NRNP 656 LATEST UPDATE FINAL EXAM QUESTIONS AND CORRECT ANSWERS| GRADED A+

NRNP 6566 WEEK1-5 Midterm LATEST
UPDATE QUESTIONS AND CORRECT
ANSWERS| GRADED A+


Describe cytochrome p450 system - (correct answer) -Cytochrome p450 system is a
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series of enzymes used to metabolize medications
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Inhibitors - (correct answer) -block metabolic activity from one or more CYP450 enzymes
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Inducers - (correct answer) -increase CYP450 enzyme activity by increasing enzyme
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synthesis
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Describe effect on low and high albumin levels on active drug levels especially for drugs
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that are highly protein bound - (correct answer) -Albumin is the plasma protein with the
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greatest capacity for binding drugs. Binding plasma proteins affect drug distribution into
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tissues, because only drug that is not bound is available to penetrate tissues, bind to
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receptors, and exert activity. As free drug leaves the blood stream, more bound drug is
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released from binding sites.
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Low albumin levels - (correct answer) -malnutrition, chronic illness
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Highly protein bound drugs can lead to - (correct answer) -toxicity in patients with low
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albumin levels, example malnutrition or chronic illness. This is because there are fewer
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than the normal sites for the drug to bind
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Describe the ways the hepatic first pass effect- which is metabolism during first pass
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through the liver - (correct answer) -Alternative routes include:
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suppository
intravenous
intramuscular
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transdermal
sublingual

These allow drugs to bypass the first-pass effect and be absorbed directly into systemic
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circulation
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Be able to calculate creatinine clearance using Cockgraft Gault equation: - (correct
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answer) -Male = 140-age times weight in kilograms divided by serum creatinine times
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72.
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Women = CRCL (male) times 0.85
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, Describe what determines the frequency of drug administration - (correct answer) -half
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life
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Be familiar with the beers criteria and how to use it - (correct answer) -Potentially
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Inappropriate Medication Use in Older Adults
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to call attention to medications that are most commonly problematic and thus should be
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avoided in older adults
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Describe factors that affect absorption - (correct answer) -low blood state (shock or
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arrest), contact time with GI tract too fast (diarrhea = cant absorb), delayed stomach
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emptying (large meal = delayed absorption)Drug- to drug or drug to food interactions
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Describe the factors that affect distribution - (correct answer) -low albumin levels, body
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composition, cardiac decompensation (heart failure), age
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Describe the factors that affect metabolism - (correct answer) -genetics, age, organ
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function
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Describe factors that affect excretion - (correct answer) -affected by abnormal kidney or
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liver function, age, drug interactions
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Define narrow therapeutic index. How would you monitor a patient with a narrow
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therapeutic index? - (correct answer) -Therapeutic index is the dose range of effiency of
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med is optimized while side effects are minimized
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Narrow therapeutic index drugs are defined as those drugs where small differences in
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dose or blood concentration may lead to dose and blood concentration dependant,
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serious therapeutic failures or adverse drug reactions.
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You will need to monitor blood tests to monitor blood concentrations and dose
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adjustments accordingly.
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Describe how aging can affect absorption, distribution, metabolism and excretion -
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(correct answer) -decreased organ function, poorly tolerate drugs that require
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metabolism, lower rates of excretion
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decrease in small-bowel surface area, slowed gastric emptying, increase in gastric PH,
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changes in drug absorption
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With age, body fat generally increases and total body water decreases. Increased fat
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increases the volume of distribution for highly lipophilic drugs (for example, diazepam
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and chlordiazepoxide), which may increase their elimination half-lives.
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Serum albumin decreases and alpha 1 acid glycoprotein increases -- Phenytoin and
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warfarin are examples of medications with a higher risk of toxic effects when serum
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albumin increases
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hepatic metabolism of many drugs through cytochrome P enzyme system decreases
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with age; decreasing 30-40%
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decreased renal elimination vl vl




Identify 1st degree heart block - (correct answer) -cardiologist consult
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Order echo to rule out structural diagnosis, check thyroid levels, medications,
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electrolytes and identify and treat cause
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