1p|pPp ap gpe
NURS 5334 PHARM PRACTICE EXAM QUESTIO
p p p p p
NS AND CORRET ANSWERS GRADED A+|| BRAN
p p p p p p
D NEW!!
p
MODULEp1
• WhatparepthepBONprulespandpregulationspforpprescriptivepauthoritypfo
rp thepadvanceppracticepnurse?
• Texaspisp veryp restricted
• Describeptheppharmacokineticpprocessespofpabsorption,pdistribution,p
metabolismpandpeliminationpandphowpdifferencespinpthesepareaspaffec
tp drugpaction.
• Absorption
• Drug’spmovementpfrompthepsitepofpadministrationpintopth
ep blood.
• Distribution
• Drug’spmovementpfrompthepbloodpintopthepinterstitialpspace
p ofptissuespandpfromptherepintopcells.
• Metabolism
• Biotransformationpispthepenzymaticallypmediatedpalterationpof
p drugpstructure.
• Elimination
• Combinationp ofp metabolismpandp excretion
• Discusspthepimpactpofpfoodponpdrugpabsorption,pdrugpmetabolismpandpo
np drugptoxicitypandpaction—
aspwellpasptheptimingpofpdrugpadministration.
LIFESPAN
• HepaticpmetabolismpandpGFRpincreasepduringppregnancy,pdosagespof
p somepdrugspmaypneedptopbepincreased.
• Ratep ofpalbuminptop waterp decreases
• Thirdptrimester:pRenalpbloodpflowpispdoubledpandprena
lp excretionpispacceleratedp(drugspexcretedprapidly)
• Tonepandp mobilitypofp bowelp decrease
• Prolongationp ofp drugp effectspTotalp(½p lifep increases)
Understandpstagesp ofp developmentp inp pregnancy
,2p|pPp ap gpe
• Conception:pthroughp weekp2
• Embryonicpperiod:p weekp3-weekp8
a)p Grossp malformationsp canpbep producedpbyp teratogens
• Fetalpperiod:p weekp9-delivery
• Understandp pregnancyp labeling
• 3pcategoriespnow
a)p Pregnancy,plactation,pmalep&pfemalepreproductivep poten
tial
• Howpdop youp decreasep riskpinpthep infantp duringp breastfeeding?
• Takepmedspimmediatelypafterpbreastfeeding,pavoidpdrugspthat
p haveplongphalf-
lives,pchoosepdrugspthatptendptopbepexcludedp frompmilk,pavo
idpdrugspthatparepknownptopbephazardous.
• Howpdop pediatricppatientsp differpinp theirp responsep top medications?
• Absorption
a) Oral?
• Neonates:pdrugpremainpinpthepstomachplongerp w
hichpincreasesptheplevels,plowpaciditypcanpaffectp
thepabsorptionpofpacidplabilepdrugs
b) Parenteral?
• Reponsesparep slowpandp erratic.
• Infancy:pabsorptionpispmoreprapidpthanpinpneonates
p &padults
• Bestpavoidedpinpinfants
c) Transdermal?
• Greaterpskinppermeabilitypwhichpincreasesp to
picalpdrugpabsorptionpandpincreasespthepriskp
forptoxicity
• Distribution
a) Proteinp binding
,3p|pPp ap gpe
1.p Neonates:plesspprotein-binding—
increasedp availabilitypofphighlypproteinpboundpdru
gspsuchpasp phenytoin,pdiazepam,pandpphenobarbita
l.pReducedp dosagespneededpinpthesephighlypboundp
drugs.
b) Bloodp BrainpBarrier
1.p Notpfullypdevelopedpatpbirth,pdrugsphavepeasyp ac
cessptopthepCNS,pdosespshouldpbepreduced.
• Metabolism
a) Hepaticp function?
1.p Liverphasn’tpreachedpfullp maturation—
sensitivep topdrugspeliminatedpbypthepCYP450.pL
iver’sp abilityptopmetabolizepdrugspincreasespabo
utponep monthpafterpbirth.
b) Tphalfplife
1.p Decreasedp byp asp muchp asp48-72p hours
• Excretion
a) Renal?
1.pGFRpispsignificantlypreducedpatpbirth,pdrugsp elimi
natedpbypthepkidneyspmustpbepgivenpinpap reduced
pdosagepandplongerpdosingpintervals.
• Whatp educationpneedsp top bepgivenptopparents?
• Whatptopdopifpchildpspitsp outpmedicationp orpthrowspitpup
• Effectivepeducation:pdosagepsizepandptiming,proute,ptechnique
p ofpadministration,pdurationpofptreatment,phowptopstorepthep d
rug,pnaturepandptimepcoursepofpthepdesiredpresponse,pnaturep
andptimepcoursepofpadversepreactions.
• Comparepandpcontrastppharmacokineticspandp pharmacody
namicspofpspecialppopulations—pediatrics,polder
, 4p|pPp ap gpe
adultsp andpthosepthatp areppregnant.
• Pediatrics—theyphaveporganpimmaturity,pelderly—
theyphaveporganp degeneration,plosspofpnephrons,pexcretionpofpdrug
pispdecreasedpandp youphaveptopgivepthisppopulationpaplowerpdosepo
fpmedication.p Medicationpcanppasspthroughpmilkpofplactatingpfema
les.
• Analyzep apdrugpinteractionp top determinep anp appropriatepcoursepofp action.
• Basicpmechanismpofpdrug-
drugpinteractionspthroughppharmacokineticp interactionsparepalteredpa
bsorption,palteredpdistribution,palteredp metabolism,pandpalteredprenal
pexcretion.
• Identifypmedicationspwithpapnarrowptherapeuticpinde
xp requiringpdrugplevelpmonitoring.
1.
• Discussp thepeffectpofpionizationpandp pHp onp absorption.
• Drugspthatparepweakpacidsparepbestpabsorbedpinpacidicpenvironments.p
Acidicpdrugspaccumulateponpthepalkalinepside,pbasicpdrugspaccumulate
p onpthepacidicp sidepknownpaspionptrapping.p Ionizationp ofpthep drugsp i
sp pHpdependent,p whenptheppHpandpthepfluidponponepsidep ofpthep me
mbranepdifferspfromptheppHponpthepotherpside,pdrugpmoleculesptendp t
opaccumulateponpthepsidepwhereptheppHpmostpfavorspionization.
• Discussp factorsp affectingp drugp distribution.
• Competitionp forp proteinpbindingpandpalterationp ofp extracellularp pH
• Discusspbarrierspaffectingpdrugpdistribution—
suchpaspplacentalp membrane,pbloodpbrainpbarrierpandpvolume
pofpdistribution.
• Placentalpmembrane:pdrugsparepeasilyppassedpthroughpthepplacental
p membrance
• Bloodpbrainpbarrier:pthepPGPppumpspdrugspbackpintopthepbloodpan
dp therebyplimitsptheirpaccessptopthepbrain.
• Volumep ofp distribution:
• Discussp thep“first-passp effect”—whatp effectp canp thisp haveponp distribution
NURS 5334 PHARM PRACTICE EXAM QUESTIO
p p p p p
NS AND CORRET ANSWERS GRADED A+|| BRAN
p p p p p p
D NEW!!
p
MODULEp1
• WhatparepthepBONprulespandpregulationspforpprescriptivepauthoritypfo
rp thepadvanceppracticepnurse?
• Texaspisp veryp restricted
• Describeptheppharmacokineticpprocessespofpabsorption,pdistribution,p
metabolismpandpeliminationpandphowpdifferencespinpthesepareaspaffec
tp drugpaction.
• Absorption
• Drug’spmovementpfrompthepsitepofpadministrationpintopth
ep blood.
• Distribution
• Drug’spmovementpfrompthepbloodpintopthepinterstitialpspace
p ofptissuespandpfromptherepintopcells.
• Metabolism
• Biotransformationpispthepenzymaticallypmediatedpalterationpof
p drugpstructure.
• Elimination
• Combinationp ofp metabolismpandp excretion
• Discusspthepimpactpofpfoodponpdrugpabsorption,pdrugpmetabolismpandpo
np drugptoxicitypandpaction—
aspwellpasptheptimingpofpdrugpadministration.
LIFESPAN
• HepaticpmetabolismpandpGFRpincreasepduringppregnancy,pdosagespof
p somepdrugspmaypneedptopbepincreased.
• Ratep ofpalbuminptop waterp decreases
• Thirdptrimester:pRenalpbloodpflowpispdoubledpandprena
lp excretionpispacceleratedp(drugspexcretedprapidly)
• Tonepandp mobilitypofp bowelp decrease
• Prolongationp ofp drugp effectspTotalp(½p lifep increases)
Understandpstagesp ofp developmentp inp pregnancy
,2p|pPp ap gpe
• Conception:pthroughp weekp2
• Embryonicpperiod:p weekp3-weekp8
a)p Grossp malformationsp canpbep producedpbyp teratogens
• Fetalpperiod:p weekp9-delivery
• Understandp pregnancyp labeling
• 3pcategoriespnow
a)p Pregnancy,plactation,pmalep&pfemalepreproductivep poten
tial
• Howpdop youp decreasep riskpinpthep infantp duringp breastfeeding?
• Takepmedspimmediatelypafterpbreastfeeding,pavoidpdrugspthat
p haveplongphalf-
lives,pchoosepdrugspthatptendptopbepexcludedp frompmilk,pavo
idpdrugspthatparepknownptopbephazardous.
• Howpdop pediatricppatientsp differpinp theirp responsep top medications?
• Absorption
a) Oral?
• Neonates:pdrugpremainpinpthepstomachplongerp w
hichpincreasesptheplevels,plowpaciditypcanpaffectp
thepabsorptionpofpacidplabilepdrugs
b) Parenteral?
• Reponsesparep slowpandp erratic.
• Infancy:pabsorptionpispmoreprapidpthanpinpneonates
p &padults
• Bestpavoidedpinpinfants
c) Transdermal?
• Greaterpskinppermeabilitypwhichpincreasesp to
picalpdrugpabsorptionpandpincreasespthepriskp
forptoxicity
• Distribution
a) Proteinp binding
,3p|pPp ap gpe
1.p Neonates:plesspprotein-binding—
increasedp availabilitypofphighlypproteinpboundpdru
gspsuchpasp phenytoin,pdiazepam,pandpphenobarbita
l.pReducedp dosagespneededpinpthesephighlypboundp
drugs.
b) Bloodp BrainpBarrier
1.p Notpfullypdevelopedpatpbirth,pdrugsphavepeasyp ac
cessptopthepCNS,pdosespshouldpbepreduced.
• Metabolism
a) Hepaticp function?
1.p Liverphasn’tpreachedpfullp maturation—
sensitivep topdrugspeliminatedpbypthepCYP450.pL
iver’sp abilityptopmetabolizepdrugspincreasespabo
utponep monthpafterpbirth.
b) Tphalfplife
1.p Decreasedp byp asp muchp asp48-72p hours
• Excretion
a) Renal?
1.pGFRpispsignificantlypreducedpatpbirth,pdrugsp elimi
natedpbypthepkidneyspmustpbepgivenpinpap reduced
pdosagepandplongerpdosingpintervals.
• Whatp educationpneedsp top bepgivenptopparents?
• Whatptopdopifpchildpspitsp outpmedicationp orpthrowspitpup
• Effectivepeducation:pdosagepsizepandptiming,proute,ptechnique
p ofpadministration,pdurationpofptreatment,phowptopstorepthep d
rug,pnaturepandptimepcoursepofpthepdesiredpresponse,pnaturep
andptimepcoursepofpadversepreactions.
• Comparepandpcontrastppharmacokineticspandp pharmacody
namicspofpspecialppopulations—pediatrics,polder
, 4p|pPp ap gpe
adultsp andpthosepthatp areppregnant.
• Pediatrics—theyphaveporganpimmaturity,pelderly—
theyphaveporganp degeneration,plosspofpnephrons,pexcretionpofpdrug
pispdecreasedpandp youphaveptopgivepthisppopulationpaplowerpdosepo
fpmedication.p Medicationpcanppasspthroughpmilkpofplactatingpfema
les.
• Analyzep apdrugpinteractionp top determinep anp appropriatepcoursepofp action.
• Basicpmechanismpofpdrug-
drugpinteractionspthroughppharmacokineticp interactionsparepalteredpa
bsorption,palteredpdistribution,palteredp metabolism,pandpalteredprenal
pexcretion.
• Identifypmedicationspwithpapnarrowptherapeuticpinde
xp requiringpdrugplevelpmonitoring.
1.
• Discussp thepeffectpofpionizationpandp pHp onp absorption.
• Drugspthatparepweakpacidsparepbestpabsorbedpinpacidicpenvironments.p
Acidicpdrugspaccumulateponpthepalkalinepside,pbasicpdrugspaccumulate
p onpthepacidicp sidepknownpaspionptrapping.p Ionizationp ofpthep drugsp i
sp pHpdependent,p whenptheppHpandpthepfluidponponepsidep ofpthep me
mbranepdifferspfromptheppHponpthepotherpside,pdrugpmoleculesptendp t
opaccumulateponpthepsidepwhereptheppHpmostpfavorspionization.
• Discussp factorsp affectingp drugp distribution.
• Competitionp forp proteinpbindingpandpalterationp ofp extracellularp pH
• Discusspbarrierspaffectingpdrugpdistribution—
suchpaspplacentalp membrane,pbloodpbrainpbarrierpandpvolume
pofpdistribution.
• Placentalpmembrane:pdrugsparepeasilyppassedpthroughpthepplacental
p membrance
• Bloodpbrainpbarrier:pthepPGPppumpspdrugspbackpintopthepbloodpan
dp therebyplimitsptheirpaccessptopthepbrain.
• Volumep ofp distribution:
• Discussp thep“first-passp effect”—whatp effectp canp thisp haveponp distribution
