NUR 641E final Exam 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 last.is 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: -
ANSWER- Discovery: 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 -
ANSWER- furosemide.
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.
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 last.is 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: -
ANSWER- Discovery: 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 -
ANSWER- furosemide.
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.
