NURS 615 PHARM EXAM 1 MARYVILLE QUESTIONS AND ANSWERS LATEST DOWNLOAD 2023/2024 BEST EXAM, Exams of Nursing

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What is meant by the onset of action, peak of action, duration of action of medications? - CORRECT ANSWERS The onset of action is the time between the drug administration and the time that you see the drugs minimum effect. Onset is the first sign of a drugs therapeutic effect. Peak of action is the time of the maximum concentration of the drug in the blood. Duration of action is the onset of action and the metabolism of the drug below the dose needed for an effect. Explain first pass metabolism. - CORRECT ANSWERS This occurs when the concentration of the drug is greatly reduced before it reaches the systemic circulation. It is the portion of the drug lost during absorption. Generally, occurs in the liver or gut wall. After a drug is swallowed it is absorbed by the digestive system and enters the hepatic system. It is then carried by the portal vein to the liver before it reaches the rest of the body. The liver metabolizes many drugs to such an extent that only a small portion of the drug reaches the rest of the body. bioavailability of the drug thus is greatly reduced by the liver. Sublingual administration can bypass the first pass system plus it is also faster than oral route. What is a steady state? - CORRECT ANSWERS The overall intake of a drug is fairly and dynamic equilibrium with its elimination. Steady state is reached when the time of four to five times the half- life is reached since the drug had been started. What factors affect the drug's absorption? - CORRECT ANSWERS Absorption involves several steps. First the drug must be introduced via route of administration and the form of medication like tablet or capsule. In IV or IM administration the absorption is less variable and bioavailability is near 100%. IV administration is considered to lose no portion of the drug. The fastest route of absorption is inhalation. Drugs must pass through the epithelial cells of the GI tract to be absorbed by the circulatory system. Cell membranes may affect the absorption of some drugs because they are made of lipid bilayers that are semi permeable. This means only small uncharged solutes can pass through the membrane. Whether or not a molecule is ionized affects the absorption, since ionic molecules are charged. Solubility favors charged species. Permeability favors neutral species. Some molecules have special channels to facilitate movement from the lumen into the circulation. The Henderson Hasselbeck equation offers a way to determine the portion that is ionized in a given pH. Weak acids will be present in their nonionic form in the stomach because of the acidic pH and bases will be in their ionic form. Nonionic species diffuse easier through cell membranes. Weak acids have a higher absorption rate in the stomach. The opposite is true in the basic environment of the stomach. Identify drug metabolism and the role of the isoenzymes of the P450 system. - CORRECT ANSWERS CYPs are the major enzymes in drug metabolism. Must drugs undergo deactivation by CYPs are directly facilitated secretion from the body. Many substances are bioactivated by CYPs to form their active compound. Many drugs increase or decrease the activity of CYPs isoenzymes either by inducing biosynthesis of an isozyme, which is enzyme induction or by directly inhibiting the activity of CYP which is enzyme inhibition. This is a major source of adverse drug reactions since changes in

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CYPs activity may affect the metabolism and clearance of certain drugs. When two drugs are both metabolized by the CYP450 system the drugs should be administered at separate times to prevent toxic effects. What factors are associated with clinical judgment when prescribing medications? - CORRECT ANSWERS Prescribing a drug is based on a thorough assessment of the patient and the patient's environment. The determination of potential medical and nursing diagnoses, a review of the potential alternative therapies, specific knowledge about the drug chosen, and the disease process it is going to treat, known as patient centered care. The best therapy is usually the least invasive, least expensive, and the least likely to cause adverse reactions What are the criteria for choosing an effective drug? - CORRECT ANSWERS Multiple drugs may be able to treat a specific condition. You must consult nationally recognized guidelines for disease management to determine the most effective drug. How does hypoalbuminemia affect the process of prescribing? - CORRECT ANSWERS Many drugs that carry an electric charge are bound to albumin in the blood. The distribution of the drug to target tissues may be affected if hypoalbuminemia is present. What is the drug's half-life? - CORRECT ANSWERS In clinical practice it takes about four to five times the half-life for a drugs concentration to read steady state after a drug is started, stopped or changed. Hal life is the amount of time for a drug to be half cleared. What is the efficacy of the drug? - CORRECT ANSWERS Efficacy is the maximum response achievable from a drug. Intrinsic activity is a term used to describe the efficacy of a drug relative to a drugs highest observed efficacy. Effectiveness refers to the ability of a drug to produce the wanted effect. On the drug concentration curve what is the first sign of a therapeutic effect? - CORRECT ANSWERS The onset of action. What is the purpose of a peak and trough level? - CORRECT ANSWERS To determine if the drug is within therapeutic range. Which is either dosage range or blood plasma or serum concentration usually expected to affect desired effects. Some patients require doses or concentrations above or below this range and some patients have toxicity within this range. Describe the purpose of the blood brain barrier and the fetal placental barrier. - CORRECT ANSWERS The blood brain barrier is a highly selective permeability barrier that separates circulating blood from

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What does the FDA have the authority to approve? - CORRECT ANSWERS FDA is responsible for protecting and promoting public health through the regulation and supervision of food safety, tobacco products, prescription and over the counter drugs, biopharmaceutical, vaccines, blood transfusions medical devices cosmetics animal foods and feed and vet products. Post marketing surveillance is how the FDA monitors drug safety. It also determines all of the labeling for all prescription and over the counter meds. FDA does not regulate herbal supplements. What is off label prescribing? - CORRECT ANSWERS Off label use is the prescription of drugs for un approved indication or age group dosage of route of administration. Both prescription and otc drugs can be used in off label ways. However, most studies focus on prescription drugs. Off label use is legal unless it violates ethical or safety guidelines. There can be health risks or differences in legal liability. What factors place an infant and child at risk when prescribing medications? - CORRECT ANSWERS In general, there is a lack of safety studies related to medications and the pediatric population. Adverse drug reactions are most common in this age group. Children are not just small adults they metabolize drugs differently than adults. What adverse drug reactions (ADRs) are the elderly at risk of developing? - CORRECT ANSWERS Physiological changes in elderly adults affect mainly how medications are metabolized by the kidney and liver. Hepatic blood flow nearly decreases by 1/2 or 40 % in older adults, and some degree of chronic kidney disease is present in nearly ½ of older adults. The median renal blood flow decreases by ½ by the time the patient is 80 years old. Although individual rates vary and 1/3 of older adults maintain normal renal function. Heart failure affects more than 40% of persons older than 80 years. This further reduces the function of aging kidneys and liver. Aging decreases first pass clearance in the liver and a number of common drugs like warfarin, benzodiazepines, and opiates require much lower diseases in older adults. Distribution of drugs to body compartments is changed by the decrease in the ratio of lean body weight to body fat. Levels of serum proteins which bind to many drugs decrease in older adults because of malnutrition and dietary changes that are common for both intentional and unintentional reasons. Drug metabolism can be affected by drug abuse like alcohol. Up to 10 % of older adults are heavy or problem drinkers. What are the ADRS related to special populations? - CORRECT ANSWERS These can be related to genetics, age, gender, drug interactions, and medical conditions. Type 1 hypersensitivity - CORRECT ANSWERS immediate is a reaction provoked by reexposure to a specific type of antigen or allergen. Symptoms include mild irritation to anaphylactic shock.

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Cytotoxic hypersensitivity the antibodies produce an immune response that binds to antigens (allergens) at the surface of the cell. Antigens can be either intrinsic (apart of the body)or extrinsic (outside of the body). ABO blood incompatibility where the blood cells have a different antigen on them. B cell proliferation will take place, and antibodies to foreign blood types are produced. IgG and IgM bind to these antigens to form complexes that activate the pathway of the complement activation to eliminate cells presenting as foreign antigens. That is mediators of acute inflammation are generated at the site and membranes attack cause cell lysis and death. This reaction takes hours to a day. - CORRECT ANSWERS Type 2 hypersensitivity 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 that progress to disease produces immune complex diseases. The reaction can take hours, days, or weeks depending on whether or not there is an immunologic memory of the precipitating antigen. Typically clinical features begin a week following the initial antigen challenge causing the immune complexes to cause an inflammatory response. - CORRECT ANSWERS Type 3 hypersensitivity delayed this reaction takes 2-3 days to begin. Unlike other types of reaction, it is not antibody meditated but a cell-mediated response. - CORRECT ANSWERS Type 4 hypersensitivity Which medications interact with St. John's Wort? - CORRECT ANSWERS A medicinal herb with antidepressant effects and potent anti-inflammatory properties. St Johns wort interacts with SSRIs, warfarin, and birth control. Taking with SSRIs can lead to an increased serotonin level causing serotonin syndrome. Combining estrogen contraceptives with st johns wort can lead to decreased efficacy of the contraceptive. Decreases the efficacy of HIV meds, cholesterol meds, and transplant meds. How does doxazosin work? - CORRECT ANSWERS It is an alpha one adrenergic blocker that inhibits the binding of norepinephrine released from the sympathetic nerve terminals to the alpha one receptors and then to the membrane of vascular smooth muscle cells. The primary effect of this inhibition is relaxed vascular smooth muscle tone or vasodilation which increases peripheral vascular resistance leading to decreasing blood pressure. It is used to treat high blood pressure and urinary retention associated with benign prostatic hyperplasia (BPH). Also shows potential to treat erectile dysfunction and chronic epididymitis. Adverse effects include orthostatic hypertension and reflex tachycardia. What is the action and effect of beta blockers? - CORRECT ANSWERS Beta blockers are a drug class used to manage cardiac arrhythmias. Used to prevent a second attack after the first heart attack this is called secondary prevention. They have been used in hypertension but are no longer the first choice of treatment. Beta blockers block the action of endogenous catecholamines (epi & nor-epi) on adrenergic beta receptors of the sympathetic nervous system which mediates the fight or flight

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What effect is produced with cholinergic blockers? - CORRECT ANSWERS An anticholinergic agent is a substance that blocks the neurotransmitter acetylcholine in central and peripheral nervous system. 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 nervous system are responsible for the involuntary movement of smooth muscles. Smooth muscles are present in GI tract Gu tract and lungs. Anticholinergics are divided into three categories which are antimuscarinic agents, ganglionic blockers and neuromuscular blockers. Anticholinergic drugs are used to treat many conditions which include GI disorder, GU disorders, respiratory disorders, sinus bradycardia, insomnia, dizziness. Anticholinergics typically have an antisialagogue effect or decrease salvia production and can produce a level of sedation for many of these effects cholinergic analogs produce the opposite effects. Aderenergic agonists are made up of two group what are these two groups? - CORRECT ANSWERS Catacholimine and non catacholmine What are antichollenergic drugs used for? - CORRECT ANSWERS Antichollenergics are used in 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. What are the three main medications that are non-selective/direct acting agonists? - CORRECT ANSWERS Norepinephrine, epinephrine, and dopamine What receptors does norepinephrine stimulate? - CORRECT ANSWERS Alpha 1 causing vasoconstriction, thus increasing blood pressure Beta-adrenergic blockers, the most widely used adrenergic blockers, work by? - CORRECT ANSWERS preventing stimulation of the sympathetic nervous system by inhibiting the action of catecholamines at beta-adrenergic receptors. Beta 1 receptors occur where? - CORRECT ANSWERS heart, kidney, Alpha 1 receptors are located where? - CORRECT ANSWERS Mainly on smooth muscle throughout the body, on iris, urinary system, liver, kidney

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When alpha 1 is activated what occurs? - CORRECT ANSWERS Vasoconstriction- heart, mydrasis- iris, urinary retention- urinary, glycogenolysis- liver, & release of renin- kidney Alpha 2 receptors are located where? - CORRECT ANSWERS GI- slow digestion & pancreas-decrease insulin secretion Beta 1 receptors cause? - CORRECT ANSWERS Increase contractility, increase heart rate, & increase av node conduction-heart, kidney- increase renin release/increase BP Beta 2 receptors occur where? - CORRECT ANSWERS lungs, vascular smooth muscle & arteries of skeletal muscle, GI & Uterus, & Pancreas Beta 2 receptors cause? - CORRECT ANSWERS bronchodialation- lungs, vasodilation-vascular smooth muscle & arteries of skeletal muscle, decrease motility-GI, increase in insulin- pancreas, & inhibition of labor- uterus Beta 3 receptors occur where? - CORRECT ANSWERS fat tissue, urinary Beta 3 receptors cause? - CORRECT ANSWERS breakdown of stored fat-fat, urinary- relaxation of bladder Cholinergic receptors include? Muscurinic and nicotinic - CORRECT ANSWERS Muscurinic receptors are found where? - CORRECT ANSWERS M1- GI, M2- Cardiac, M3- Seceratoty glands, lungs, & smooth muscles in eyes Muscurinin receptors cause? - CORRECT ANSWERS m1 & m3- increased calcium M2- increase potassium & decrease HR Nicotinic receptors are found where? - CORRECT ANSWERS Neuromuscular junction- NM NN-CNS Nicotinic receptors cause? - CORRECT ANSWERS NM- Muscle contraction & NN- transmission of cholinergic signals