Pharmacology (Chapt. 4-6)

hizibema's version from 2017-03-26 00:02

Section 1

Question Answer
AbsorptionMovement of drug from site of administration into the blood
DistributionMovement of drug from blood to the interstitial space of tissue and from there to cells
EliminationThe combination of metabolism and excretion; Change of drug structure and movement out of the body
ExcretionMovement of drugs and their metabolites out of the body
MetabolismEnzymatically mediated alteration of drug structure
PharmacokineticsDrug movement into and out of body or throughout body.
Maximizing Effects and Minimizing Harm Requires Achieve concentrations high enough to elicit response, and avoid concentrations too high
Balance of Maximizing Effects and Minimizing Harm is Achieved by Selecting most appropriate route, dosage, and dosing schedule by considering pharmacokinetic factors
Drugs Must Cross... Membranes to enter blood from their administration site; must cross membranes to leave vascular system and reach their sites of action; must cross membranes to undergo metabolism and excretion
Passage with the Aid of a Transport SystemMay require energy or pores
Passage Through ChannelsRequires small size
Direct Penetration of the MembraneRequires lipid solubility
The Ability of a drug to cross a biologic membrane is determined primarily by what? Its ability to pass through single cells due to the cells composing most membranes are very close to one another
The Major barrier to passage through a cell is what? Cytoplasmic membrane (membrane that surrounds every cell) that consists of phospholipids (lipid and an atom of phosphate)
Cell membranes are composed of fat with phosphateTrue
Most drugs enter cells through channels or poresFalse
P-glycoprotein transports many drugs out of cellsTrue
A transport mechanism is needed for a water-soluble drug to enter a cellTrue
Ionization is a process that allows a drug to enter a cellFalse
If a quaternary ammonium compound drug is injected into a vein it will produce effects but it will not if taken orallyTrue
Polar drugs can enter fetal circulation and breast milkFalse
Acetylsalicylic acid (aspirin), like most drugs, is primarily absorbed in the small intestineFalse
Enteric drugs should not be crushed due to crushing these preparations can cause stomach distress or cause the acid in the stomach to alter the drugTrue
The intravenous route is less painful than the intramuscular route when frequent administration of analgesic drugs is needed for a childTrue
A depot intramuscular (IM) injection of an antibiotic to treat syphilis will be completely effective within 24 hours after administrationFalse
The protein-bound portion of a drug in circulation is the drug that is not able to exert its actionTrue
First-pass effect means most of the drug is activated by the liver, so it must be administered orallyFalse
If a drug has extensive first-pass effect, administering the drug by dissolving under the tongue (sublingually) allows the drug to be absorbed directly into systemic circulation bypassing first pass in the liverTrue
Adding a drug to a patient's drug schedule can cause the other drugs to be metabolized more slowly or more rapidlyTrue
Intestinal enzymes can release drugs from bile in the duodenum causing the drug to be reabsorbedTrue
The nurse would expect that an IV antibiotic prescribed for bacterial meningitis would most likely get to the site of infection if the patient is an adultFalse
Chemotherapy is administered through a central intravenous line due to chemotherapy is caustic to the vein and a large central vein has rapid blood flow, which dilutes and moves the medication quicklyTrue
The nurse is administering an intravenous push dose of an opiate analgesic (morphine sulfate). After administering half of the dose, the nurse notes that patient's respirations have decreased from 15/min to 11/min. What is the priority nursing action at this time?Stop infusing the rest of the drug
The nurse inadvertently administered subcutaneously heparin 100 units/mL, which is available on the nursing unit as part of an intravenous flush protocol, instead of the heparin 5000 units/mL that was prescribed to prevent post-operative deep vein thrombosis (DVT). What is the priority nursing concern?Consulting the prescriber for direction
The nurse realizes that when attempting to inject insulin, which lowers blood glucose, into the subcutaneous fat above the deltoid muscle in a very thin child, the drug may have been inadvertently administered into the muscle. What is the patient at risk for?blood glucose dropping too rapidly
Which laboratory test result suggests that a patient's excretion of a drug may be impairedeGFR: 30 mL/min
What is a priority nursing action in PACU to promote excretion of most anesthetics?Encourage deep breathing
Digoxin (Lanoxin) is a drug that has a narrow therapeutic range. When administering this drug, what does the nurse need to do?Carefully monitor the patient for therapeutic and toxic effects; Be diligent about the timing of administering the medication; and Monitor blood levels of the drug to assess if it is in the therapeutic range
Grapefruit juice inhibits the cytochrome P450 CYP3A4 drug metabolizing enzyme and inhibits p-glycoprotein in the intestines for days after ingestion. This especially affects calcium channel blockers, benzodiazepines, cyclosporine, and "statin" drugs. The nurse should teach a patient who is prescribed any of these drugs that drinking grapefruit juice can cause what problem? Excess levels of drug in the blood
A patient is receiving vancomycin 500 mg every 6 hours IV for a serious infection. Vancomycin IV has an immediate onset and can be neurotoxic, yet adequate levels of the drug are needed to treat the infection. the prescriber has ordered peak and trough levels to be drawn. When would the nurse expect the peak and trough levels to be drawn?Peak level 1.5 hours after infusion and trough level 30 minutes before the next dose
A patient stopped taking levothyroxine (Synthroid) 3 days ago. this drug has a half-life of 7 days. He/She tells the nurse that the drug must not have been necessary due to he/she does not feel any different. what is the basis of the nurse's explanation of why the patient has not noticed any change in how he/she feels?The drug's previous doses have not been completely eliminated from the body

Section 2

Question Answer
Pharmacodynamics includes the study of how drugs workTrue
Phase 2 of the dose-response relationship starts at the point when the therapeutic effect does not increase with increasing the doseFalse
Maximal efficacy is defined as the largest effect that a drug can produceTrue
Potency is defined as the dose of drug needed to get the desired effectTrue
Two drugs in the same therapeutic class with different recommended doses (2 mg vs. 200 mg) can have equal effectsTrue
A drug that stimulates the family of receptors that are transcription factors does not reach a peak therapeutic effect until taken regularly for days to weeksTrue
A drug that is selective for specific receptors will produce more unintended effects than a non-selective drugFalse
If a drug is selective for specific receptors, it is safeFalse
Affinity is the strength of attraction between a drug and its receptorTrue
Drugs with high intrinsic activity cause an intense responseTrue
An agonist drug blocks the stimulation of a receptorFalse
If a receptor is constantly bombarded by a drug, the cell can down-regulate and decrease the response to the drugTrue
If a patient suddenly stops taking an antagonist drug, he/she can have hypersensitivity of the receptor and overstimulationTrue
The ED50 is usually the recommended dose for the drugTrue
The nurse is reading research about a drug. the literature states that the drug is potent. What does this mean?The drug produces its effects at low doses
Except for gene therapy, which statement are true about drug-receptor interactions?Drugs can mimic the actions of endogenous molecules; and Drugs can block the actions of endogenous molecules
The nurse is administering morphine sulfate for moderate to severe post-operative pain. Based on the effect of modulating processes that are affected by morphine, what should the nurse do?Assess respiratory rate and hold the medication if respirations are weak or fewer than 12/min; Assist the patient when ambulating to prevent injury; and Encourage ambulation if not contraindicated to promote bowel motility
Which assessment finding suggests hypersensitivity of receptors when a patient suddenly stops taking atenolol (Tenormin), a beta2 receptor antagonist that slows the heart rate?Pulse 118 beats/min
A patient who has overdosed on methadone HCl (Metadol), an opiate, is brought into the emergency department unresponsive with severely depressed respirations. The patient receives intravenous naloxone HCl (Narcan), a narcotic antagonist, with a dramatic improvement in the level of consciousness and respiratory rate and effort within minutes. Which is a priority nursing action 45-60 minutes after the naloxone HCl is administered?Assess for the need to administer another dose of naloxone HCl due to respiratory and CNS depression might occur as the naloxone HCl effect is ending
When the therapeutic index of a drug is narrow, what should the nurse expect?Blood levels of the drug would be monitored throughout the therapy

Section 3

Question Answer
A prescriber may prescribe a drug solely due to its interaction with another drugTrue
Powdered drugs can be mixed once they are dissolved in a liquidFalse
Alcohol, bananas, cigarette smoking, chewing tobacco, chocolate candy, garlic, and grapefruit juice can interact with drugs and cause adverse effectsTrue
Antacids increase urinary excretion of alkaline drugsFalse
Adding potassium clavulanate to amoxicillin (Augmentin) prevents the body's beta-lactamase enzyme from destroying the amoxicillinTrue
The nurse should consult with the prescriber regarding adequate blood levels of oral drugs when a patient has persistent diarrheaTrue
The nurse is providing discharge teaching for a patient who will be taking metronidazole (Flagyl) after discharge. The drug information states to caution the patient that a reaction similar to the action of disulfiram (Antabuse) can occur. It is a priority to teach the patient to avoid which food or drink?Beer
It is the nurse's responsibility at this institution to decide what time a drug will be administered. Cholestyramine (Questran) has been prescribed for a patient who takes many drugs for diabetes and hypertension. The patient takes the other drugs at 0900 and 1700. At this institution, drugs can be given up to 1 hours before or after the assigned time. Based on proper timing of administration of this drug, when should the cholestyramine be administered?1100
Patients receiving certain drugs that are metabolized by the CYP3A4 enzyme should not drink grapefruit juice due to grapefruit juice inhibits the CYP3A4 enzyme and the drug transporter P-glycoprotein. The patient asks what might happen if she drinks grapefruit juice and take the medication. the nurse's response is based on knowledge that the effect could be what?Impaired metabolism and excretion of the drug
A male patient is prescribed clopidogrel (Plavix) to prevent blood clots after experiencing a myocardial infarction (MI, "hear attack"). He self-prescribes omeprazole (Prilosec OTC) for heartburn. Due to omeprazole can inhibit the efficacy of clopidogrel (Plavix), it is a priority for the nurse to teach the patient to report which effect?Sudden shortness of breath or chest pain
A patient has been taking phenytoin (Dilantin), a drug with a narrow therapeutic index, to control seizures. If fenobibrate (Tricor) is prescribed to lower triglycerides, drug interaction puts the patient at risk for which effect?Seizures
Tobacco induces the CYP1A2 liver enzyme. Methadone is metabolized by the CYP1A2 liver enzyme. If a drug-addicted patient was treated with methadone and smoked cigarettes, what would this tobacco use be expected to do?Speed the elimination of methadone
A patient has been prescribed sildenafil (Viagra) for erectile dysfunction. The nurse teaches the patient that metabolism of this drug may be increased, possibly decreasing the effect, if the patient uses which dietary supplement?Garlic
Muscle pain from the adverse effect of rhabdomyolysis is possible if a patient, who is prescribed which type of drug, does not inform the prescriber that the patient drinks grapefruit juice? Lovastatin (Mevacor) for high cholesterol