NRNP 6566 WK1-5 Midterm Exam With
Complete Solution Graded A+
Describe cytochrome p450 system - Answer Cytochrome p450 system is a series of
enzymes used to metabolize medications
Inhibitors - Answer block metabolic activity from one or more CYP450 enzymes
Inducers - Answer increase CYP450 enzyme activity by increasing enzyme synthesis
Describe effect on low and high albumin levels on active drug levels especially for drugs
that are highly protein bound - Answer Albumin is the plasma protein with the greatest
capacity for binding drugs. Binding plasma proteins affect drug distribution into tissues,
because only drug that is not bound is available to penetrate tissues, bind to receptors,
and exert activity. As free drug leaves the blood stream, more bound drug is released
from binding sites.
Low albumin levels - Answer malnutrition, chronic illness
Highly protein bound drugs can lead to - Answer toxicity in patients with low albumin
levels, example malnutrition or chronic illness. This is because there are fewer than the
normal sites for the drug to bind
Describe the ways the hepatic first pass effect- which is metabolism during first pass
through the liver - Answer Alternative routes include:
suppository
intravenous
intramuscular
inhalational aerosol
transdermal
sublingual
These allow drugs to bypass the first-pass effect and be absorbed directly into systemic
circulation
Be able to calculate creatinine clearance using Cockgraft Gault equation: - Answer Male
= 140-age times weight in kilograms divided by serum creatinine times 72.
Women = CRCL (male) times 0.85
Describe what determines the frequency of drug administration - Answer half life
plasma concentration
, Be familiar with the beers criteria and how to use it - Answer Potentially Inappropriate
Medication Use in Older Adults
to call attention to medications that are most commonly problematic and thus should be
avoided in older adults
Describe factors that affect absorption - Answer low blood state (shock or arrest),
contact time with GI tract too fast (diarrhea = cant absorb), delayed stomach emptying
(large meal = delayed absorption)Drug- to drug or drug to food interactions
Describe the factors that affect distribution - Answer low albumin levels, body
composition, cardiac decompensation (heart failure), age
Describe the factors that affect metabolism - Answer genetics, age, organ function
Describe factors that affect excretion - Answer affected by abnormal kidney or liver
function, age, drug interactions
Define narrow therapeutic index. How would you monitor a patient with a narrow
therapeutic index? - Answer Therapeutic index is the dose range of effiency of med is
optimized while side effects are minimized
Narrow therapeutic index drugs are defined as those drugs where small differences in
dose or blood concentration may lead to dose and blood concentration dependant,
serious therapeutic failures or adverse drug reactions.
You will need to monitor blood tests to monitor blood concentrations and dose
adjustments accordingly.
Describe how aging can affect absorption, distribution, metabolism and excretion -
Answer decreased organ function, poorly tolerate drugs that require metabolism, lower
rates of excretion
decrease in small-bowel surface area, slowed gastric emptying, increase in gastric PH,
changes in drug absorption
With age, body fat generally increases and total body water decreases. Increased fat
increases the volume of distribution for highly lipophilic drugs (for example, diazepam
and chlordiazepoxide), which may increase their elimination half-lives.
Serum albumin decreases and alpha 1 acid glycoprotein increases -- Phenytoin and
warfarin are examples of medications with a higher risk of toxic effects when serum
albumin increases
hepatic metabolism of many drugs through cytochrome P enzyme system decreases
with age; decreasing 30-40%
decreased renal elimination
Identify 1st degree heart block - Answer cardiologist consult
Order echo to rule out structural diagnosis, check thyroid levels, medications,
electrolytes and identify and treat cause
Complete Solution Graded A+
Describe cytochrome p450 system - Answer Cytochrome p450 system is a series of
enzymes used to metabolize medications
Inhibitors - Answer block metabolic activity from one or more CYP450 enzymes
Inducers - Answer increase CYP450 enzyme activity by increasing enzyme synthesis
Describe effect on low and high albumin levels on active drug levels especially for drugs
that are highly protein bound - Answer Albumin is the plasma protein with the greatest
capacity for binding drugs. Binding plasma proteins affect drug distribution into tissues,
because only drug that is not bound is available to penetrate tissues, bind to receptors,
and exert activity. As free drug leaves the blood stream, more bound drug is released
from binding sites.
Low albumin levels - Answer malnutrition, chronic illness
Highly protein bound drugs can lead to - Answer toxicity in patients with low albumin
levels, example malnutrition or chronic illness. This is because there are fewer than the
normal sites for the drug to bind
Describe the ways the hepatic first pass effect- which is metabolism during first pass
through the liver - Answer Alternative routes include:
suppository
intravenous
intramuscular
inhalational aerosol
transdermal
sublingual
These allow drugs to bypass the first-pass effect and be absorbed directly into systemic
circulation
Be able to calculate creatinine clearance using Cockgraft Gault equation: - Answer Male
= 140-age times weight in kilograms divided by serum creatinine times 72.
Women = CRCL (male) times 0.85
Describe what determines the frequency of drug administration - Answer half life
plasma concentration
, Be familiar with the beers criteria and how to use it - Answer Potentially Inappropriate
Medication Use in Older Adults
to call attention to medications that are most commonly problematic and thus should be
avoided in older adults
Describe factors that affect absorption - Answer low blood state (shock or arrest),
contact time with GI tract too fast (diarrhea = cant absorb), delayed stomach emptying
(large meal = delayed absorption)Drug- to drug or drug to food interactions
Describe the factors that affect distribution - Answer low albumin levels, body
composition, cardiac decompensation (heart failure), age
Describe the factors that affect metabolism - Answer genetics, age, organ function
Describe factors that affect excretion - Answer affected by abnormal kidney or liver
function, age, drug interactions
Define narrow therapeutic index. How would you monitor a patient with a narrow
therapeutic index? - Answer Therapeutic index is the dose range of effiency of med is
optimized while side effects are minimized
Narrow therapeutic index drugs are defined as those drugs where small differences in
dose or blood concentration may lead to dose and blood concentration dependant,
serious therapeutic failures or adverse drug reactions.
You will need to monitor blood tests to monitor blood concentrations and dose
adjustments accordingly.
Describe how aging can affect absorption, distribution, metabolism and excretion -
Answer decreased organ function, poorly tolerate drugs that require metabolism, lower
rates of excretion
decrease in small-bowel surface area, slowed gastric emptying, increase in gastric PH,
changes in drug absorption
With age, body fat generally increases and total body water decreases. Increased fat
increases the volume of distribution for highly lipophilic drugs (for example, diazepam
and chlordiazepoxide), which may increase their elimination half-lives.
Serum albumin decreases and alpha 1 acid glycoprotein increases -- Phenytoin and
warfarin are examples of medications with a higher risk of toxic effects when serum
albumin increases
hepatic metabolism of many drugs through cytochrome P enzyme system decreases
with age; decreasing 30-40%
decreased renal elimination
Identify 1st degree heart block - Answer cardiologist consult
Order echo to rule out structural diagnosis, check thyroid levels, medications,
electrolytes and identify and treat cause
