ANCC AGPCNP Study Set Questions with Correct Answers Latest Update

ANCC AGPCNP Study Set Questions with Correct Answers Latest Update Pharmacology - Answers study of the interaction between the body and drugs Pharmacokinetics - Answers the movement of drugs trough the body (absorption, bioavailability, distribution, metabolism, and excretion) Pharmacodynamics - Answers The study of the physiologic and biochemical effects of drugs (what a drug does to the body) Pharmacogenomics - Answers the study of how a person's genes affect response to medications. Area under the curve (AUC) - Answers the average amount of a drug in the blood after a dose is given. It is a measure of the availability (bioavailability) of a drug after it is administered. maximum concentration (Cmax) - Answers The peak serum concentration of a drug Minimum inhibitory concentration (MIC) - Answers the lowest concentration of an antibiotic that will inhibit the growth of organisms (after overnight incubation). Trough - Answers the lowest concentration of a drug after a dose First-pass effect - Answers All oral drugs (except sublingual) must go through first-pass metabolism before released and used by body. In the liver the CYP450 system metabolizes the drug and then the active drug is released to the body to be used. What drug cannot be given orally because of extensive first-pass effect? - Answers insulin Drug Excretion - Answers Renal filtration accounts for most of drug excretion. Kidney is the principle organ for drug elimination. Age related change to pharmacokinetics - Answers - Increase in fat-to-water ratio - Decrease in albumin and plasma proteins - Decrease in liver blood flow and size - Decrease in some CYP450 enzyme pathways (decreased drug clearance) - Decrease in glomerular filtration rate (GFR) Specific Drugs affected by Kidney Disease - Answers - NSAIDS (reduction of renal blood flow will damage kidneys) - ACE inhibitors (higher risk of hyperkalemia) - Warfarin (Higher risk of over coagulation (INR 4). Severe CKD and ESRD at risk of hemorrhagic complications. Need more frequent monitoring - Lithium (increase risk of kidney injury. Monitor renal fxn closely) - Contrast dye (IV contrast can injure kidneys) - Potassium sparing diuretics (increased risk of hyperkalemia) - Oral sodium phosphate (used to cleanse bowel before colonoscopies) (May cause sudden loss of kidney fxn (AKI) as well as blood mineral disturbances) Potent CYP450 Inhibitors - Answers - THESE DRUGS SLOW DOWN CLEARANCE ((increase drug concentration, high risk for drug overdose or ASEs)) --high likelihood of drug-drug interactions - Macrolides (erythromycin, clarithromycin, telithromycin) - Antifungals (ketoconazole, fluconazole, phenytoin) - Cimetidine (Tagamet) - Citalopram (Celexa) - Protease inhibitors (saquinavir, indinavir, nelfinavir) - Grapefruit Juice (affects CYP450 system) What drugs does grapefruit interact with? - Answers - statins -erythromycin -calcium channel blocker ( nifedipine, nisoldipine) -antivirals (indinavir, saquinavir) -amiodarone -benzodiazepines (diazepam, triazolam) -cisapride -carbamazepine -buspirone What to monitor with Digoxin - Answers - Digoxin levels - EKG -electrolytes (K+,Mg+,Ca2+) What to monitor with Lithium? - Answers - blood levels - TSH (risk for hypothyroidism) Drugs to monitor drug levels - Answers - Digoxin -Theophylline -Carbamazepine -Phenytoin (Dilantin) -Lithium Safety Issues with H2 antagonists Ranitidine (Zantac) Famotidine (Pepcid) Cimetidine (Tagamet) Nizatidine (Axid) - Answers - Mental status changes with kidney disease - Avoid if creatinine clearance of 50 mL/min Safety Issues with Proton Pump Inhibitors (PPIs) Omeprazole (Prilosec) - Answers - Increased risk of fractures in postmenopausal wo