NURS 216A Final Exam – Questions With Comprehensive
Solutions
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Sherpath: Diabetes Mellitus Chapter 21 Test Case Study 4 (Short
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Terms in this set (812)
3 categories of pharmacotherapeutics Drug/medication
Biologic
NHP (natural health product)
Drug/medication A chemical agent. Historically were made from plants but are
now synthetically manufactured
Helena uses these terms interchangeably
Biologic Naturally produced in animal cells
Eg hormones, antibodies, blood products, genetic treatment
modalities
NHP Natural health product. Naturally occurring, used as an
adjunct. Mostly derived from nature; must include this in
patients' health history as it's still considered a medication that
can interact with other drugs
Eg vitamins, minerals, dietary supplements
Nursing process Assessment: determine alterations to physiology
Planning
Intervention: pharmacotherapeutics, 90% of the time however
other therapies exist too
Evaluation: including assessment of drug action and drug side
effects. We are able to advocate for different treatment + keep
pain scale in mind
Patient education plays a big part in our nursing care, remember to always
include it!
Factors affecting administration route of Drug to target tissues
drugs Clinical setting
Medical situation
Drug dynamics
,Drug to target tissues Need to get the distribution levels to high enough levels for
the drug to have effects on its target tissues
Eg calcium; it's destroyed in the GI = causes problems with
vitamin D absorption = low levels of calcium in the bones =
bones are harder to rebuild due to decreased blood flow
Therefore: there's a challenge to get the drug to its target
Are drug routes interchangeable? No, but it also depends on the setting, acuity, and the drug
itself
Oral route of administration By mouth; liquid, pills, powder
Also called 'enteral': passes thru GI tract
Most common route and also the most challenging in terms of
kinetics
Why is the oral route the most challenging Due to the acidic environment and peristalsis dependency
route? Need to go past the 1st pass metabolism, then the drug will
have a systemic effect; influencing tissues, organs, and this all
depends on how the drug is prepared. It doesn't stay
localized!
Need to keep down the meds (can't swallow, crushing pills
isn't an option, and nausea/vomiting also an issue)
1st pass metabolism Metabolism of a drug before it reaches systemic circulation
Sublingual route of administration Under the tongue, no swallowing
Capillary absorption in the oral mucosa into bloodstream.
Bypasses GI system and therefore the 1st pass metabolism
Faster acting than oral drugs, can be given in emergencies
Eg. nitroglycerin given for angina; can see its effect within
seconds
Intranasal route of administration aka insufflation
Into the nasal cavity, capillary absorption
Can have a localized or systemic effect, this is preparation
dependent
Localized effect in intranasal administration Used for allergies, and is corticosteroid based. A percentage
will still reach systemic circulation but this depends on its
preparation; not enough to cause severe side fx, unless taken
often enough. These drugs have a good affinity for receptors
so they WILL attach, need to be careful!
Systemic effect in intranasal administration Used for vaccines, etc to elicit an immune response.
Immediate effect, very lipophilic and small molecules
Direct CNS effect in intranasal Diffusion occurs across the mucosa & distribution along the
administration CNS nerve network, eg cocaine
Not used in clinicals, very addictive
,Inhalation drugs Breathed into lungs - enter the pulmonary capillary network
to cause rapid effects, can be local or systemic depending on
preparation
Local effect of inhalation drugs For example asthma drugs; dilate bronchioles. Stays within the
lungs but a certain percentage still reaches systemic
circulation
Systemic effect of inhalation drugs For example general anesthesia drugs. Absorbs into
capillaries and is delivered around the body
Endotracheal route of administration Used in ER/ICU situations, or in a surgery/when patient can't
breathe, like epinephrine
Topical route of administration Applied directly to a surface - skin/eye creams, ointments,
liquids. Elicit a local effect with a minimal systemic presence
Systemic presence of topical drugs Systemic presence % can be contraindicated, for example
Retinoid creams will have a local effect in the reticular layer of
the dermis. Low systemic effect but still contraindicated in
pregnancy b/c small amounts are absorbed into capillaries,
can be bad/teratogenic for the fetus
Molecule size in topical drugs Many molecules are too large to penetrate all skin layers --
keratinized layer prevents this from happening
Molecule size can be expressed in daltons = reflects the
molecular weight; can't penetrate the dermis where capillaries
are
Transdermal route of administration Can be in a patch form. Works via dermal capillary absorption
- systemic effect is desired!
Long acting with sustained rate of release; reaches the
therapeutic level and stays there. Low daltons, very lipophilic
Rectal route of administration Inserted into the lower GI/rectum
Has a local (increases lube of stool) and a systemic effect
(unreliable and many factors affect it). 25% will enter portal
circulation and 75% will work locally
Bypasses 1st pass metabolism
Parenteral routes of administration All require an injection:
Intravenous/IV, intramuscular (IM), subcutaneous (SC)
Always bypass the GI
, Intravenous route of administration Most common clinically. Injected into vein and NOT arteries
b/c they spasm!
Immediate absorption + fast onset of action b/c the bypass of
1st pass metabolism
Systemic effect and common in the hospital settings, however
is expensive (need trained professionals) and there's a risk for
infection
Intramuscular route of administration Needle goes into muscles
Capillary bed absorption into the bloodstream; muscles are
very vascular!
Has a systemic effect but is painful. Used for epinephrine in
allergic reactions
Remember epinephrine can't be given orally because it
becomes completely denatured by the stomach acids
Aqueous preparation in IM Faster effect
Depot preparation in IM Slower effect
Why is the dorsogluteal site not The site of injection comes very close to the sciatic nerve; can
recommended for IM injections cause extreme pain or paralysis!
Subcutaneous route of administration Injection into the adipose tissue of the hypodermis, absorbed
via the capillary bed
Systemic effect but can have a faster or slower onset -
preparation dependent
Pharmacokinetics How drugs move through the body
Movement of the drugs across cell membranes via the lipid
bilayer; lipids like lipids!
ADME
What is molecular kinetics affected by Molecular characteristics and membrane transport
Molecular characteristics This includes charge, lipophilicity vs. hydrophilicity and size of
the molecules
Charge (ionization) of molecules 90% the time, drug molecules are neutral so they can easily
absorb
Neutral atoms/molecules are converted into electrically
charged ones (IONIZED)
Ionized atoms are also polar!!!!
Non ionized = non polar
ABSORPTION favors non charged/non polar molecules, but
METABOLISM will charge the molecules making them easy to
excrete
Solutions
Save
Students also studied
Sherpath: Diabetes Mellitus Chapter 21 Test Case Study 4 (Short
30 terms 24 terms 22 terms
jesssbee Preview kenanderson2017 Preview Brittany182
Terms in this set (812)
3 categories of pharmacotherapeutics Drug/medication
Biologic
NHP (natural health product)
Drug/medication A chemical agent. Historically were made from plants but are
now synthetically manufactured
Helena uses these terms interchangeably
Biologic Naturally produced in animal cells
Eg hormones, antibodies, blood products, genetic treatment
modalities
NHP Natural health product. Naturally occurring, used as an
adjunct. Mostly derived from nature; must include this in
patients' health history as it's still considered a medication that
can interact with other drugs
Eg vitamins, minerals, dietary supplements
Nursing process Assessment: determine alterations to physiology
Planning
Intervention: pharmacotherapeutics, 90% of the time however
other therapies exist too
Evaluation: including assessment of drug action and drug side
effects. We are able to advocate for different treatment + keep
pain scale in mind
Patient education plays a big part in our nursing care, remember to always
include it!
Factors affecting administration route of Drug to target tissues
drugs Clinical setting
Medical situation
Drug dynamics
,Drug to target tissues Need to get the distribution levels to high enough levels for
the drug to have effects on its target tissues
Eg calcium; it's destroyed in the GI = causes problems with
vitamin D absorption = low levels of calcium in the bones =
bones are harder to rebuild due to decreased blood flow
Therefore: there's a challenge to get the drug to its target
Are drug routes interchangeable? No, but it also depends on the setting, acuity, and the drug
itself
Oral route of administration By mouth; liquid, pills, powder
Also called 'enteral': passes thru GI tract
Most common route and also the most challenging in terms of
kinetics
Why is the oral route the most challenging Due to the acidic environment and peristalsis dependency
route? Need to go past the 1st pass metabolism, then the drug will
have a systemic effect; influencing tissues, organs, and this all
depends on how the drug is prepared. It doesn't stay
localized!
Need to keep down the meds (can't swallow, crushing pills
isn't an option, and nausea/vomiting also an issue)
1st pass metabolism Metabolism of a drug before it reaches systemic circulation
Sublingual route of administration Under the tongue, no swallowing
Capillary absorption in the oral mucosa into bloodstream.
Bypasses GI system and therefore the 1st pass metabolism
Faster acting than oral drugs, can be given in emergencies
Eg. nitroglycerin given for angina; can see its effect within
seconds
Intranasal route of administration aka insufflation
Into the nasal cavity, capillary absorption
Can have a localized or systemic effect, this is preparation
dependent
Localized effect in intranasal administration Used for allergies, and is corticosteroid based. A percentage
will still reach systemic circulation but this depends on its
preparation; not enough to cause severe side fx, unless taken
often enough. These drugs have a good affinity for receptors
so they WILL attach, need to be careful!
Systemic effect in intranasal administration Used for vaccines, etc to elicit an immune response.
Immediate effect, very lipophilic and small molecules
Direct CNS effect in intranasal Diffusion occurs across the mucosa & distribution along the
administration CNS nerve network, eg cocaine
Not used in clinicals, very addictive
,Inhalation drugs Breathed into lungs - enter the pulmonary capillary network
to cause rapid effects, can be local or systemic depending on
preparation
Local effect of inhalation drugs For example asthma drugs; dilate bronchioles. Stays within the
lungs but a certain percentage still reaches systemic
circulation
Systemic effect of inhalation drugs For example general anesthesia drugs. Absorbs into
capillaries and is delivered around the body
Endotracheal route of administration Used in ER/ICU situations, or in a surgery/when patient can't
breathe, like epinephrine
Topical route of administration Applied directly to a surface - skin/eye creams, ointments,
liquids. Elicit a local effect with a minimal systemic presence
Systemic presence of topical drugs Systemic presence % can be contraindicated, for example
Retinoid creams will have a local effect in the reticular layer of
the dermis. Low systemic effect but still contraindicated in
pregnancy b/c small amounts are absorbed into capillaries,
can be bad/teratogenic for the fetus
Molecule size in topical drugs Many molecules are too large to penetrate all skin layers --
keratinized layer prevents this from happening
Molecule size can be expressed in daltons = reflects the
molecular weight; can't penetrate the dermis where capillaries
are
Transdermal route of administration Can be in a patch form. Works via dermal capillary absorption
- systemic effect is desired!
Long acting with sustained rate of release; reaches the
therapeutic level and stays there. Low daltons, very lipophilic
Rectal route of administration Inserted into the lower GI/rectum
Has a local (increases lube of stool) and a systemic effect
(unreliable and many factors affect it). 25% will enter portal
circulation and 75% will work locally
Bypasses 1st pass metabolism
Parenteral routes of administration All require an injection:
Intravenous/IV, intramuscular (IM), subcutaneous (SC)
Always bypass the GI
, Intravenous route of administration Most common clinically. Injected into vein and NOT arteries
b/c they spasm!
Immediate absorption + fast onset of action b/c the bypass of
1st pass metabolism
Systemic effect and common in the hospital settings, however
is expensive (need trained professionals) and there's a risk for
infection
Intramuscular route of administration Needle goes into muscles
Capillary bed absorption into the bloodstream; muscles are
very vascular!
Has a systemic effect but is painful. Used for epinephrine in
allergic reactions
Remember epinephrine can't be given orally because it
becomes completely denatured by the stomach acids
Aqueous preparation in IM Faster effect
Depot preparation in IM Slower effect
Why is the dorsogluteal site not The site of injection comes very close to the sciatic nerve; can
recommended for IM injections cause extreme pain or paralysis!
Subcutaneous route of administration Injection into the adipose tissue of the hypodermis, absorbed
via the capillary bed
Systemic effect but can have a faster or slower onset -
preparation dependent
Pharmacokinetics How drugs move through the body
Movement of the drugs across cell membranes via the lipid
bilayer; lipids like lipids!
ADME
What is molecular kinetics affected by Molecular characteristics and membrane transport
Molecular characteristics This includes charge, lipophilicity vs. hydrophilicity and size of
the molecules
Charge (ionization) of molecules 90% the time, drug molecules are neutral so they can easily
absorb
Neutral atoms/molecules are converted into electrically
charged ones (IONIZED)
Ionized atoms are also polar!!!!
Non ionized = non polar
ABSORPTION favors non charged/non polar molecules, but
METABOLISM will charge the molecules making them easy to
excrete
