Nurs 5334-Advanced Pharm-Test 1 Exam #1 Questions
with correct answers
Pregnancy: Changes in drug metabolism - ✔✔-Hepatic metabolism and GFR
increase during pregnancy, dosages of some drugs may need to be increased
-For some drugs, hepatic metabolism increases during pregnancy--> some drugs
may need to be increased
-Tone and motility of the bowel decrease in pregnancy, causing intestinal transit
time to increase
-->more time for drugs to be absorbed--> might need to reduce dosage
-Prolongation of drug effects total 1-2 life increases
Fetal development in pregnancy (stages) - ✔✔-preimplantation/presomite:
conception-2 weeks: all or nothing
-embryonic period: weeks 3-8: gross malformations
-Fetal period: week 9- term: exposure disrupts function not gross anatomy
Pregnancy Labeling - ✔✔-As of 2015, the Food and Drug Administration had a
Pregnancy and Lactation Labeling Rule change.
-No more lettering of the categories of drugs for pregnancy. According to the
lettering system, drugs can be put into one of five risk categories: be A, B, C, D,
and X.
-By 2020, all prescriptions must remove lettering labels altogether.
-The PLLR requires three sections for labeling:
o (1) pregnancy, (2) lactation, and (3) females and males of reproductive
potential.
,How do you decrease risk in the infant during breastfeeding? - ✔✔o Take the
drugs immediately after breastfeeding
o Avoid drugs that have long half-lives
o Choose drugs that tend to be excluded from milk, and that are least likely to
affect the infant
o Avoid the drugs that are known to be hazardous
o Use the lowest effective dosage for the shortest possible time
o Abandon plans to breastfeed if a necessary drug is known to be harmful to the
child.
How do pediatric patients differ in their response to medication? Absorption? -
✔✔o Oral administration
-Gastric emptying time is prolonged & irregular in early infancy
· Adult function at 5-8 months
· For drugs that are absorbed primarily from the stomach, delayed gastric
emptying enhances absorption
· For drugs that are absorbed primarily from the intestine, absorption is delayed
· Because gastric emptying time is irregular, the precise effect on absorption is not
predictable
- Gastric Acidity
· Very low 24 hours after birth
· Does not reach adult values for 2 years
· Low acidity absorption of acid-labile drugs is increased
o Intramuscular
-Slow, erratic in neonates
- Delayed absorption as a result of low blood flow during the first few days of life
,- By early infancy, absorption of IM drugs is more rapid than in neonates and
adults
o Skin
- More rapid and complete in infants than in older children and adults
- The stratum corneum of the infant's skin is very thin, and blood flow to the skin
is greater in infants than in older patients. Because of this enhanced absorption,
infants are at increased risk for toxicity from topical drugs.
How do pediatric patients differ in their response to medication? Distribution r/t
protein binding? - ✔✔-Binding of drugs to albumin and other plasma proteins is
limited in the infant
- Amount of serum albumin is relatively low
- Endogenous compounds (fatty acids, bilirubin) compete with drugs for available
binding sites
- Limited drug/protein binding in infants --> concentration of free levels of drugs
that usually undergo extensive protein binding in adults is relatively high in the
infant --> intensified effects
- Reduced dosage needed
- Adult protein binding capacity by 10-12 months of age
How do pediatric patients differ in their response to medication? Distribution r/t
BBB? - ✔✔- Not fully developed at birth
- Drugs and other chemicals have relatively easy access to the CNS
- Infants are especially sensitive to drugs that affect CNS function
- all medicines employed for their CNS effects (e.g., morphine, phenobarbital)
should be given in reduced dosage
- Dosage should also be reduced for drugs used for actions outside the CNS if
those drugs are capable of producing CNS toxicity as a side effect
, How do pediatric patients differ in their response to medication? Metabolism r/t
Hepatic function? - ✔✔o The drug-metabolizing capacity of newborns is low
o Neonates are especially sensitive to drugs that are eliminated primarily by
hepatic metabolism
o The liver's capacity to metabolize many drugs increased rapidly about 1 month
after birth
o The ability to metabolize drugs at the adult level is reached a few months later
o Complete liver maturation occurs by 1 year of age
o Dosages must be reduced
How do pediatric patients differ in their response to medication? Renal excretion?
- ✔✔o Significantly reduced at birth
o Low renal blood flow, glomerular filtration, and active tubular secretion
o Drugs eliminated primarily by renal excretion must be given in reduced dosage
and/or longer dosing intervals
o Adult levels of renal function achieved by 1 year
Definition of polypharmacy - ✔✔Treatment with multiple drugs
Beers List - ✔✔a list of drugs for which monitoring is especially important and
possible inappropriate to administer in elderly patients
-should avoid these drugs
Geriatric patient changes in absorption - ✔✔o Altered GI absorption is not a
major factor in drug sensitivity
with correct answers
Pregnancy: Changes in drug metabolism - ✔✔-Hepatic metabolism and GFR
increase during pregnancy, dosages of some drugs may need to be increased
-For some drugs, hepatic metabolism increases during pregnancy--> some drugs
may need to be increased
-Tone and motility of the bowel decrease in pregnancy, causing intestinal transit
time to increase
-->more time for drugs to be absorbed--> might need to reduce dosage
-Prolongation of drug effects total 1-2 life increases
Fetal development in pregnancy (stages) - ✔✔-preimplantation/presomite:
conception-2 weeks: all or nothing
-embryonic period: weeks 3-8: gross malformations
-Fetal period: week 9- term: exposure disrupts function not gross anatomy
Pregnancy Labeling - ✔✔-As of 2015, the Food and Drug Administration had a
Pregnancy and Lactation Labeling Rule change.
-No more lettering of the categories of drugs for pregnancy. According to the
lettering system, drugs can be put into one of five risk categories: be A, B, C, D,
and X.
-By 2020, all prescriptions must remove lettering labels altogether.
-The PLLR requires three sections for labeling:
o (1) pregnancy, (2) lactation, and (3) females and males of reproductive
potential.
,How do you decrease risk in the infant during breastfeeding? - ✔✔o Take the
drugs immediately after breastfeeding
o Avoid drugs that have long half-lives
o Choose drugs that tend to be excluded from milk, and that are least likely to
affect the infant
o Avoid the drugs that are known to be hazardous
o Use the lowest effective dosage for the shortest possible time
o Abandon plans to breastfeed if a necessary drug is known to be harmful to the
child.
How do pediatric patients differ in their response to medication? Absorption? -
✔✔o Oral administration
-Gastric emptying time is prolonged & irregular in early infancy
· Adult function at 5-8 months
· For drugs that are absorbed primarily from the stomach, delayed gastric
emptying enhances absorption
· For drugs that are absorbed primarily from the intestine, absorption is delayed
· Because gastric emptying time is irregular, the precise effect on absorption is not
predictable
- Gastric Acidity
· Very low 24 hours after birth
· Does not reach adult values for 2 years
· Low acidity absorption of acid-labile drugs is increased
o Intramuscular
-Slow, erratic in neonates
- Delayed absorption as a result of low blood flow during the first few days of life
,- By early infancy, absorption of IM drugs is more rapid than in neonates and
adults
o Skin
- More rapid and complete in infants than in older children and adults
- The stratum corneum of the infant's skin is very thin, and blood flow to the skin
is greater in infants than in older patients. Because of this enhanced absorption,
infants are at increased risk for toxicity from topical drugs.
How do pediatric patients differ in their response to medication? Distribution r/t
protein binding? - ✔✔-Binding of drugs to albumin and other plasma proteins is
limited in the infant
- Amount of serum albumin is relatively low
- Endogenous compounds (fatty acids, bilirubin) compete with drugs for available
binding sites
- Limited drug/protein binding in infants --> concentration of free levels of drugs
that usually undergo extensive protein binding in adults is relatively high in the
infant --> intensified effects
- Reduced dosage needed
- Adult protein binding capacity by 10-12 months of age
How do pediatric patients differ in their response to medication? Distribution r/t
BBB? - ✔✔- Not fully developed at birth
- Drugs and other chemicals have relatively easy access to the CNS
- Infants are especially sensitive to drugs that affect CNS function
- all medicines employed for their CNS effects (e.g., morphine, phenobarbital)
should be given in reduced dosage
- Dosage should also be reduced for drugs used for actions outside the CNS if
those drugs are capable of producing CNS toxicity as a side effect
, How do pediatric patients differ in their response to medication? Metabolism r/t
Hepatic function? - ✔✔o The drug-metabolizing capacity of newborns is low
o Neonates are especially sensitive to drugs that are eliminated primarily by
hepatic metabolism
o The liver's capacity to metabolize many drugs increased rapidly about 1 month
after birth
o The ability to metabolize drugs at the adult level is reached a few months later
o Complete liver maturation occurs by 1 year of age
o Dosages must be reduced
How do pediatric patients differ in their response to medication? Renal excretion?
- ✔✔o Significantly reduced at birth
o Low renal blood flow, glomerular filtration, and active tubular secretion
o Drugs eliminated primarily by renal excretion must be given in reduced dosage
and/or longer dosing intervals
o Adult levels of renal function achieved by 1 year
Definition of polypharmacy - ✔✔Treatment with multiple drugs
Beers List - ✔✔a list of drugs for which monitoring is especially important and
possible inappropriate to administer in elderly patients
-should avoid these drugs
Geriatric patient changes in absorption - ✔✔o Altered GI absorption is not a
major factor in drug sensitivity
