NUR-641E Advanced Pathophysiology and Pharmacology Final Exam Study Guide Graded A+

NUR-641E Advanced Pathophysiology and Pharmacology Final Exam Study Guide Graded A+ Pharmacokinetics - CORRECT ANSWER-Involves ADME (absorption, distribution, metabolism and elimination). Absorption: absorption from the administration site either directly or indirectly into the blood/plasma. Distribution: reversibly or irreversibly move from the bloodstream into the interstitial and intracellular fluid. Metabolism: bio-transformed via hepatic metabolism or by other tissues. Elimination: lastly, the drug & its metabolites are eliminated from the body The route of administration with the highest bio-availability is - CORRECT ANSWER-Intravenous; putting entire dose into a patient's vein and bypassing absorption. Intravenous route avoids first-pass metabolism in the liver. rectal administration disadvantages - CORRECT ANSWER-variable and erratic absorption Steady state (SS) - CORRECT ANSWER-is usually reached within 4-5 half-lives of a drug The half-life of a drug is defined as - CORRECT ANSWER-how long it takes for half the drug to be excreted from the body Half-life of a drug - CORRECT ANSWER-Determines how frequently the drug must be administered Predicts how long toxic effects can last Half-life is constant with first-order pharmacokinetics of a drug Zero-order (nonlinear) pharmacokinetics means a drug is metabolized at a constant rate per unit time. CYP3A4 substrate drugs - CORRECT ANSWER-May have enhanced activity if any CYP3A4 inducer drugs are used along with it. Drug development steps (according to the FDA) - CORRECT ANSWER-Discovery: laboratory research to develop the new drug Pre-clinical research with animal testing for safety (Phase I) Clinical research on human subjects for medication safety (Phase II) Clinical research in humans comparing the new drug to accepted medications or placebo depending on the study (Phase III) FDA review of the results to determine approval Post-marketing study to identify adverse effects not found in earlier clinical studies (Phase IV) Medication safety organizations - CORRECT ANSWER-The Institute for Safe Medication Practices (ISMP) The Institute of Medicine (IOM) The Joint Commission The National Coordinating Council for Medication Error Reporting and Prevention (NCCMERP) Food and Drug Administration (FDA) Safe Use Initiative Adverse Drug Reactions (ADRs) - CORRECT ANSWER-Two basic type of ADRs: pharmacological and idiosyncratic. 85% to 90% of ADRs are pharmacological. Adverse drug reactions are usually preventable, frequently occur in a hospital or nursing home setting, and include medication errors, adverse drug effects, allergic and idiosyncratic type reactions. ADRs are not commonly reported; the FDA does not mandate that ADRs be reported. Polypharmacy involves using multiple healthcare providers for care, using multiple medications, and using several pharmacies for prescription filling. Cardiovascular-Angiotensin converting enzyme inhibitors (ACEIs): - CORRECT ANSWER-Lisinopril, captopril, enalapril, ramipril, benazepril, fosinopril; *ACEIs reduce blood pressure by suppressing the release of angiotensin-converting enzyme. *Important side effects of ACE inhibitors include cough and angioedema; discontinue the ACEI if angioedema occurs. Angiotensin II receptor blocking agents (ARBs): - CORRECT ANSWER-Candesartan (Atacand), eprosartan (Teveten), irbesartan (Avapro), losartan (Cozaar), telmisartan (Micardis) and valsartan (Diovan). ARBs reduce blood pressure by blocking angiotensin II receptors. Cardiovascular-Essential (primary) hypertension - CORRECT ANSWER-Accounts for 90% of cases; secondary hypertension may be caused by chronic renal failure. Nitroglycerin - CORRECT ANSWER-nitrate drug used in the treatment of angina; a nitrate drug that can be administered IV, SL, a topical ointment and as a transdermal patch PDE-5 inhibitors - CORRECT ANSWER--Pulmonary hypertension therapy -Include sildenafil. Inhibit cGMP PDE5 and prolong vasodilatory effect of nitric oxide. cGMP phosphodiesterase - CORRECT ANSWER-an enzyme in cells that converts cGMP into GMP Amiodarone - CORRECT ANSWER-is the antiarrhythmic of choice when there is coexisting heart failure; can cause thyroid and pulmonary toxicity. Alpha-1 adrenergic stimulation - CORRECT ANSWER-results in vasoconstriction and increased blood pressure. Alpha-1 adrenergic blockade - CORRECT ANSWER-results in vasodilation and reduced blood pressure Beta-1 adrenergic stimulation - CORRECT ANSWER-by beta agonists (e.g., isoproterenol) results in increased heart rate, increased blood pressure and increased cardiac output. Beta-1 adrenergic blockade - CORRECT ANSWER-results in reduced heart rate, reduced blood pressure and reduced cardiac output. Left heart failure - CORRECT ANSWER-The heart does not adequately circulate blood to systemic system. Due to pressure overload or volume overload Right heart failure - CORRECT ANSWER-The heart does not adequately circulate blood to the pulmonic system. Can be due to volume overload or regurgitation in Tricuspid Valve or Pulmonic Valve. Can lead to systemic edema, back up of blood in liver and lower extremities Furosemide (Lasix) - CORRECT ANSW