NURS 5334 Pharm Study Guide Quiz 1 Latest Update with 100%Correct Answers.

NURS 5334 Pharm Study Guide Quiz 1 Latest Update with 100%Correct Answers. MODULE 1 • What are the BON rules and regulations for prescriptive authority for the advance practice nurse? • Texas is very restricted • Describe the pharmacokinetic processes of absorption, distribution, metabolism and elimination and how differences in these areas affect drug action. • Absorption • Drug’s movement from the site of administration into the blood. • Distribution • Drug’s movement from the blood into the interstitial space of tissues and from there into cells. • Metabolism • Biotransformation is the enzymatically mediated alteration of drug structure. • Elimination • Combination of metabolism and excretion • Discuss the impact of food on drug absorption, drug metabolism and on drug toxicity and action—as well as the timing of drug administration. LIFESPAN • Hepatic metabolism and GFR increase during pregnancy, dosages of some drugs may need to be increased. • Rate of albumin to water decreases • Third trimester: Renal blood flow is doubled and renal excretion is accelerated (drugs excreted rapidly) • Tone and mobility of bowel decrease • Prolongation of drug effects Total (½ life increases) Understand stages of development in pregnancy 12/4/23, 4:44 PM NURS 5334 Pharm Study Guide Quiz 1 Latest Update Best E… about:blank 3/83 • Conception: through week 2 • Embryonic period: week 3-week 8 a) Gross malformations can be produced by teratogens • Fetal period: week 9-delivery • Understand pregnancy labeling • 3 categories now a) Pregnancy, lactation, male & female reproductive potential • How do you decrease risk in the infant during breastfeeding? • Take meds immediately after breastfeeding, avoid drugs that have long half-lives, choose drugs that tend to be excluded from milk, avoid drugs that are known to be hazardous. • How do pediatric patients differ in their response to medications? • Absorption a) Oral? • Neonates: drug remain in the stomach longer which increases the levels, low acidity can affect the absorption of acid labile drugs b) Parenteral? • Reponses are slow and erratic. • Infancy: absorption is more rapid than in neonates & adults • Best avoided in infants c) Transdermal? • Greater skin permeability which increases topical drug absorption and increases the risk for toxicity • Distribution a) Protein binding 12/4/23, 4:44 PM NURS 5334 Pharm Study Guide Quiz 1 Latest Update Best E… about:blank 4/83 1. Neonates: less protein-binding—increased availability of highly protein bound drugs such as phenytoin, diazepam, and phenobarbital. Reduced dosages needed in these highly bound drugs. b) Blood Brain Barrier 1. Not fully developed at birth, drugs have easy access to the CNS, doses should be reduced. • Metabolism a) Hepatic function? 1. Liver hasn’t reached full maturation—sensitive to drugs eliminated by the CYP450. Liver’s ability to metabolize drugs increases about one month after birth. b) T half life 1. Decreased by as much as 48-72 hours • Excretion a) Renal? 1. GFR is significantly reduced at birth, drugs eliminated by the kidneys must be given in a reduced dosage and longer dosing intervals. • What education needs to be given to parents? • What to do if child spits out medication or throws it up • Effective education: dosage size and timing, route, technique of administration, duration of treatment, how to store the drug, nature and time course of the desired response, nature and time course of adverse reactions. • Compare and contrast pharmacokinetics and pharmacodynamics of special populations—pediatrics, older 12/4/23, 4:44 PM NURS 5334 Pharm Study Guide Quiz 1 Latest Update Best E… about:blank 5/83 adults and those that are pregnant. • Pediatrics—they have organ immaturity, elderly—they have organ degeneration, loss of nephrons, excretion of drug is decreased and you have to give this population a lower dose of medication. Medication can pass through milk of lactating females. • Analyze a drug interaction to determine an appropriate course of action. • Basic mechanism of drug-drug interactions through pharmacokinetic interactions are altered absorption, altered distribution, altered metabolism, and altered renal excretion. • Identify medications with a narrow therapeutic index requiring drug level monitoring. 1. • Discuss the effect of ionization and pH on absorption. • Drugs that are weak acids are best absorbed in acidic environments. Acidic drugs accumulate on the alkaline side, basic drugs accumulate on the acidic side known as ion trapping. Ionization of the drugs is pH dependent, when the pH and the fluid on one side of the membrane differs from the pH on the other side, drug molecules tend to accumulate on the side where the pH most favors ionization. • Discuss factors affecting drug distribution. • Competition for protein binding and alteration of extracellular pH • Discuss barriers affecting drug distribution—such as placental membrane, blood brain barrier and volume of distribution. • Placental membrane: drugs are easily passed through the placental membrance • Blood brain barrier: the PGP pumps drugs back into the blood and thereby limits their access to the brain. • Volume of distribution: