Clayton's Basic Pharmacology for Nurses: Test 1 2023 test bank with complete solution

deals with the study of drugs and their actions on living organisms pharmacology examples of therapeutic methods include the following: - drug therapy - diet therapy - physiotherapy - psychological therapy therapy which focuses on treatment with drugs drug therapy therapy which focuses on treatment with diet diet therapy therapy which focuses on treatment with natural physical forces (e.g. water, light, heat) physiotherapy therapy which focuses on the identification of stressors and methods that can be used to reduce or eliminate stress psychological therapy chemical substances that have an effect on living organisms drugs therapeutic drugs, used for the prevention or treatment of diseases medicines each drug has 3 names: - chemical name - generic name - brand name describes the drug's chemical composition and molecular structure chemical name non-proprietary name, given by the US Adopted Names Council, considered the official name and the one listed by the FDA generic name proprietary name, drug has a registered trademark, use of the name is restricted by the drug's patent owner (usually the manufacturer) trademark/brand name drugs may be classified by a variety of methods according to: - the body system they affect - their therapeutic use or clinical indication - their physiologic or chemical action drugs which require an order by a health professional who is licensed to prescribe drugs prescription drugs drugs which are sold without a prescription in a pharmacy or in the health section of department or grocery strores nonprescription/over the counter (OTC) drugs drugs or chemical substances used for nontherapeutic purposes; obtained illegally or have not been approved for use by the FDA illegal drugs a biologic product that is close in structure and function to an existing approved biologic product biosimilar drug __________________ provides a legal basis for drug treatments and protects the consumer from false claims made by the drug manufacturer legislation the two amendments to the Federal Good, Drug, and Cosmetic Act of 1938 - The Durham Humphrey Amendment of 1951 - The Kefauver-Harris Drug Amendment of 1962 amendment which divides medicines into prescription and nonprescription (OTC) categories based on safety The Durham Humphrey Amendment amendment which provides greater control and surveillance of the distribution and clinical testing of investigational drugs and requires that a product be proven both safe and effective before release for sale; result of the thalidomide tragedy The Kefauver-Harris Drug Amendment act passed by Congress in 1970, composite law designed to improve the administration and regulation of the manufacturing, distribution, and dispensing of drugs that require control by the government because of their high incidence of abuse Controlled Substances Act the basic structure of the Controlled Substances Act consists of ___ classifications, or __________________, of controlled substances - 5 - schedules schedule ___ drugs have a very high potential for abuse, are not currently accepted for medical use in the US, and lack of accepted safety for use under medical supervision I lysergic acid diethylamide, peyote, heroin, and hashish are all examples of which schedule of drugs schedule I schedule ___ drugs have a high potential for abuse, are currently accepted for medical use in the US, have abuse potential that may lead to severe psychological of physical dependence, and do not come with refills II amphetamines, morphine, hydrocodone/acetaminophen (Vicodin, Lortab, Norco), methadone, oxycodone/aspirin (Percodan), methylphenidate (Ritalin), and amphetamin/dextroamphetamine (Adderall) are all examples of which schedule of drugs schedule II schedule ___ drugs have a high potential for abuse, are currently accepted for medical use in the US, have abuse potential which may lead to moderate or low physical dependence or high psychological dependence, and which have a prescriptions which outdate in 6 months with no more that 5 refills within that month III aspirin/codeine (Empirin with codeine), apirin/butalbital/caffeine (Fiorinal), acetaminophen/codeine (Tylenol with codeine) are all examples of which schedule of drugs schedule III schedule ___ drugs have a low potential for abuse compared with drugs in previous class, are currently accepted for medical use in the US, have abuse potential that may lead to limited physical or psychological dependence, and which have a prescription which outdates in 6 months with no more than 5 refills IV phenobarbital, chlordiazepoxide, diazepam, flurazepam, and temazepam are all examples for which schedule of drugs schedule IV schedule ___ drugs have low potential for abuse, are currently accepted for medical use in the US, have an abuse potential of limited physcial or psychological dependence liability compared with other classes, prescription may not be required, and which have a prescription which outdates in 6 months with no more than 5 refills V atropine/diphenoxylate (Lomotil, Virtussin AC) is an example of which schedule of drugs schedule V organization developed to enforce the Controlled Substances Act, gather intelligence, train officers, and conduct research in the area of dangerous drugs and drugs of abuse Drug Enforcement Administration (DEA) nurses may not have controlled substances in their possession unless the following conditions are met: - the nurse is giving them to a patient under an order from a healthcare provider - the nurse is a patient for whom a healthcare provider has prescribed scheduled drugs - the nurse is the official custodian of a limited supply of controlled substances on a unit or for a department of the hospital it currently takes an average of ___ to ___ years and more than $2 billion in research and development costs to bring a single new drug to market 8 to 15 the Food, Drug, and Cosmetic Act of 1938 charged the FDA with the responsibility of ________________ new drugs regulating rules and regulations evolved by the FDA divide new drug development into 4 stages: - preclinical research and development - clinical research and development - New Drug Application (NDA) review - postmarketing surveillance phase of new drug development which begins with the discovery, synthesis, and purification of the drug; the goal of this stage is to use laboratory studies to determine whether the experimental drug has therapeutic value and whether the drug appears to be safe in animals perclinical research phase only about ___% of the chemicals tested in the preclinical phase advance to the clinical testing phase 20% phase of new drug development in which humans are first tested clinical research and development stage phase of the clinical research and development stage in which studies determine an experimental drug's pharmacologic properties, such as its pharmacokinetics, metabolism, safe dosage range, potential for toxicity at a certain dosage, and safe routes of administration phase 1 phase of the clinical research and development stage in which a smaller population of patients who have the condition that the drug is designed to treat experiment with various dosages to determine success and rate safety of the drugs intended use phase 2 phase of the clinical research and development stage in which a larger patient population is used to ensure the statistical significance of the results phase 3 procedure used by the FDA to expedite the development and approval of drugs for the treatment of life-threatening illnesses through rules which allow certain INDs to receive the highest priority for review within the agency fast tracking process used by the FDA to expedite the development and approval of drugs for the treatment of life-threatening illness by conducting studies alongside principal controlled clinical trials but without a concurrent control group parallel tracking if safety concerns are identified after a drug is approved for marketing the FDA issues a ________________________________ to the package insert of the product black box warning medicines which are developed to treat rare diseases and illness (ex: cystic fibrosis, Hansen's disease, sickle cell anemia, blepharospasm, infant botulism, etc.) orphan drugs term used to describe individuals with rare diseases which manufacturers/companies do not research drug therapies for because of inability to recover the cost for reasearch health orphans drugs do not create new responses but rather alter existing physiologic activity in several different ways specific sites which the drug usually forms chemical bonds with receptors a drug only forms a bond with a receptor if: - the drug and the receptor have similar shapes - the drug has a chemical affinity for the receptor the study of the interactions between drugs and their receptors and the series of events that result in a pharmacologic response pharmacodynamics T/F: the better the fit between the receptor and the drug molecule the better the response of the drug T drugs that interact with a receptor to stimulate a response are known as agonists drugs that attach to a receptor but do not stimulate a response antagonists drugs that interact with a receptor to stimulate a response but inhibit other responses partial agonists 3 routes of drug administration: - enteral - parenteral - percutaneous when using the _______________ route, the drug is administered directly into the GI tract by oral, rectal, or nasogastric route enteral when using the _________________ route, the drug bypasses the GI tract with the use of subcutaneous, intramuscular, or intravenous injection parenteral when using the ___________________ route, the drug is absorbed through the skin and mucous membranes percutaneous after administration, all drugs go through 5 stages: - liberation - absorption - distribution - metabolism - excretion the study of what the body does to the drug pharmacokinetics release of a drug from the dosage form to be dissolved in body fluids for absorption liberation liberation of a drug within the body can be manipulated by: - pharmaceutical dosage form used (e.g. solution, suspension, capsule, tablet) - administering the drug with or without food and water in the patient's stomach the process whereby a drug is transferred from its site of entry into the body to the circulating fluids of the body for distribution around the body absorption the rate at which a drug is absorbed depends on: - route of administration - blood flow through the tissue where the drug is administered - solubility of the drug the rate of absorption when a drug is administered by a parenteral route depends on the rate of blood flow through the tissues absorption of a drug is slowest when administered this way subcutaneous injection T/F: after a drug enters a patient's bloodstream, it is still retrievable F the absorption of topical drugs that have been applied to the skin can be influenced by: - drug concentration - length of contact time - size of the affected area - thickness of the skin surface - hydration of tissue - degree of skin disruption when drugs are inhaled, their absorption can be influenced by: - depth of the patient's respiration - fineness of the droplet particles - available surface area of the patient's mucous membranes - contact time - hydration state - blood supply to area - concentration of the drug itself refers to the ways in which a drug is transported throughout the body by the circulating body fluids to the sites of action or to the receptors that the drug affects distribution organs with the most extensive ______________ supply receive the distributed drug most rapidly blood two factors influencing drug distribution: - protein binding - lipid/fat solubility only the _______________ portion of a drug is able to diffuse into tissues, interact with receptors, and produce physiologic effects unbound more lipid-soluble drugs have a high affinity for ________________ tissue, which serves as a repository site for these agents adipose T/F: the same proportions of bound and free drug are maintained in the blood at all times T the process whereby the body inactivates drugs metabolism the enzyme systems of the __________ are the primary sites for the metabolism of drugs liver the most important factors for the conversion of drugs to their metabolites are: - genetic variations of enzyme systems - concurrent use of other drugs - exposure to environmental pollutants - concurrent illnesses - age the elimination of drug metabolites and, in some cases, of the active drug itself from the body excretion the two primary routes of excretion are: - through the GI tract into the feces - through the renal tubules into the urine a patient with renal failure often has a ___________________ in the action and duration of a drug if the dosage and frequency of administration are not adjusted to allow for the patient's reduced renal function increase drugs are eliminated from the body by means of: - metabolism - excretion the amount of time requires for 50% of the drug to be eliminated from the body half-life drugs with long half-lives need to be administered ___________________, whereas drugs with short half-lives need to be administered every __________________ to maintain therapeutic activity - once a day - 4 to 6 hours in regards to drug therapy, monitoring ________________ or ________________ function is important; whenever laboratory data reflect impairment of either function, the nurse should notify the health care provider - renal - hepatic when the concentration of a drug at the site of action is sufficient to start a physiologic response onset of action the time at which the drug reaches the highest concentrations on the target receptor sites, thereby inducing the maximal pharmacologic response for the dose given peak action how long the drug has a pharmacologic effect duration of action the onset, peak, and duration of action of a drug are often illustrated by a time-response curve which is known as a drug concentration-time profile the drug concentration is targeted to be in the mid-range between minimum effective response and the toxic response, this is known as the therapeutic range when a drug is circulating in the blood, a blood sample may be drawn and assayed to determine the amount of drug present, this is known as a drug blood level the expected response of a drugs use desired action unintended drug responses which may affect multiple systems of the body side effects any noxious, unintended and undesired effect of a drug which occurs at dosages used in humans for prophylaxis, diagnosis, or therapy adverse drug reaction (ADR) mild ADRs common adverse effects serious, possibly toxic ADRs serious adverse effects an injury resulting from medical intervention related to a drug; medication errors adverse drug events (ADE) the most commonly seen ADRs: - rash - nausea - itching - thrombocytopenia - vomiting - hyperglycemia - diarrhea classes of medication which account for the largest number of ADR's - antibiotics - cardiovascular medicines - cancer chemotherapy agents - analgesics - antiinflammatory agents occurs when something unusual or abnormal happens when a drug is first administered; generally a result of a patient's inability to metabolize a drug because of genetic deficiency of certain enzymes idiosyncratic reaction occurs after previous exposure to a medication, when re-exposed antibodies cause a reaction; most commonly seen as hives which cause severe itching allergic/hypersensitivity reactions severe itching is also called uticaria severe or life threatening reaction to drug which a patient was previously exposed to; causes respiratory distress and cardiovascular colapse anaphylactic reaction occurs when the action of one drug is altered or changed by the action of another drug drug interaction drug interactions are elicited in two ways: - by agents that when combined increase the actions of one or both drugs - by agents that when combined decrease the effectiveness of one or both drugs the mechanisms of drug interactions can be categorized as those that change the ___________________ of a drug and those that enhance the ____________________ effect of a drug - ADME - pharmacological most drug interactions that change absorption take place in the GI tract (specifically the stomach) drug interactions that cause a change in distribution usually affect the ____________________ of a drug to an inactive site binding if a drug is 90% bound to a protein, then ___% of the drug is proving the physiologic effect 10% drug interactions usually result from a change in metabolism that involves inhibiting or inducing (stimulating) the __________________ that metabolize a drug enzymes medicines known to bind to enzymes and to slow the metabolism of other drugs include: - verapamil - cloramphenicol - ketoconazole - amiodarone - cimetidine - erythromycin common drugs that bind to enzymes and increase the metabolism of other drugs: - phenobarbital - carbamazepine - rifampin - phenytoin when administered with enzyme inducers, the dosages of the more rapidly metabolized drugs should generally be _______________ to provide therapeutic activity increased drug interactions that cause a change in excretion usually act in the ________________ __________________ by changing the pH to enhance or inhibit excretion kidney tubules when two drugs with similar actions are taken for an increased effect additive effect when the combined effect of two drugs is greater than the sum of the effect of each drug given together synergistic effect when one drug interferes with the action of another antagonistic effect when the displacement of the first drug from protein-binding sites by a second drug increases the activity of the first drug because more unbound drug is available displacement when the first drug inhibits the metabolism or excretion of the second drug, thereby causing increased activity of the second drug intereference when the first drug is chemically incompatible with the second drug, thereby causing deterioration when the drugs are mixed in the same syringe or solution or are administered together at the same site incompatibility signs of incompatibility drug-drug interactions include: - haziness - formation of precipitate - change in the color of the solution when the drugs are mixed hydrocodone + acetaminophen = added analgesic effect additive effect aspirin + codeine = much greater analgesic effect synergistic effect tetracycline + antacid = decreased absorption of the tetracycline antagonistic effect warfarin + valproic acid = increased anticoagulant effect displacement probenecid + ampicillin = prolonged antibacterial activity of ampicillin because probenecid blocks the renal excretion of ampicillin interference ampicillin + gentamicin = ampicillin inactivates gentamicin incompatibility list of factors identified as contributors to the variable response to drugs - age - body weight - gender - metabolic rate - psychology - tolerance - dependence - cumulative effect age ranges most sensitive to the effects of drugs: infants and very old most pediatric doses are caculated by _____________________ per _____________________ of body weight milligrams per kilogram a developing science that studies differences in the normal function of men and women and addresses how people of each gender perceive and experience disease gender-specific medicine chronic smoking ________________ the metabolism of some drugs, thereby requiring larger doses to be administered more frequently for therapeutic effect enhances patients who are in shock have reduced peripheral vascular circulation and will absorb ____________________ or _______________________ injected drugs more slowly - intramuscularly - subcutaneously patients with conditions such as nephrotic syndrome or malnutrition may have reduces amounts of _____________ ___________________ in the blood that are necessary for adequate distribution of drugs serum proteins patients with kidney failure generally will excrete drugs at a ______________ rate and must have significant _____________________ in dosages of medications that are excreted by the kidneys - slower - reductions occurs when a person begins to require higher dosage of a medication to produce the same effects that a lower dosage once provided tolerance occurs when a person is unable to control his or her desire for ingestion of drugs drug dependence less than ___% of patients using opioids for acute pain relief become addicted 1% The buildup of drug concentration in the body due to multiple doses taken within short intervals drug accumulation the ability of a drug to induce living cells to mutate and become cancerous carcinogenicity topical administration with percutaneous absorption is usually effective for __________________ because their outer layer of skin is not fully developed infants transdermal administration in _________________ patients is often difficult to predict geriatric in most cases, medicines are administered _________________ orally medicines given _______________________ are usually erratically absorbed in neonates and older adults intramuscularly timed-release tablets, enteric-coated tablets, and sublingual tablets should not be ____________________ because this will increase their absorption rate and thus the potential for toxicity crushed the GI absorption of medicines is influenced by some of these factors: - gastric pH - gastric emptying time - motility of the GI tract - enzymatic activity - blood flow of the mucous lining of the stomach and intestines - permeability and maturation of the mucosal membrane - concurrent disease processes premature infants have a gastric pH of ___ to ___ 6 to 8