NUR 4590 CBE COMPREHENSIVE
COMMUNITY HEALTH REVIEW SHEET
FULL SOLUTIONS
●● The route of administration with the highest bio-availability is
Answer: Intravenous; putting entire dose into a patient's vein and
bypassing absorption. Intravenous route avoids first-pass metabolism in
the liver.
●● rectal administration disadvantages
Answer: variable and erratic absorption
●● Steady state (SS)
Answer: is usually reached within 4-5 half-lives of a drug
●● The half-life of a drug is defined as
Answer: how long it takes for half the drug to be excreted from the body
●● Half-life of a drug
Answer: Determines how frequently the drug must be administered
Predicts how long toxic effects can last
,Half-life is constant with first-order pharmacokinetics of a drug
Zero-order (nonlinear) pharmacokinetics means a drug is metabolized at
a constant rate per unit time.
●● CYP3A4 substrate drugs
Answer: May have enhanced activity if any CYP3A4 inducer drugs are
used along with it.
●● Drug development steps (according to the FDA)
Answer: Discovery: laboratory research to develop the new drug
Pre-clinical research with animal testing for safety (Phase I)
Clinical research on human subjects for medication safety (Phase II)
Clinical research in humans comparing the new drug to accepted
medications or placebo depending on the study (Phase III)
FDA review of the results to determine approval
,Post-marketing study to identify adverse effects not found in earlier
clinical studies (Phase IV)
●● Medication safety organizations
Answer: The Institute for Safe Medication Practices (ISMP)
The Institute of Medicine (IOM)
The Joint Commission
The National Coordinating Council for Medication Error Reporting and
Prevention (NCCMERP)
Food and Drug Administration (FDA) Safe Use Initiative
●● Adverse Drug Reactions (ADRs)
Answer: Two basic type of ADRs: pharmacological and idiosyncratic.
85% to 90% of ADRs are pharmacological.
Adverse drug reactions are usually preventable, frequently occur in a
hospital or nursing home setting, and include medication errors, adverse
drug effects, allergic and idiosyncratic type reactions.
, ADRs are not commonly reported; the FDA does not mandate that ADRs
be reported.
Polypharmacy involves using multiple healthcare providers for care,
using multiple medications, and using several pharmacies for
prescription filling.
●● Cardiovascular-Angiotensin converting enzyme inhibitors (ACEIs):
Answer: Lisinopril, captopril, enalapril, ramipril, benazepril, fosinopril;
*ACEIs reduce blood pressure by suppressing the release of angiotensin-
converting enzyme.
*Important side effects of ACE inhibitors include cough and
angioedema; discontinue the ACEI if angioedema occurs.
●● Angiotensin II receptor blocking agents (ARBs):
Answer: Candesartan (Atacand), eprosartan (Teveten), irbesartan
(Avapro), losartan (Cozaar), telmisartan (Micardis) and valsartan
(Diovan).
ARBs reduce blood pressure by blocking angiotensin II receptors.
●● Cardiovascular-Essential (primary) hypertension
Answer: Accounts for 90% of cases; secondary hypertension may be
caused by chronic renal failure.
COMMUNITY HEALTH REVIEW SHEET
FULL SOLUTIONS
●● The route of administration with the highest bio-availability is
Answer: Intravenous; putting entire dose into a patient's vein and
bypassing absorption. Intravenous route avoids first-pass metabolism in
the liver.
●● rectal administration disadvantages
Answer: variable and erratic absorption
●● Steady state (SS)
Answer: is usually reached within 4-5 half-lives of a drug
●● The half-life of a drug is defined as
Answer: how long it takes for half the drug to be excreted from the body
●● Half-life of a drug
Answer: Determines how frequently the drug must be administered
Predicts how long toxic effects can last
,Half-life is constant with first-order pharmacokinetics of a drug
Zero-order (nonlinear) pharmacokinetics means a drug is metabolized at
a constant rate per unit time.
●● CYP3A4 substrate drugs
Answer: May have enhanced activity if any CYP3A4 inducer drugs are
used along with it.
●● Drug development steps (according to the FDA)
Answer: Discovery: laboratory research to develop the new drug
Pre-clinical research with animal testing for safety (Phase I)
Clinical research on human subjects for medication safety (Phase II)
Clinical research in humans comparing the new drug to accepted
medications or placebo depending on the study (Phase III)
FDA review of the results to determine approval
,Post-marketing study to identify adverse effects not found in earlier
clinical studies (Phase IV)
●● Medication safety organizations
Answer: The Institute for Safe Medication Practices (ISMP)
The Institute of Medicine (IOM)
The Joint Commission
The National Coordinating Council for Medication Error Reporting and
Prevention (NCCMERP)
Food and Drug Administration (FDA) Safe Use Initiative
●● Adverse Drug Reactions (ADRs)
Answer: Two basic type of ADRs: pharmacological and idiosyncratic.
85% to 90% of ADRs are pharmacological.
Adverse drug reactions are usually preventable, frequently occur in a
hospital or nursing home setting, and include medication errors, adverse
drug effects, allergic and idiosyncratic type reactions.
, ADRs are not commonly reported; the FDA does not mandate that ADRs
be reported.
Polypharmacy involves using multiple healthcare providers for care,
using multiple medications, and using several pharmacies for
prescription filling.
●● Cardiovascular-Angiotensin converting enzyme inhibitors (ACEIs):
Answer: Lisinopril, captopril, enalapril, ramipril, benazepril, fosinopril;
*ACEIs reduce blood pressure by suppressing the release of angiotensin-
converting enzyme.
*Important side effects of ACE inhibitors include cough and
angioedema; discontinue the ACEI if angioedema occurs.
●● Angiotensin II receptor blocking agents (ARBs):
Answer: Candesartan (Atacand), eprosartan (Teveten), irbesartan
(Avapro), losartan (Cozaar), telmisartan (Micardis) and valsartan
(Diovan).
ARBs reduce blood pressure by blocking angiotensin II receptors.
●● Cardiovascular-Essential (primary) hypertension
Answer: Accounts for 90% of cases; secondary hypertension may be
caused by chronic renal failure.
