Page 1 of 53
FINAL PREP 6-12 NRNP 6566 |
NRNP 6566 WK1-5 MIDTERM PRACTICE EXAM
QUESTIONS WITH ANSWERS
Identify 1st degree heart block -- ANSWER--cardiologist consult
Order echo to rule out structural diagnosis, check thyroid levels, medications,
electrolytes and identify and treat cause
Identify 2nd degree heart block -- ANSWER--permanent pacemaker,
continuous tele monitoring, possible transcutaneous pacing, determine cause; IV
atropine if poor perfusion s/s every 3-5 minutes with max of 3mg if poor
perfusion. No response to atropine, use dopamine, epinephrine, isoproterenol
Identify 3rd degree heart block/complete heart block -- ANSWER--Permanent
pacemaker, telemetry monitoring and transcutaneous pacing if needed, identify
cause, IV atropine if s/s poor perfusion. If no response to atropine, use
dopamine, epinephrine and isoproterenol
Define narrow therapeutic index. How would you monitor a patient with a
narrow therapeutic index? -- ANSWER--Therapeutic index is the dose range of
effiency of med is optimized while side effects are minimized
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Narrow therapeutic index drugs are defined as those drugs where small
differences in dose or blood concentration may lead to dose and blood
concentration dependant, serious therapeutic failures or adverse drug reactions.
You will need to monitor blood tests to monitor blood concentrations and dose
adjustments accordingly.
Describe how aging can affect absorption, distribution, metabolism and
excretion -- ANSWER--decreased organ function, poorly tolerate drugs that
require metabolism, lower rates of excretion decrease in small-bowel surface
area, slowed gastric emptying, increase in gastric PH, changes in drug
absorption
With age, body fat generally increases and total body water decreases. Increased
fat increases the volume of distribution for highly lipophilic drugs (for example,
diazepam and chlordiazepoxide), which may increase their elimination
halflives.
Serum albumin decreases and alpha 1 acid glycoprotein increases -- Phenytoin
and warfarin are examples of medications with a higher risk of toxic effects
when serum albumin increases hepatic metabolism of many drugs through
cytochrome P enzyme system decreases with age; decreasing 30-40% decreased
renal elimination
Describe effect on low and high albumin levels on active drug levels especially
for drugs that are highly protein bound -- ANSWER--Albumin is the plasma
protein with the greatest capacity for binding drugs. Binding plasma proteins
affect drug distribution into tissues, because only drug that is not bound is
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available to penetrate tissues, bind to receptors, and exert activity. As free drug
leaves the blood stream, more bound drug is released from binding sites.
Low albumin levels -- ANSWER--malnutrition, chronic illness
Highly protein bound drugs can lead to -- ANSWER--toxicity in patients with
low albumin levels, example malnutrition or chronic illness. This is because
there are fewer than the normal sites for the drug to bind
Describe the ways the hepatic first pass effect- which is metabolism during first
pass through the liver -- ANSWER--Alternative routes include:
suppository intravenous intramuscular inhalational aerosol transdermal
sublingual
These allow drugs to bypass the first-pass effect and be absorbed directly into
systemic circulation
Describe cytochrome p450 system -- ANSWER--Cytochrome p450 system is a
series of enzymes used to metabolize medications
Inhibitors -- ANSWER--block metabolic activity from one or more CYP450
enzymes
Inducers -- ANSWER--increase CYP450 enzyme activity by increasing enzyme
synthesis
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Be able to calculate creatinine clearance using Cockgraft Gault equation: --
ANSWER--Male = 140-age times weight in kilograms divided by serum
creatinine times 72.
Women = CRCL (male) times 0.85
Describe what determines the frequency of drug administration -- ANSWER-
half life plasma concentration
Be familiar with the beers criteria and how to use it -- ANSWER--Potentially
Inappropriate Medication Use in Older Adults to call attention to medications
that are most commonly problematic and thus should be avoided in older adults
Describe factors that affect absorption -- ANSWER--low blood state (shock or
arrest), contact time with GI tract too fast (diarrhea = cant absorb), delayed
stomach emptying (large meal = delayed absorption)Drug- to drug or drug to
food interactions
Describe the factors that affect distribution -- ANSWER--low albumin levels,
body composition, cardiac decompensation (heart failure), age
Describe the factors that affect metabolism -- ANSWER--genetics, age, organ
function
FINAL PREP 6-12 NRNP 6566 |
NRNP 6566 WK1-5 MIDTERM PRACTICE EXAM
QUESTIONS WITH ANSWERS
Identify 1st degree heart block -- ANSWER--cardiologist consult
Order echo to rule out structural diagnosis, check thyroid levels, medications,
electrolytes and identify and treat cause
Identify 2nd degree heart block -- ANSWER--permanent pacemaker,
continuous tele monitoring, possible transcutaneous pacing, determine cause; IV
atropine if poor perfusion s/s every 3-5 minutes with max of 3mg if poor
perfusion. No response to atropine, use dopamine, epinephrine, isoproterenol
Identify 3rd degree heart block/complete heart block -- ANSWER--Permanent
pacemaker, telemetry monitoring and transcutaneous pacing if needed, identify
cause, IV atropine if s/s poor perfusion. If no response to atropine, use
dopamine, epinephrine and isoproterenol
Define narrow therapeutic index. How would you monitor a patient with a
narrow therapeutic index? -- ANSWER--Therapeutic index is the dose range of
effiency of med is optimized while side effects are minimized
, Page 2 of 53
Narrow therapeutic index drugs are defined as those drugs where small
differences in dose or blood concentration may lead to dose and blood
concentration dependant, serious therapeutic failures or adverse drug reactions.
You will need to monitor blood tests to monitor blood concentrations and dose
adjustments accordingly.
Describe how aging can affect absorption, distribution, metabolism and
excretion -- ANSWER--decreased organ function, poorly tolerate drugs that
require metabolism, lower rates of excretion decrease in small-bowel surface
area, slowed gastric emptying, increase in gastric PH, changes in drug
absorption
With age, body fat generally increases and total body water decreases. Increased
fat increases the volume of distribution for highly lipophilic drugs (for example,
diazepam and chlordiazepoxide), which may increase their elimination
halflives.
Serum albumin decreases and alpha 1 acid glycoprotein increases -- Phenytoin
and warfarin are examples of medications with a higher risk of toxic effects
when serum albumin increases hepatic metabolism of many drugs through
cytochrome P enzyme system decreases with age; decreasing 30-40% decreased
renal elimination
Describe effect on low and high albumin levels on active drug levels especially
for drugs that are highly protein bound -- ANSWER--Albumin is the plasma
protein with the greatest capacity for binding drugs. Binding plasma proteins
affect drug distribution into tissues, because only drug that is not bound is
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available to penetrate tissues, bind to receptors, and exert activity. As free drug
leaves the blood stream, more bound drug is released from binding sites.
Low albumin levels -- ANSWER--malnutrition, chronic illness
Highly protein bound drugs can lead to -- ANSWER--toxicity in patients with
low albumin levels, example malnutrition or chronic illness. This is because
there are fewer than the normal sites for the drug to bind
Describe the ways the hepatic first pass effect- which is metabolism during first
pass through the liver -- ANSWER--Alternative routes include:
suppository intravenous intramuscular inhalational aerosol transdermal
sublingual
These allow drugs to bypass the first-pass effect and be absorbed directly into
systemic circulation
Describe cytochrome p450 system -- ANSWER--Cytochrome p450 system is a
series of enzymes used to metabolize medications
Inhibitors -- ANSWER--block metabolic activity from one or more CYP450
enzymes
Inducers -- ANSWER--increase CYP450 enzyme activity by increasing enzyme
synthesis
, Page 4 of 53
Be able to calculate creatinine clearance using Cockgraft Gault equation: --
ANSWER--Male = 140-age times weight in kilograms divided by serum
creatinine times 72.
Women = CRCL (male) times 0.85
Describe what determines the frequency of drug administration -- ANSWER-
half life plasma concentration
Be familiar with the beers criteria and how to use it -- ANSWER--Potentially
Inappropriate Medication Use in Older Adults to call attention to medications
that are most commonly problematic and thus should be avoided in older adults
Describe factors that affect absorption -- ANSWER--low blood state (shock or
arrest), contact time with GI tract too fast (diarrhea = cant absorb), delayed
stomach emptying (large meal = delayed absorption)Drug- to drug or drug to
food interactions
Describe the factors that affect distribution -- ANSWER--low albumin levels,
body composition, cardiac decompensation (heart failure), age
Describe the factors that affect metabolism -- ANSWER--genetics, age, organ
function
