NURS 615 PHARM EXAM 1 LATEST REAL EXAM QUESTIONS AND CORRECT ANSWERS|GRADED A (MARYVILLE UNIVERSITY)

NURS 615 PHARM EXAM 1 LATEST REAL EXAM QUESTIONS AND CORRECT ANSWERS|GRADED A (MARYVILLE UNIVERSITY) Norepinephrine stimulates which receptors Alpha 1 - vasoconstriction (increased BP) Indications for Norepinephrine cardiac arrest and hypotensive shock The three main meds of direct acting agonists (non-selective) Norepinephrine, epinephrine, dopamine How does hypoalbuminemia affect the process of prescribing? Low albumin = More free drug (bc the drug can't bind to albumin aka protein) = increased adverse effects What is a Black Box Warning: is considered a contraindication to administer that drug. What is the drugs half-life? Half-life specifically means the amount of time it takes for an administered drug to be halfway cleared from the system. Peak of action: the time between drug administration and maximum concentration of drug in the blood stream. Best therapeutic effect. Duration of action: the time between onset of action and metabolism of drug below the minimum needed for an effect. The length of time you have the drug in your system. Explain first pass metabolism much of the drug is lost in the absorption process. The liver metabolizes many drugs, thus reduces the bioavailability of the drug. What is the fasted route of absorption: The fastest route of absorption is inhalation, and not as mistakenly considered the IV administration. What does grapefruit have to do with CYP? Grapefruit is an inhibitor and will decrease the metabolism of drugs by the cyp enzymes Why does the GI tract take longer to absorb? The GI tract is lined with epithelial cells; drugs must permeate through these cells in order to be absorbed into the circulatory system. What is One particular cellular barrier that may prevent absorption of a given drug? the cell membrane. Cell membranes are essentially lipid bilayers which form a semipermeable membrane. Pure lipid bilayers are generally permeable only to small and uncharged solutes, hence whether or not a molecule is ionized will affect its absorption, since ionic molecules are charged. What is solubility? Solubility favors charged species, permeability favors neutral species. Some molecules have special exchange proteins and channels to facilitate movement from the lumen into the circulation. Why does absorption occur at a slower rate for oral, IM, SQ routes? Absorption occurs at a slower rate because the complex membrane systems of GI mucosal layers, muscle, and skin delay drug passage. According to the WHO what is the first step in the prescribing process? The first step is to define the patient's problem The second step is to specify the therapeutic objective The third step is to choose which drug or treatment is needed. Step 4 of the WHO approach: Start the treatment Step 5 of the WHO approach: Educate the patient Step 6 of the WHO approach: Monitor the treatment Phase 1 of drug development: The drug is tested on healthy volunteers Phase 2 of drug development: trials with people who have the disease for which the drug is thought to be effective Phase 3 of drug development: Large numbers of patients in medical research centers receive the drug in phase 3. This larger sampling provides information about infrequent or rare adverse effects. The FFA will approve a new drug application if phase 3 studies are satisfactory. Phase 4 of drug development: This phase is voluntary and involves post market surveillance of the drug's therapeutic effects at the completion of phase 3. The pharmaceutical company receives reports from doctors and other health care professionals about the therapeutic results and adverse effects of the drug. Some medications, for example, have been found to be toxic and have been removed from the market after their initial release. The ability of a drug to cross a cell membrane depends on: whether the drug is water or lipid (fat) soluble. Lipid-soluble drugs easily cross through cell membranes; water-soluble drugs can't. Lipid-soluble drugs can also cross the blood-brain barrier and enter the brain. As a drug travels through the body, it comes in contact with? proteins such as the plasma protein albumin. The drug can remain free or bind to the protein. The portion of a drug that's bound to a protein is inactive and can't exert a therapeutic effect. Only the free, or unbound, portion remains active. A drug is said to be highly protein-bound if more than 80% of the drug is bound to protein. Identify drug metabolism and the role of isoenzymes in the p450 system CYPs are the are the major enzymes involved in drug metabolism accounting for about 75% of the total metabolism. Naturally occurring compounds may induce or inhibit CYP activity. For example, bioactive compounds found in grapefruit juice and some other fruit juices including dihydroxy forgotten and parasitin A have been found to inhibit CYP3a4 mediated metabolism of certain medications leading to increased bioavailability and the strong possibility of overdosing. When 2 drugs are both metabolized by the p450 system the drug should be administered at separate times to prevent the metabolism of one drug resulting in toxic effects of the other drug. (because it would have less protein to bind too, thus more free-floating drug) What is the efficacy of a drug? Efficacy is the maximum response achievable from a drug. Effectiveness refers to the ability of the drug to produce a beneficial effect. On the drug concentration curve what is the first sign of a therapeutic effect? The onset of action What is the purpose of a peak and trough level? To determine if the drug is in therapeutic range.