Midterm_exam
NURS 633 Midterm_exam
• Midterm exam (80 points): Review all topics 1-8 readings. Timed
1 hour and 40 minutes and will not allow backtracking after they
have been submitted. The exam can be taken at any time during
Topic 8. The last date to access Jan 18, 2017. The exam is made
up of multiple choice questions.
Quiz 1
• Concept regarding CYP450 enzymes
Cytochrome P450 enzymes are essential for the metabolism of
many medications. Although this class has more than 50
enzymes, six of them metabolize 90 percent of drugs, with the
two most significant enzymes being CYP3A4 and CYP2D6.
Genetic variability (polymorphism) in these enzymes may
influence a patient's response to commonly prescribed drug
classes, including beta blockers and antidepressants.
Cytochrome P450 enzymes can be inhibited or induced by
drugs, resulting in clinically significant drug-drug interactions
that can cause unanticipated adverse reactions or therapeutic
failures. Interactions with warfarin, antidepressants, antiepileptic
drugs, and statins often involve the cytochrome P450 enzymes.
Knowledge of the most important drugs metabolized by
cytochrome P450 enzymes, as well as the most potent inhibiting
and inducing drugs, can help minimize the possibility of adverse
drug reactions and interactions. Although genotype tests can
determine if a patient has a specific enzyme polymorphism, it
has not been determined if routine use of these tests will
improve outcomes.
, Midterm_exam
• Potency of a drug
potency is a measure of drug activity expressed in terms of
the amount required to produce an effect of given intensity.
• 1st order and 2nd order of pharmacokinetics
ABSORPTION, distribution, metabolism, elimination (order)
Quiz 2
• Drug reduce afterload or systemic vascular resistance
Beta 1 adrenergic blockers, calcium channel blockers,
vasodilators
Resistance a muscle overcomes to contract in the Aorta
, Midterm_exam
antihypertensive drugs have their primary action on systemic vascular
resistance. Some of these drugs produce vasodilation by interfering
with sympathetic adrenergic vascular tone (sympatholytics) or by
blocking the formation of angiotensin II or its vascular receptors.
Other drugs are direct arterial dilators, and some are mixed arterial
and venous dilators. Although less commonly used because of a high
incidence of side effects, there are drugs that act on regions in the
brain that control sympathetic autonomic outflow. By reducing
sympathetic efferent activity, centrally acting drugs decrease arterial
pressure by decreasing systemic vascular resistance and cardiac
output.
• Hypertensive emergency
hypertensive emergency is severe
hypertension with signs of damage to target
organs (primarily the brain, cardiovascular
system, and kidneys). Diagnosis is by BP
measurement, ECG, urinalysis, and serum BUN
and creatinine measurements. Treatment is
immediate BP reduction with IV drugs (eg,
clevidipine, fenoldopam, nitroglycerin,
nitroprusside, nicardipine, labetalol, esmolol,
hydralazine).
Diagnosis
• Very high BP
• Identify target-organ involvement: ECG, urinalysis, BUN,
creatinine; if neurologic findings, head CT
Testing typically includes ECG, urinalysis, and serum BUN and
creatinine.
Patients with neurologic findings require head CT to diagnose
intracranial bleeding, edema, or infarction.
Patients with chest pain or dyspnea require chest x-ray.
, Midterm_exam
ECG abnormalities suggesting target-organ damage include signs
of left ventricular hypertrophy or acute ischemia.
Urinalysis abnormalities typical of renal involvement include
RBCs, RBC casts, and proteinuria.
Diagnosis is based on the presence of a very high BP and findings
of target-organ involvement.
Treatment
• Admit to ICU
• Short-acting IV drug: nitrates, fenoldopam, nicardipine, or
labetalol
• Goal: 20 to 25% reduction MAP in 1 to 2 h
Hypertensive emergencies are treated in an ICU; blood pressure is
progressively (although not abruptly) reduced using a short-
acting, titratable IV drug. Choice of drug and speed and degree of
reduction vary somewhat with the target organ involved, but
generally a 20 to 25% reduction in MAP over an hour or so is
appropriate, with further titration based on symptoms. Achieving
“normal” BP urgently is not necessary. Typical first-line drugs
include nitroprusside, fenoldopam, nicardipine, and labetalol (see
Table: Parenteral Drugs for Hypertensive Emergencies).
Nitroglycerin alone is less potent.
Clevidipine
1–21 mg/h IV Atrial Most hypertensive
fibrillation, emergencies
fever,
insomnia, Should be used
nausea, cautiously in patients
headache with acute heart
NURS 633 Midterm_exam
• Midterm exam (80 points): Review all topics 1-8 readings. Timed
1 hour and 40 minutes and will not allow backtracking after they
have been submitted. The exam can be taken at any time during
Topic 8. The last date to access Jan 18, 2017. The exam is made
up of multiple choice questions.
Quiz 1
• Concept regarding CYP450 enzymes
Cytochrome P450 enzymes are essential for the metabolism of
many medications. Although this class has more than 50
enzymes, six of them metabolize 90 percent of drugs, with the
two most significant enzymes being CYP3A4 and CYP2D6.
Genetic variability (polymorphism) in these enzymes may
influence a patient's response to commonly prescribed drug
classes, including beta blockers and antidepressants.
Cytochrome P450 enzymes can be inhibited or induced by
drugs, resulting in clinically significant drug-drug interactions
that can cause unanticipated adverse reactions or therapeutic
failures. Interactions with warfarin, antidepressants, antiepileptic
drugs, and statins often involve the cytochrome P450 enzymes.
Knowledge of the most important drugs metabolized by
cytochrome P450 enzymes, as well as the most potent inhibiting
and inducing drugs, can help minimize the possibility of adverse
drug reactions and interactions. Although genotype tests can
determine if a patient has a specific enzyme polymorphism, it
has not been determined if routine use of these tests will
improve outcomes.
, Midterm_exam
• Potency of a drug
potency is a measure of drug activity expressed in terms of
the amount required to produce an effect of given intensity.
• 1st order and 2nd order of pharmacokinetics
ABSORPTION, distribution, metabolism, elimination (order)
Quiz 2
• Drug reduce afterload or systemic vascular resistance
Beta 1 adrenergic blockers, calcium channel blockers,
vasodilators
Resistance a muscle overcomes to contract in the Aorta
, Midterm_exam
antihypertensive drugs have their primary action on systemic vascular
resistance. Some of these drugs produce vasodilation by interfering
with sympathetic adrenergic vascular tone (sympatholytics) or by
blocking the formation of angiotensin II or its vascular receptors.
Other drugs are direct arterial dilators, and some are mixed arterial
and venous dilators. Although less commonly used because of a high
incidence of side effects, there are drugs that act on regions in the
brain that control sympathetic autonomic outflow. By reducing
sympathetic efferent activity, centrally acting drugs decrease arterial
pressure by decreasing systemic vascular resistance and cardiac
output.
• Hypertensive emergency
hypertensive emergency is severe
hypertension with signs of damage to target
organs (primarily the brain, cardiovascular
system, and kidneys). Diagnosis is by BP
measurement, ECG, urinalysis, and serum BUN
and creatinine measurements. Treatment is
immediate BP reduction with IV drugs (eg,
clevidipine, fenoldopam, nitroglycerin,
nitroprusside, nicardipine, labetalol, esmolol,
hydralazine).
Diagnosis
• Very high BP
• Identify target-organ involvement: ECG, urinalysis, BUN,
creatinine; if neurologic findings, head CT
Testing typically includes ECG, urinalysis, and serum BUN and
creatinine.
Patients with neurologic findings require head CT to diagnose
intracranial bleeding, edema, or infarction.
Patients with chest pain or dyspnea require chest x-ray.
, Midterm_exam
ECG abnormalities suggesting target-organ damage include signs
of left ventricular hypertrophy or acute ischemia.
Urinalysis abnormalities typical of renal involvement include
RBCs, RBC casts, and proteinuria.
Diagnosis is based on the presence of a very high BP and findings
of target-organ involvement.
Treatment
• Admit to ICU
• Short-acting IV drug: nitrates, fenoldopam, nicardipine, or
labetalol
• Goal: 20 to 25% reduction MAP in 1 to 2 h
Hypertensive emergencies are treated in an ICU; blood pressure is
progressively (although not abruptly) reduced using a short-
acting, titratable IV drug. Choice of drug and speed and degree of
reduction vary somewhat with the target organ involved, but
generally a 20 to 25% reduction in MAP over an hour or so is
appropriate, with further titration based on symptoms. Achieving
“normal” BP urgently is not necessary. Typical first-line drugs
include nitroprusside, fenoldopam, nicardipine, and labetalol (see
Table: Parenteral Drugs for Hypertensive Emergencies).
Nitroglycerin alone is less potent.
Clevidipine
1–21 mg/h IV Atrial Most hypertensive
fibrillation, emergencies
fever,
insomnia, Should be used
nausea, cautiously in patients
headache with acute heart
