is reached

• Repeated loading doses -> toxic
• After loading dose -> maintenance doses to maintain drug concentration at steady state when

given repeatedly at a consistent dose and constant dosing interval

• · What are risk factors for drug interactions?

Answer

• Drug distribution is influenced by vascular permeability and permeability of cell membranes,

regional blood flow and pH, cardiac output, tissue perfusion, the ability of the drug to bind tissue

and plasma proteins, and the drug's lipid solubility. Drugs are easily distributed in highly perfused organs such as the liver, heart, and kidney. Tissues with decreased perfusion, such as muscle, fat, and peripheral organs, result in decreased drug distribution.

• The age of the patient, common disease state and polypharmacy; pharmacokinetic and

pharmacodynamic nature of drugs; the influence of disease on drug metabolism; prescriber issues such as multiple drug prescription by multiple prescribers, inadequate knowledge of prescribers' on DDIs or poor recognition of the relevance of DDIs by prescribers

• · What factors affect drug excretion?

Answer

• The main route of drug excretion, elimination of drugs from the body, is through the kidneys.

Drugs are also excreted through bile, the lungs, saliva, sweat, and breast milk. The kidneys filter free drugs (in healthy kidneys, drugs bound to protein are not filtered), water-soluble drugs, and drugs that are unchanged. The lungs eliminate volatile drug substances, and products metabolize to carbon dioxide (CO2) and water (H2O).

• Factors affecting renal excretion of drugs include

Answer kidney function, protein binding, urine pH and urine flow. Impaired renal function may lead to a clinically significant accumulation of drugs eliminated by the kidneys

• · What is the half-life of a medication? 2 / 3

Answer

• Time it takes for the amount of drug in the body to be reduced by half

• The amount of drug administered, amount of drug remaining in the body from previous does,

metabolism, and elimination affect half life

• Liver/kidney dysfunction -> half life is prolonged and less drug is metabolized and eliminated
• Ex. Ibuprofen has a half-life of about 2 hours.

§ If a person takes 200 mg, in 2 hours, 50% of the drug will be gone, leaving 100 mg.§ Two hours later, another 50% of the drug will be gone, this time leaving 50 mg.§ In another 2 hours, 50% more will be gone, so only 25 mg will remain.§ This process continues such that 10 hours after 200 mg of ibuprofen has been taken, if no additional doses are administered, 6.25 mg of the drug remains.

• · Know information about Ginkgo Biloba (refer to handout)

Answer

• used to treat ailments such as asthma, bronchitis, fatigue, and tinnitus. It has also been used to

improve memory, prevent Alzheimer disease and other dementias, decrease intermittent claudication, and as a treatment for sexual dysfunction and multiple sclerosis. Side effects include headache, nausea, GI upset, dizziness, and allergic reactions that include severe reactions leading to death. In patients taking blood thinners, ginkgo has been shown to increase bleeding risk.

• · What are potential problems when the elderly take multiple medications?-

Answer More drug interactions!

• Physiologic changes associated with aging can influence absorption, distribution,

metabolism, and excretion of drugs as well as pharmacodynamic responses at receptors and target organs

§ A reduction in total body water and lean body mass, resulting in increased body fat, which alters the volume of distribution of drugs § A reduction in kidney mass and lower kidney blood flow, leading to a reduced glomerular filtration rate (GFR) and reduced clearance of drugs excreted by the kidneys § A reduction in liver size and blood flow, resulting in reduced hepatic clearance of drugs

§ A decline in the physiologic processes that maintain equilibrium in the older adult may mean a

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