NURS308_Midterm exam study guide _ Chapter 2 - 35

Chapter 2. Review of Basic Principles of Pharmacology 1. A patient’s nutritional intake and laboratory results reflect hypoalbuminemia. This is critical to prescribing because: Distribution of drugs to target tissue may be affected. 2. Drugs that have a significant first-pass effect: Are rapidly metabolized by the liver and may have little if any desired action 3.The route of excretion of a volatile drug will likely be the: Lungs 4. Medroxyprogesterone (Depo Provera) is prescribed intramuscularly (IM) to create a storage reservoir Increase the length of time a drug is available and active 5. The NP chooses to give cephalexin every 8 hours based on knowledge of the drug’s: Biological half-life 6. Azithromycin dosing requires that the first day’s dosage be twice those of the other 4 days of the prescription. This is considered a loading dose. A loading dose: Rapidly achieves drug levels in the therapeutic range 7. The point in time on the drug concentration curve that indicates the first sign of a therapeutic effect is the: Onset of action 8. Phenytoin requires that a trough level be drawn. Peak and trough levels are done: To determine if a drug is in the therapeutic range 9. A laboratory result indicates that the peak level for a drug is above the minimum toxic concentration. This means that the: Concentration will produce an adverse response 10. Drugs that are receptor agonists may demonstrate what property? Desensitization or downregulation with continuous use 11. Drugs that are receptor antagonists, such as beta blockers, may cause: An exaggerated response if abruptly discontinued 12. Factors that affect gastric drug absorption include: Lipid solubility of the drug 13. Drugs administered via IV: Begin distribution into the body immediately 14. When a medication is added to a regimen for a synergistic effect, the combined effect of the drugs is: Greater than the sum of the effects of each drug individually 15. Which of the following statements about bioavailability is true? Bioavailability issues are especially important for drugs with narrow therapeutic ranges or sustained-release mechanisms. 16.Which of the following statements about the major distribution barriers (blood-brain or fetal-placental) is true? The blood-brain barrier slows the entry of many drugs into and from brain cells. 17.Drugs are metabolized mainly by the liver via phase I or phase II reactions. The purpose of both of these types of reactions is to: Change drug molecules to a form that an excretory organ can excrete 18. Once they have been metabolized by the liver, the metabolites may be: More active than the parent drug Less active than the parent drug Totally “deactivated” so they are excreted without any effect 19. All drugs continue to act in the body until they are changed or excreted. The ability of the body to excrete drugs via the renal system would be increased by: Unbinding a nonvolatile drug from plasma proteins 20. Steady state is: When the amount of drug in the body remains constant 21. Two different pain medications are given together for pain relief. The drug—drug interaction Additive 22.Actions taken to reduce drug—drug interaction problems include all of the following EXCEPT: Prescribing a third drug to counteract the adverse reaction of the combination 23. Phase I oxidative-reductive processes of drug metabolism require certain nutritional elements. Which of the following would reduce or inhibit this process? Neither Protein malnutrition OR Iron-deficiency anemia 24. The time required for the amount of drug in the body to decrease by 50% is called: Half-life 25. An agonist activates a receptor and stimulates a response. When given frequently over time, the body may: Downregulate the numbers of that specific receptor 26. Drug antagonism is best defined as an effect of a drug that: Is modified by the concurrent administration of another drug 27.Instructions to a client regarding self-administration of oral enteric-coated tablets should include which of the following statements? “To achieve best effect, take the tablet with at least 8 ounces of fluid.” 28. The major reason for not crushing a sustained-release capsule is that, if crushed, the coated beads of the drugs could possibly result in: Toxicity 29. Which of the following substances is the most likely to be absorbed in the intestines rather than in the stomach? Sodium bicarbonate 30. Which of the following variables is a factor in drug absorption? A rich blood supply to the area of absorption leads to better absorption 31. An advantage of prescribing a sublingual medication is that the medication is: Absorbed rapidly 32. Drugs that use CYP 3A4 isoenzymes for metabolism may: Induce and inhibit the metabolism of another drug 33. Therapeutic drug levels are drawn when a drug reaches steady state. Drugs reach steady state: After four to five half-lives 34. Upregulation or hypersensitization may lead to: An exaggerated response if the drug is withdrawn Chapter 7. Cultural and Ethnic Influences in Pharmacotherapeutics 1.Cultural factors that must be taken into account when prescribing include(s): Who the decision maker is in the family regarding health-care decisions Attitudes regarding the use of drugs to treat illness The patient’s view of health and illness 2. Ethnic differences have been found in drug: Hepatic metabolism 3. The National Standards of Culturally and Linguistically Appropriate Services are required to be implemented in all: Organizations that receive federal funds 4.According to the National Standards of Culturally and Linguistically Appropriate Services, an interpreter for health care: Must be a professionally trained medical interpreter 5.According to the U.S. Office of Minority Health, poor health outcomes among African Americans are attributed to: Discrimination, cultural barriers, and lack of access to health care 6. The racial difference in drug pharmacokinetics seen in American Indian or Alaskan Natives are: Largely unknown due to lack of studies of this population 7. Pharmacokinetics among Asians are universal to all the Asian ethnic groups. False 8. Alterations in drug metabolism among Asians may lead to: Slower metabolism of antidepressants, requiring lower doses 9.Asians from Eastern Asia are known to be fast acetylators. Fast acetylators: Require higher doses of drugs metabolized by acetylization to achieve efficacy 10. Hispanic native healers (curanderas): Use herbs and teas in their treatment of illness Chapter 8. An Introduction to Pharmacogenomics 1.Genetic polymorphisms account for differences in metabolism, including: Poor metabolizers, who lack a working enzyme Intermediate metabolizers, who have one working, wild-type allele and one mutant allele Extensive metabolizers, with two normally functioning alleles 5. Migraines in pregnancy may be safely treated with: Acetaminophen with codeine (Tylenol #3) 6. Xi, a 54-year-old female, has a history of migraines that do not respond well to OTC migraine medication. She is asking to try Maxalt (rizatriptan) because it works well for her friend. Appropriate decision making would be: Prescribe Maxalt and arrange to have her observed in the clinic or urgent care with the first dose. 7. Kelly is a 14-year-old patient who presents to the clinic with a classic migraine. She says she is having a headache two to three times a month. The initial plan would be: Prescribe NSAIDs as abortive therapy and have her keep a headache diary to identify her triggers 8. Jayla is a 9-year-old patient who has been diagnosed with migraines for almost 2 years. She is missing up to a week of school each month. Her headache diary confirms she averages four or five migraines per month. Which of the following would be appropriate? Prescribe propranolol (Inderal) to be taken daily for at least 3 months. 9.Amber is a 24-year-old patient who has had migraines for 10 years. She reports a migraine on average of once a month. The migraines are effectively aborted with naratriptan (Amerge). When refilling Amber’s naratriptan, education would include: Naratriptan will interact with antidepressants, including selective serotonin reuptake inhibitors (SSRIs) and St John’s wort, and she should inform any providers she sees that she has migraines. Continue to monitor her headaches, if the migraine is consistently happening around her menses there is preventive therapy available. Pregnancy is contraindicated when taking a triptan 10. When prescribing for migraines, patient education includes: Stress reduction and regular sleep are integral to migraine treatment. 11.Juanita presents to the clinic with a complaint of headaches off and on for months. She reports they feel like someone is “squeezing” her head. She occasionally takes Tylenol for the pain, but usually just “toughs it out.” Initial treatment for tension headache includes asking her to keep a headache diary and a prescription for: Naproxen (Aleve) 12. Nonpharmacologic therapy for tension headaches includes: Biofeedback Stress management Massage therapy 13. James has been diagnosed with cluster headaches. Appropriate acute therapy would be: Oxygen 100% for 15 to 30 minutes 14. Preventative therapy for cluster headaches includes: Ergotamine nightly before bed 15.When prescribing any headache therapy, appropriate use of medications needs to be discussed to prevent medication-overuse headaches. A clinical characteristic of medication-overuse headaches is that they: Recur when medication wears off