NUR 641E Final Exam 2023 | Advanced for the Nurse Educator with Complete Solutions

NUR 641E Final Exam 2023 | Advanced for the Nurse Educator with Complete Solutions. Pharmacokinetics involves - ANSWER-absorption, distribution, metabolism and elimination). Absorption: - ANSWER-absorption from the administration site either directly or indirectly into the blood/plasma. Distribution: - ANSWER-reversibly or irreversibly move from the bloodstream into the interstitial and intracellular Metabolism: - ANSWER-biotransformed via hepatic metabolism or by other tissues. Elimination: - ANSWER-tissues. lastly, the drug and its metabolites are eliminated from the body. route of administration with the highest bioavailability - ANSWER-intravenous; putting entire dose into a patient's vein and bypassing absorption. avoids first-pass metabolism - ANSWER-Intravenous route administration has variable and erratic absorption. n - ANSWER-Rectal administration 4. Steady state (SS) - ANSWER-absorption. n is usually reached within 4-5 half-lives of drug. Half-life of a drug is - ANSWER-how long it takes for half the drug to be excreted from the body. Determines how frequently the drug must be administered. Predicts how long toxic effects can constant with first-order pharmacokinetics of a drug. Zero-order (nonlinear) pharmacokinetics - ANSWER-means a drug is metabolized at a constant rate per unit time. CYP3A4 substrate drugs - ANSWER-may have enhanced activity if any CYP3A4 inducer drugs are used along with it. Drug development process involves these steps according to the FDA: - ANSWERDiscovery: laboratory research to develop the new drug. Preclinical research with animal testing for safety (Phase I). Clinical research on human subjects for medication safety (Phase II). Clinical research in humans comparing the new drug to accepted medications placebo depending on the study (Phase III). FDA review of the results to determine approval. Post marketing study to identify adverse effects not found in earlier clinical studies (Phase IV) 2. Medication safety organizations - ANSWER-The Institute for Safe Medication Practices (ISMP) The Institute of Medicine (IOM) The Joint Commission The National Coordinating Council for Medication Error Reporting and Prevention (NCC MERP) Food and Drug Administration (FDA) Safe Use Initiative Two basic type of ADRS: - ANSWER-pharmacological and idiosyncratic. 85% to 90% of ADRS - ANSWER-are pharmacological. Adverse drug reactions are usually preventable, - ANSWER-frequently occur in a hospital or nursing home setting, and include medication errors, adverse drug effects, and allergic idiosyncratic type reactions. ADRS are not commonly reported; - ANSWER-the FDA does not mandate that ADRS be reported. Polypharmacy - ANSWER-involves using multiple health care providers for care, using multiple medications, and using several pharmacies prescription filling. Angiotensin converting enzyme inhibitors (ACEIS): - ANSWER-lisinopril, captopril, enalapril, ramipril, benazepril, fosinopril. ACEIS reduce blood pressure enzyme. - ANSWER-by suppressing the release of angiotensin-converting enzyme. Important side effects of ACE inhibitors - ANSWER-Important include cough and angioedema; discontinue the ACEI if angioedema occurs. Angiotensin II receptor blocking agents (ARBS): - ANSWER-Icandesartan (Atacand), eprosartan (Teveten), irbesartan (Avapro), losartan (Cozaar), telmisartan (Micardis) and valsartan (Diovan). ARBS reduce blood pressure - ANSWER-by blocking angiotensin II receptors. Essential (primary) hypertension - ANSWER-Essential (primary) accounts for 90% of cases; secondary hypertension may caused by chronic renal failure. Nitroglycerin - ANSWER-Nitroglycerin is a nitrate drug that can be administered IV, SL, a topical ointment and as a transdermal patch. Nitrates are contraindicated - ANSWER-with PDE-5 inhibitors (e.g., sildenafil and vardenafil) Amiodarone is the antiarrhythmic - ANSWER-Of choice when there is coexisting heart failure; can cause thyroid and pulmonary toxicity. Alpha-1 adrenergic stimulation - ANSWER-results in vasoconstriction and increased blood pressure. Alpha-1 adrenergic blockade - ANSWER-results in vasodilation and reduced blood pressure. Beta-1 adrenergic stimulation - ANSWER-by beta agonists (e.g., isoproterenol) results in increased heart rate, increased blood pressure, and increased cardiac output. Beta-1 adrenergic blockade results - ANSWER-in reduced heart rate, reduced blood pressure, and reduced cardiac output. Left heart failure - ANSWER-causes reduced delivery of oxygenated blood to the body tissues. Right heart failure - ANSWER-is associated with pulmonary disease and increased pulmonary vascular resistance. drug that relieves heart failure symptoms but does not reduce mortality - ANSWERfurosemide. Loop diuretics like furosemide - ANSWER-are potent diuretics, can cause diuretic resistance and hypokalemia, and work on receptors in the thick ascending renal loop of Henle. Loop diuretics inhibit - ANSWER-reabsorption of sodium and chloride at this site in the kidney. Potassium-sparing diuretics: - ANSWER-spironolactone, triamterene. Milrinone - ANSWER-phosphodiesterase inhibitor used for acute heart failure. Children diagnosed with the tetralogy of Fallot can stop hypoxic spells - ANSWER-by squatting down compensatory mechanism). Patent ductus arteriosus (PDA) - ANSWER-is a congenital heart defect with a continuous machine- like murmur heard over the left upper sternal border in both systole and diastole, a bounding pulse and a thrill on palpation. PDA can be effectively treated - ANSWER-IV NSAIDS such as indomethacin. Raynaud's disease - ANSWER-vasospastic disorder typically seen during cold weather. Raynaud's involves - ANSWER-the small arteries and arterioles in the fingers; occasionally, the toes are also involved. Raynaud's is treated - ANSWER-with dihydropyridine-type calcium channel blockers (e.g., nifedipine) because they cause peripheral vasodilation. Asthma - ANSWER-is an obstructive airway disease associated with airflow obstruction, mucus production, hyperreactivity of the bronchial tissue, and inflammation. Mild persistent asthma - ANSWER-is best treated with a short-acting beta-2 agonist (SABA) plus an inhaled corticosteroid. . Moderate persistent asthma - ANSWER-is best treated with an inhaled low-dose corticosteroid and a long-acting bronchodilator. Severe persistent asthma - ANSWER-is best treated with a long-acting beta-2 agonist (LABA), plus a high-potency inhaled corticosteroid, plus an oral corticosteroid drug. Inhaled short-acting beta-2 agonists (SABA) - ANSWER-are indicated only for PRN use. Long-acting beta-2 agonists (LABA, e.g., salmeterol) - ANSWER-should never be used in an acute asthma exacerbation; use a short-acting beta-2 agonist (SABA, e.g., albuterol). short-acting Short-acting beta-2 agonists (SABA) - ANSWER-are used in acute asthmatic attacks, but can increase heart rate, tremors, nervousness, and reduce serum potassium levels. , Instruct a patient on any inhaled corticosteroid - ANSWER-rinse the mouth after each use Advair (fluticasone and salmeterol) - ANSWER-Advair example of a long-acting beta agonist and a corticosteroid. Anoro ellipta (umeclidium/vilanterol) - ANSWER-is an example of a long-acting beta agonist and an anticholinergic agent. Combivent (albuterol/ipratropium) - ANSWER-example of a short-acting beta agonist and an anticholinergic agent. Tiotropium - ANSWER-Tiotropium is long-acting anticholinergic agent, not for acute asthmatic attacks, and is used once a day in asthma and COPD. Cystic fibrosis (CF) - ANSWER-is a pulmonary disorder typically seen in childhood, with an increased production of a protein-producing thick mucus that blocks the airways, pancreatic ducts, sweat gland ducts, and vas deferens. CF of the pancreas - ANSWER-also known as fibrocystic disease of the pancreas. Respiratory distress syndrome - ANSWER-is a lung disorder characterized by increased pulmonary resistance and caused by a surfactant deficiency. Respiratory distress syndrome - ANSWER-a lung disorder characterized by increased pulmonary resistance and caused by a surfactant deficiency. NSAIDS - ANSWER-have anti-inflammatory, analgesic, and antipyretic activity. Acetaminophen - ANSWER-has analgesic and antipyretic activity, but not antiinflammatory activity. The NSAID considered safe to use by individuals with heart disease - ANSWERnaproxen.