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NUR 641E Midterm Study Guide
1. Prodrug: 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
2. Bioavailability: 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
3. Steady state (of a drug): 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
4. Pharmacokinetics: The process by which drugs are absorbed, distributed within
the body, metabolized, and excreted. -what the body does to the drug
5. First pass: the fact that a medication in the GI tract passes through the liver
before entering other organs
6. does not: bioequivalence does/does not affect bioavailability
7. Bioequivalence: relative therapeutic effectiveness of chemically equivalent
drugs.
8. Bioavailability (is affected by): -chemical instability
- solubility -first pass metabolism
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9. Cytochrome P450: -enzymes that function to metabolize potentially toxic com-
pounds, 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.
10. cytochrome p450 inducer: An inducer increases the metabolism of a substrate
resulting in a decreased level or effect of the substrate
11. cytochrome p450 inhibitor: An inhibitor decreases the metabolism of a sub-
strate resulting in an increased level or effect of the substrate.
12. Clopidogrel: prodrug that must be activated by hepatic CYP2C19 metabolism;
individuals who are poor metabolizers may not form the active metabolite and have reduced antiplatelet response
13. half-life (determines): how often a drug is administered
14. 4-5: steady state is reached in - times the half-life
15. Warfarin (MOA): -Vitamin K antagonist
-Factors II, VII, IX, X -takes several days to take effect -monitor INR
16. Vitamin K: warfarin antidote
17. Heparin (MOA): -rapid anticoagulation by binding with antithrombin III and in-
hibits factors IXa, Xa, XIIa, and XIII -aPTT monitoring (low dose SQ does not require monitoring)
18. Apixaban (MOA): direct factor Xa inhibitor
4 / -maintain therapeutic range over longer period -good for drugs with short half-life (i.e. morphine with half-life of 2-4 hours)
28. aPTT: activated partial thromboplastin time
29. 30-40 seconds: Normal activated partial thromboplastin time (APTT)
30. 1.5-2.5: therapeutic aPTT is x more than normal aPTT
31. low dose heparin: -5000 units BID
-does not require aPTT monitoring
32. INR: international normalized ratio
33. 2-3 (INR): therapeutic INR for warfarin
34. <1.1: normal INR
35. Dabigatran (Pradaxa): -direct thrombin inhibitor
- anticoagulant -blood factor IIa inhibitor
36. idarucizumab: antidote for dabigatran
37. factor xa inhibitors: apixaban, edoxaban, rivarozaban, fondaparinux
38. apixiban (MOA): -Factor Xa inhibitor
39. Edoxaban (MOA): -Factor Xa inhibitor
40. Rivaroxaban (MOA): -factor Xa inhibitor
41. Fondaparinux (MOA): -factor Xa inhibitor
42. Pulmonary Embolism: -usually a clot from the leg that blocks the pulmonary
vasculature -affects right ventricle d/t backing up of blood
5 / -can cause pulmonary hypertension -risk factors: immobility, obesity, hormonal birth control, smoking, HTN
43. pulmonary hypertension: -elevated pulmonary pressure resulting from an in-
crease 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
44. CVA (risk factors): HTN, HLD, DM, Smoking, FHx CVA, Hx TIA/CVA, AFib
45. action potential: -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
46. threshold potential: The minimum membrane potential that must be reached
in order for an action potential to be generated.
47. absolute refractory period: The minimum length of time after an action poten-
tial during which another action potential cannot begin.
48. relative refractory period: 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
49. caseous necrosis: -degeneration and death of tissue with a cheese-like ap-
pearance -associated with TB
50. tuberculosis: -An infectious disease that may affect almost all tissues of the
body, especially the lungs
- airborne -caseous necrosis
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56. (antibiotics that) inhibit cell wall integrity: - penicillins
- ampicillin
- cephalosporins
- carbapenems
57. (antibiotics that) inhibit bacterial protein synthesis: - aminoglycoside
- tetracyclines
- fluoroquinolones
58. Fluoroquinolones: use is reserved for pneumonias or exasperations of chronic
bronchitis to decrease the potential for development of further development
59. endotoxic bacteria: -gram negative bacteria that stain red or pink
-stuck to outside of cell and released when the bacteria die
60. exotoxic bacteria: -gram positive bacteria that stain purple
-released from bacteria
61. invasion period: -when immune and inflammatory responses are initiated
62. pneumonia: -infection of lower respiratory tract
-sixth leading cause of death in U.S. -CAP, HCAP, HAP, VAP -HAP has 20-50% mortality -VAP occurs in up to 25% of ventilated patients -aspiration of oropharyngeal secretions is most common route of lower respiratory tract infection -most important guardian of lower respiratory tract is alveolar macrophage (Toll- like receptors) -pneumonococcus is most common and lethal cause of out/inpatient pneumonias -viral pneumonia is seasonal and usually mild and self limiting; however, pan- demics... -mostly preceded by URI
8 / -pulmonary consolidation
63. pulmonary consolidation: In pneumonia, the process by which the lungs be-
come solidified as they fill with exudates. -CXR for pneumonia will show this and infiltrates. Acute bronchitis will not
64. Upper respiratory tract (infections): Sinusitis - blockage of sinuses
Otitis media - infection of the middle ear Tonsillitis - inflammation of the tonsils Laryngitis - infection of the larynx that leads to loss of voice Pharyngitis - Sore throat
65. (Antibiotics that should be) Avoided in Children: -Tetracyclines -> teeth
staining -Fluoroquinolones -> arthrotoxicity
66. Antibodies in newborns: -IgG passed to fetus through placenta in third
trimester -colostrum and breastmilk contain IgA -passive immunity from mother -starts making own antibodies (IgM) 3-6 months after birth. There is a period when maternal antibodies are tapering off and newborn is only secreting minimal amounts of antibodies at about 3 months. -IgG levels start to rise again at around 1 year
67. B cell (maturation): -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
68. (types of) T cells: Helper T cells (CD4+): stimulates cytotoxic t cells, B cells, and
10 / longed expiration, tachycardia, an tachypnea, pulsus paradoxus, respiratory alka- losis, hypoxemia
73. pulsus paradoxus: beats have weaker amplitude with respiratory inspiration,
stronger with expiration
74. increased (RR): - Fever
- Asthma
- Dehydration
- COPD
- Hyperventilation
- Lung conditions
- Infections
- Newborns
- Acidosis
- Overdoses
- Heart Conditions -increased CO2 levels, decreased O2 levels
75. COPD (treatment): COPD TREATMENT
Ï Immunizations Ï Antibiotics Ï Bronchodialators Ï Corticosteroids - Oral and Inhaled Ï Beta-Adrenergic Agonists Ï 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
11 / failure.
76. infant weight loss: -average of 5% over the first 3-4 days
-water loss
77. hypoxemia (at altitude): -lack of oxygen at high levels
-causes hyperventilation to accomodate for lack of O -leads to respiratory alkalosis
78. (normal) magnesium: 1.5-2.
79. (normal) calcium: 8.5-10.
80. (normal) sodium: 135- 145
81. (normal) potassium: 3.5- 5
82. aldosterone: -"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
83. loop diuretics (MOA): Act on ascending loop of Henle, inhibit sodium-potassi-
um-chloride transporter; decrease renal vascular resistance
84. thiazide diuretics (MOA): Decrease sodium reabsorption at distal convoluted
tubule; net loss of sodium and potassium
85. potassium sparing diuretics (MOA): Aldosterone antagonist in the distal con-
voluted tubule
86. atrial netriuretic peptide: acts acutely to reduce plasma volume by at least 3
mechanisms: increased renal excretion of salt and water, vasodilation, and in- creased vascular permeability.
87. edema (oncotoic pressure): Edema occurs when there is a decrease in plasma
oncotic pressure, an increase in hydrostatic pressure, an increase in capillary permeability, or a combination of these factors. Edema also can be present when
13 / darkening stool and epigastric pain)
100. diphenhydramine (side effects): Cardiovascular: tachycardia,
hypotension, palpitations Neurological: drowsiness, seizures Respiratory: mucus plugs, wheezing
101. lortadine: lack of sedation and impairment of performance, longer
duration of action, and absence of anticholinergic side effects.
102. dimenhydrinate (onset of action): within 15 minutes; lasts 3-6 hours
103. (patients with history of kidney stones should) avoid: calcium
104. tendon
rupture: Fluoroquinolones have a black box warning for or tendonitis. There is an increased risk in elderly patients.
105. Pseudomembranous colitis: Clindamycin, ampicillin, cephalosporins (C. diff)
106. chronic pain: episode of pain that lasts for 6 months or longer;
may be intermittent or continuous. NOT cancer pain
