NUR-641E Advanced Pathophysiology and Pharmacology for the Nurse Educator Exam (Questions and Answers)

Pharmacokinetics - Answer-Involves ADME (absorption, distribution, metabolism and elimination). Absorption: absorption from the administration site either directly or indirectly into the blood/plasma. Distribution: reversibly or irreversibly move from the bloodstream into the interstitial and intracellular fluid. Metabolism: bio-transformed via hepatic metabolism or by other tissues. Elimination: lastly, the drug & its metabolites are eliminated from the body 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 drugZero-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.