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Pharmacology Module #1,#2 & #3 EXAM
REVIEW, pharmacology module 3, Adv
Pharm 5334 UTA Exam 1 Questions and
Answers
What are the four phases of pharmacokinetics? - Ans - Absorption, distribution, metabolism, excretion Bioavailability - Ans The extent of drug that becomes available to the body after absorption "Free Drug" - Ans - The drug that is not bound to protein that is free to exert a therapeutic effect Nicotine is a? What (3) effects does it have? - Ans - A CYP 450 inducer
- Increase metabolism of drug and result in decreased effects and shortened half-life Grapefruit Juice is a? What (3) effects does it have? - Ans - A CYP 450 Inhibitor
- Decreased metabolism
- Drug toxicity
- Shorted half life
Kidneys - Ans The main organs responsible for drug excretion Half-life - Ans The time required for one half of the drug to be removed from the body Peak Effect - Ans The time taken for the drug to reach maximum therapeutic response Peak Level - Ans - The highest concentration of drug in blood Drug Polymorphism - Ans The effect of a patient's age, gender, size, body composition and other characteristics on the pharmacokinetics of a specific drug Drug Polymorphism can be categorized into what (3) different factors. - Ans 1. Environmental (diet & nutritional status)
- Cultural
- Genetic factors How can high-fat diets affect absorption? How can malnutrition affect absorption? - Ans - High Fat Diets = increased absorption of many drugs
- Malnutrition = alter the ability to absorb or eliminate medication
Generic Medication - Ans - Most commonly used
- most prescriptions are Pharmacokinetics of Oral Medications (4 steps) - Ans 1. Drug is ingested
- Disintegrated
- Forms a dissolution
- Absorption can occur What is absorption? - Ans - The movement of a drug from its site of administration into the bloodstream for distributions to tissues A drug that is absorbed through the intestines must ______ pass through the _______ before it reaches the ________ circulation. - Ans - A drug that is absorbed through the intestines must first pass through the liver before it reaches the systemic circulation High first-pass effect - Ans - A large portion is changed into an inactive metabolite Which routes of medication administration would be impacted by first pass effect? - Ans - Anything GI related can have first pass effect
- Oral and Rectal administration
Which routes will not be impacted by first-pass effect? - Ans - Parenteral and topical What are the (3) basic routes of medication administration? - Ans - Enteral, Parenteral, and topical What is enteral route of medication administration? - Ans - Is absorbed through the GI mucosa What is parenteral route of medication administration? What does it normally refer to? - Ans - The fastest route
- Any route other than the GI tract
- Normally refers to injection
Would the dose of medication for an oral tablet be the same as intravenous injection of the same medication? Why or Why Not? Which will have a larger dose? - Ans - No
- The intravenous route bypasses the liver
- The oral dose will be much larger If the drug has a high first pass rate would you give the same dose IV as you did PO? Why or why not? - Ans - No
How can food impact absorption? - Ans - Delay absorption and binding How can food temperature impact absorption? Effect of Hot & Cold? - Ans - Hot foods = vasodilation which can increase absorption of medications
- Cold foods = can cause vasoconstriction which can delay the absorption of medication How can Increased Gastric pH impact absorption? - Ans - Stomach more alkaline
- Many drugs will not be absorbed well in a more alkaline pH How can interaction of medications impact absorption? - Ans - impair absorption
- Some medications are enteric coated, which is a hard coating that prevents the breakdown of the tablet in the stomach, but instead, the medication will travel to the duodenum and will be broken down in the more alkaline environment of the small intestines. Some medications are considered Extended Release, meaning the tablet is formulated to slowly release medication over time. - Enteric coated and extended release medications should not be crushed. What is the function of albumin with drugs? - Ans - Binds the drug As unbound free drug decreases, ________ bound drug is released from _________ to maintain a balance - Ans - more
- proteins Drugs are dosed according to how bound they are to ___________. - Ans - Albumin Drugs are considered to be highly protein bound if greater than _______ is bound to protein. - Ans 90% What occurs if a person with low albumin takes a highly-protein bound drug? Why? What can it cause? - Ans - Increases the risk for toxic effects
- There are less binding sites available and causes excess of free drug What occurs if a person takes two highly-protein bound drugs? What can it cause? Which drug is displaced? - Ans - medications compete for the binding sites
- Can cause more free drug leading to toxicity
- The lower bound drug is displaced What are (4) situations that decrease protein? - Ans 1. Malnutrition
- Alcoholism
- Liver disease
- Kidney disease Enzymes from the CYP system are involved in _____ metabolism? -
Ans - how well the medications will be excreted more accurately than a creatinine level alone Ideally, we want the creatinine clearance to be (____Greater or Less than______) than _______ mL/min. - Ans - greater than 30 mL/min. *** After ____ half-lives, most drugs are considered to be removed from the body, with approximately ______% of the drug remaining in the system. - Ans - 5
- 3% *** Equilibrium is when .... - Ans - The amount of the drug excreted is = to the amount absorbed from each dose *** Steady state normally occurs after how many half-lifes? - Ans - 4- Tylenol half-life - Ans 2-3 hours Aleve half-life - Ans 12-17 hours Therapeutic Effect? Example? - Ans - A positive physiologic change in a faulty system.
- ex: lowered blood pressure in a patient with hypertension What are side effects? What do you need to educate the patient on? - Ans - Physiologic effects not related to desired drug effects
- Teach patient about side effects and how to prevent them if possible Drugs with a narrow therapeutic range require: close monitoring to ensure that no _______ occurs. Examples are: _________, _________, and _____________. - Ans - toxicity
- warfarin, digoxin, and phenytoin What is tolerance? - Ans - Decreased responsiveness over the course of therapy What is tachyphylaxis? - Ans - Rapid decrease in response What is an idiosyncratic reaction? - Ans - Unexpected response, unknown why it occurs and is rare Type A - ADR - Ans Dose-related and drug-drug interactions Type B - ADR - Ans idiosyncratic and allergic reactions
Pharmacokinetic Interactions with two drugs: Excretion can be effected because? - Ans - Some drugs increase or decrease renal excretion because they alter glomerular filtration Additive Drug Effect with drug-drug interactions? - Ans - 1+1 = 2 Synergistic Effects with drug-drug interactions? - Ans - 1+1 = greater than 2 Antagonistic Effect with drug-drug interactions? - Ans - 1+1 = less than 2 Additive effect is like ________, synergistic effect is like ________, and Antagonistic effect is like ________ - Ans - Additive Effect = Addition
- Synergistic Effect = Multiplication
- Antagonistic = Subtraction What is onset? - Ans - The amount of time required for therapeutic response What is Duration? - Ans - The amount of time that a drug produces a therapeutic response
- Trough Level -
Ans - The lowest concentration of the drug, normally drawn prior to the next dose The nurse is providing discharge instruction to a female client who delivered a healthy, full-term infant. What information should the nurse provide about taking medication while breastfeeding? - Ans - Many medications cross into the breast milk in small amounts and could cause harm to the infant Maternal Factors for Drug Therapy? - Ans - Liver and kidney function can affect amount of drug in the circulation, which can increase the amount of drug the fetus is exposed to Absorption: neonatal and pediatric considerations. Gastric pH? Gastric emptying? First-pass effect? Intramuscular absorption rate? - Ans - Gastric pH higher until 1-2 years of age
- Gastric emptying is slowed
- First-pass is decreased because of immature liver
- IM absorption is faster and irregular. Distribution: neonatal and pediatric considerations. Water levels in infants? Water levels in premature? Water levels in children 1-12? - Ans - Infants = 70-80% water
- Premature = 85%
- Children 1-12 = 64% Distribution: neonatal and pediatric considerations. Fat content? Protein & protein binding? More drugs able to enter? - Ans - Low fat content
Pharmacogenetics is the study of? - Ans - the genetic basis for variations in the body's response to drugs, with a focus of variations related to a single gene. Preclinical Investigational Drug Studies can take place in what two things? This testing allows for information on what two things? - Ans 1. - In vitro: a glass or plastic container (test tube)
- In vivo: in a living organism (mouse)
- Dosing Clinical Research - Phase 1: Study participants? Length of study? Purpose? What percentage of drugs move to the next phase? - Ans - Study Participants: 20 to 100 healthy volunteers or people with the disease/condition.
- Length of Study: Several months
- Purpose: Safety and dosage
- Approximately 70% Clinical Research - Phase 2: Study participants? Length of study? Purpose? What percentage of drugs move to the next phase? - Ans - Study Participants: Up to several hundred people with the disease/condition.
- Length of Study: Several months to 2 years
- Purpose: Efficacy and side effects
- Approximately 33% Clinical Research - Phase 3: Study participants? Length of study? Purpose? What percentage of drugs move to the next phase? - Ans - Study Participants: 300 to 3,000 volunteers who have the disease or condition
- Length of Study: 1 to 4 years
- Purpose: Efficacy and monitoring of adverse reactions
- Approximately 25-30% Clinical Research - Phase 4: Study participants? Purpose? - Ans - Study Participants: Several thousand volunteers who have the disease/condition
- Purpose: Safety and efficacy Once a drug company has information that the new drug is safe and effective, FDA Drug Review Occurs. What are they doing? - Ans - The FDA reviews the information and either approves or requires more information before allowing the pharmaceutical company to market the drug to the public.
What are the (7) ethical principles? - Ans 1. Autonomy
- Beneficence
- Confidentiality
- Nonmaleficence
- Justice
- Veracity
- Fidelity Ethical Principles: What is autonomy? - Ans - An individual's right to make their own decisions and to have information to do so Ethical Principles: What is beneficence? - Ans - Doing good Ethical Principles: What is confidentiality? - Ans - keeping information about a patient private and only including those involved in care in conversation about the patients Ethical Principles: What is nonmaleficence? - Ans - To do NO harm Ethical Principles: What is justice? - Ans - equal care for all, no preference based on socioeconomic status, race, age, gender, etc.
Ethical Principles: What is veracity? - Ans - to tell the truth Ethical Principles: What is fidelity? - Ans - to keep your promises A client receives 10 mg of morphine orally at home for pain management. The client is in the emergency department and is to receive 4 mg of morphine IV for severe pain. The client asks the nurse why they are only getting 4mg of IV morphine when at home they take 10mg of morphine. What is the best response by the nurse? - Ans Intravenous medications go directly into the bloodstream while oral medications must first go through the liver and some of the medication is made inactive A client with seasonal allergies takes diphenhydramine at bedtime to help their symptoms. The client becomes hyperactive and is unable to sleep. What type of reaction is the patient experiencing? - Ans Paradoxical Reaction The nurse is providing discharge education to an older adult client who will be on 5 prescription drugs. What physiologic changes in the older adult population put this client at risk for drug interactions? - Ans GFR is decreased, protein production by liver is decreased, number of working nephrons decreased, blood flow to the gastrointestinal tract is reduced, fat content is increased.
