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NUR 641E Midterm Study Guide Questions and Answers
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Prodrug - ANSWER-An inactive drug dosage form that is converted to an active metabolite by various biochemical reactions once it is inside the body. -Cytochrome P -Ex. Aspirin, psilocybin, heroin Bioavailability - ANSWER-the rate at and the extent to which a nutrient is absorbed and used -Affected by route of administration and drug dosage -Drug clearance (rate drug leaves circulation) -Steady state concentration -Affected by chemical stability, solubility, and first pass Steady state (of a drug) - ANSWER-stable level of drug in the body, occurs in 5 half lives of the drug -rate of drug being added to system is equal to amount being eliminated from system Pharmacokinetics - ANSWER-The process by which drugs are absorbed, distributed within the body, metabolized, and excreted. -what the body does to the drug First pass - ANSWER-the fact that a medication in the GI tract passes through the liver before entering other organs does not - ANSWER-bioequivalence does/does not affect bioavailability Bioequivalence - ANSWER-relative therapeutic effectiveness of chemically equivalent drugs. Bioavailability (is affected by) - ANSWER--chemical instability -solubility -first pass metabolism Cytochrome P450 - ANSWER--enzymes that function to metabolize potentially toxic compounds, including drugs and products of endogenous metabolism such as bilirubin, principally in the liver. -genetics influence presence of enzymes -affects metabolism of warfarin, antidepressants, antiepileptics, and statins. -the levels of these drugs are higher when taken with certain drugs that are
inhibitors (ex. warfarin with omeprazole) because there is competition for enzyme metabolism. -inducers lead to decreased plasma concentration of drug. cytochrome p450 inducer - ANSWER-An inducer increases the metabolism of a substrate resulting in a decreased level or effect of the substrate
inhalation - ANSWER--drug effects as rapid as IV bolus -minimizes systemic side effects of respiratory drugs
oral - ANSWER--antidotes may be provided -most common, convenient, and economical method of drug administration -most complicated drug pathway -low gastric pH inactivates some drugs -20-60 minutes for effects -enteric, extended-release enteric-coated - ANSWER--protects the drug from stomach acid -delivers to less acidic intestine -useful for drugs that are acid labile or irritating to stomach (ex. omeprazole, aspirin) extended-release - ANSWER--control drug release -maintain therapeutic range over longer period -good for drugs with short half-life (i.e. morphine with half-life of 2-4 hours) aPTT - ANSWER-activated partial thromboplastin time 30-40 seconds - ANSWER-Normal activated partial thromboplastin time (APTT) 1.5-2.5 - ANSWER-therapeutic aPTT is x more than normal aPTT low dose heparin - ANSWER--5000 units BID -does not require aPTT monitoring INR - ANSWER-international normalized ratio 2-3 (INR) - ANSWER-therapeutic INR for warfarin <1.1 - ANSWER-normal INR Dabigatran (Pradaxa) - ANSWER--direct thrombin inhibitor -anticoagulant -blood factor IIa inhibitor idarucizumab - ANSWER-antidote for dabigatran factor xa inhibitors - ANSWER-apixaban, edoxaban, rivarozaban, fondaparinux apixiban (MOA) - ANSWER--Factor Xa inhibitor -Eliquis Edoxaban (MOA) - ANSWER--Factor Xa inhibitor
Fondaparinux (MOA) - ANSWER--factor Xa inhibitor -Arixtra Pulmonary Embolism - ANSWER--usually a clot from the leg that blocks the pulmonary vasculature -affects right ventricle d/t backing up of blood -can cause pulmonary hypertension -risk factors: immobility, obesity, hormonal birth control, smoking, HTN pulmonary hypertension - ANSWER--elevated pulmonary pressure resulting from an increase in pulmonary vascular resistance to blood flow through small arteries and arterioles. -increased afterload causes increase in RV size as contractility cannot overcome the resistance CVA (risk factors) - ANSWER-HTN, HLD, DM, Smoking, FHx CVA, Hx TIA/CVA, AFib action potential - ANSWER--sodium moves into cell (depolarization) -threshold potential must be reached -potassium moves out of cell (repolarization) -returns to resting potential by pumping sodium out of cell and potassium back into cell threshold potential - ANSWER-The minimum membrane potential that must be reached in order for an action potential to be generated. absolute refractory period - ANSWER-The minimum length of time after an action potential during which another action potential cannot begin. relative refractory period - ANSWER-A period after firing when a neuron is returning to its normal polarized state and will fire again only if the incoming message is much stronger than usual caseous necrosis - ANSWER--degeneration and death of tissue with a cheese-like appearance -associated with TB tuberculosis - ANSWER--An infectious disease that may affect almost all tissues of the body, especially the lungs -airborne -caseous necrosis -1/4 of world population infected -> leading cause of death d/t infectious disease
-high risk countries include Mexico, Phillippines, Gautamala, China, Haiti, India -congregate settings such as homeless shelters are high risk, including for employees -increased in the mid 90s d/t AIDS but have decreased since 2000s
exotoxic bacteria - ANSWER--gram positive bacteria that stain purple -released from bacteria invasion period - ANSWER--when immune and inflammatory responses are initiated
pneumonia - ANSWER--infection of lower respiratory tract -sixth leading cause of death in U.S. -CAP, HCAP, HAP, VAP -HAP has 20-50% mortality -VAP occurs in up to 25% of ventilated patients -aspiration of oropharyngeal secretions is most common route of lower respiratory tract infection -most important guardian of lower respiratory tract is alveolar macrophage (Toll- like receptors) -pneumonococcus is most common and lethal cause of out/inpatient pneumonias -viral pneumonia is seasonal and usually mild and self limiting; however, pandemics... -mostly preceded by URI -pulmonary consolidation pulmonary consolidation - ANSWER-In pneumonia, the process by which the lungs become solidified as they fill with exudates. -CXR for pneumonia will show this and infiltrates. Acute bronchitis will not Upper respiratory tract (infections) - ANSWER-Sinusitis - blockage of sinuses Otitis media - infection of the middle ear Tonsillitis - inflammation of the tonsils Laryngitis - infection of the larynx that leads to loss of voice Pharyngitis - Sore throat (Antibiotics that should be) Avoided in Children - ANSWER--Tetracyclines -> teeth staining -Fluoroquinolones -> arthrotoxicity Antibodies in newborns - ANSWER--IgG passed to fetus through placenta in third trimester -colostrum and breastmilk contain IgA -passive immunity from mother -starts making own antibodies (IgM) 3-6 months after birth. There is a period when maternal antibodies are tapering off and newborn is only secreting minimal amounts of antibodies at about 3 months. -IgG levels start to rise again at around 1 year B cell (maturation) - ANSWER--Directed by bone marrow sites that harbor stromal cells, which nurture the lymphocyte stem cells and provide hormonal signals -Millions of distinct B cells develop and "home" to specific sites in the lymph nodes, spleen, and GALT -Come into contact with antigens throughout life
(types of) T cells - ANSWER-Helper T cells (CD4+): stimulates cytotoxic t cells, B cells, and macrophages to develop immune response Cytotoxic T cells (CD8+): simulates cell apopotosis Memory T cells: antigen specific t cells that retain a memory of prior infections ABO (compatibility) - ANSWER-O is universal donor; AB universal receiver respiratory acidosis (causes) - ANSWER-• Depression of the respiratory center. (1) Head injuries. (2) Oversedation with sedatives and/or narcotics.
- Conditions affecting pulmonary function. (1) COPD (2) Pneumonia. (3) Atelectasis.
- Conditions that interfere with chest wall excursion. (1) Thoracic trauma: flail chest. (2) Diseases affecting innervation of thoracic muscle (Guillain-Barré syndrome, myasthenia gravis, polio). (3) Mechanical hypoventilation. cytokines (cause fever) - ANSWER-These proinflammatory cytokines reach the CNS where, through induction of central mediators such as prostaglandins (PGs), they are able to increase the temperature set point and cause fever -hypothalamus regulates temperature Asthma - ANSWER--chronic inflammatory disorder of the bronchial mucosa that causes bronchial hyper-responsiveness, constriction of the airways, and variable airflow obstruction that is reversible -chest constriction, expiratory wheezing, dyspnea, nonproductive coughing, prolonged expiration, tachycardia, an tachypnea, pulsus paradoxus, respiratory alkalosis, hypoxemia pulsus paradoxus - ANSWER-beats have weaker amplitude with respiratory inspiration, stronger with expiration increased (RR) - ANSWER-- Fever
- Asthma
- Dehydration
- COPD
- Hyperventilation
- Lung conditions
- Infections
- Newborns
- Acidosis
potassium sparing diuretics (MOA) - ANSWER-Aldosterone antagonist in the distal convoluted tubule
atrial netriuretic peptide - ANSWER-acts acutely to reduce plasma volume by at least 3 mechanisms: increased renal excretion of salt and water, vasodilation, and increased vascular permeability. edema (oncotoic pressure) - ANSWER-Edema occurs when there is a decrease in plasma oncotic pressure, an increase in hydrostatic pressure, an increase in capillary permeability, or a combination of these factors. Edema also can be present when lymphatic flow is obstructed. angiotensin - ANSWER-a peptide hormone that constricts blood vessels, causes the retention of sodium and water, and produces thirst and a salt appetite amiodarone (pharmacokinetics) - ANSWER-Onset: 2-3 days (oral) Within minutes (IV) Peak Effect: 3-7 days (oral) Duration: varies Half-life: 40-55 days heart failure (patients) - ANSWER-have more than just heart failure. look for underlying angina, HTN... digoxin (and electrolytes) - ANSWER-hypomagnesemia, hypercalcemia, and hypokalemia hyperkalemia (renal failure) - ANSWER-renal failure results in elevated potassium levels because the body cannot clear the excess potassium from the blood stream through the kidneys like it normally does. hyperkalemia (addison's disease) - ANSWER-deficiency of aldosterone will result in decreased excretion of potassium hypercalcemia (treatment) - ANSWER--calcitonin, pamidronate (nitrogen containing biphosphonate compensatory hyperplasia - ANSWER-an adaptive mechanism that enables certain organs to regenerate; occurs significantly in epidermal and intestinal epithelia, hepatocytes, bone marrow cells, fibroblasts, and some bone, cartilage, and smooth muscle. naproxen - ANSWER-NSAID said for use in CAD patient NSAIDs (MOA) - ANSWER-Reversibly inhibit COX-1 & COX- Block prostaglandin synthesis
NSAID alternative - ANSWER-COX 2 inhibitors; given with risk of GI bleed (indicated by darkening stool and epigastric pain) diphenhydramine (side effects) - ANSWER-Cardiovascular: tachycardia, hypotension, palpitations Neurological: drowsiness, seizures Respiratory: mucus plugs, wheezing lortadine - ANSWER-lack of sedation and impairment of performance, longer duration of action, and absence of anticholinergic side effects. dimenhydrinate (onset of action) - ANSWER-within 15 minutes; lasts 3-6 hours (patients with history of kidney stones should) avoid - ANSWER-calcium tendon rupture - ANSWER-Fluoroquinolones have a black box warning for or tendonitis. There is an increased risk in elderly patients. Pseudomembranous colitis - ANSWER-Clindamycin, ampicillin, cephalosporins (C. diff) chronic pain - ANSWER-episode of pain that lasts for 6 months or longer; may be intermittent or continuous. NOT cancer pain
