NURS 8024 TEST PAPER 2025 QUESTIONS AND ANSWERS
RATED A+
✔✔Adverse effects of Minoxidil (Rogaine) - ✔✔• Allergic and irritant contact dermatitis
• Hair growth in undesirable locations - reversible on stopping the drug
• Patients instructed to wash hands after applying
• Percutaneous absorption of minoxidil minimal in normal scalp - possible systemic
effects on blood pressure
✔✔Trichogenic Agents - Finasteride (Propecia) - ✔✔blocks conversion of testosterone
to dihydrotestosterone (androgen responsible for androgenic alopecia in genetically
predisposed men)
Oral agent promotes hair growth, prevents further hair loss.
Tx at leaset 3-6 months to see increased hair growth
Continued Rx necessary to sustain benefit
ADE:decreased libido, ejaculation disorders, erectile dysfunction-resolve in most men
who remain on therapy -and w/ discontinuation
*Pregnant women should not be exposed to the drug because of the potential for
inducing genital abnormalities in male fetuses*
✔✔Bimatoprost (Latisse) - ✔✔*Treatment of the eyelashes*
• Prostaglandin analog, 0.03% ophthalmic solution
• MOA unknown
• QHS application to skin of upper eyelid margins (base of eyelashes) separate
disposable applicator each eye
• Remove contact lenses prior to using
• ADE-pruritus, conjunctival hyperemia, skin pigmentation, erythema of eyelids
• Possible ↑ brown iris pigmentation-likely permanent
✔✔Antitrichogenic Agents - Eflornithine (Vaniqa) - ✔✔effects biosynthesis of
polyamines Polyamines required for cell division growth
• Topical -Reduces facial hair growth in approx. 30% of women when applied twice daily
for 6 months
• Hair growth returns to pretreatment levels 8 weeks after discontinuing
• Local adverse effects-stinging, burning, and folliculitis
✔✔Anti-Inflammatory Agents-Corticosteroids - ✔✔• Efficacy of topical corticosteroids for
tx inflammatory dermatoses
• Numerous types available w/ choices of potencies, concentrations, and vehicles
,• Anti-inflammatory and antimitotic effects
• Original-hydrocortisone
*Therapeutic effectiveness -based primarily on their anti-inflammatory activity*
✔✔Topical Corticosteroids - ✔✔• Minimally absorbed w/ application to normal skin
• Significantly increased absorption in inflamed skin (atopic dermatitis etc.)
• Occlusion w/ plastic wrap -tenfold increase in absorption
*• Significant regional anatomic variation in corticosteroid penetration
• Compared w/ absorption from the forearm, hydrocortisone is absorbed
• 0.14 times as well through the plantar foot arch
• 0.83 times as well through the palm
• 3.5 times as well through the scalp
• 6 times as well through the forehead
• 9 times as well through vulvar skin
• 42 times as well through scrotal skin
✔✔Adverse systemic effects of topical corticosteroids - ✔✔• All absorbable topical
corticosteroids have potential to suppress Hypothalamic Pituitary adrenal (HPA) axis
• Iatrogenic Cushing's syndrome can occur as a result of long term use of topical
corticosteroids in large quantities
• Steroid induced glaucoma/cataracts
* Adverse systemic effects in children-may take lesser amt/duration for ADE- growth
retardation possible
• Pregnancy -caution advised-esp. 1st trimester
• Geriatric patients more susceptible to secondary infection
✔✔Adverse local effects of topical corticosteroids - ✔✔Atrophy-shiny, depressed,
wrinkled appearing skin with prominent telangiectasia
-Purpura and ecchymosis
- Telangiectatic vessels, pustules, and papules
-Perioral dermatitis
- Steroid acne
- hypopigmentation
- Hypertrichosis
- Increased intraocular pressure
- worsening of cutaneous infections
✔✔Capsaicin - ✔✔• Naturally occurring substance derived from hot chili peppers
• Exact MOA unknown
• Initially stimulates then desensitizes and degenerates cutaneous nociceptive neurons
• Causes local depletion of substance P, involved in sensory perception and pain
transmission
,• Available as a 0.025% cream and 0.075% cream
• Apply 3-4 x daily
• Used for Tx postherpetic neuralgia, painful diabetic neuropathy, being investigated for
Tx psoriasis, vitiligo, intractable pruritus
✔✔Geriatric Changes in functional capacities include - ✔✔Most major organ systems
show decline beginning in young adulthood and continuing throughout the lifespan
✔✔Geriatric medication absorption - ✔✔Large GI surface area- absorption usually not
affected (passive diffusion)
✔✔Compounds requiring active transport in Geriatrics may have delayed absorption
due to: - ✔✔GI changes w/ age - reduction in acid (more alkaline environment)
• Reduction in
• Blood flow
• Enzyme activity
• Gastric emptying
• Bowel motility
✔✔Geriatric Changes in Distribution Include - ✔✔- Decrease in Lean body mass
- Increase in total body fat percentage
- Decrease in total body water
- Decrease in Serum Albumin - Most common binding protein - can result in ↑ in free
drug concentration, Decrease dose in drugs that are highly protein bound
- Hepatic blood flow %
✔✔Geriatric changes in biotransformation (metabolism) - ✔✔• Inconsistent changes in
liver function with age....
• reduced liver size and enzyme content - Drug clearance may be compromised
• Decrease in Phase I metabolism r/t P450
• Phase II conjugation may be affected by
↓ liver blood flow
• May need lower dose - Monitoring for ADE
✔✔Changes in Geriatric Drug elimination - ✔✔Changes in renal function- single most
important
physiologic causative factor in ADRs
• Decrease in nephrons
• Decrease in blood flow
• Decrease in cardiac output and renal perfusion
• Decrease in GFR- ↑ in sclerosed glomeruli
• Creatinine clearance-↓ by about 10% per decade after age 40
• Calculation of creatinine clearance impaired d/t decreased muscle mass
✔✔Golden rule of drug elimination in geriatrics - ✔✔Start low, go slow
, ✔✔Formula used to measure creatinine clearance - ✔✔Cockcroft-Gault formula
✔✔Cockcroft-Gault Formula - ✔✔• Can be overestimated w/ conventional calculations
• Recommended simple modification of Cockcroft-Gault equation
• Estimated creatinine clearance (mL/min) - replace Scr w/ 1mg/dl (if the value is <1)
• For women, the result should be multiplied by 0.85 (d/t ↓ muscle mass)
✔✔Declines in hearing, vision, and manual dexterity have what effect on
pharmacokinetics and pharmacodynamics in in the eldery? - ✔✔result in unintentional
overdose and noncompliance with medication regimens
✔✔Decline in resting heart rate, stroke volume, and cardiac output has what effect on
pharmacokinetics and pharmacodynamics in the elderly? - ✔✔slows absorption,
distribution, and excretion of drugs
✔✔Impaired response of baroreceptors (concentrated in the internal carotid arteries and
aortic arch) to pressure changes has what effect on pharmacokinetics and
pharmacodynamics in the elderly? - ✔✔resulting in BP instability, esp. w/ position
∆
✔✔A more variable drug effect on CNS in the elderly is due to - ✔✔• r/t ↓ blood supply,
changes in the blood-brain barrier (allowing fatsoluble drugs to permeate the brain),
•↓ in acetylcholine, dopamine, and serotonin
→ potentiating ADRs
✔✔The altered number and sensitivity to receptor sites in the elderly causes -
✔✔declines in neurotransmitter function and increased sensitivity of older adults to
ADRs
✔✔Respiratory capacity declines in the elderly cause - ✔✔decreased elimination of
volatile drugs. (inhalation anesthetics)
✔✔Acid secretion, blood flow, and GI tract motility
↓ and pH level ↑ possibly causes - ✔✔reduced drug absorption
✔✔A decline in hepatic blood flow, enzyme production, biotransformation, and phase I
oxidation reactions in the liver of the elderly causes - ✔✔reduction in metabolism of
some drugs, ↑ half-life & risk of ADRs/Toxicities
✔✔Declines in renal mass/function, blood flow, GFR, creatinine clearance →
exacerbated by chronic illnesses in the elderly can cause - ✔✔prolonged elimination
half-life of drugs, accumulation of metabolites in the blood stream which potentiates
toxicities.
RATED A+
✔✔Adverse effects of Minoxidil (Rogaine) - ✔✔• Allergic and irritant contact dermatitis
• Hair growth in undesirable locations - reversible on stopping the drug
• Patients instructed to wash hands after applying
• Percutaneous absorption of minoxidil minimal in normal scalp - possible systemic
effects on blood pressure
✔✔Trichogenic Agents - Finasteride (Propecia) - ✔✔blocks conversion of testosterone
to dihydrotestosterone (androgen responsible for androgenic alopecia in genetically
predisposed men)
Oral agent promotes hair growth, prevents further hair loss.
Tx at leaset 3-6 months to see increased hair growth
Continued Rx necessary to sustain benefit
ADE:decreased libido, ejaculation disorders, erectile dysfunction-resolve in most men
who remain on therapy -and w/ discontinuation
*Pregnant women should not be exposed to the drug because of the potential for
inducing genital abnormalities in male fetuses*
✔✔Bimatoprost (Latisse) - ✔✔*Treatment of the eyelashes*
• Prostaglandin analog, 0.03% ophthalmic solution
• MOA unknown
• QHS application to skin of upper eyelid margins (base of eyelashes) separate
disposable applicator each eye
• Remove contact lenses prior to using
• ADE-pruritus, conjunctival hyperemia, skin pigmentation, erythema of eyelids
• Possible ↑ brown iris pigmentation-likely permanent
✔✔Antitrichogenic Agents - Eflornithine (Vaniqa) - ✔✔effects biosynthesis of
polyamines Polyamines required for cell division growth
• Topical -Reduces facial hair growth in approx. 30% of women when applied twice daily
for 6 months
• Hair growth returns to pretreatment levels 8 weeks after discontinuing
• Local adverse effects-stinging, burning, and folliculitis
✔✔Anti-Inflammatory Agents-Corticosteroids - ✔✔• Efficacy of topical corticosteroids for
tx inflammatory dermatoses
• Numerous types available w/ choices of potencies, concentrations, and vehicles
,• Anti-inflammatory and antimitotic effects
• Original-hydrocortisone
*Therapeutic effectiveness -based primarily on their anti-inflammatory activity*
✔✔Topical Corticosteroids - ✔✔• Minimally absorbed w/ application to normal skin
• Significantly increased absorption in inflamed skin (atopic dermatitis etc.)
• Occlusion w/ plastic wrap -tenfold increase in absorption
*• Significant regional anatomic variation in corticosteroid penetration
• Compared w/ absorption from the forearm, hydrocortisone is absorbed
• 0.14 times as well through the plantar foot arch
• 0.83 times as well through the palm
• 3.5 times as well through the scalp
• 6 times as well through the forehead
• 9 times as well through vulvar skin
• 42 times as well through scrotal skin
✔✔Adverse systemic effects of topical corticosteroids - ✔✔• All absorbable topical
corticosteroids have potential to suppress Hypothalamic Pituitary adrenal (HPA) axis
• Iatrogenic Cushing's syndrome can occur as a result of long term use of topical
corticosteroids in large quantities
• Steroid induced glaucoma/cataracts
* Adverse systemic effects in children-may take lesser amt/duration for ADE- growth
retardation possible
• Pregnancy -caution advised-esp. 1st trimester
• Geriatric patients more susceptible to secondary infection
✔✔Adverse local effects of topical corticosteroids - ✔✔Atrophy-shiny, depressed,
wrinkled appearing skin with prominent telangiectasia
-Purpura and ecchymosis
- Telangiectatic vessels, pustules, and papules
-Perioral dermatitis
- Steroid acne
- hypopigmentation
- Hypertrichosis
- Increased intraocular pressure
- worsening of cutaneous infections
✔✔Capsaicin - ✔✔• Naturally occurring substance derived from hot chili peppers
• Exact MOA unknown
• Initially stimulates then desensitizes and degenerates cutaneous nociceptive neurons
• Causes local depletion of substance P, involved in sensory perception and pain
transmission
,• Available as a 0.025% cream and 0.075% cream
• Apply 3-4 x daily
• Used for Tx postherpetic neuralgia, painful diabetic neuropathy, being investigated for
Tx psoriasis, vitiligo, intractable pruritus
✔✔Geriatric Changes in functional capacities include - ✔✔Most major organ systems
show decline beginning in young adulthood and continuing throughout the lifespan
✔✔Geriatric medication absorption - ✔✔Large GI surface area- absorption usually not
affected (passive diffusion)
✔✔Compounds requiring active transport in Geriatrics may have delayed absorption
due to: - ✔✔GI changes w/ age - reduction in acid (more alkaline environment)
• Reduction in
• Blood flow
• Enzyme activity
• Gastric emptying
• Bowel motility
✔✔Geriatric Changes in Distribution Include - ✔✔- Decrease in Lean body mass
- Increase in total body fat percentage
- Decrease in total body water
- Decrease in Serum Albumin - Most common binding protein - can result in ↑ in free
drug concentration, Decrease dose in drugs that are highly protein bound
- Hepatic blood flow %
✔✔Geriatric changes in biotransformation (metabolism) - ✔✔• Inconsistent changes in
liver function with age....
• reduced liver size and enzyme content - Drug clearance may be compromised
• Decrease in Phase I metabolism r/t P450
• Phase II conjugation may be affected by
↓ liver blood flow
• May need lower dose - Monitoring for ADE
✔✔Changes in Geriatric Drug elimination - ✔✔Changes in renal function- single most
important
physiologic causative factor in ADRs
• Decrease in nephrons
• Decrease in blood flow
• Decrease in cardiac output and renal perfusion
• Decrease in GFR- ↑ in sclerosed glomeruli
• Creatinine clearance-↓ by about 10% per decade after age 40
• Calculation of creatinine clearance impaired d/t decreased muscle mass
✔✔Golden rule of drug elimination in geriatrics - ✔✔Start low, go slow
, ✔✔Formula used to measure creatinine clearance - ✔✔Cockcroft-Gault formula
✔✔Cockcroft-Gault Formula - ✔✔• Can be overestimated w/ conventional calculations
• Recommended simple modification of Cockcroft-Gault equation
• Estimated creatinine clearance (mL/min) - replace Scr w/ 1mg/dl (if the value is <1)
• For women, the result should be multiplied by 0.85 (d/t ↓ muscle mass)
✔✔Declines in hearing, vision, and manual dexterity have what effect on
pharmacokinetics and pharmacodynamics in in the eldery? - ✔✔result in unintentional
overdose and noncompliance with medication regimens
✔✔Decline in resting heart rate, stroke volume, and cardiac output has what effect on
pharmacokinetics and pharmacodynamics in the elderly? - ✔✔slows absorption,
distribution, and excretion of drugs
✔✔Impaired response of baroreceptors (concentrated in the internal carotid arteries and
aortic arch) to pressure changes has what effect on pharmacokinetics and
pharmacodynamics in the elderly? - ✔✔resulting in BP instability, esp. w/ position
∆
✔✔A more variable drug effect on CNS in the elderly is due to - ✔✔• r/t ↓ blood supply,
changes in the blood-brain barrier (allowing fatsoluble drugs to permeate the brain),
•↓ in acetylcholine, dopamine, and serotonin
→ potentiating ADRs
✔✔The altered number and sensitivity to receptor sites in the elderly causes -
✔✔declines in neurotransmitter function and increased sensitivity of older adults to
ADRs
✔✔Respiratory capacity declines in the elderly cause - ✔✔decreased elimination of
volatile drugs. (inhalation anesthetics)
✔✔Acid secretion, blood flow, and GI tract motility
↓ and pH level ↑ possibly causes - ✔✔reduced drug absorption
✔✔A decline in hepatic blood flow, enzyme production, biotransformation, and phase I
oxidation reactions in the liver of the elderly causes - ✔✔reduction in metabolism of
some drugs, ↑ half-life & risk of ADRs/Toxicities
✔✔Declines in renal mass/function, blood flow, GFR, creatinine clearance →
exacerbated by chronic illnesses in the elderly can cause - ✔✔prolonged elimination
half-life of drugs, accumulation of metabolites in the blood stream which potentiates
toxicities.
