NURS 633 Midterm exam_NUR 633 Midterm exam: Grand Canyon University

NUR 633 Midterm exam ⦁ (80 points): Review all topics 1-8 readings. Timed 1 hour and 40 minutes and will not allow backtracking after they have been submitted. The exam can be taken at any time during Topic 8. The last date to access Jan 18, 2017. The exam is made up of multiple choice questions. Quiz 1 ⦁ Concept regarding CYP450 enzymes Cytochrome P450 enzymes are essential for the metabolism of many medications. Although this class has more than 50 enzymes, six of them metabolize 90 percent of drugs, with the two most significant enzymes being CYP3A4 and CYP2D6. Genetic variability (polymorphism) in these enzymes may influence a patient's response to commonly prescribed drug classes, including beta blockers and antidepressants. Cytochrome P450 enzymes can be inhibited or induced by drugs, resulting in clinically significant drug-drug interactions that can cause unanticipated adverse reactions or therapeutic failures. Interactions with warfarin, antidepressants, antiepileptic drugs, and statins often involve the cytochrome P450 enzymes. Knowledge of the most important drugs metabolized by cytochrome P450 enzymes, as well as the most potent inhibiting and inducing drugs, can help minimize the possibility of adverse drug reactions and interactions. Although genotype tests can determine if a patient has a specific enzyme polymorphism, it has not been determined if routine use of these tests will improve outcomes. ⦁ Potency of a drug potency is a measure of drug activity expressed in terms of the amount required to produce an effect of given intensity. ⦁ 1st order and 2nd order of pharmacokinetics ABSORPTION, distribution, metabolism, elimination (order) Quiz 2 ⦁ Drug reduce afterload or systemic vascular resistance Beta 1 adrenergic blockers, calcium channel blockers, vasodilators Resistance a muscle overcomes to contract in the Aorta antihypertensive drugs have their primary action on systemic vascular resistance. Some of these drugs produce vasodilation by interfering with sympathetic adrenergic vascular tone (sympatholytics) or by blocking the formation of angiotensin II or its vascular receptors. Other drugs are direct arterial dilators, and some are mixed arterial and venous dilators. Although less commonly used because of a high incidence of side effects, there are drugs that act on regions in the brain that control sympathetic autonomic outflow. By reducing sympathetic efferent activity, centrally acting drugs decrease arterial pressure by decreasing systemic vascular resistance and cardiac output. ⦁ Hypertensive emergency hypertensive emergency is severe hypertension with signs of damage to target organs (primarily the brain, cardiovascular system, and kidneys). Diagnosis is by BP measurement, ECG, urinalysis, and serum BUN and creatinine measurements. Treatment is immediate BP reduction with IV drugs (eg, clevidipine, fenoldopam, nitroglycerin, nitroprusside, nicardipine, labetalol, esmolol, hydralazine).