Exam I Flashcards
(220 cards)
1
Q
A pathological barrier leading to individual drug variations include:
A. Age
B. Kidney function
C. Family history
A
B. Kidney function
2
Q
The concentration of the drug at the receptor is primarily determined by:
A. pharmacokinetics
B. pharmacodynamics
C. administration
A
B. pharmacodynamics
3
Q
The best clinical evidence for drug effectiveness comes from a:
A. large, random-controlled trial with double-blinding
B. large, random-controlled trial with single-blinding
C. small, random-controlled trial with double-blinding
D. small, random-controlled trial with single-blinding
A
A. large, random-controlled trial with double-blinding
4
Q
Off-label use refers to using a drug:
A. which is a generic substitute for the ordered trade drug.
B. which is a close-substitute for the ordered trade drug.
C. for a purpose approved by the FDA.
D. for a purpose not approved by the FDA
A
D. for a purpose not approved by the FDA
5
Q
Most adverse drug effects are identified in phase \_\_\_ of clinical testing. I II III IV
A
Phase III
6
Q
The preferred drug name to eliminate confusion among health care providers is the: A. chemical name B. trade name C. generic name D. common name
A
C. generic name
7
Q
Contraindication
A
A pre-existing condition that prevents use of a drug under all but the most severe circumstances
8
Q
Precaution
A
A pre-existing condition that significantly increases the likelihood of an adverse reaction
Not life threatening
9
Q
Adverse Drug Reactions (ADR)
A
Noxious, unintended, and undesired effect that occurs at normal drug doses.
Mild: Drowsiness, nausea, itching, rash
Severe:
Respiratory depression, neutropenia, liver injury, anaphylaxis, hemorrhage
Risk Factors for ADRs
Elderly or very young
Severe illness
Multiple drug use
10
Q
Side effects
A
Nearly unavoidable secondary drug effect produced at therapeutic doses.
Generally predictable
Develop immediately, or weeks to months
Intensity usually dose-dependent
Examples
Aspirin- gastric irritation
Antihistamines- drowsiness
11
Q
Toxicity
A
Detrimental physiological effects caused by excessive dosing.
Examples
Morphine- respiratory depression
Insulin- severe hypoglycemia
Sometimes used to indicate a severe ADR
Ex. Neutropenia by anticancer drugs
12
Q
Idiosyncratic Effect
A
Uncommon drug response resulting from a genetic predisposition.
G6PD deficiency (African and Mediterranean descent - Aspirin causes red blood cell hemolysis
Slower inactivation of a drug, allowing effects to last longer
- Ex. Succinylcholine (Muscle relaxant) – malignant hyperthermia
13
Q
Paradoxical Effect
A
Effect opposite of intended drug response
For example, a sedative may cause nervousness or agitation.
14
Q
Iatrogenic Disease
A
A disease produced by a healthcare provider or by a drug.
Ex. Some antipsychotic drugs may cause symptoms similar to Parkinson’s disease.
iatros- physician
-genic to produce
15
Q
Carcinogenic Effect
A
The ability of certain medications and environmental chemicals to cause cancer.
16
Q
Hepatotoxicity
A
Drugs are the leading cause of liver failure
Metabolism produces toxic metabolites
Drug combinations increase the risk of liver damage – alcohol & Tylenol
Monitor liver function tests (LFTs)
Signs and Symptoms of Liver Damage
Jaundice, dark urine, light-colored stools, nausea and vomiting, malaise, abdominal discomfort, loss of appetite
17
Q
QT Interval Drugs
A
Prolong QT interval on ECG Increased ventricular repolarization time Risk of ventricular dysrhythmias Caution using in patients with: Dysrhythmias Elderly Low potassium or magnesium Women (longer QT intervals than men)
18
Q
Nephrotoxicity
A
kidney damage
Monitor blood urea nitrogen (BUN), creatinine, creatinine clearance, urinalysis
19
Q
Bone Marrow Toxicity
A
bone marrow damage
Monitor periodic blood counts
20
Q
Ototoxicity
A
inner ear damage
21
Q
MEDWATCH
A
MEDWATCH is the FDA Medical Products Reporting Program.
You can file your report electronically via their internet site (www.fda.gov/medwatch).
This is an important program for bringing ADRs and product problems to light.
22
Q
An unwanted reaction caused by an overdose is: A. an adverse drug reaction. B. a side effect. C. a toxicity. D. an allergic reaction.
A
C. a toxicity
23
Q
Anaphylaxis is defined as all of the following except: A. bronchospasm. B. laryngeal edema. C. hypotension. D. rash.
A
D. rash
24
Q
An idiosyncratic effect is defined as:
A. an immune response triggered by prior exposure.
B. an uncommon response resulting from a genetic predisposition.
C. a disease caused by a provider or drug.
D. the ability to cause cancer.
A
B. an uncommon response resulting from a genetic predisposition
25
Medication Guides
Medication Guides
FDA approved guides to educate patients about how to minimize harm from dangerous drugs
MedGuides are required:
Patient adherence to directions is essential
Potential for serious side effects is present
26
Black Box Warnings
Black Box Warnings
Strongest safety warning a drug can carry and still be on the market
Required for drugs with serious or life-threatening risks
27
```
Identify the highest-risk patient for adverse drug effects:
A. 25-year-old male with a leg fracture
B. 70-year-old male with alcoholism
C. 5-year-old female with Strep. throat
D. 15-year-old with appendicitis
```
B. 70-year-old male with alcoholism
28
Safe Medication Administration –
| 6 Rights
```
Client/Patient
Drug
Dose
Route
Time
Documentation
```
Mnemonic: Patients Do Drugs Round The Day
29
What is the blood-brain barrier? Name two ways drugs enter the brain.
The capillaries of the brain do not have gaps between the cells of the capillaries. Drugs must pass through the cell membrane or be transported by a transport system.
30
The cytochrome P450 system refers to a family of enzymes which does what?
Metabolize drugs.
31
Kidneys are unable to excrete what type of drugs?
Highly lipid-soluble.
32
Define prodrug.
An inactive compound which can be converted into an active drug.
33
Define the first-pass effect.
Blood passes through the liver before reaching the systemic circulation.
34
How do hepatic inducers affect the rate of drug metabolism?
Increases.
35
If a drug binds to albumin and displaces another drug from the site, what happens to the serum concentration of the drug displaced?
Increases
36
At what age does the infant’s liver develop into its full capacity?
One year.
37
The most important organ for drug excretion is what?
The kidneys.
38
Which drugs remain in the urine for excretion?
Polar and ionized drugs.
39
Define enterohepatic circulation.
Drugs excreted in the bile are reabsorbed into the portal blood.
40
What type of drugs easily enters breast milk?
Lipid-soluble or lipophilic
41
Define the minimum effective concentration (MEC).
The plasma drug level at which a drug has a therapeutic effect.
42
Define toxic concentration.
The plasma drug level at which toxic effects begin.
43
Define therapeutic range.
The range of plasma drug levels that fall between the MEC and the toxic concentration.
44
Define duration.
The length of time the drug is in the therapeutic range.
45
Define half-life.
The time required for the amount of drug in the body to decrease by 50%. For example if the half-life is one day, in 1 day, 50% is left; in 2 days, 25% is left; in 3 days, 12.5% is left; etc.
46
How many half-lives does it take to clear a drug from the body? What about the half lives of metabolites?
4 half-lives.
| Some metabolites may have longer half-lives than the drug itself.
47
Define plateau. What is the relationship between absorption and elimination?
Steady concentration of drug reached after repeated doses.
| Absorption = Elimination
48
Why are loading doses given?
To shorten the time to plateau.
49
Why are maintenance doses given?
To continue the plateau.
50
What type of drugs cross the placenta?
Lipid-soluble or lipophilic.
51
Define pharmacokinetics.
The study of drug movement throughout the body.
52
The cell membrane is composed of what?
A double layer of molecules known as phospholipids.
53
Name two ions which can pass through channels or pores.
Na+ and K+
54
Define transport system. Is it selective or nonselective?
A system which transports drugs from one side of a cell membrane to another.
Only carries drugs with a particular structure.
55
What type of drug can penetrate a cell membrane?
Lipophilic or lipid-soluble
56
List two types of non-lipid soluble drugs.
Polar molecules and most ions
57
Define polar molecule. They dissolve well in what solvent?
Molecules which have an unequal or uneven distribution of electrons yet no net charge.
Water.
58
Define ion.
Atoms which have a net electrical charge.
59
An acid tends to ionize in what type of environment?
Base
60
A base tends to ionize in what type of environment?
Acid
61
Explain ion trapping or pH partitioning.
When there is a pH gradient between two sides of a cell membrane, acidic drugs will ionize and stay on the basic side. Basic drugs will ionize and stay on the acidic side. Ionized drugs do not cross cell membranes.
62
Define absorption.
The movement of drug from its site of administration into the blood.
63
Rapidly dissolving drugs will have what type of onset?
Rapid
64
An increased surface area for absorption will cause absorption to increase or decrease?
Increase
65
Drugs are absorbed more rapidly in areas where blood flow is what?
High
66
What types of drugs are absorbed rapidly through the cell membrane?
Lipophilic or lipid soluble
67
Delayed gastric emptying may delay the absorption of a drug meant to be absorbed where?
Intenstines
68
Parenteral drugs refer to routes of administration where?
Outside the GI tract.
69
What is the rate of absorption for intravenous administration?
Instantaneous.
70
What is the barrier to intramuscular absorption?
Capillary wall.
71
What types of drugs are absorbed from intramuscular and subcutaneous sites?
Poorly soluble drugs (water-soluble)
72
Which route is the safest for drug administration?
Oral
73
Define chemically equivalent.
Drugs contain the same amount of the identical chemical compound.
74
Define bioavailability.
Drugs contain the same amount of the identical chemical compound and are absorbed at the same rate and to the same extent.
75
Where are enteric-coated drugs meant to dissolve?
Intestine
76
Why are sustained-release capsules utilized?
Maintain a steady release of the drug all day.
77
What is the most common mechanism by which drugs enter a cell?
Direct penetration of the membrane
78
Should enteric-coated drugs be crushed? Why or why not?
No, the drug would interact with stomach acids.
79
What does the p-glycoprotein do?
It is a transmembrane protein which transports drugs out of the cells back into the blood stream or into lumens such as renal tubules or intestinal lumens.
80
What is a quaternary ammonium compound?
It is a compound with at least one nitrogen atom which has four bonds rather than three bonds. It has a positive charge and is unable to cross most membranes.
81
How long should a drug be administered intravenously to ensure the lowest serum concentration of the drug in the circulation?
Over one minute to fully distribute drug within entire blood volume.
82
List three most important properties of drugs. Which is the most important?
Effectiveness, safety, selectivity.
| Effectiveness most important.
83
What does selectivity mean?
Produces only desired responses for which it is given.
84
List three types of drug names. Which is the best for communicating between health professionals?
Chemical, generic, trade
| Generic name is the best.
85
What factor primarily determines the drug concentration at the receptor?
Administration.
86
Pharmacokinetics determines what?
How much of a drug reaches the sites of action
87
List four processes of pharmacokinetics.
Absorption, distribution, metabolism, excretion
88
How does changing the route from intravenous to oral influence dosage?
Oral dosages are usually higher than intravenous dosages, because there is a barrier to absorption.
89
Pharmacodynamics refers to what action?
The nature and intensity of response at its site of action.
90
Name the six rights of safe medication administration.
Right patient, right drug, right dose, right route, right time, right documentation
91
Explain the difference between a contraindication and precaution.
A contraindication prevents the drug use under all but the most severe circumstances. A precaution increases the likelihood of an adverse reaction, but not a life–threatening one.
92
The Federal Food, Drug, and Cosmetic Act of 1938 resulted in what mandate?
Testing for toxicity
93
The Harris-Kefauver Amendment of 1962 mandated what two requirements?
Proof of effectiveness and rigorous testing procedures.
94
The Controlled Substances Act of 1970 identified drugs with a potential for what? What was developed?
Potential for abuse.
| Developed Schedules I – V
95
Schedule I includes what types of drugs? Schedule II?
Schedule I- Drugs with no acceptable medical use and high abuse potential.
Schedule II- Drugs with therapeutic use, but high abuse potential.
96
THE FDA Amendments Act (FDAAA) of 2007 allowed the FDA oversight over what?
Safety oversight over drugs that had been approved. Specifically gave the FDA the authority to require postmarketing safety studies, labeling changes to include new safety information, and restricting the distribution of drugs with safety concerns.
97
What does “off-label” mean?
Taking a drug approved by the FDA for as different reason. The FDA did not approve it for this alternative use.
98
The Randomized Controlled Trial (RCT) requires what three features in drug testing?
Controls, randomization, blinding
99
Preclinical testing of a drug is done on whom?
Animals
100
List the four phases of clinical testing and identify the sample and goal. Which is post-marketing?
Phase I – healthy volunteers, evaluation of drug metabolism, pharmacokinetics, and biologic effects
Phase II & III– patients, therapeutic use and dosage, safety and effectiveness
Phase IV – patients, postmarketing surveillance of a large population
101
What is the best human resource for drug information?
Pharmacists.
102
Define an adverse drug reaction.
Any noxious, unintended, and undesired effect that occurs at NORMAL drug doses.
103
List 4 risk factors for adverse drug reactions.
Elderly, very young, severe illness, multiple drug use
104
Define side effect.
A nearly unavoidable secondary drug effect produced at therapeutic doses.
105
Define allergic reaction.
An immune response triggered by a previous sensitizing administration.
106
Define paradoxical effect.
Effect opposite of intended drug response.
107
Define physical dependence.
A state in which the body has adapted to prolonged drug exposure and will result in an abstinence syndrome if the drug is abruptly discontinued.
108
Define teratogenic effect. When do most malformations occur?
The ability to cause a drug-induced birth defect. In the first trimester after
implantation (risk at 3-8 weeks).
109
List 5 symptoms of ototoxicity.
Deafness, dizziness, balance problems, tinnitus, headache
110
What are 3 symptoms of anaphylaxis?
Bronchospasm, laryngeal edema, hypotension
111
What are REMS?
REMS are risk evaluation and mitigation plans to minimize drug-induced harm.
112
What are strategies promote understandable patient education?
Avoid jargon, technical terms, and abbreviations. Provide written instructions and illustrations or diagrams. Use repetition. Relate new content to previous learning. Highlight important concepts. Ask the patient to summarize in own words what was taught.
113
What factors may vary learning needs?
Life span, gender, lifestyle, diet, habits, environment, culture, genetic variations
114
What are the benefits of shared goals?
Shared goals lead to improved adherence and promote therapeutic outcomes.
115
What components must be included in a complete patient education plan for a newly-prescribed drug?
Drug name and reason for use; dosage, route, and frequency; duration of therapy; missed or double dose management; special directions for administration, drug stability, storage, and disposal; managing side effects; reporting serious adverse drug reactions; interactions with food, drugs, herbs, and disease states; and self-monitoring techniques.
116
Who should be included in patient education sessions?
Family members and caregivers involved in the patient’s care.
117
What is the correct way to make sure you are dispensing the right drug?
Do 3 checks! Check before preparing the drug, after preparing the drug, and before administering the drug.
118
What are the nursing responsibilities in medication administration?
Ascertaining appropriateness of drug order; reconciliation of drugs when a patient is being admitted, transferred or discharged; accurate transcription of the medication order; correct administration of the drug to the right patient; accurate documentation of administration and responses to drug.
119
What are the professional responsibilities of medication administration?
Follow institutional policies and procedures, as well as state and federal laws and regulations concerning medication administration.
120
Define pharmacodynamics
Study of what drugs do to the body and how they do it.
121
Discuss the three phases of the dose-response curve.
Phase 1 – no measurable response
Phase 2 – increased dose increases response
Phase 3 – No further increase in response
122
Define maximal efficacy.
Largest effect which can be produced by a drug.
123
Define relative potency.
Amount of drug needed to produce an effect. A potent drug produces effects at low doses.
124
The binding of a drug to a receptor does what to body processes?
Turns processes on or off.
125
How does a cell membrane-embedded enzyme work?
Binding to the receptor on the cell membrane activates an enzyme inside the cell.
126
How do ligand-gated ion channels work?
Binding to the receptor on the cell membrane activates ion channels.
127
How do G protein-coupled receptors work?
Binding to the receptor activates the G protein which activates the effector.
128
Where are transcription factors found? How do they work?
On the DNA in the cell.
| Activate transcription of messenger RNA to make protein.
129
Which type of receptor is the fastest?
Ligand-gated ion channels
130
Explain the simple occupancy theory of drug-receptor interaction.
The intensity of the response is determined by the number of receptors occupied.
131
Define affinity
The strength of attraction between drug and receptor.
132
Define intrinsic activity
The ability of the drug to activate a receptor upon binding.
133
Define agonists
Drugs which bind to the receptor and mimic the action of endogenous regulatory molecules.
134
Explain the actions of full and partial agonists.
Full agonists have high intrinsic activity and produce a full effect. Partial agonists have a moderate intrinsic activity and produce a partial effect.
135
Define antagonists.
Drugs which bind to the receptor and block the action of endogenous regulatory molecules.
136
Explain the difference between competitive and noncompetitive antagonists.
Competitive antagonists bind reversibly, and a maximal response can be achieved by increasing the concentration of the agonist.
Noncompetitive antagonists bind irreversibly, and the maximal response cannot be achieved.
137
Explain up and down regulation.
Down regulation includes decreasing the number of receptors &/or response. Up regulation includes increasing the number of receptors &/or response.
138
List three receptorless drugs.
Antacids, antiseptics, saline laxatives.
139
Define the average effective dose (ED50).
Dose producing a therapeutic response in 50% of the population.
140
Define the therapeutic index. Is a large index safer or more dangerous?
The ratio of the lethal dose to the average effective dose. Safer.
141
What is the relationship between the number of drugs a patient takes and the risk of drug-drug interactions?
The more drugs the patient takes, the higher the risk of drug-drug interactions.
142
List three types of drug-drug interactions.
Potentiative, inhibitory, unique.
143
How may laxatives affect absorption?
Laxatives can decrease absorption by increasing drug passage.
144
Decreasing cardiac output may do what to drug excretion?
Decrease drug excretion.
145
What organ system is responsible primarily for drug metabolism?
Liver
146
What happens to drug levels of drugs metabolized by the P450 system when the system is inhibited? Induced?
When metabolism is inhibited in the P450 pathway, drugs being metabolized by that pathway are not metabolized as rapidly and plasma drug levels increase. Conversely, when the system is induced, metabolism of those drugs occurs more rapidly, decreasing plasma drug levels.
147
What 4 processes happen with the induction of PGP (P-Glycoprotein)?
Decreased intestinal absorption, decreased fetal exposure, decreased brain exposure, increased elimination of drugs into bile or urine
148
Calcium may do what to the absorption of tetracycline?
Decrease absorption.
149
How does grapefruit affect the absorption of drugs from the intestines?
How long does grapefruit exert this effect?
Grapefruit inhibits CYP3A4 metabolism in the intestinal wall for 72 hours, so more drug is absorbed. The serum level of the drug increases.
150
How would you administer a drug on an empty stomach?
1 hr before or 2 hours after a meal
151
What are the three adrenocorticoid hormones?
Glucocorticoids, mineralocorticoids, adrenal androgens.
152
Discuss the target of glucocorticoids.
Penetrate the cell membrane and activate cytoplasmic receptors that travel to cell nucleus and activate or decrease transcription of messenger RNA codes for regulatory proteins.
153
Basal levels of cortisol are lowest at what time? Highest when?
Lowest before bedtime. Highest before waking.
154
What is the physiologic dose of prednisone? Of hydrocortisone?
5-7 mg/day. 20-30 mg/day.
155
Adverse effects are more common with physiologic or pharmacologic doses?
Pharmacologic
156
When are pharmacological doses of glucocorticoids usually given?
Usually in the early morning (before 9 a.m.) with food.
157
How do glucocorticoids affect metabolism?
Promote glucose availability and storage as glycogen, catabolize proteins, and promote lipolysis of fats
158
How do glucocorticoids support blood pressure?
Decrease capillary permeability and maintain vasoconstriction.
159
How do glucocorticoids affect infant lungs?
Accelerate lung maturation.
160
Discuss the glucocorticoid effects on mood.
Mild: insomnia, anxiety, agitation, irritability
Severe: delirium, hallucinations, depression, euphoria, mania, suicide
161
What is the cause of Cushing’s syndrome? Describe the signs and symptoms common in Cushing’s syndrome.
Excessive glucocorticoids. Obesity, hyperglycemia, hypertension, hypernatremia, hypokalemia, hypervolemia, decreased resistance to infection, psychiatric changes, muscle wasting, osteoporosis, thinning of skin, fat redistribution, hirsutism, acne, menstrual irregularities
162
How do glucocorticoids affect blood sugars?
Glucocorticoids may increase blood sugars, requiring increases in antidiabetic drugs.
163
How does glucocorticoid therapy affect immune function?
Glucocorticoids may impair immune function, predisposing patients to bacterial and fungal infections.
164
How do glucocorticoids affect wound healing?
Impair wound healing
165
Abrupt cessation of high-dose chronic glucocorticoids may result in what?
Adrenal insufficiency
166
Prolonged use of glucocorticoids in a pregnant mother can lead to what disease in the infant?
Fetal adrenal hypoplasia (adrenal insufficiency)
167
Describe methods of administering glucocorticoids which may minimize their adverse effects.
Lowest dosage for shortest duration; switch from multiple doses to one AM dose; alternate day dosing before 9 am; use of topical, inhalation or local injection instead of systemic doses; therapy for osteoporosis.
168
Glucocorticoids do not need to be tapered if given for less than how many weeks?
2-3 weeks
169
What drugs administered with glucocorticoids can increase the risk of hypokalemia? GI bleed?
Diuretics, beta-adrenergic agonists.
| NSAIDS, ASA, alcohol.
170
Discuss nursing interventions for patients taking glucocorticoids.
Monitor height and weight, I & O, VS, edema, electrolytes, blood sugars, A1c, CBC, LFTs, BUN, creatinine, and cortisol. Encourage an eye exam every 6 months.
Monitor height and weight in children. DEXA scans for screening for osteoporosis. Watch neonate for adrenal insufficiency if the mother was on corticosteroids during pregnancy. Discourage breastfeeding if patient is taking more than 5mg of Prednisone per day.
171
Discuss the main points to be stressed in patient education for glucocorticoids
Take oral steroids with food before 9 am. Taper doses. Take missed doses when remembered (but do not double doses). Limit joint movement for 1-2 days after joint injection. Check for bruising & edema. May need to increase dose with stress. Wear medical ID and carry emergency supply. Avoid communicable diseases. Avoid aspirin, NSAIDS, and alcohol. Encourage weight-bearing exercises. Watch for signs of bleeding.
172
Explain the 3x3 Rule for mild or febrile illness.
Take three times the usual dose for three days.
173
What are recommended dietary measures for individuals on glucocorticoids?
Low calorie, restricted salt, high potassium foods, increased protein, increased calcium, vitamin D intake.
174
Aldosterone is what kind of steroid?
| Aldosterone retains what? Excretes what?
Mineralocorticoid. Retains sodium and water. Excretes potassium and hydrogen.
175
Addison’s disease may have deficiencies of what two steroids? What are the signs and symptoms of Addison’s disease?
Glucocorticoids and mineralocorticoids. Hypoglycemia, hyponatremia, hypotension, hyperkalemia, GI distress, weakness, circulatory collapse, renal failure, increased skin pigmentation, death.
176
What is the drug of choice for adrenal hormone insufficiency? What two properties does it have? When is it given?
Hydrocortisone. Glucocorticoid and some mineralocorticoid properties. Daily dose before 9 AM OR 2/3 dose before 9 AM & 1/3 dose in PM.
177
Florinef (Fludrocortisone) causes retention of what? Excretion of what? When is it given?
Sodium and water. Potassium and hydrogen. In the morning.
178
Discuss at least four things you would monitor to assess a patient’s response to Florinef (Fludrocortisone)?
Weight, blood pressure, hypokalemia, heart size, edema
179
What are the symptoms of acute adrenal insufficiency (adrenal crisis)?
Hypotension, dehydration, weakness, lethargy, vomiting, diarrhea, shock, death.
180
What determines the intensity of the drug response?
The concentration of a drug at its sites of action
181
Which two groups are more sensitive to drugs?
Infants and the elderly
182
Diseases of which two organs can cause the accumulation of drug to toxic levels?
Kidney and liver
183
Explain pharmacodynamic tolerance.
Adaptive responses occur with long-term administration requiring higher drug levels to get the same response.
184
Explain metabolic tolerance.
Because of increased drug metabolism, an increased dosage is needed to maintain therapeutic drug levels.
185
Which drug commonly demonstrates tachyphylaxis over a short time of administration?
Nitroglycerin patches
186
Define the placebo effect.
The placebo effect is defined as that component of a drug response that is caused by psychological factors.
187
What are the three types of pharmacogenomics alterations?
Immune response, metabolism, and target.
188
Why do some patients have no pain relief from codeine?
A variant cytochrome P450 is unable to convert codeine to morphine.
189
How does starvation increase the free drug concentration level of some drugs?
Decreased binding to albumin increases the drug level in the bloodstream.
190
How does the change in glomerular filtration in the third trimester affect the pregnant woman’s drug clearance?
The increased glomerular filtration increases the renal excretion of drugs.
191
How does intestinal motility affect drug levels in a pregnant woman?
Slowed motility allows more drug to be absorbed.
192
List 4 types of drugs and explain their likelihood of crossing the placenta.
Lipid-soluble – easy, Ionized – difficult, Highly polar – difficult, Protein-bound - difficult
193
What percentage of birth defects is caused by drugs?
Less than 1%.
194
What is the risk of malformations by a teratogen?
10%
195
When does implantation occur? When do gross organ malformations occur from teratogens?
2 weeks. 3-8 weeks.
196
From what week are the developmental processes of the brain affected?
Week 9
197
When is the best time for a breastfeeding mother to take a short-acting drug to limit drug levels in the breast milk?
Immediately after breastfeeding
198
What FDA drug classification has adequate studies in pregnant women to demonstrate no risk to fetus of woman?
Class A
199
Is a lack of teratogenesis in animals proof of safety in humans?
No
200
What type of drugs readily enters breast milk?
Lipid-soluble drugs
201
When should a nursing mother take a medicine in order to minimize transfer of the drug into the breast milk?
Immediately after breastfeeding
202
Pediatrics refers to patients under what age?
16 years
203
Define neonates and infants.
Neonates – first 4 weeks, Infants – weeks 5 through 1 year
204
Discuss the effect of blood flow on the absorption of IM medications in neonates and infants.
Neonates – slower than infants and adults due to slow and erratic blood flow, Infants – more rapid than neonates or adults
205
Discuss the difference in subQ dosing in neonates and infants.
Neonates and infants have higher maximum drug levels that last for longer durations above the MEC. .
206
Discuss how decreased protein binding in neonates and infants affect drug distribution.
Low albumin levels provide fewer binding sites which increases the free drug levels.
207
An immature blood-brain barrier in the infant increases the likelihood of what kind of effects?
Sensitivity to CNS effects of drugs
208
The infant’s hepatic metabolism reaches an adult level at what age?
One year.
209
When does the infant’s GFR reach adult levels?
One year.
210
A child’s hepatic metabolism peaks at what age? The child’s metabolism is greater than an adult during what ages?
Two years. 1-12 years.
211
How do sulfonamides cause neurological toxicity in infants under 2 months old?
Sulfonamides displace the bilirubin from the plasma proteins. Bilirubin crosses the blood-brain barrier causing neurological toxicity.
212
What drug is implicated with Reye’s syndrome when administered in children with chicken pox or influenza?
Aspirin
213
What is the most accurate method of determining dosage in children?
Body Surface Area (BSA)
214
A decrease in lean body mass in the elderly is associated with what change in total body water? How does this total body water change affect water-soluble drug concentrations?
A decrease in lean body mass is associated with a decrease in total body water. This decrease in total body water will increase a concentration of water-soluble drugs.
215
The elderly show what change in hepatic metabolism of drugs?
A decrease in hepatic metabolism of drugs
216
What is the most important cause of adverse reactions in the elderly?
Decreased renal excretion
217
What lab most accurately assesses renal clearance?
Creatinine clearance
218
What labs are frequently used instead of creatinine clearance to monitor renal function?
Blood urea nitrogen (BUN), Creatinine
219
Drugs with what type of therapeutic indexes are most likely to cause adverse reactions?
Drugs with low therapeutic indexes
220
How do multiple drugs affect the risk of drug interactions?
Increases the risk of drug interactions
