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A collection of questions and answers related to the nrnp 6566 wk1-5 midterm exam. It covers various topics in the field of nursing, including hyperthyroidism, atrial fibrillation, creatinine clearance, beers criteria, chads2 score, therapeutic index, cytochrome p450 system, drug absorption, distribution, metabolism, and excretion, hypertension, hypertensive emergency, hypertensive urgency, and heart block. The document also includes detailed explanations and rationales for each answer, making it a valuable resource for students preparing for the exam.
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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 the factors that affect distribution - anslow albumin levels, body composition, cardiac decompensation (heart failure), age Describe the factors that affect metabolism - ansgenetics, age, organ function Describe the ways the hepatic first pass effect- which is metabolism during first pass through the liver - ansAlternative 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 what determines the frequency of drug administration - anshalf life plasma concentration Dihydropyridine Calcium Channel Blockers - ansnefedipine, amlodipine these primarily act on vascular smooth muscles Use this for hypertension Essential hypertension - ansunknown cause 95% cases; onset 25 years old - 55 Secondary hypertension- related to known cause or disease process. This could be from estrogen uses, renal disease, pregnant, endocrine disorders Isolated systolic blood pressure- hypertension and systolic blood pressure greater than 140 over 90 Effectively treated with diuretics and long-acting calcium channel blockers Signs and symptoms of hypertension: headache in the morning, epitaxis, lightheadedness, visual disturbances, S4 present related to left ventricular hypertrophy, retinal changes, hematuria (which is rare) Highly protein bound drugs can lead to - anstoxicity 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 Hypertension definition - anssustained BP of 140's over 90's for a sustained period of time Stage 1 is 140-159; and 90-99 diastolic Stage 2 is equal or greater than 160 over greater or equal to 100 diastolic Hypertension medications based on history - ansNon-African Americans can take thiazide diuretics, calcium channel blockers, ace inhibitors, ARBs (grade B) African Americans need thiazides, calcium channel blockers (grade b); grade c for patient with diabetes mellitus Adults equal to or greater than the age of 18 with chronic kidney disease- ace inhibitors, ARBS grade b - regardless of race or other comorbidities Hypertensive emergency - ansSeverely elevated blood pressure 180 over 120 can occur with lower blood pressure if impending or progressive target organ dysfunction ( example : encephalopathy, intracranial hemorrhage, acute myocardial infarction, pulmonary edema with acute LV failure, unstable angina, dissecting aortic aneurysm or eclampsia
TEE should always proceed DCCV to rule out valve disease or thrombus Inducers - ansincrease CYP450 enzyme activity by increasing enzyme synthesis Inhibitors - ansblock metabolic activity from one or more CYP450 enzymes Low albumin levels - ansmalnutrition, chronic illness Non-Dihydropyridine Calcium Channel blocker - ansDiltiazem < verapamil Primarily act on the heart Use these for CP, SVT (verapamil), controlling irregular heart rate and lowering blood pressure (Diltiazem) Tachycardia - ansvagal manuever, adenosine (6 or 12 mg), betablocker or calcium channel blocker. Know what conditions each class would be used to treat Treatment for hyperthyroidism - anspropanolol (inderal) 10mg 4 times a day (up to 80 mg) Metoprolol 25 mg by mouth (Up to 50 mg) every 6*8 hours Antithyroid medications- methimazole (tapazole) initial dose is 30 to 60mg a day in three doses, and then maintenance of 5 to 15 mg daily If intolerant to tapazole, propylthiouracil initial dose is 300 to 600 mg a day in 4 doses, maintenance dosage is 100 to 150 mg daily in three doses Ventricular fibrillation - ansDefibrillate and CPR Ventricular Tachycardia - ansStable- betablocker Amiodarone, sotalol, mexiletine to reduce number of shocks MG if torsades EPS / ablation Unstable - CPR, epinephrine vasopressin, amiodarone, lidocaine, magnesium, airway management