NRNP 6566 Key Concepts Week 1 to 5-comprehensive study guide- with questions and answers

NRNPvs6566vsKeyvsConceptsvsWeekvs1vstovs5-comprehensivevsstudyvsguide-


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Weekvs1

1. DescribevsthevscytochromevsP450vssystem.v s Describevshowvsinducersvsandvsinhibitorsvsaffe
ctvsthevscytochromevssystemvsandvshowvsthatvsaffectsvsthevshalf-lifevsofvsmedications.
a. Cytochromevsp450vssystemvsisvsavsseriesvsofvsenzymesvsusedvstovsmetabolizevsmedications.
b. DrugsvsthatvscausevsCYP450vsmetabolicvsdrugvsinteractionsvsarevsreferredvstovsasvseithervsinhi
bitorsvsorvsinducers.vsInducersvsincreasevsCYP450vsenzymevsactivityvsbyvsincreasingvsenzy
mevssynthesis
c. InhibitorsvsblockvsthevsmetabolicvsactivityvsofvsonevsorvsmorevsCYP450vsenzymes
2. Describevsthevsaffectvsonvslowvsandvshighvsalbuminvslevelsvsonvsactivevsdrugvslevelsvsespeciallyvsfor
drugsvsthatvsarevshighlyvsproteinvsbound.
vs


a. Albuminvsisvsthevsplasmavsproteinvswithvsthevsgreatestvscapacityvsforvsbindingvsdrugs.
i. Bindingvstovsplasmavsproteinsvsaffectsvsdrugvsdistributionvsintovstissues,vsbecausevso
nlyvsdrugvsthatvsisvsnotvsboundvsisvsavailablevstovspenetratevstissues,vsbindvstovsrecept
ors,vsandvsexertvsactivity.vsAsvsfreevsdrugvsleavesvsthevsbloodstream,vsmorevsboundvsdr
ugvsisvsreleasedvsfromvsbindingvssites.
b. Highlyvsproteinvsboundvsdrugs,vslowvsalbuminvslevelsvs(w/vsmalnutrition,vsorvschronicvsillness
)vsmayvsleadvstovstoxicityvsbecausevstherevsarevsfewervsthanvsthevsnormalvssitesvsforvsthevsdrugv
s tovsbind
3. Describevswaysvstovslessenvsthevshepaticvsfirstvspassvseffect:vsmetabolismvsduringvsfirstvspassvsthrou
ghvsthevsliver
a. Alternativevsroutesvs(suppository,vsintravenous,vsintramuscular,vsinhalationalvsaerosol,vstra
nsdermal,vsandvssublingual)vsavoidvsthevsfirst-
passvseffectvs allowvsdrugsvstovsbevsabsorbedvsdirectlyvsintovsthevssystemicvscirculation
vs


4. BevsablevstovscalculatevscreatininevsclearancevsusingvsthevsCockgraftvsGaultvsequiation:
a. Malevs v s =vs([140-age]vs×vsweightvsinvskg)/(serumvscreatininevs×vs72)
b. Femalevs vs =vsCrClvs(male)vs×vs0.85
5. Describevswhatvsdeterminesvsthevsfrequencyvsofvsdrugvsadministration:

, a. Drugvshalf-life,vsplasmavsconcentration
6. BevsfamiliarvswithvsthevsBeersvscriteriavsandvshowvstovsusevsit:
a. PotentiallyvsInappropriatevsMedicationvsUsevsinvsOldervsAdults
i. tovscallvsattentionvstovsmedicationsvsthatvsarevscommonlyvsproblematic,vsandvsthusvss
houldvsbevsavoidedvsinvsmostvsoldervsadults
7. Describevsfactorsvsthatvsaffectvsabsorption,vsdistribution,vsmetabolismvsandvsexcretion:
a. Absorptionvs vs lowvsbloodvsstatevs(shockvsorvsarrest);vscontactvstimevswithvsGIvstractvstoovsfastv
s (diarrheavs=vscan’tvsabsorb);vsdelayedvsstomachvsemptyingvs(largevsmealvs=vsdelayedvsabsor
ption);vsdrug-drugvsorvsdrug-foodvsinteractions
b. Metabolismvs vs genetics,vsage,vsorganvsfunction
c. Distributionvs vs lowvsalbuminvslevels,vsbodyvscomposition,vscardiacvsdecompvs(HF),vsandvsage
d. Excretionvs affectedvsbyvsabnormalvskidneyvsorvslivervsfunction;vsage,vsdrugvsinteractions
vs


8. Definevsnarrowvstherapeuticvsindexv s Howvswouldvsyouvsmonitorvsavspatientvswithvsavsnarrowvsther
apeuticvsindex?

, a. Therapeuticvsindex:vsdosevsrangevswherevsefficacyvsofvsmedvsisvsoptimizedvswhilevssidevse
ffectsvsminimized
b. Narrowvstherapeuticvsindexvs(NTI)vsdrugsvsarevsdefinedvsasvsthosevsdrugsvswherevssma
llvsdifferencesvsinvsdosevsorvsbloodvsconcentrationvsmayvsleadvstovsdosevsandvsbloodvsconce
ntrationvsdependent,vsseriousvstherapeuticvsfailuresvsorvsadversevsdrugvsreactions.
c. Bloodvstestsvstovsmonitorvsbloodvsconcentrationsvsandvsdosevsadjustmentsvsaccordingly
9. Describevshowvsagingvsaffectvsabsorption,vsdistribution,vsmetabolism,vsandvsexcretion
a. Decreasedvsorganvsfunction,vspoorlyvstoleratevsdrugsvsthatvsrequirevsmetabolism,vslowervsrat
esvsofvsexcretion
b. decreasevsinvssmall-
bowelvssurfacevsarea,vsslowedvsgastricvsemptying,vsandvsanvsincreasevsinvsgastricvspH,vsc
hangesvsinvsdrugvsabsorption
c. Withvsage,vsbodyvsfatvsgenerallyvsincreasesvsandvstotalvsbodyvswatervsdecreases.vsIncrease
dvsfatvsincreasesvsthevsvolumevsofvsdistributionvsforvshighlyvslipophilicvsdrugs
(eg,vs diazepam,vs chlordiazepoxide)v s andv s mayv s increasev s theirv s eliminationv s half-lives.
d. Serumvsalbuminvs decreasesvs andv salphav s1-acidv s glycoproteinv s increases
i. Phenytoinvsandvswarfarinvsarevsexamplesvsofvsdrugsvswithvsavshighervsriskvsofvstoxicvse
ffectsvswhenvsthevsserumvsalbuminvslevelvsdecreases
e. hepaticvsmetabolismvsofvsmanyvsdrugsvsthroughvsthevscytochromevsP-
450vsenzymevssystemvsdecreasesvswithvsage.vsForvsdrugsvswithvsdecreasedvshepaticvsmeta
bolismvsclearancevstypicallyvsdecreasesvs30vstovs40%.
i. Drugsvs metabolizedvs inv sphasev s 1vs reactionsvs likelyv s prolonged
ii. First-
passvsmetabolismvs(metabolism,vstypicallyvshepatic,vsthatvsoccursvsbeforevsavsdrugvsr
eachesvssystemicvscirculation)vsdecreasingvsbyvsaboutvs1%/yrvsaftervsagevs40.
1. Thus,vsforvsavsgivenvsoralvsdose,vsoldervsadultsvsmayvshavevshighervscirculatingv
s drugvsconcentrations.
f. Decreasedvs renalvs elimination




Weekvs2vsandvs3

1. Identifyvsandvsdescribevs12vsleadvsEKGsvsthatvsdemonstrate:
a. 1st,vs2nd,vsandvs3rdvsdegreevsAVvsblocks
i. 1stvsdegreevsHB cardsvsconsult

, ii. 2ndvsdegreevsHBvs typevs1vs&vs2
vs


1. Typevs1:vsEchovs(r/ovsstructuralvsdx),vsThyroidvslevels,vsmeds,vslytesvstovsidentif
yvsandvstreatvscause
2. Typevs2:vsPPM,vscontinuousvstelevswithvstranscutaneousvspacingvsifvsneeded,
vs determinevscause;vsIVvsatropinevsifvspoorvsperfusionvss/svsqvs3-
5mvswithvsmaxvs3mgvsifvss/svspoorvsperfusion;
3. Ifvsnovsresponsevstovsatropine vs dopa,vsepi,vsisoproterenol
iii. 3rdvsdegree/vscompletevsHB:vsPPM;vstelevsandvstranscutaneousvspacevsifvsneded;vsid
entifyvscause;vsIVvsatropinevsifvss/svspoorvsperfusion;vsIfvsnovsresponsevstovsatropine
dopa,vsepi,vsisoproterenol
vs


b. STEMIvsinvsanyvsleadvs(knowvswhatvsareavsofvsthevsheartvsisvsaffectedvsbasedvsonvsleadvslocation
)
c. Atrialvsfibrillation: