NSG6005 Wk9 Assignment3 Quiz

Question 1. Jonathan has been diagnosed with strep throat and needs a prescription for an antibiotic. He says the last time he had penicillin he developed a red, blotchy rash. The appropriate antibiotic to prescribe would be:

Penicillin VK, since his rash does not sound like a serious rash

Amoxicillin

Cefadroxil (Duricef)

Erythromycin

Question 2. Tetracyclines are contraindicated in children younger than 8 years because of:

Risk of developing cartilage problems

Development of significant diarrhea

Risk of kernicterus

Adverse effects on bone growth

Question 3. Lisa is a healthy non-pregnant adult woman who recently had a UTI. She is asking about drinking cranberry juice to prevent a recurrence of the UTI. The answer to give her would be:

“Sixteen ounces per day of cranberry juice cocktail will prevent UTIs.”

“100% cranberry juice or cranberry juice extract may decrease UTIs in some patients.”

“There is no evidence that cranberry juice helps prevent UTIs.”

“Cranberry juice only works to prevent UTIs in children.”

NSG6005 Wk9 Assignment3 Quiz

Question 4. Rose is a 3 year old with an upper respiratory infection (URI). Treatment for her URI would include:

Amoxicillin

Diphenhydramine

Pseudoephedrine

Nasal saline spray

Question 5. Patient education for a patient who is prescribed antibiotics for sinusitis includes:

Use of nasal saline washes

Use of inhaled corticosteroids

Avoiding the use of ibuprofen while ill

Use of laxatives to treat constipation

Question 6. Patients who should be cautious about using decongestants for an upper respiratory infection include:

School-age children

Patients with asthma

Patients with cardiac disease

Patients with allergies. NSG6005 Wk9 Assignment3 Quiz

Question 7. Janet was recently treated with clindamycin for an infection. She calls the advice nurse because she is having frequent diarrhea that she thinks may have blood in it. What would be the appropriate care for her?

Encourage increased fluids and fiber

Assess for pseudomembranous colitis

Advise her to eat yogurt daily to help restore her gut bacteria

Start her on an antidiarrheal medication

NSG6005 Wk9 Assignment3 Quiz

Question 8. To prevent further development of antibacterial resistance it is recommended fluoroquinolones be reserved for treatment of:

Urinary tract infections in young women

Upper respiratory infections in adults

Skin and soft tissue infections in adults

Community-acquired pneumonia in patients with comorbidities

Question 9. Nicole is a 4-year-old female with a febrile urinary tract infection. She is generally healthy and has no drug allergies. Appropriate initial therapy for her UTI would be:

Azithromycin

Trimethoprim/sulfamethoxazole

Ceftriaxone

Ciprofloxacin

Question 10. Sally is a 16-year-old female with a urinary tract infection. She is healthy, afebrile, with no use of antibiotics in the previous 6 months and no drug allergies. An appropriate first-line antibiotic choice for her would be:

Azithromycin

Trimethoprim/sulfamethoxazole

Ceftriaxone

Levofloxacin

NSG 6005 Advanced Pharmacology Midterm & Final Exam Study Guide

NSG 6005 Advanced Pharmacology Midterm—Study Guide

There will be 75 questions on the Midterm.  Most will be multiple choice.  There are a couple True/False and 5 matching questions.  I suggest you review your PowerPoints and Textbook Assignments.  I hope this study guide is helpful.

Make sure you know the following topics very well. 

• When a medication is listed below, make sure you know all about it and how to apply it to different patient situations: What disease process it is used for?,  how does it work?, when should it not be used?, adverse effects, pros/cons, interactions, patient education factors (should it be taken w/ food? At bedtime?), tapering, preliminary and post treatment labs, black box warnings/CI, etc. NSG 6005 Advanced Pharmacology Midterm & Final Exam Study Guide.
• If a disease process is mentioned below—know how to diagnose and recommended treatment guidelines.

• General principles of pharmacokinetics and dynamics? NSG6005 Wk9 Assignment3 Quiz

PHARMACOKINETICS-  What the body does to the drug”

Absorption –Entry of drug to the blood stream. Usually depends on passive diffusion of drug through cell membranes.

• Absorption depends on: blood flow at site, drugs lipid soluability (> lipic, > soluabililty that directly penetrate the memebrane), local PH and drug ionization (non-ionized absorb better), pharmaceutical processing (coatings and additives.
• Blood brain barrier: allow lipid soluable only. May pump out any drug that it sees as foreign, hard to treat CNS infections.
• Placenta: allows lipid drugs so does not protect from lipid soluable drugs, which is why pregnant women are limited to drugs. Know gestation age. NSG 6005 Advanced Pharmacology Midterm & Final Exam Study Guide.

Distribution
: fat ratio changes may alter distribution, especially a people age.

• Fat soluable drugs may be accumulated: weight loss will release these drugs.
• Water soluable drugs are affected by dehydration

Biotransformation (Metabolism) : Drugs become more hydrophilic (water soluable) for excretion.

• Also referred to as the P450 system or cytochrome P450 system. (a group of enzymes in the liver identified for their ability to breakdown drugs.)
• Hepatic “First Pass Effect” (parenteral (IV or IM) meds bypass this enzymatic effect)
• breaks PO meds down to some degree, some are protected with coating but they don’t always work
• Metabolites
  Usually less active, less toxic, easier
• to excrete
• Prodrugs – inactive in form given but metabolized to active drug (ex: enalapril)
• Liver function determined by liver enzymes. NSG 6005 Advanced Pharmacology Midterm & Final Exam Study Guide.
• Failing liver produces fewer enzymes, drugs available longer: caution
• Excretion: Process by which medications are eliminated from the body unchanged or as metabolites
• Kidneys are main organ of excretion
• If poor renal function, drug may accumulate, may
  wish to prescribe less of drug
• Also eliminated via respiration, breast milk, defecation. Tears, sweat, saliva not as significant.
• START LOW AND GO SLOW!!!!

PHARMOCODYNAMICS- “effect of drug on the body”

Receptors: Drugs must bind to for effect o Help a process happen: agonist

o Block a process from happening: antagonist o Know that:

• All drugs have an effect
• A drug’s ability to cause a response is ?called its efficacy
• If you give a bigger dose you will get a bigger effect up to a point, most drugs have a ceiling. NSG6005 Wk9 Assignment3 Quiz

2) CRITERIA FOR CHOOSING AND EFFECTIVE DRUG?

• ) Effectiveness: elicits responses for which it is given – most important
• Safety: Cannot produce harmful effects even at very high dosages and for long time
  oNo such thing as completely safe drug
• Selectivity: Only elicits response for which it is given, no side effects
• No such thing as a selective drug, all have ADRs
• Reversible action: most drugs should be reversible. NSG 6005 Advanced Pharmacology Midterm & Final Exam Study Guide.
• Predictability: Know with certainty exactly how individual patient will respond – impossible, must individualize
• Ease of administration: simple, convenient route – enhances compliance and decreases errors
• Freedom from drug interactions: few drugs are without drug interaction
• Low cost: easy to afford; significant factor in adherence, esp. with elderly
• Chemical stability: drugs ability to be stored for long time without loss of effectiveness – variable between drugs
• Possession of simple generic name: easier to remember and less confusion amongst drugs

3) SYNERGISTIC EFFECT: When two or more drugs are given

together they can react with each other: An effect arising between two or more agents, entities, factors, or substances that produces an effect greater than the sum of their individual effects. It is opposite of antagonism.

o Can be positive (synergistic) • Morphine and Motrin

o Can be negative (compete with each other) • Asa and Coumadin

4) Therapeutic drug levels: (not sure if this is correct)

Minimal Effective Concentration (MEC) – plasma drug level below which therapeutic effects will not occur.

Therapeutic Index or Range– margin of safety

• The wider or bigger it is, the safer the drug. o Example 1: Drug A: normal dose is 1 mg, toxic dose is 10 mg
• Acetaminophen’s therapeutic range is 30 times the MEC
  o Example 2: Drug B: normal dose is 9 mg, toxic dose is 10 mg o Lithium’s therapeutic range is 3 times the MEC. NSG6005 Wk9 Assignment3 Quiz

5) WHAT IS MEANT BY A SIGNIFICANT FIRST-PASS EFFECT?

Metabolism is the process of changing one chemical into another.  The liver is a major organ for drug metabolism because it contains high amounts of drug-metabolizing enzymes and because it is the first organ encountered by drugs once they are absorbed from the GI tract. Metabolism by the liver following oral administration is called FIRST-PASS METABOLISM and is important in determining whether a drug can be orally administered. NSG 6005 Advanced Pharmacology Midterm & Final Exam Study Guide.

6) HOW DO YOU KNOW HOW OFTEN TO PRESCRIBE A MEDICATION-1/2 LIFE OF MEDICATIONS.

• Half-life- amount of time it takes to reduce the plasma concentration by 50%.
• In pharmacokinetics, steady state refers to the situation where the overall intake of a drug is fairly in dynamic equilibrium with its elimination. In practice, it is generally considered that steady state is reached when a time of 4 to 5 the half-life for a drug after regular dosing has started.

7) AGONISTS VERSUS ANTAGONISTS:

            AGONISTS:  Drugs that produces a physiological response when combined with a receptor.

ANTAGONISTS:  a substance or drug that interferes with or inhibits the physiological action of another.

8) SUSTAINED RELEASE MEDICATION CONSIDERATIONS- implies slow release over time. It is defined as the type of dosage in which a portion of the drug is released immediately, and then the remaining/maintenance dose) is then released slowly by achieving a therapeutic level which is prolonged. NSG 6005 Advanced Pharmacology Midterm & Final Exam Study Guide.

 

9) SUBLINGUAL MEDICATION ADVANTAGES.

• Sublingual medication administration (under the tongue) and buccal (between the cheek and gum) allow drugs to have a more rapid onset of action and to avoid liver metabolism as they enter the blood stream.
• Nitroglycerin given under the tongue can act within minutes to treat an angina attack.

10) FIRST STEP IN THE PRESCRIBING PROCESS ACCORDING TO WHO?

• The first step in the prescribing process is an accurate diagnosis and a determination of a therapeutic objective. (page 29)

WHO SIX-STEP MODEL OF RATIONAL PRESCRIBING:

            STEP 1: DEFINE THE PATIENTS PROBLEM

STEP 2: SPECIFY THE THERAPEUTIC OBJECTIVE

STEP 3: CHOOSE THE TREATMENT

STEP 4: START THE TREATMENT

STEP 5: EDUCATE THE PATIENT

STEP 6: MONITOR EFFECTIVENESS

11) THERAPEUTIC GOALS OF PRESCRIBING: 

            Before deciding what medication to prescribe, it is important to clarify the therapeutic objective.

• Is this goal to cure the disease
• Relieve symptoms of the disease
• Long term prevention
• Is the goal treating the combination of 2 outcomes (pain and inflammation)
• Palliative therapy
• The provider should clarify whether the treatment goals are curative, symptom relieving or preventative.
• Include patient in this stage as a partner of treatment. NSG 6005 Advanced Pharmacology Midterm & Final Exam Study Guide.

12.) Patients at risk for adverse drug reactions. (page 55)

• Genetic abnormalities
• Age
• Sex
• Polypharmacy
• Concomitant medical conditons
• Children- are at higher risk primarily because medication dosages must be tailored to their body weight, immature organ function.
• Elderly- polypharmacy, decreased renal and hepatic function

13) FACTORS AFFECTING PATIENTS ADHERANCE TO A DRUG REGIMEN:

• Highest risk is those patients with asymptomatic condition, chronic conditions. Cognitive impairment, psychiatric illness or disorders with significant lifestyle changes (smoker), and those with complex multiple daily dosing.
• Adherance implies a voluntary act of negotiation and joint acceptance of a treatment regimen.
• Patients harbor strong concerns about the need for their medication and the risk for taking it. NSG 6005 Advanced Pharmacology Midterm & Final Exam Study Guide.
• Limited access to health care
• Restricted formularies
• High drug costs and co-payments

14) HOW DOES FOOD IN DIGESTIVE TRACT AFFECT ABSORPTION?

1. a) the presence of food in the GI tract can influence the rate and extent of absorption
2. b) alteration of PH- food tends to increase stomach PH by acting as a buffer.
3. c) gastric emptying –fats and some drugs tend to reduce gastric emptying and delay onset of action of drugs.
4. d) stimulation of GI secretions- GI secretions produced in response to food may result in degredation of drugs that are susceptible to enzymatic metabolism, reducing bioavailablity. Secretions may also increase bioavailability. NSG 6005 Advanced Pharmacology Midterm & Final Exam Study Guide.
5. e) fats stimulate bile secretion- bile salts dissolute poorly soluable drugs.
6. f) food induced changes in blood flow- blood flow to the GIT and liver increases blood flow after a meal. The faster the rate of drug presentation to the liver: the larger the fraction of the drug that escapes first-pass metabolism.

g)competition of food components and drugs: possibility of competitive inhibition of drug absorption, especially with drugs who have similar chemical structure of nutrients.

15) RECOMMENDATIONS REGARDING FIBER AND CV HEALTH.

1. A) Dietary fiber may lower cholesterol
2. b) provide feeling of fullness, thus causing weight loss.
3. c) increased soluable fiber intake has been associated with better glucose and improve blood lipid panels.

16) TETROGENIC VITAMINS-

1. a) vitamin A- can effect embryonic development

17)ANEMIAS- KNOW CHARACTERISTICS AND HOW TO TREAT. See # 27

18.Warfarin – This medication is used to treat blood clots (such as in deep vein thrombosis–DVT or pulmonary embolus-PE) and/or to prevent new clots from forming in your body. Preventing harmful blood clots helps to reduce the risk of a stroke or heart attack. Conditions that increase your risk of developing blood clots include a certain type of irregular heart rhythm (atrial fibrillation), heartvalve replacement, recent heart attack, and certain surgeries (such as hip/knee replacement).

Warfarin is commonly called a “blood thinner,” but the more correct term is “anticoagulant.” It helps to keep blood flowing smoothly in your body by decreasing the amount of certain substances (clotting proteins) in your blood. NSG 6005 Advanced Pharmacology Midterm & Final Exam Study Guide.

Pharmacotherapeutics

Warfarin

Pharmacokinetics

• Well-absorbed when taken orally
• Metabolized by CYP 1A2 and 2C9
• Half-life of 3 to 4 days
• Precautions and contraindications§

Pregnancy category X

• Use cautiously in patients with fall risk, dementia, or

uncontrolled hypertension.

• Avoid in hypermetabolic state.
• Adverse drug reactions
• Bleeding
• Antidote is vitamin K
• Allergic reactions
• Many drug-drug interactions
• Antiplatelet drugs
• Thrombolytic drugs
• Anticoagulant effect may be decreased by
• Oral contraceptives, carbamazepine, etc.
• Vitamin K-containing foods

Clinical use and dosing

• Drug of choice for deep vein thrombosis (DVT) and pulmonary embolism (PE)
• Start at 5 mg per day (7.5 mg/d if weight greater than 80 kg).
• Consider lower dose if
• Older than 75 years
• NSG 6005 Advanced Pharmacology Midterm & Final Exam Study Guide.

Multiple comorbid conditions

• Elevated liver enzymes
• Changing thyroid status
• Dose to maintain international normalized ratio (INR) between 2 and 3.

Monitoring

• INR daily until in therapeutic range for 2

consecutive days

• Then two or three times weekly for 1 to 2 weeks
• Then less frequently but at least every 6 week