AACN Pharmacology Exam 2025

GI flora changes from antibiotics - Correct 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 - Correct 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 Major binding proteins - Correct Ans-Alpha1-acid glycoprotein Albumin *Both decreased in critical illness Protein bound drugs - Correct 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 - Correct Ans-Gentamicin - free fraction relatively independent of protein Volume of distribution - Correct Ans-The extent to which a drug moves out of intravascular space into body tissues (Lot of movement out = high volume of distribution) Dependent upon lipid vs water solubility and protein binding High Vd - Correct Ans-Poorly protein bound, lipid soluble Sepsis - Correct Ans-qSOFA score 2 --higher is worse qSOFA (quick sequential organ failure assessment) - Correct Ans-respiratory rate 22 SBP /=100 GCS 15 Septic shock - Correct Ans-MAP 65, Lactic 2 despite adequate (30ml/kg NS) fluid boluses 3 hour surviving sepsis bundle - Correct Ans--measure lactate, get BCs, hang ABX w/in 1hr of arrival -if lactate 4 or MAP 65, 30ml/kg fluid bolus 6 hour surviving sepsis bundle - Correct 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 - Correct 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 - Correct Ans-Specific receptors throughout the body that are stimulated by or inhibit sympathomimetic activity -Alpha (respond to sympathomimetic activity - usu excitatory) -Beta (inhibit sympathomimetic activity - usu inhibitory) Alpha 1 stimulation - Correct Ans-**vasoconstriction therefore increased PVR/BP -also bladder contraction, pupil dilation alpha 2 stimulation - Correct Ans-inhibits norepi release therefore decreases sympathetic outflow and alpha 1 stimulation Beta 1 stimulation - Correct 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 - Correct Ans-smooth mm relaxer therefore bronchodilator and sk mm vasodilation also increases hepatic gluconeogenesis dopaminergic stimulation - Correct Ans-enhances response to more dopamine causes end organ and mesenteric vasodilation V1 receptor stimulation - Correct Ans-mostly location in vascular smooth muscle--cause vasoconstriction also cause platelet aggregation from increased VWF and factor VII V2 stimulation - Correct Ans-mostly in distal nephrons, so causes increased h20 reabsorption in kidneys also increase amount of VWF and factor VII Beta 1 + alpha 1 - Correct Ans-increased inotropy and vasoconstriction vasporessors - Correct Ans-do NOT cross BBB Vasopressor average half life - Correct Ans-2 minutes in case of extravasation - Correct Ans-first line: phentolamine second line: 1" topical 2% nitro paste redosed q8h Phentolamine (Regitine) - Correct Ans-alpha adrenergic blocker that reverses the alpha 1 mediated vasoconstriction. administer directly into infiltrated catheter, then remove catheter. NE mix solution - Correct Ans-MUST be in dextrose containing solution (D5W or D5NS) -NS causes oxidation reaction which decreases drug potency NE - Correct Ans-Half life: 2-2.5 min