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NUR 641E MIDTERM STUDY GUIDE WITH
COMPLETE SOLUTIONS
Prodrug CORRECT ANSWER An inactive drug dosage form that is converted to an active metabolite by various biochemical reactions once it is inside the body. -Cytochrome P -Ex. Aspirin, psilocybin, heroin Bioavailability CORRECT ANSWER the rate at and the extent to which a nutrient is absorbed and used -Affected by route of administration and drug dosage -Drug clearance (rate drug leaves circulation) -Steady state concentration -Affected by chemical stability, solubility, and first pass Steady state (of a drug) CORRECT ANSWER stable level of drug in the body, occurs in 5 half-lives of the drug -rate of drug being added to system is equal to amount being eliminated from system Pharmacokinetics CORRECT ANSWER The process by which drugs are absorbed, distributed within the body, metabolized, and excreted. -what the body does to the drug First pass CORRECT ANSWER the fact that a medication in the GI tract passes through the liver before entering other organs does not CORRECT ANSWER bioequivalence does/does not affect bioavailability Bioequivalence CORRECT ANSWER relative therapeutic effectiveness of chemically equivalent drugs. Bioavailability (is affected by) CORRECT ANSWER -chemical instability -solubility -first pass metabolism Cytochrome P450 CORRECT ANSWER -enzymes that function to metabolize potentially toxic compounds, including drugs and products of endogenous metabolism such as bilirubin, principally in the liver. -genetics influence presence of enzymes -affects metabolism of warfarin, antidepressants, antiepileptics, and statins. -the levels of these drugs are higher when taken with certain drugs that are inhibitors (ex. warfarin with omeprazole) because there is competition for enzyme metabolism. -inducers lead to decreased plasma concentration of drug.
cytochrome p450 inducer CORRECT ANSWER An inducer increases the metabolism of a substrate resulting in a decreased level or effect of the substrate cytochrome p450 inhibitor CORRECT ANSWER An inhibitor decreases the metabolism of a substrate resulting in an increased level or effect of the substrate. Clopidogrel CORRECT ANSWER prodrug that must be activated by hepatic CYP2C metabolism; individuals who are poor metabolizers may not form the active metabolite and have reduced antiplatelet response half-life (determines) CORRECT ANSWER how often a drug is administered 4-5 CORRECT ANSWER steady state is reached in - times the half-life Warfarin (MOA) CORRECT ANSWER -Vitamin K antagonist -Factors II, VII, IX, X -takes several days to take effect -monitor INR Vitamin K CORRECT ANSWER warfarin antidote Heparin (MOA) CORRECT ANSWER -rapid anticoagulation by binding with antithrombin III and inhibits factors IXa, Xa, XIIa, and XIII -aPTT monitoring (low dose SQ does not require monitoring) Apixaban (MOA) CORRECT ANSWER direct factor Xa inhibitor parenteral administration CORRECT ANSWER -directly into systemic circulation -poor absorption or unstable in GI tract (ex. heparin, insulin), rapid absorption, unable to take meds PO -IV, IM, SQ, ID IV CORRECT ANSWER -into the vein -can be given through bolus (rapid peak) or infusion (lower peak, longer duration) -ex. rocuronium (neuromuscular blocker) IM CORRECT ANSWER -aqua solutions absorbed rapidly -depot absorbed slowly in a nonaqueous solution such as polyethene glycol (simple diffusion) SQ CORRECT ANSWER -absorption via simple diffusion -constant, slow, and sustained effects -not for drugs that cause tissue irritation d/t pain and necrosis ID CORRECT ANSWER -diagnostic determination and allergy sensitivity
Edoxaban (MOA) CORRECT ANSWER -Factor Xa inhibitor -Savaysa Rivaroxaban (MOA) CORRECT ANSWER -factor Xa inhibitor -Xarelto Fondaparinux (MOA) CORRECT ANSWER -factor Xa inhibitor -Arixtra Pulmonary Embolism CORRECT ANSWER -usually a clot from the leg that blocks the pulmonary vasculature -affects right ventricle d/t backing up of blood -can cause pulmonary hypertension -risk factors: immobility, obesity, hormonal birth control, smoking, HTN pulmonary hypertension CORRECT ANSWER -elevated pulmonary pressure resulting from an increase in pulmonary vascular resistance to blood flow through small arteries and arterioles. -increased afterload causes increase in RV size as contractility cannot overcome the resistance CVA (risk factors) CORRECT ANSWER HTN, HLD, DM, Smoking, FHx CVA, Hx TIA/CVA, AFib action potential CORRECT ANSWER -sodium moves into cell (depolarization) -threshold potential must be reached -potassium moves out of cell (repolarization) -returns to resting potential by pumping sodium out of cell and potassium back into cell threshold potential CORRECT ANSWER The minimum membrane potential that must be reached in order for an action potential to be generated. absolute refractory period CORRECT ANSWER The minimum length of time after an action potential during which another action potential cannot begin. relative refractory period CORRECT ANSWER A period after firing when a neuron is returning to its normal polarized state and will fire again only if the incoming message is much stronger than usual caseous necrosis CORRECT ANSWER -degeneration and death of tissue with a cheese-like appearance -associated with TB tuberculosis CORRECT ANSWER -An infectious disease that may affect almost all tissues of the body, especially the lungs -airborne
-caseous necrosis -1/4 of world population infected -> leading cause of death d/t infectious disease -high risk countries include Mexico, Phillippines, Gautamala, China, Haiti, India -congregate settings such as homeless shelters are high risk, including for employees -increased in the mid 90s d/t AIDS but have decreased since 2000s isoniazid (INH) CORRECT ANSWER -antiTB
- take daily for 6-12 months and most likely with other meds too -worked if 3 neg. sputum cultures, no temp.
- Liver toxicity (hepato) check liver fxn --> JAUNDICE
- Don't take with alcohol (liver fxn remember?)
- Take on empty stomach polypharmacy (side effects) CORRECT ANSWER -hallucinations -appetite alterations -tiredness, decreased alertness, AMS -weakness, falls -dizziness -skin rashes -anxiety, excitability vertical transmission CORRECT ANSWER when a parasite is transmitted from a parent to its offspring horizontal transmission CORRECT ANSWER disease is spread through a population from one infected individual to another empiric antimicrobial therapy CORRECT ANSWER 1) site of infection and organism most likely to be colonizing the site
- prior knowledge of bacteria known to colonize the person
- local bacteria resistance patterns of organisms that are available at the hospital (antibiotics that) inhibit cell wall integrity CORRECT ANSWER -penicillins -ampicillin -cephalosporins -carbapenems (antibiotics that) inhibit bacterial protein synthesis CORRECT ANSWER - aminoglycoside -tetracyclines -fluoroquinolones Fluoroquinolones CORRECT ANSWER use is reserved for pneumonias or exasperations of chronic bronchitis to decrease the potential for development of further development
B cell (maturation) CORRECT ANSWER -Directed by bone marrow sites that harbor stromal cells, which nurture the lymphocyte stem cells and provide hormonal signals -Millions of distinct B cells develop and "home" to specific sites in the lymph nodes, spleen, and GALT -Come into contact with antigens throughout life -Have immunoglobulin as surface receptors for antigens (types of) T cells CORRECT ANSWER Helper T cells (CD4+): stimulates cytotoxic t cells, B cells, and macrophages to develop immune response Cytotoxic T cells (CD8+): simulates cell apopotosis Memory T cells: antigen specific t cells that retain a memory of prior infections ABO (compatibility) CORRECT ANSWER O is universal donor; AB universal receiver respiratory acidosis (causes) CORRECT ANSWER • Depression of the respiratory center. (1) Head injuries. (2) Oversedation with sedatives and/or narcotics.
- Conditions affecting pulmonary function. (1) COPD (2) Pneumonia. (3) Atelectasis.
- Conditions that interfere with chest wall excursion. (1) Thoracic trauma: flail chest. (2) Diseases affecting innervation of thoracic muscle (Guillain-Barré syndrome, myasthenia gravis, polio). (3) Mechanical hypoventilation. cytokines (cause fever) CORRECT ANSWER These proinflammatory cytokines reach the CNS where, through induction of central mediators such as prostaglandins (PGs), they are able to increase the temperature set point and cause fever -hypothalamus regulates temperature Asthma CORRECT ANSWER -chronic inflammatory disorder of the bronchial mucosa that causes bronchial hyper-responsiveness, constriction of the airways, and variable airflow obstruction that is reversible -chest constriction, expiratory wheezing, dyspnea, nonproductive coughing, prolonged expiration, tachycardia, an tachypnea, pulsus paradoxus, respiratory alkalosis, hypoxemia pulsus paradoxus CORRECT ANSWER beats have weaker amplitude with respiratory inspiration, stronger with expiration
increased (RR) CORRECT ANSWER - Fever
- Asthma
- Dehydration
- COPD
- Hyperventilation
- Lung conditions
- Infections
- Newborns
- Acidosis
- Overdoses
- Heart Conditions -increased CO2 levels, decreased O2 levels COPD (treatment) CORRECT ANSWER COPD TREATMENT ● Immunizations ● Antibiotics ● Bronchodialators ● Corticosteroids - Oral and Inhaled ● Beta-Adrenergic Agonists ● Oxygen Therapy - Low flow rate: Normally, CO2 stimulates breathing b/c it initiates Hypoxic Drive. Chronic COPD patients have chronic elevated carbon dioxide levels. They "retrain" their bodies to breath when they are low in oxygen. High rate flow may actually stop breathing. This will increase PaC02 leading to somulence and respiratory failure. infant weight loss CORRECT ANSWER -average of 5% over the first 3-4 days -water loss hypoxemia (at altitude) CORRECT ANSWER -lack of oxygen at high levels -causes hyperventilation to accomodate for lack of O -leads to respiratory alkalosis (normal) magnesium CORRECT ANSWER 1.5-2. (normal) calcium CORRECT ANSWER 8.5-10. (normal) sodium CORRECT ANSWER 135- (normal) potassium CORRECT ANSWER 3.5- aldosterone CORRECT ANSWER -"salt-retaining hormone" which promotes the retention of Na+ by the kidneys. na+ retention promotes water retention, which promotes a higher blood volume and pressure -promotes potassium excretion -acts on late distal tubule and collecting duct of kidney
hepatocytes, bone marrow cells, fibroblasts, and some bone, cartilage, and smooth muscle. naproxen CORRECT ANSWER NSAID said for use in CAD patient NSAIDs (MOA) CORRECT ANSWER Reversibly inhibit COX-1 & COX- Block prostaglandin synthesis COX 2 inhibitor (MOA) CORRECT ANSWER Inhibits COX-2, but does not inhibit COX- NSAID alternative CORRECT ANSWER COX 2 inhibitors; given with risk of GI bleed (indicated by darkening stool and epigastric pain) diphenhydramine (side effects) CORRECT ANSWER Cardiovascular: tachycardia, hypotension, palpitations Neurological: drowsiness, seizures Respiratory: mucus plugs, wheezing lortadine CORRECT ANSWER lack of sedation and impairment of performance, longer duration of action, and absence of anticholinergic side effects. dimenhydrinate (onset of action) CORRECT ANSWER within 15 minutes; lasts 3- hours (patients with history of kidney stones should) avoid CORRECT ANSWER calcium tendon rupture CORRECT ANSWER Fluoroquinolones have a black box warning for _____ _____ or tendonitis. There is an increased risk in elderly patients. Pseudomembranous colitis CORRECT ANSWER Clindamycin, ampicillin, cephalosporins (C. diff) chronic pain CORRECT ANSWER episode of pain that lasts for 6 months or longer; may be intermittent or continuous. NOT cancer pain
