NUR 334 FINAL QUESTIONS AND ANSWERS
Prescribing basics - Answers - Prescribing is regulated by state BON
Proper RX - Answers - Providers name and address, Telephone
DEA
Pt name/DOB/Addres
Name of Drug, strength, SIG(directions) with indication/Route and frequency, Quantity
and signature.
Drug Schedules: Most addictive to least - Answers - 1: Heroin,LSD, MJ
2: hydrocodone, cocaine, Methamphetamine, methadone, oxycodone, meperidine,
fentanyl, adderall, ritalin
3: codeine, ketamine, testosterone
4: xanax, valium, soma, ambient, tramadol
5: antidiarrheal, antitussives, lomotil, lyrica
Pharmicodyamics - Answers - The effects of drug on the body. Receptors are large
molecules usually proteins, that interact and mediate the action of drugs
agonist - Answers - produce receptor stimulation and a conformational change every
time they bind. Do not need all available receptors to produce a maximum response
Partial agonist - Answers - drugs that have properties in b/w those of full agonist and
antagonist. They bind to receptors but when they occupy the receptor sites, they
stimulate only some of the receptors.
antagonist - Answers - drugs with affinity for a receptor but with no intrinsic activity.
Affinity allows the antagonist to bind to receptors, but lack of intrinsic activity prevents
the bound antagonist from causing receptor activation. The block action of drugs (ex.
Narcan)
Bioavailabity - Answers - % of administered dosage of the drug that survives the first
pass through the liver and reaches the blood stream
half life - Answers - Time required for the amount of a drug in the body to decline by
50%, drugs with shorter half lives must be administer frequently. 4.5-5.5 times the half
life to get steady state and to be limited from the body
what the body does to the drug - Answers - absorption, distribution, metabolism,
excretion
,Distribution - Answers - movement of absorbed drug in bodily fluids throughout the body
to target tissue. Properties affecting: lipid/water solubility, PH affects ionization of drug,
protein binding, size of molecule (smaller molecules are more able to diffuse)
Tissue: fat, bone, blood/brain barrier (only lipid soluble will pass), placental barrier
(many drugs can pass)
Protein binding - Answers - unbound drug is free which is active, crosses membrane.
Low plasma proteins result in more free drug. Competition: when 2 highly bound drugs
are given it increases the level of both drugs
Metabolism - Answers - take place in the liver mostly. Chemical change of a drug
structure to:
Enhance excretion, inactivate the drug, increase therapeutic action, active a prodrug
(inactive until metabolized in the body into the active compound, ex: levodopa), increase
or decrease toxicity
CYP450 - Answers - enzymes constitutes the most important of the phase I
metabolizing enzymes (account for about 75% of drug metabolism in the liver)
Phase 2: conjugation reaction occur leading to large increases in hydrophilicity of the
substrates rendering them more readily excretable
Substrate - Answers - an agent that is metabolized by an enzyme into a metabolite and
product and eventually excreted
Inhibitors - Answers - compete with other drugs for a particular enzyme affecting the
metabolism (decreased) of the substrate and decreases the excretion of the substrate
and increasing the circulating drug
inducer - Answers - competes with other drugs for a particular enzyme affecting
metabolism of the substrate (increases) decreasing the efficacy of the drug
excretion - Answers - renal: passive glomerular filtration, active tubular secretion,
tubular reabsorption, gi tract, lung, sweat and salivary, mammary
genomics - Answers - study of the complete set of genetic information present in a cell,
an organism, or species
pharmacogenetics - Answers - the study of the influence of hereditary factors on the
response of individual organisms to drugs, and the study of variations of DNA and RNA
characteristics as related to drug response
Pharmacogenetics tests - Answers - Mentioned on drug labels can be classified as "test
required," "test recommended," and "information only." Currently, four drugs are
required to have pharmacogenetics testing performed before they are prescribed:
cetuximab, trastuzumab, maraviroc and dasatinib
, wafarin, carbamazepine, valproic acid and abacavir are recommended to tests prior to
initial dosing
Carbamazepine and Asisans - Answers - Initiating carbamazepine therapy in these
patients (allele HLA-B*1502) are at high risk for developing Steven Johnson syndrome
or toxic epidermal necrolysis (TEN)
The ability of the anesthetic to penetrate the axon membrane is determined by 3
properties. What are they? - Answers - Molecular size, Lipid solubility, degree of
ionization at tissue pH
Why is epinephrine given with local anesthetics? - Answers - Decreases local blood flow
(decreased risk of bleeding)
Delays systemic absorption of the anesthetic
prolongs anesthesia
reduces the risk of toxicity
What is the most widely used local anesthetic? - Answers - Lidocaine
What is a possible fatal reaction to benzocaine - Answers - Methemoglobinemia
What is included in application guidelines for topical anesthetics - Answers - avoid
wrapping the site and heating the site, avoid application to open skin
Which medication will not cause rebound headaches from overuse? - Answers -
propranolol (preventative)
What is the best option for menstural migraine? - Answers - low dose estrogen about 3
days prior to menses
What food can trigger migraines? - Answers - Hot dog d/t nitrates
What medication is a Seratonin 1B1D receptor agonist? - Answers - Sumatriptan
Butterbur can help as prevention for migraine therapy. What side effect can occur? -
Answers - Liver damage
What are the 3 main classes of opiod receptors? - Answers - Mu kappa delta
Which of the following will reserve he effects caused by opioid agonist? - Answers -
naloxone
Which of the medications are used to treat OIC? - Answers - Naloxegol,
methylinaltrexone, lubiprostone
Prescribing basics - Answers - Prescribing is regulated by state BON
Proper RX - Answers - Providers name and address, Telephone
DEA
Pt name/DOB/Addres
Name of Drug, strength, SIG(directions) with indication/Route and frequency, Quantity
and signature.
Drug Schedules: Most addictive to least - Answers - 1: Heroin,LSD, MJ
2: hydrocodone, cocaine, Methamphetamine, methadone, oxycodone, meperidine,
fentanyl, adderall, ritalin
3: codeine, ketamine, testosterone
4: xanax, valium, soma, ambient, tramadol
5: antidiarrheal, antitussives, lomotil, lyrica
Pharmicodyamics - Answers - The effects of drug on the body. Receptors are large
molecules usually proteins, that interact and mediate the action of drugs
agonist - Answers - produce receptor stimulation and a conformational change every
time they bind. Do not need all available receptors to produce a maximum response
Partial agonist - Answers - drugs that have properties in b/w those of full agonist and
antagonist. They bind to receptors but when they occupy the receptor sites, they
stimulate only some of the receptors.
antagonist - Answers - drugs with affinity for a receptor but with no intrinsic activity.
Affinity allows the antagonist to bind to receptors, but lack of intrinsic activity prevents
the bound antagonist from causing receptor activation. The block action of drugs (ex.
Narcan)
Bioavailabity - Answers - % of administered dosage of the drug that survives the first
pass through the liver and reaches the blood stream
half life - Answers - Time required for the amount of a drug in the body to decline by
50%, drugs with shorter half lives must be administer frequently. 4.5-5.5 times the half
life to get steady state and to be limited from the body
what the body does to the drug - Answers - absorption, distribution, metabolism,
excretion
,Distribution - Answers - movement of absorbed drug in bodily fluids throughout the body
to target tissue. Properties affecting: lipid/water solubility, PH affects ionization of drug,
protein binding, size of molecule (smaller molecules are more able to diffuse)
Tissue: fat, bone, blood/brain barrier (only lipid soluble will pass), placental barrier
(many drugs can pass)
Protein binding - Answers - unbound drug is free which is active, crosses membrane.
Low plasma proteins result in more free drug. Competition: when 2 highly bound drugs
are given it increases the level of both drugs
Metabolism - Answers - take place in the liver mostly. Chemical change of a drug
structure to:
Enhance excretion, inactivate the drug, increase therapeutic action, active a prodrug
(inactive until metabolized in the body into the active compound, ex: levodopa), increase
or decrease toxicity
CYP450 - Answers - enzymes constitutes the most important of the phase I
metabolizing enzymes (account for about 75% of drug metabolism in the liver)
Phase 2: conjugation reaction occur leading to large increases in hydrophilicity of the
substrates rendering them more readily excretable
Substrate - Answers - an agent that is metabolized by an enzyme into a metabolite and
product and eventually excreted
Inhibitors - Answers - compete with other drugs for a particular enzyme affecting the
metabolism (decreased) of the substrate and decreases the excretion of the substrate
and increasing the circulating drug
inducer - Answers - competes with other drugs for a particular enzyme affecting
metabolism of the substrate (increases) decreasing the efficacy of the drug
excretion - Answers - renal: passive glomerular filtration, active tubular secretion,
tubular reabsorption, gi tract, lung, sweat and salivary, mammary
genomics - Answers - study of the complete set of genetic information present in a cell,
an organism, or species
pharmacogenetics - Answers - the study of the influence of hereditary factors on the
response of individual organisms to drugs, and the study of variations of DNA and RNA
characteristics as related to drug response
Pharmacogenetics tests - Answers - Mentioned on drug labels can be classified as "test
required," "test recommended," and "information only." Currently, four drugs are
required to have pharmacogenetics testing performed before they are prescribed:
cetuximab, trastuzumab, maraviroc and dasatinib
, wafarin, carbamazepine, valproic acid and abacavir are recommended to tests prior to
initial dosing
Carbamazepine and Asisans - Answers - Initiating carbamazepine therapy in these
patients (allele HLA-B*1502) are at high risk for developing Steven Johnson syndrome
or toxic epidermal necrolysis (TEN)
The ability of the anesthetic to penetrate the axon membrane is determined by 3
properties. What are they? - Answers - Molecular size, Lipid solubility, degree of
ionization at tissue pH
Why is epinephrine given with local anesthetics? - Answers - Decreases local blood flow
(decreased risk of bleeding)
Delays systemic absorption of the anesthetic
prolongs anesthesia
reduces the risk of toxicity
What is the most widely used local anesthetic? - Answers - Lidocaine
What is a possible fatal reaction to benzocaine - Answers - Methemoglobinemia
What is included in application guidelines for topical anesthetics - Answers - avoid
wrapping the site and heating the site, avoid application to open skin
Which medication will not cause rebound headaches from overuse? - Answers -
propranolol (preventative)
What is the best option for menstural migraine? - Answers - low dose estrogen about 3
days prior to menses
What food can trigger migraines? - Answers - Hot dog d/t nitrates
What medication is a Seratonin 1B1D receptor agonist? - Answers - Sumatriptan
Butterbur can help as prevention for migraine therapy. What side effect can occur? -
Answers - Liver damage
What are the 3 main classes of opiod receptors? - Answers - Mu kappa delta
Which of the following will reserve he effects caused by opioid agonist? - Answers -
naloxone
Which of the medications are used to treat OIC? - Answers - Naloxegol,
methylinaltrexone, lubiprostone
