Exam 1

Question 1

Stages of pharmocokinetics

Answer 1

1. absorption
2. distribution
3. metabolism
4. excretion

Question 2

Explain excretion

Answer 2

Elimination of meds from body

Question 3

Explain absorption

Answer 3

Transmission of meds from administration location to bloodstream

Question 4

Explain metabolism

Answer 4

Changes meds into less active forms by actions of enzymes

Question 5

Explain distribution

Answer 5

Transportation of meds to sites of action by body fluids

Question 6

Oral route of administration

Answer 6

Barriers: meds need to pass through layer of epithelial cells that line GI track
Absorption pattern: varies greatly based on stability/solubility of med, GI pH, food in stomach, form of med (liquid/enteric encoated)

Question 7

Sublingual route of administration

Answer 7

Barriers: swallowing before dissolution allows gastric pH to inactivate med
Absorption pattern: quickly through the highly vascular mucous membranes

Question 8

Inhalation route of administration

Answer 8

Barriers: inspiratory effort
Absorption pattern: rapid through alveolor capillary networks

Question 9

Subcutaneous route of admission

Answer 9

Barriers: no significant barrier, capillary walls have large spaces between cells
Absorption pattern: solubility of med in water (higher solubility = higher absorption) and blood perfusion at site of injection (higher perfusion = rapid)

Question 10

Intravenous route of administration

Answer 10

Barriers: none
Absorption pattern: immediate (directly into bloodstream) and complete (reaches blood in its entirety)

Question 11

Fastest route of administration

Answer 11

Intravenous

Question 12

Slowest route of administration

Answer 12

Oral

Question 13

10 “rights” to medication administration

Answer 13

Client
Medication
Dose
Time
Route
Documentation
Education
Refuse
Assessment
Evaluation

Question 14

Phlebitis

Answer 14

Inflammation of the vein

Question 15

Extravasation

Answer 15

Infiltration of vesicant (highly irritating) medication into tissues surrounding veins

Question 16

Infiltration

Answer 16

Administration of non-vesicant solution into tissues surrounding vein

Question 17

Colloids

Answer 17

Maintain a high osmotic pressure in the blood and stays in intravascular space longer

Ex: albumin, dextran

Question 18

Crystalloids

Answer 18

Increase intravascular volume when it is reduced from hemorrhage, dehydration, or loss of fluids

Ex: 0.9% NaCl, DSW, LR

Question 19

Isotonic

Answer 19

Balance of water and solutes

Ex: 0.9%NaCl, 5% dextrose in water, LR

Question 20

Hypertonic

Answer 20

To move fluid out of cells

Ex: dextrose 10% in water (D5W), 3% NaCl

Question 21

Hypotonic

Answer 21

To move fluid into cells

Ex: 0.45% NaCl

Question 22

What hormones are responsible for the regulation of fluid and electrolytes

Answer 22

Aldosterone, antidiuretic hormone (ADH) (vasopressin), natriuretic peptides (NPs)

Question 23

What is the primary function to help regulate blood pressure

Answer 23

Aldosterone

Question 24

What does aldosterone do in the body

Answer 24

Signals the kidney and colon to increase the amount of sodium sent into the bloodstream which causes the water to retain water in the blood which increases blood volume

Question 25

What does antidiuretic hormone (ADH) (vasopressin) do in the body

Answer 25

Affects fluid volume by reducing amount of water passed out in urine or returning more water to bloodstream; decreases blood pressure during dehydration or hemorrhage high levels = retain water in body low levels = excrete too much water

Question 26

What does natriuretic peptides (NPs) do in the body

Answer 26

Synthesized by heart, brain, and other organs and secreted in response to the increased blood volume and pressure usually in response to heart failure actions = reduce arterial pressure by decreasing blood volume and systemic vascular resistance

Question 27

What happens when blood osmolarity decreases?

Answer 27

Supresses ADH

Question 28

Interventions if urine output is not enough (less than 30cc per hour)

Answer 28

Indicator of perfusion (post op/shock) pharm therapy = diuretics, ACE inhibitors, ARBs, direct renin inhibitors

Question 29

s/s of fluid deficit in adults

Answer 29

Increased heart rate, weak peripheral pulses, orthostatic or postural hypotension, poor skin turgor, dry flakey skin, increased respiratory rate

Question 30

s/s of fluid deficit in infants and children

Answer 30

Dry mouth and tongue, lack of tears, no wet diaper for 3 hours, sunken eyes cheeks and fontanels, listlessness and irritability

Question 31

Causes of fluid deficit

Answer 31

vomiting, diarrhea, diaphoresis, burns, severe wounds, long term NPO, diuretic therapy, GI suction, diabetes, impaired thirst, fever

Question 32

s/s of fluid overload

Answer 32

increased pulse, high BP, decreased pulse pressure, elevated central venous pressure, distended neck and hand veins, weight gain, increased RR, SOB, shallow RR, moist crackles, pitting edema, AMS, paresthesia, enlarged liver, increased motility

Question 33

Causes of fluid overload

Answer 33

excessive fluid replacement, kidney failure (end stage), heart failure, long term corticosteroid therapy, psychiatric disorders with polydipsia, water intoxication

Question 34

Common type of fluid overload

Answer 34

hypervolemia

Question 35

Interventions for fluid deficit

Answer 35

fluid replacement (oral fluids, pedialyte, IV fluids), drug therapy (antiemetics, antipyretics, desmopressin for diabetes), monitor I and O to ensure it is working

Question 36

Interventions for fluid overload

Answer 36

remove excess fluid (diuretics like furosemide - loop diuretic), fluid restriction, watch for skin breakdown, I&O and weight to ensure it is working

Question 37

Postural hypotension

Answer 37

change in bp from lying to sitting or sitting to standing can be from hypoglycemia

Question 38

Manifestations of hyponatremia

Answer 38

SALT LOSS seizure/stupor abdominal cramping/confusion lethargic tendon reflexes diminished/trouble concentrating loss of urine and appetite orthostatic hypotension/overactive bowel sounds shallow respirations (later on) spasms of muscle

Question 39

Interventions for hyponatremia

Answer 39

drug and nutrition therapy to restore sodium (bring up slowly) drugs = reduce drugs like diuretics (those increase sodium loss), prescribe IV saline, drugs that promote excretion of water instead of sodium for mild hyponatremia oral sodium intake and restrict fluid intake

Question 40

s/s of hypernatremia

Answer 40

vary depending on if hyper or hypovolemia is present short attention span, agitated, confused, stupor, lethargy, muscle twitching, muscle contractions, weaker muscles over time, deep tendon reflexes reduced, increased pulse for hypotension, descreased heart rate for hypertension

Question 41

Interventions for hypernatremia

Answer 41

diuretics to promote sodium loss (furosemide, bumetanide) - typically when others ineffective, heavy hitter nutrition therapy - dietary sodium restriction

Question 42

biggest concern for hyponatremia

Answer 42

neuro and dehydration

Question 43

risk factors for hypokalemia

Answer 43

excessive fluid loss, diuretic drugs (loop like lasix), kidney disease, corticosterioids, cushings syndrome, wound drainage (GI), HF,

Question 44

risk factors for hyperkalemia

Answer 44

over ingestion of potassium, rapid infusion, burns, crush injuries, kidney failure, adrenal insuffiency, acidosis, diabetes, MI, salt substitutes

Question 45

hyperkalemia manifestations

Answer 45

bradycardia, hypotension, ECG changes of tall peaked T waves, asystole, and V-fib, twitching, tingling, burning sensations, numbness, increased motility with diarrhea, hyperactive bowel sounds, watery bowel movements

Question 46

temporary fixes for hyperkalemia

Answer 46

first administer insulin 10-15 units of regular along with 50mL of 50% dextrose to prevent hypoglycemia, if ECG changes to tall peaked T waves, give calcium gluconate first to stablize cardiac muscle. also give bicarbonate (1 ampule over 5 min) to stimulate na/k pumps albuterol as nebulizer by lowering levels of k by promoting its movement into cells

Question 47

Interventions for hypokalemia

Answer 47

give PIV potassium 20mEq/100mL or postassium supplements (with plenty of water and sitting up for 30 min to prevent esophagitis)

Question 48

more permanent fixes for hyperkalemia

Answer 48

loop diuretics (furosemide), sodium polystyrene sulfonate (kayexalate), dialysis, hemodialysis

Question 49

Hypocalcemia history

Answer 49

orthopedic surgery, bone healing, thyroid surgery, irradiation of the upper middle chest and neck area, recent anterior neck injury

Question 50

hypocalcemia s/s

Answer 50

paresthesia, frequent muscle spasms, trousseaus sign, chvosteks sign, weak and thready pulse, hyperactive BS, cramping, diarrhea, osteoporosis, scoliosis

Question 51

2 clinical manifestations of hypocalcemia

Answer 51

trousseaus sign (spasm or palmer flexion after BP cuff inflation) chvosteks sign (facial twitching after tapping the ipsilateral cheek)