NURS 5005 FINAL EXAM QUESTIONS WITH
CORRECT ANSWERS
four basic pharmacokinetic processes - ANSWER absorption, distribution,
metabolism, excretion
what organs systems are majorly related to each pharmacokinetic process -
ANSWER absorption (GI tract, skin), distribution (blood), metabolism (liver),
excretion (kidneys)
Lipophilicity - ANSWER the chemical attraction of a substance to lipid or fat
molecules. a drugs lipophilicity relates to how quickly a drug can take effect.
fentynal is a drug that has high lipophilicity and it gets into the CNS very fast
how do most drugs get across the membrane - ANSWER direct penetration.
other ways to get across are channels/pores and transport systems
what type of molecules have the most movement across membranes? - ANSWER
polar molecules move the best through membranes because the possess
uneven charge distribution (but have no net charge).
Ions, that possess a net charge, are not able to cross membrane as easily.
What is ion trapping? - ANSWER uncharged molecules move across membrane,
such as from a low pH compartment to a high(er) pH compartment. charged
molecules are "trapped" and can't travel back across the membrane.
example of this is a weak acid moving from the stomach (low pH) to the blood
(higher pH). the acid then becomes charged. orally administered drugs are
meant to be trapped in the blood so they can be distributed.
why should a nurse be aware of if a patient is taking antacids before giving a
medication? - ANSWER because if the antacids change the pH of the stomach, it
will impair drug absorption and will not be able to make it to the blood stream
and the drug target.
why does drinking charcoal work in oral medication drug overdoses? - ANSWER
because it makes the stomach pH more basic and weakly acidic drugs are
unable to enter the bloodstream
what route of administration has 100% absorption rate? - ANSWER IV
,how does protein binding affect drug distribution? - ANSWER when drugs are
bound to proteins, like albumin, the drug molecules are "benched" and are
unable to have affects until they detach from the protein. warfarin, for example,
can have up to 99% albumin binding. when bound to albumin, warfrarin can not
move out of the bloodstream or have therapeutic effects. This means that the
drug has to be dosed correctly and differs from patient to patient because of its
high binding and low bioavailability.
what drugs can pass though the placenta? - ANSWER it should be assumed that
all drugs can pass through the placenta. however, lipid soluble drugs are more
likely to pass compared to charged/protein bound drugs.
how are drugs metabolized? - ANSWER biotransformation, enzymatic alteration
of drug structure, liver, and P450 proteins. the primary site of metabolism is the
liver.
what is the first pass effect? - ANSWER rapid hepatic inactivation of certain
orally administered drugs that cause the drug to never reach the site of action.
when a drug has a high first pass effect, it is important to use a higher dosage to
account for the inactivation.
it is important to note that if the liver is damaged, the 1st pass effect will not
work and this can impact the dosage requirement for therapeutic effect
why are liver and kidney health important to be aware of for medication
administration and perscription? - ANSWER Because majority of drug
metabolism happens in the liver and the major mechanism of drug removal is the
kidneys. If these organs are not functioning normally, this can impact the drugs
ability to be used and removed.
why do we monitor plasma drug levels? - ANSWER because we want to keep the
drug in the therapeutic range and prevent toxic concentrations or minimum
effective concentrations.
what is a drug half life? - ANSWER the time it takes for the amount of the drug to
decrease by 50
%.
when will a drug that is administered repeatedly in doses of equal sizes reach a
plateu? - ANSWER 4 half lives
What is pharmacodynamics? - ANSWER physiological effects of drugs and the
molecular mechanisms by which effects are produced.
what is more important, drug potency or drug efficacy? - ANSWER drug efficacy,
which is the largest response that a drug can produce, is more important when
,comparing to potency. the higher the dose, the higher the efficacy (until you hit
the plateau). when drugs are more potent, there is more room for error.
what are the 4 receptor families and what are examples of each? - ANSWER -cell
membrane-embedded enzymes (insulin receptors)
-ligand-gated ion channels (nAChR, GABA recpetor, Ca2+ channel)
-G-protein couple receptors (mAChR, beta1 AR, opiond receptors)
-transcription factors (estrogen receptors, glucocorticoid receptors)
what is an agonist? - ANSWER molecules that binds and activates receptors
(turns on)
what is an antagonist? - ANSWER molecules that bind and inhibit activation
(block)
what is a competitive antagonist? - ANSWER a molecule that binds reversibly to
receptor which causes need for more agonist to produce a certain response
what is ED50? - ANSWER the effective and therapeutic dose for 50% of the
population. if a drug is not toxic, it is common to give over the ED50 so that the
maximum amount of people will experience a therapeutic response.
What is the theraputic index? - ANSWER it is a measure of the drug's safety. the
greater the therapeutic index, the safer the drug. drugs with TI lower then 3 are
not given. examples of drugs with a TI of 4 are digoxin, lithium, and warfarin. all
of these drugs require testing of plasma levels to make sure patients are given a
safe and therapeutic dose.
what are the basic mechanisms of drug-drug interactions? - ANSWER -direct
chemical or physical reaction (most commonly seen when given drugs together
in an IV)
-pharmacokinetic interactions (altered absorption, distribution, metabolism, or
excretion)
-pharmacodynamic interactions (interactions at the same site of action or
interactions at different sites of action)
-combined toxicity interactions
how can food impact pharmacokinetics? - ANSWER food can alter drug
metabolism (grapefruit juice effect, p450 metabolism) or they can impact
absorption (how taking medications on an empty stomach can maximize drug
absorption).
how are neurotransmitters removed from the synapse? - ANSWER diffusion,
enzymatic degradation, reuptake. many meds act by removing NT from the
synapse using at least one of these mechanisms
, what does the parasympathetic nervous system affect? - ANSWER heart rate
(decreases), gastric secretions, bladder and bowels, vision, bronchial smooth
muscle
what does the sympathetic nervous system affect? - ANSWER regulation of
cardiovascular system, heart rate (increases), body temperature, fight or flight
response
what are the effects of parasympathetic NS stimulation? - ANSWER -decrease
heart rate
-increase gastric secretions and salivation
-increase bladder voiding
-increase bowel movement
-increase pupil constriction (near vision)
-increase bronchoconstriction
-increase pulmonary secretions
-increase glycogen synthesis in the liver
-causes erection
what are the effects of sympathetic NS stimulation? - ANSWER -increase heart
rate
-decrease gastric secretions and salivation
-decrease bladder voiding
-decrease bowel movement and GI motility
-increase pupil relaxation (far vision)
-increase bronchodilation
-causes ejaculation
-increase renin release from the kidney
-increases adrenal secretions
-increases basal metabolism
-increases lipolysis (breakdown of fat cells)
-increases glycogenolysis in skeletal muscle
-increases sweating
what are the three primary neurotransmitters in the PNS? - ANSWER
acetylcholine, norepinephrine, epinephrine
where is acetylcholine released from in the PNS? - ANSWER -all preganglionic
neurons
-all parasymathetic NS postganglionic neurons
-postganglionic neurons of the sympathetic NS that innervate sweat glands
-somatic motor neurons
where is norepinephrine released from in the PNS? - ANSWER all sympathetic
NS post ganglionic neurons, except sweat glands
CORRECT ANSWERS
four basic pharmacokinetic processes - ANSWER absorption, distribution,
metabolism, excretion
what organs systems are majorly related to each pharmacokinetic process -
ANSWER absorption (GI tract, skin), distribution (blood), metabolism (liver),
excretion (kidneys)
Lipophilicity - ANSWER the chemical attraction of a substance to lipid or fat
molecules. a drugs lipophilicity relates to how quickly a drug can take effect.
fentynal is a drug that has high lipophilicity and it gets into the CNS very fast
how do most drugs get across the membrane - ANSWER direct penetration.
other ways to get across are channels/pores and transport systems
what type of molecules have the most movement across membranes? - ANSWER
polar molecules move the best through membranes because the possess
uneven charge distribution (but have no net charge).
Ions, that possess a net charge, are not able to cross membrane as easily.
What is ion trapping? - ANSWER uncharged molecules move across membrane,
such as from a low pH compartment to a high(er) pH compartment. charged
molecules are "trapped" and can't travel back across the membrane.
example of this is a weak acid moving from the stomach (low pH) to the blood
(higher pH). the acid then becomes charged. orally administered drugs are
meant to be trapped in the blood so they can be distributed.
why should a nurse be aware of if a patient is taking antacids before giving a
medication? - ANSWER because if the antacids change the pH of the stomach, it
will impair drug absorption and will not be able to make it to the blood stream
and the drug target.
why does drinking charcoal work in oral medication drug overdoses? - ANSWER
because it makes the stomach pH more basic and weakly acidic drugs are
unable to enter the bloodstream
what route of administration has 100% absorption rate? - ANSWER IV
,how does protein binding affect drug distribution? - ANSWER when drugs are
bound to proteins, like albumin, the drug molecules are "benched" and are
unable to have affects until they detach from the protein. warfarin, for example,
can have up to 99% albumin binding. when bound to albumin, warfrarin can not
move out of the bloodstream or have therapeutic effects. This means that the
drug has to be dosed correctly and differs from patient to patient because of its
high binding and low bioavailability.
what drugs can pass though the placenta? - ANSWER it should be assumed that
all drugs can pass through the placenta. however, lipid soluble drugs are more
likely to pass compared to charged/protein bound drugs.
how are drugs metabolized? - ANSWER biotransformation, enzymatic alteration
of drug structure, liver, and P450 proteins. the primary site of metabolism is the
liver.
what is the first pass effect? - ANSWER rapid hepatic inactivation of certain
orally administered drugs that cause the drug to never reach the site of action.
when a drug has a high first pass effect, it is important to use a higher dosage to
account for the inactivation.
it is important to note that if the liver is damaged, the 1st pass effect will not
work and this can impact the dosage requirement for therapeutic effect
why are liver and kidney health important to be aware of for medication
administration and perscription? - ANSWER Because majority of drug
metabolism happens in the liver and the major mechanism of drug removal is the
kidneys. If these organs are not functioning normally, this can impact the drugs
ability to be used and removed.
why do we monitor plasma drug levels? - ANSWER because we want to keep the
drug in the therapeutic range and prevent toxic concentrations or minimum
effective concentrations.
what is a drug half life? - ANSWER the time it takes for the amount of the drug to
decrease by 50
%.
when will a drug that is administered repeatedly in doses of equal sizes reach a
plateu? - ANSWER 4 half lives
What is pharmacodynamics? - ANSWER physiological effects of drugs and the
molecular mechanisms by which effects are produced.
what is more important, drug potency or drug efficacy? - ANSWER drug efficacy,
which is the largest response that a drug can produce, is more important when
,comparing to potency. the higher the dose, the higher the efficacy (until you hit
the plateau). when drugs are more potent, there is more room for error.
what are the 4 receptor families and what are examples of each? - ANSWER -cell
membrane-embedded enzymes (insulin receptors)
-ligand-gated ion channels (nAChR, GABA recpetor, Ca2+ channel)
-G-protein couple receptors (mAChR, beta1 AR, opiond receptors)
-transcription factors (estrogen receptors, glucocorticoid receptors)
what is an agonist? - ANSWER molecules that binds and activates receptors
(turns on)
what is an antagonist? - ANSWER molecules that bind and inhibit activation
(block)
what is a competitive antagonist? - ANSWER a molecule that binds reversibly to
receptor which causes need for more agonist to produce a certain response
what is ED50? - ANSWER the effective and therapeutic dose for 50% of the
population. if a drug is not toxic, it is common to give over the ED50 so that the
maximum amount of people will experience a therapeutic response.
What is the theraputic index? - ANSWER it is a measure of the drug's safety. the
greater the therapeutic index, the safer the drug. drugs with TI lower then 3 are
not given. examples of drugs with a TI of 4 are digoxin, lithium, and warfarin. all
of these drugs require testing of plasma levels to make sure patients are given a
safe and therapeutic dose.
what are the basic mechanisms of drug-drug interactions? - ANSWER -direct
chemical or physical reaction (most commonly seen when given drugs together
in an IV)
-pharmacokinetic interactions (altered absorption, distribution, metabolism, or
excretion)
-pharmacodynamic interactions (interactions at the same site of action or
interactions at different sites of action)
-combined toxicity interactions
how can food impact pharmacokinetics? - ANSWER food can alter drug
metabolism (grapefruit juice effect, p450 metabolism) or they can impact
absorption (how taking medications on an empty stomach can maximize drug
absorption).
how are neurotransmitters removed from the synapse? - ANSWER diffusion,
enzymatic degradation, reuptake. many meds act by removing NT from the
synapse using at least one of these mechanisms
, what does the parasympathetic nervous system affect? - ANSWER heart rate
(decreases), gastric secretions, bladder and bowels, vision, bronchial smooth
muscle
what does the sympathetic nervous system affect? - ANSWER regulation of
cardiovascular system, heart rate (increases), body temperature, fight or flight
response
what are the effects of parasympathetic NS stimulation? - ANSWER -decrease
heart rate
-increase gastric secretions and salivation
-increase bladder voiding
-increase bowel movement
-increase pupil constriction (near vision)
-increase bronchoconstriction
-increase pulmonary secretions
-increase glycogen synthesis in the liver
-causes erection
what are the effects of sympathetic NS stimulation? - ANSWER -increase heart
rate
-decrease gastric secretions and salivation
-decrease bladder voiding
-decrease bowel movement and GI motility
-increase pupil relaxation (far vision)
-increase bronchodilation
-causes ejaculation
-increase renin release from the kidney
-increases adrenal secretions
-increases basal metabolism
-increases lipolysis (breakdown of fat cells)
-increases glycogenolysis in skeletal muscle
-increases sweating
what are the three primary neurotransmitters in the PNS? - ANSWER
acetylcholine, norepinephrine, epinephrine
where is acetylcholine released from in the PNS? - ANSWER -all preganglionic
neurons
-all parasymathetic NS postganglionic neurons
-postganglionic neurons of the sympathetic NS that innervate sweat glands
-somatic motor neurons
where is norepinephrine released from in the PNS? - ANSWER all sympathetic
NS post ganglionic neurons, except sweat glands
