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Pharmacokinetics involves - CORRECT ANSWER -absorption, distribution, metabolism and elimination).
Absorption: - CORRECT ANSWER -absorption from the administration site either directly or indirectly into the blood/plasma.
Distribution: - CORRECT ANSWER -reversibly or irreversibly move from the bloodstream into the interstitial and intracellular
Metabolism: - CORRECT ANSWER -biotransformed via hepatic metabolism or by other tissues.
Elimination: - CORRECT ANSWER -tissues. lastly, the drug and its metabolites are eliminated from the body.
route of administration with the highest bioavailability - CORRECT ANSWER - intravenous; putting entire dose into a patient's vein and bypassing absorption.
avoids first-pass metabolism - CORRECT ANSWER -Intravenous route
administration has variable and erratic absorption. n - CORRECT ANSWER -Rectal administration
- Steady state (SS) - CORRECT ANSWER -absorption. n is usually reached within 4- 5 half-lives of drug.
Half-life of a drug is - CORRECT ANSWER -how long it takes for half the drug to be excreted from the body. Determines how frequently the drug must be administered. Predicts how long toxic effects can last.is constant with first-order pharmacokinetics of a drug.
Zero-order (nonlinear) pharmacokinetics - CORRECT ANSWER -means a drug is metabolized at a constant rate per unit time.
CYP3A4 substrate drugs - CORRECT ANSWER -may have enhanced activity if any CYP3A4 inducer drugs are used along with it.
Drug development process involves these steps according to the FDA: - CORRECT ANSWER -Discovery: laboratory research to develop the new drug. Preclinical research with animal testing for safety (Phase I). Clinical research on human subjects for medication safety (Phase II). Clinical research in humans comparing the new drug to accepted medications placebo depending on the study (Phase III). FDA review of the results to determine approval. Post marketing study to identify adverse effects not found in earlier clinical studies (Phase IV)
- Medication safety organizations - CORRECT ANSWER -The Institute for Safe Medication Practices (ISMP) The Institute of Medicine (IOM) The Joint Commission The National Coordinating Council for Medication Error Reporting and Prevention (NCC MERP) Food and Drug Administration (FDA) Safe Use Initiative
ARBS reduce blood pressure - CORRECT ANSWER -by blocking angiotensin II receptors.
Essential (primary) hypertension - CORRECT ANSWER -Essential (primary) accounts for 90% of cases; secondary hypertension may caused by chronic renal failure.
Nitroglycerin - CORRECT ANSWER -Nitroglycerin is a nitrate drug that can be administered IV, SL, a topical ointment and as a transdermal patch.
Nitrates are contraindicated - CORRECT ANSWER -with PDE-5 inhibitors (e.g., sildenafil and vardenafil)
Amiodarone is the antiarrhythmic - CORRECT ANSWER -Of choice when there is coexisting heart failure; can cause thyroid and pulmonary toxicity.
Alpha-1 adrenergic stimulation - CORRECT ANSWER -results in vasoconstriction and increased blood pressure.
Alpha-1 adrenergic blockade - CORRECT ANSWER -results in vasodilation and reduced blood pressure.
Beta-1 adrenergic stimulation - CORRECT ANSWER -by beta agonists (e.g., isoproterenol) results in increased heart rate, increased blood pressure, and increased cardiac output.
Beta-1 adrenergic blockade results - CORRECT ANSWER -in reduced heart rate, reduced blood pressure, and reduced cardiac output.
Left heart failure - CORRECT ANSWER -causes reduced delivery of oxygenated blood to the body tissues.
Right heart failure - CORRECT ANSWER -is associated with pulmonary disease and increased pulmonary vascular resistance.
drug that relieves heart failure symptoms but does not reduce mortality - CORRECT ANSWER -furosemide.
Loop diuretics like furosemide - CORRECT ANSWER -are potent diuretics, can cause diuretic resistance and hypokalemia, and work on receptors in the thick ascending renal loop of Henle.
Loop diuretics inhibit - CORRECT ANSWER -reabsorption of sodium and chloride at this site in the kidney.
Potassium-sparing diuretics: - CORRECT ANSWER -spironolactone, triamterene.
Milrinone - CORRECT ANSWER -phosphodiesterase inhibitor used for acute heart failure.
Children diagnosed with the tetralogy of Fallot can stop hypoxic spells - CORRECT ANSWER -by squatting down compensatory mechanism).
Severe persistent asthma - CORRECT ANSWER -is best treated with a long-acting beta-2 agonist (LABA), plus a high-potency inhaled corticosteroid, plus an oral corticosteroid drug.
Inhaled short-acting beta-2 agonists (SABA) - CORRECT ANSWER -are indicated only for PRN use.
Long-acting beta-2 agonists (LABA, e.g., salmeterol) - CORRECT ANSWER -should never be used in an acute asthma exacerbation; use a short-acting beta-2 agonist (SABA, e.g., albuterol).
short-acting Short-acting beta-2 agonists (SABA) - CORRECT ANSWER -are used in acute asthmatic attacks, but can increase heart rate, tremors, nervousness, and reduce serum potassium levels.
, Instruct a patient on any inhaled corticosteroid - CORRECT ANSWER -rinse the mouth after each use
Advair (fluticasone and salmeterol) - CORRECT ANSWER -Advair example of a long-acting beta agonist and a corticosteroid.
Anoro ellipta (umeclidium/vilanterol) - CORRECT ANSWER -is an example of a long-acting beta agonist and an anticholinergic agent.
Combivent (albuterol/ipratropium) - CORRECT ANSWER -example of a short- acting beta agonist and an anticholinergic agent.
Tiotropium - CORRECT ANSWER -Tiotropium is long-acting anticholinergic agent, not for acute asthmatic attacks, and is used once a day in asthma and COPD.
Cystic fibrosis (CF) - CORRECT ANSWER -is a pulmonary disorder typically seen in childhood, with an increased production of a protein-producing thick mucus that blocks the airways, pancreatic ducts, sweat gland ducts, and vas deferens.
CF of the pancreas - CORRECT ANSWER -also known as fibrocystic disease of the pancreas.
Respiratory distress syndrome - CORRECT ANSWER -is a lung disorder characterized by increased pulmonary resistance and caused by a surfactant deficiency.
Respiratory distress syndrome - CORRECT ANSWER -a lung disorder characterized by increased pulmonary resistance and caused by a surfactant deficiency.
NSAIDS - CORRECT ANSWER -have anti-inflammatory, analgesic, and antipyretic activity.
Acetaminophen - CORRECT ANSWER -has analgesic and antipyretic activity, but not anti-inflammatory activity.
The NSAID considered safe to use by individuals with heart disease - CORRECT ANSWER -naproxen.
Gout is treated with - CORRECT ANSWER -antigout drugs (e.g., allopurinol, colchicine, febuxostat) and uricosuric drugs (probenecid, sulfinpyrazone).
NSAIDS can cause - CORRECT ANSWER -GI bleeding (indicated by darkening of stools and epigastric pain); one recommendation is switch to a COX-2 inhibitor (i.e., celecoxib).
Ankylosing spondylitis - CORRECT ANSWER -is a chronic inflammatory joint disease characterized by fusion and stiffening of the spine and sacroiliac joints.
acetaminophen overdose. - CORRECT ANSWER -Acute liver disorders (e.g., acute hepatitis, hepatotoxicity) may be caused by
Osteoblast cells on bone - CORRECT ANSWER -cause bone formation;
osteoclasts are cells on bone - CORRECT ANSWER -that cause bone breakdown.
Osteomalacia - CORRECT ANSWER -is a condition of insufficient bone mineralization (softening of bone).
Osteoporosis - CORRECT ANSWER -is a metabolic disorder with reduced bone mass/density.
Osteosarcoma - CORRECT ANSWER -is cancer of the bone.
Paget's disease - CORRECT ANSWER -is a disorder in which abnormal new bone growth occurs at a faster rate than normal, involving increased resorption of spongy bone tissue. ing
pathologic fracture - CORRECT ANSWER -dorbeod fracture occurring at the site of a pre-existing bone abnormality, and occurs with a force that is considerably less than that which would cause a bone fracture at a different site.
Antidiuretic hormone (ADH) - CORRECT ANSWER -is synthesized in the hypothalamus and causes the reabsorption of water in the distal tubule and collecting duct of the kidney.
essential treatment for hyponatremia - CORRECT ANSWER -normal saline IV (0.9%NaCl).
Orthostasis can be a significant side effect - CORRECT ANSWER -with use of a diuretic drug.
Orthostatic hypotension - CORRECT ANSWER -defined as a decrease of>20mmHg systolic blood pressure or decrease of >10mmHgdiastolic blood pressure within 3 minutes of assuming a standing position.
Causes of hyperkalemia: - CORRECT ANSWER -low potassium intake, renal insufficiency, systemic lupus erythematosus, Addison's disease, use of potassium- sparing diuretics.
Treatment of hyperkalemia - CORRECT ANSWER -include calcium gluconate, loop diuretics, patiromer (Veltassa), thiazide diuretics, sodium polystyrene sulfonate (Kayexalate), regular insulin IV, and inhaled albuterol.
Insulin and beta-2 agonist inhalers are used to treat - CORRECT ANSWER - hyperkalemia because they move potassium from the bloodstream into the cells; insulin also increases the transport of glucose from the bloodstream into the cells.
Hyperglycemia can occur with - CORRECT ANSWER -increased release of cortisol, epinephrine, glucagon, and growth hormone into the bloodstream.
Hypoglycemia can be caused by - CORRECT ANSWER -starvation and intense exercise.
patient with type I diabetes who exercises heavily may have symptoms of - CORRECT ANSWER -hunger, headache, lightheadedness, confusion, tachycardia, and pallor due to hypoglycemia.
Obesity is a risk factor for developing - CORRECT ANSWER -type 2 diabetes because of increased insulin resistance.
Glucagon stimulates - CORRECT ANSWER -glycogenolysis by the liver.
Dawn phenomenon (dawn effect) - CORRECT ANSWER -occurs in the early morning hours (i.e., between 2 a.m. and 8 a.m.); blood glucose levels increase in patients with diabetes. There is not nighttime hypoglycemia.
Somogyi effect - CORRECT ANSWER -occurs after an episode of untreated nighttime hypoglycemia, causing increased blood glucose levels in the morning; treated by increasing food intake near bedtime or reducing the evening insulin dose.
Laxatives: stimulants - CORRECT ANSWER -senna, Bisacodyl, magnesium oxide [milk of magnesia], magnesium citrate, castor oil),
Laxatives: bulk - CORRECT ANSWER -(psyllium, methylcellulose),
Laxatives: stool softeners - CORRECT ANSWER -docusate),
Laxatives: sugars - CORRECT ANSWER -lactulose),
Laxatives: osmotic agent trapping water in the GI lumen - CORRECT ANSWER - polyethylene glycol), mineral oil.
Linaclotide (Linzess) - CORRECT ANSWER -for chronic idiopathic constipation (CIC).
The safest laxative for chronic use is - CORRECT ANSWER -methylcellulose (Citrucel, Metamucil).
Octreotide - CORRECT ANSWER -a potent vasoconstrictor used in treating acute GI bleeds.
Antiemetic agents: - CORRECT ANSWER -antihistamines, phenothiazines (e.g. prochlorperazine), 5HT3 receptor antagonists (e.g., ondansetron [Zofran], granisetron).
Ondansetron can cause - CORRECT ANSWER -constipation, headache, and heart conduction irregularities (prolonged QT interval).
pharmacologic actions reduce nausea and vomiting. - CORRECT ANSWER -SHT receptor antagonists inhibit serotonin receptors inside the chemoreceptor trigger zone (CTZ) and inhibit serotonin receptors on vagal nerve terminals;
Dumping syndrome (rapid gastric emptying) - CORRECT ANSWER -can occur after a partial gastrectomy and has symptoms of rapid pulse, hypotension, pallor, weakness, sweating, and faintness.
Dumping syndrome can cause - CORRECT ANSWER -a high osmotic gradient in the small intestine, resulting in a rapid movement of fluid from blood vessels into the intestinal lumen.
organ that can regrow back to its original size - CORRECT ANSWER -The liver depending on the area of tissue removed; this is a type of compensatory hyperplasia.
Vitamin B12 deficiency can occur - CORRECT ANSWER -after a partial gastrectomy; this may cause the patient to develop a pernicious anemia.
UFH: - CORRECT ANSWER -unfractionated heparin.
LMWH: - CORRECT ANSWER -(low molecular weight heparin) enoxaparin (Lovenox); inhibits factor Xa.
Heparin produces rapid anticoagulation by binding with - CORRECT ANSWER - antithrombin III, and inhibits factors IXa, Xa, XIIa, and XIII.
aPTT - CORRECT ANSWER -Monitor heparin (low dose SC heparin [5000 units BID] does not require aPTT monitoring).
Warfarin inhibits vitamin K-dependent blood factors - CORRECT ANSWER -II, VII, IX and X; takes several days for its anticoagulant effect.
(INR) - CORRECT ANSWER -Monitor the International Normalized Ratio when warfarin is used.
Blood Factor Ila inhibitor - CORRECT ANSWER -(direct thrombin inhibitor): dabigatran (Pradaxa).
antidote to dabigatran-induced hemorrhage - CORRECT ANSWER -idarucizumab.
Blood factor Xa inhibitors: - CORRECT ANSWER -apixaban (Eliquis), edoxaban (Savaysa), rivaroxaban (Xarelto), fondaparinux (Arixtra).
Eptifibatide - CORRECT ANSWER -binds to GPII6/IIla receptor sites on platelets.
symptom of hemolytic anemia - CORRECT ANSWER -jaundice, caused by the destruction of heme that is greater than the hepatic conjugation and excretion of bilirubin.
Jaundice can be caused by - CORRECT ANSWER -hemolytic anemia, sickle cell anemia, pancreatitis,o cholecystitis, and multidrug therapy used to treat pulmonary tuberculosis.
Erythropoietin - CORRECT ANSWER -is a substance manufactured in the kidney; the anemia of chronic renal failure reduces erythropoietin production, and should be used to correct the anemia of chronic renal failure.
Olanzapine, - CORRECT ANSWER -a second-generation antipsychotic, has the advantage of being available as a long-acting injection for acute psychotic reactions.
Drugs most effective in alcohol withdrawal - CORRECT ANSWER -lorazepam (Ativan) and phenobarbital; if liver dysfunction is present, lorazepam is the preferred agent because of its different metabolic pathway than other benzodiazepines.
All benzodiazepine drugs - CORRECT ANSWER -(e.g., diazepam, lorazepam, clonazepam, midazolam) can increase falls in the elderly and other people unsteady on their feet.
Drugs acting on the sympathetic nervous system include - CORRECT ANSWER - epinephrine, norepinephrine, dopamine and dobutamine.
Drugs acting on the parasympathetic nervous system include - CORRECT ANSWER -atropine, oxybutynin, and ipratropium.
Arachnoid villi - CORRECT ANSWER -absorb excess cerebrospinal fluid (CSF) that accumulates in the cerebral venous sinuses that surround the brain; the villi maintain normal CSF volume and pressure.
The circle of Willis - CORRECT ANSWER -supplies collateral blood flow to the brain.
The adrenal medulla - CORRECT ANSWER -will increase secretion of the catecholamines epinephrine and norepinephrine due to sympathetic stimulation caused by increased stress.
Antidiuretic hormone (ADH) - CORRECT ANSWER -is synthesized in the hypothalamus, and acts on the renal tubular cells.
cause diabetes insipidus (DI). - CORRECT ANSWER -Low levels of antidiuretic hormone (ADH)
patients have a laboratory finding of low urine specific gravity. - CORRECT ANSWER -Diabetes insipidus (DI) patients
Multiple sclerosis - CORRECT ANSWER -a disorder involving the demyelination of CNS nerve fibers (central component of the pathological model).
Alzheimer's disease (AD) - CORRECT ANSWER -is the development of neurofibrillary tangles in the CNS.
may experience at least one seizure during their lifetime. - CORRECT ANSWER - Roughly 10% of the U.S. population
third most common neurologic disorder (after cerebrovascular disease and Alzheimer's disease). - CORRECT ANSWER -Epilepsy
Several mechanisms involved in seizure activity, - CORRECT ANSWER -but all have swift, excessive, and synchronous discharge of cerebral neurons.
