LATEST 2024 NRNP 6566 MIDTERM EXAM / NRNP6566 MIDTERM REAL EXAM QUESTIONS AND CORRECT ANSWERS

Describe cytochrome p450 system - ANSWER- Cytochrome p450 system is a series of enzymes used to metabolize medications Inhibitors - ANSWER- block metabolic activity from one or more CYP450 enzymes Inducers - ANSWER- increase CYP450 enzyme activity by increasing enzyme synthesis Describe effect on low and high albumin levels on active drug levels especially for drugs that are highly protein bound - ANSWER- Albumin is the plasma protein with the greatest capacity for binding drugs. Binding plasma proteins affect drug distribution into tissues, because only drug that is not bound is available to penetrate tissues, bind to receptors, and exert activity. As free drug leaves the blood stream, more bound drug is released from binding sites. Low albumin levels - ANSWER- malnutrition, chronic illness Highly protein bound drugs can lead to - ANSWER- toxicity in patients with low albumin levels, example malnutrition or chronic illness. This is because there are fewer than the normal sites for the drug to bind Describe the ways the hepatic first pass effect- which is metabolism during first pass through the liver - ANSWER- Alternative routes include: suppository intravenous intramuscular inhalational aerosol transdermal sublingual These allow drugs to bypass the first-pass effect and be absorbed directly into systemic circulation Be able to calculate creatinine clearance using Cockgraft Gault equation: - ANSWER- Male = 140-age times weight in kilograms divided by serum creatinine times 72. Women = CRCL (male) times 0.85 Describe what determines the frequency of drug administration - ANSWER- half life plasma concentration Be familiar with the beers criteria and how to use it - ANSWERPotentially Inappropriate Medication Use in Older Adults to call attention to medications that are most commonly problematic and thus should be avoided in older adults Describe factors that affect absorption - ANSWER- low blood state (shock or arrest), contact time with GI tract too fast (diarrhea = cant absorb), delayed stomach emptying (large meal = delayed absorption)Drug- to drug or drug to food interactions Describe the factors that affect distribution - ANSWER- low albumin levels, body composition, cardiac decompensation (heart failure), age Describe the factors that affect metabolism - ANSWER- genetics, age, organ function Describe factors that affect excretion - ANSWER- affected by abnormal kidney or liver function, age, drug interactions