AACN Pharmacology Exam Questions and Answers

AACN Pharmacology Exam Questions and Answers GI flora changes from antibiotics - Ans:-1. Decreased GI flora which produce Vit. K - warfarin pts prone to bleeding 2. Decreased production of estrogen metabolites by gut flora - estrogen based contraceptives less effective 3. MACROLIDES decrease amount of gut flora which metabolize Digoxin, therefore the active concentration increases Chelation of oral drugs - Ans:-1. Cipro with antacids 2. Cholecystyramine (prevalite) with almost any other PO drug 3. Sucralfate with any other antacid - need AT LEAST 30 MIN between administration ©GRACEAMELIA 2024/2025 ACADEMIC YEAR. ALL RIGHTS RESERVED FIRST PUBLISH OCTOBER 2024 Page 2/24 Major binding proteins - Ans:-Alpha1-acid glycoprotein Albumin *Both decreased in critical illness Protein bound drugs - Ans:-E.g. Warfarin - has very low free fraction The more protein bound a drug is, the higher chance of adverse reactions and drug interactions— changes in diet or health and other drugs competing for protein binding sites alter free fraction Drug with higher protein affinity will bind and other drug will have increased free fraction - e.g. aspirin displacing warfarin Poorly protein bound drugs - Ans:-Gentamicin - free fraction relatively independent of protein Volume of distribution - Ans:-The extent to which a drug moves out of intravascular space into body tissues ©GRACEAMELIA 2024/2025 ACADEMIC YEAR. ALL RIGHTS RESERVED FIRST PUBLISH OCTOBER 2024 Page 3/24 (Lot of movement out = high volume of distribution) Dependent upon lipid vs water solubility and protein binding High Vd - Ans:-Poorly protein bound, lipid soluble Sepsis - Ans:-qSOFA score 2 --higher is worse qSOFA (quick sequential organ failure assessment) - Ans:-respiratory rate 22 SBP /=100 GCS 15 Septic shock - Ans:-MAP 65, Lactic 2 despite adequate (30ml/kg NS) fluid boluses 3 hour surviving sepsis bundle - Ans:--measure lactate, get BCs, hang ABX w/in 1hr of arrival ©GRACEAMELIA 2024/2025 ACADEMIC YEAR. ALL RIGHTS RESERVED FIRST PUBLISH OCTOBER 2024 Page 4/24 -if lactate 4 or MAP 65, 30ml/kg fluid bolus 6 hour surviving sepsis bundle - Ans:--pressors to maintain MAP 65 if unresponsive to fluid bolus -reassess volume status if MAP 65/lactate remain 4 -continue to remeasure lactate per protocol if initial elevated Hyperglycemia in sepsis - Ans:--initiate insulin drip when two consecutive BS 180 -target BS 180, rather than lower levels -Patho: stress response causes increased glycogenolysis and hepatic gluconeogenesis. cytokine release causes insulin resistance. Adrenoreceptors - Ans:-Specific receptors throughout the body that are stimulated by or inhibit sympathomimetic activity ©GRACEAMELIA 2024/2025 ACADEMIC YEAR. ALL RIGHTS RESERVED FIRST PUBLISH OCTOBER 2024 Page 5/24 -Alpha (respond to sympathomimetic activity - usu excitatory) -Beta (inhibit sympathomimetic activity - usu inhibitory) Alpha 1 stimulation - Ans:-**vasoconstriction therefore increased PVR/BP -also bladder contraction, pupil dilation alpha 2 stimulation - Ans:-inhibits norepi release therefore decreases sympathetic outflow and alpha 1 stimulation Beta 1 stimulation - Ans:-increased heart rate (aka positive chronotropy) increased contractility (aka positive idotropy) increased speed of contractions through increases in the nerve conduction speed (aka positive dromotropism) Beta 2 stimulation - Ans:-smooth mm relaxer therefore bronchodilator and sk mm vasodilation ©GRACEAMELIA 2024/2025 ACADEMIC YEAR. ALL RIGHTS RESERVED FIRST PUBLISH OCTOBER 2024 Page 6/24 also increases hepatic gluconeogenesis dopaminergic stimulation - Ans:-enhances response to more dopamine causes end organ and mesenteric vasodilation V1 receptor stimulation - Ans:-mostly location in vascular smooth muscle--cause vasoconstriction also cause platelet aggregation from increased VWF and factor VII V2 stimulation - Ans:-mostly in distal nephrons, so causes increased h20 reabsorption in kidneys also increase amount of VWF and factor VII Beta 1 + alpha 1 - Ans:-increased inotropy and vasoconstrictio