NURS 615 PHARM EXAM 1 QUESTIONS WITH DETAILED ANSWERS 100% GUARANTEED PASS
What factors are associated with clinical judgment when prescribing medications? - Answers Prescribing
a drug is based on a thorough assessment of the patient and the patient's environment. The
determination of potential medical and nursing diagnoses, a review of the potential alternative
therapies, specific knowledge about the drug chosen, and the disease process it is going to treat, known
as patient centered care. The best therapy is usually the least invasive, least expensive, and the least
likely to cause adverse reactions
What are the criteria for choosing an effective drug? - Answers Multiple drugs may be able to treat a
specific condition. You must consult nationally recognized guidelines for disease management to
determine the most effective drug.
How does hypoalbuminemia affect the process of prescribing? - Answers Many drugs that carry an
electric charge are bound to albumin in the blood. The distribution of the drug to target tissues may be
affected if hypoalbuminemia is present.
What is the drug's half-life? - Answers In clinical practice it takes about four to five times the half-life for
a drugs concentration to read steady state after a drug is started, stopped or changed. Hal life is the
amount of time for a drug to be half cleared.
What is meant by the onset of action, peak of action, duration of action of medications? - Answers The
onset of action is the time between the drug administration and the time that you see the drugs
minimum effect. Onset is the first sign of a drugs therapeutic effect. Peak of action is the time of the
maximum concentration of the drug in the blood. Duration of action is the onset of action and the
metabolism of the drug below the dose needed for an effect.
Explain first pass metabolism. - Answers This occurs when the concentration of the drug is greatly
reduced before it reaches the systemic circulation. It is the portion of the drug lost during absorption.
Generally, occurs in the liver or gut wall. After a drug is swallowed it is absorbed by the digestive system
and enters the hepatic system. It is then carried by the portal vein to the liver before it reaches the rest
of the body. The liver metabolizes many drugs to such an extent that only a small portion of the drug
reaches the rest of the body. bioavailability of the drug thus is greatly reduced by the liver. Sublingual
administration can bypass the first pass system plus it is also faster than oral route.
What is a steady state? - Answers The overall intake of a drug is fairly and dynamic equilibrium with its
elimination. Steady state is reached when the time of four to five times the half-life is reached since the
drug had been started.
What factors affect the drug's absorption? - Answers Absorption involves several steps. First the drug
must be introduced via route of administration and the form of medication like tablet or capsule. In IV or
IM administration the absorption is less variable and bioavailability is near 100%. IV administration is
considered to lose no portion of the drug. The fastest route of absorption is inhalation. Drugs must pass
through the epithelial cells of the GI tract to be absorbed by the circulatory system. Cell membranes
, may affect the absorption of some drugs because they are made of lipid bilayers that are semi
permeable. This means only small uncharged solutes can pass through the membrane. Whether or not a
molecule is ionized affects the absorption, since ionic molecules are charged. Solubility favors charged
species. Permeability favors neutral species. Some molecules have special channels to facilitate
movement from the lumen into the circulation. The Henderson Hasselbeck equation offers a way to
determine the portion that is ionized in a given pH. Weak acids will be present in their nonionic form in
the stomach because of the acidic pH and bases will be in their ionic form. Nonionic species diffuse
easier through cell membranes. Weak acids have a higher absorption rate in the stomach. The opposite
is true in the basic environment of the stomach.
Identify drug metabolism and the role of the isoenzymes of the P450 system. - Answers CYPs are the
major enzymes in drug metabolism. Must drugs undergo deactivation by CYPs are directly facilitated
secretion from the body. Many substances are bioactivated by CYPs to form their active compound.
Many drugs increase or decrease the activity of CYPs isoenzymes either by inducing biosynthesis of an
isozyme, which is enzyme induction or by directly inhibiting the activity of CYP which is enzyme
inhibition. This is a major source of adverse drug reactions since changes in CYPs activity may affect the
metabolism and clearance of certain drugs. When two drugs are both metabolized by the CYP450
system the drugs should be administered at separate times to prevent toxic effects.
What is the efficacy of the drug? - Answers Efficacy is the maximum response achievable from a drug.
Intrinsic activity is a term used to describe the efficacy of a drug relative to a drugs highest observed
efficacy. Effectiveness refers to the ability of a drug to produce the wanted effect.
On the drug concentration curve what is the first sign of a therapeutic effect? - Answers The onset of
action.
What is the purpose of a peak and trough level? - Answers To determine if the drug is within therapeutic
range. Which is either dosage range or blood plasma or serum concentration usually expected to affect
desired effects. Some patients require doses or concentrations above or below this range and some
patients have toxicity within this range.
Describe the purpose of the blood brain barrier and the fetal placental barrier. - Answers The blood
brain barrier is a highly selective permeability barrier that separates circulating blood from the brain and
ECF in nervous system. Formed by brain endothelial cells which are formed by tight junction with an
extremely high electrical reductivity of at least 0.1 micron. The blood brain barrier allows passage of
water, some gases and lipid soluble molecules by passage diffusion. As well as the selective transport of
molecules like glycose and amino acids which are essential to neruo function. The placental barrier
impedes certain chemicals however it allows fat soluble chemicals to cross. Drugs that are more water
soluble and drugs with a higher molecular weight tend to not cross the placenta. If a drug binds to a
large protein like albumin it is even less likely to cross the placenta.
What is the difference in distribution for each medication route? - Answers Absorption has a many steps
drug must be introduced via some route in order to be absorbed then distributed.
What factors are associated with clinical judgment when prescribing medications? - Answers Prescribing
a drug is based on a thorough assessment of the patient and the patient's environment. The
determination of potential medical and nursing diagnoses, a review of the potential alternative
therapies, specific knowledge about the drug chosen, and the disease process it is going to treat, known
as patient centered care. The best therapy is usually the least invasive, least expensive, and the least
likely to cause adverse reactions
What are the criteria for choosing an effective drug? - Answers Multiple drugs may be able to treat a
specific condition. You must consult nationally recognized guidelines for disease management to
determine the most effective drug.
How does hypoalbuminemia affect the process of prescribing? - Answers Many drugs that carry an
electric charge are bound to albumin in the blood. The distribution of the drug to target tissues may be
affected if hypoalbuminemia is present.
What is the drug's half-life? - Answers In clinical practice it takes about four to five times the half-life for
a drugs concentration to read steady state after a drug is started, stopped or changed. Hal life is the
amount of time for a drug to be half cleared.
What is meant by the onset of action, peak of action, duration of action of medications? - Answers The
onset of action is the time between the drug administration and the time that you see the drugs
minimum effect. Onset is the first sign of a drugs therapeutic effect. Peak of action is the time of the
maximum concentration of the drug in the blood. Duration of action is the onset of action and the
metabolism of the drug below the dose needed for an effect.
Explain first pass metabolism. - Answers This occurs when the concentration of the drug is greatly
reduced before it reaches the systemic circulation. It is the portion of the drug lost during absorption.
Generally, occurs in the liver or gut wall. After a drug is swallowed it is absorbed by the digestive system
and enters the hepatic system. It is then carried by the portal vein to the liver before it reaches the rest
of the body. The liver metabolizes many drugs to such an extent that only a small portion of the drug
reaches the rest of the body. bioavailability of the drug thus is greatly reduced by the liver. Sublingual
administration can bypass the first pass system plus it is also faster than oral route.
What is a steady state? - Answers The overall intake of a drug is fairly and dynamic equilibrium with its
elimination. Steady state is reached when the time of four to five times the half-life is reached since the
drug had been started.
What factors affect the drug's absorption? - Answers Absorption involves several steps. First the drug
must be introduced via route of administration and the form of medication like tablet or capsule. In IV or
IM administration the absorption is less variable and bioavailability is near 100%. IV administration is
considered to lose no portion of the drug. The fastest route of absorption is inhalation. Drugs must pass
through the epithelial cells of the GI tract to be absorbed by the circulatory system. Cell membranes
, may affect the absorption of some drugs because they are made of lipid bilayers that are semi
permeable. This means only small uncharged solutes can pass through the membrane. Whether or not a
molecule is ionized affects the absorption, since ionic molecules are charged. Solubility favors charged
species. Permeability favors neutral species. Some molecules have special channels to facilitate
movement from the lumen into the circulation. The Henderson Hasselbeck equation offers a way to
determine the portion that is ionized in a given pH. Weak acids will be present in their nonionic form in
the stomach because of the acidic pH and bases will be in their ionic form. Nonionic species diffuse
easier through cell membranes. Weak acids have a higher absorption rate in the stomach. The opposite
is true in the basic environment of the stomach.
Identify drug metabolism and the role of the isoenzymes of the P450 system. - Answers CYPs are the
major enzymes in drug metabolism. Must drugs undergo deactivation by CYPs are directly facilitated
secretion from the body. Many substances are bioactivated by CYPs to form their active compound.
Many drugs increase or decrease the activity of CYPs isoenzymes either by inducing biosynthesis of an
isozyme, which is enzyme induction or by directly inhibiting the activity of CYP which is enzyme
inhibition. This is a major source of adverse drug reactions since changes in CYPs activity may affect the
metabolism and clearance of certain drugs. When two drugs are both metabolized by the CYP450
system the drugs should be administered at separate times to prevent toxic effects.
What is the efficacy of the drug? - Answers Efficacy is the maximum response achievable from a drug.
Intrinsic activity is a term used to describe the efficacy of a drug relative to a drugs highest observed
efficacy. Effectiveness refers to the ability of a drug to produce the wanted effect.
On the drug concentration curve what is the first sign of a therapeutic effect? - Answers The onset of
action.
What is the purpose of a peak and trough level? - Answers To determine if the drug is within therapeutic
range. Which is either dosage range or blood plasma or serum concentration usually expected to affect
desired effects. Some patients require doses or concentrations above or below this range and some
patients have toxicity within this range.
Describe the purpose of the blood brain barrier and the fetal placental barrier. - Answers The blood
brain barrier is a highly selective permeability barrier that separates circulating blood from the brain and
ECF in nervous system. Formed by brain endothelial cells which are formed by tight junction with an
extremely high electrical reductivity of at least 0.1 micron. The blood brain barrier allows passage of
water, some gases and lipid soluble molecules by passage diffusion. As well as the selective transport of
molecules like glycose and amino acids which are essential to neruo function. The placental barrier
impedes certain chemicals however it allows fat soluble chemicals to cross. Drugs that are more water
soluble and drugs with a higher molecular weight tend to not cross the placenta. If a drug binds to a
large protein like albumin it is even less likely to cross the placenta.
What is the difference in distribution for each medication route? - Answers Absorption has a many steps
drug must be introduced via some route in order to be absorbed then distributed.
