NRNP 6566 WK1-5 MIDTERM
QUESTIONS AND CORRECT DETAILED ANSWERS WITH RATIONALES VERIFIED ANSWERS
ALREADY GRADED A+
-Abnormal labs with hyperthyroidism - anselevated T3, T4, thyroid resin uptake, and free thyroxine index.
Sometimes T4 is normal but T3 is always high
Elevated sed rate
Elevated antinuclear antibody, without evidence of lupus or autoimmune disorder
Hypercalcemia and low h/h
Atrial fibrillation - ansStable- rate control versus rhythm control strategy (example: AV nodal blockers,
antiarrhythmics, anticoagulation). Ablation may be needed if no response to medications
Unstable- DCC/ cardioversion
Atrial Flutter - ansCardioversion
Rate control not as responsive as Afib
Be able to calculate creatinine clearance using Cockgraft Gault equation: - ansMale = 140-age times weight
in kilograms divided by serum creatinine times 72.
Women = CRCL (male) times 0.85
Be familiar with the beers criteria and how to use it - ansPotentially Inappropriate Medication Use in Older
Adults
to call attention to medications that are most commonly problematic and thus should be avoided in older
adults
CHADS 2 score - ansanything greater than 3 is high risk and start anticoagulant
1 point for each with history of heart failure, hypertension, and diabetes mellitus
Stroke is 2 points
and greater than 75 years old is one point
Define narrow therapeutic index. How would you monitor a patient with a narrow therapeutic index? -
ansTherapeutic index is the dose range of effiency of med is optimized while side effects are minimized
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 cytochrome p450 system - ansCytochrome p450 system is a series of enzymes used to
metabolize medications
Describe effect on low and high albumin levels on active drug levels especially for drugs that are highly
protein bound - ansAlbumin 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 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.
Describe factors that affect absorption - anslow 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 factors that affect excretion - ansaffected by abnormal kidney or liver function, age, drug
interactions
Describe how aging can affect absorption, distribution, metabolism and excretion - ansdecreased 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 half-lives.
