NSG 313 - Pharmacotherapeutics - Week 5 (Ch8-11)
D (Exposure to teratogens during the second and third trimesters usually disrupts function rather than producing obvious anatomic abnormalities. Exposure to teratogens during the first 2 weeks of pregnancy usually results in an "all-or-nothing" response that may result in fetal death. Exposure during the remainder of the first trimester may result in anatomic malformations.)
2. A teratogenic drug, such as methotrexate, is most likely to cause learning deficits during which phase of fetal development? a Conception through week 2 b Weeks 3 to 8 c First trimester d Second and third trimesters
C (Kidney disease can reduce drug excretion, causing drugs to accumulate in the body. If the dosage is not lowered, the drug may accumulate to toxic levels.)
2. The healthcare provider prescribes a medication that is renally eliminated for a patient with acute renal failure. The nurse recognizes the patient is at risk for which altered drug response? a Increased drug excretion b Decreased drug levels in the blood c Development of drug toxicity d Increased tolerance to the medication
A (Adjustments based on the body surface area account not only for the patient's weight but also for the patient's relative amount of body adiposity.)
1 The nurse is caring for a 12-year-old boy who weighs 72 pounds. The healthcare provider should make the most precise dosage adjustments for this patient's medications based on what? a Body surface area b Body mass index c Body weight d Body fat percentage
B (The very young are at risk for drug effects that are more intense and prolonged than those seen in adults. Drugs given by the SC route reach higher levels and remain in the system longer than in adults. Drugs given IV leave the body more slowly in infants than in adults. Gastric emptying time is prolonged in infants. The blood-brain barrier is not fully developed in infants.)
1. The nurse is caring for a group of very young patients receiving a variety of medications. Which concept guides the nurse's care of these patients? a Drugs given intravenously (IV) leave the body more quickly in infants than in adults. b Drugs given subcutaneously (SC) remain in the body longer in infants than in adults. c Gastric emptying time is shorter in infants than in children and adults. d The blood-brain barrier protects the infant's brain from toxic drugs.
enhanced impeded
A. Absorption can be ________________or ________________ in pediatric patients
gross malformations
B. Teratogenic exposure during the embryonic period (1st trimester) often results in __________________
absorption
B. the concern when administering topical drugs to children is that they have an increased risk of toxicity d/t more rapid and complete ______.
adiposity
BSA determinations account for not only the person's weight but also the person's relative amount of body _____ - making it a more precise means for controlling drug responses - esp. for very young and elderly.
disrupted function
C. Teratogenic exposure during the fetal period (2nd and 3rd trimester) often results in ______________________________________.
1
D. Complete maturation of the liver develops by age__________.
bioavailability
Differences in _____ are of the greatest concern for drugs with a narrow therapeutic range.
rapid complete
Drug absorption through the skin is more ____ and ____ in infants than older children and adults (blood flow to skin is greater)
1
E. Adult levels of renal function develops by age___________.
adherence
Factors that contribute to poor drug _____ in the elderly - forgetfulness - failure to comprehend instructions - inability to pay for meds - use of complex regimens
decreases
GFR _____ with age and in kidney disease
prolonged irregular
Gastric emptying is both _____ and _____ in early infancy and foes not reach adult values until 6-8months. - if drug is absorbed primarily from stomach = enhanced absorption - If drug is absorbed primarily by the intestines, absorption is delayed.
Abacavir
HLA-B*57:01 allele hypersensitivity - Increased risk of SJS reaction FDA requires a patient be tested for this gene prior to administration.
2/3
How many pregnant women take at least one medication during their pregnancy? ___________
neonate, infant
IM injection absorption in a ____ is slow and erratic IM injection absorption in a ____ is more rapid.
POOR
If a _____ metabolizer, when taking an active drug, there is an increased risk of toxicity. If taking a prodrug, the effect of the drug is decreased.
lower
If a patient's creatinine clearance low, a ____ dose is given.
decreased, increased
If an ULTRARAPID metabolizer - when taking an active drug the effect of the drug is _____, but if the medication is a prodrug, there's an ______ risk of toxicity.
metabolism
If liver function declines, the rate of ____ will decline - which will cause drug levels to rise. To prevent toxic accumulation, dosage of drugs eliminated via hepatic metabolism must be reduced or discontinued if liver disease develops.
breast feeding
Strategies to minimize risk of drug transmission via ____-____: - take med immediately after breast feeding - avoid drugs with long half life - avoid sustained release - choose drugs that tend to be excluded from breast milk - choose drugs less likely to effect infant - avoid drugs known to be hazardous - use lowest effective dose for shortest period of time
protein binding
___-____ capacity does not reach adult values until 10-12 months. So, drugs that undergo extensive protein binding in adults undergo much less in infants = concentration of free levels of drug is high = intensified effects
pregnancy exposure registries
_____ _____ _____ are studies that collect health information on medical product exposures such as drugs and vaccines during pregnancy and in the newborn. This info is compared with women who have not taken meds during pregnancy.
codeine
_____, used for opioid pain relief, can cause toxicity or decreased effectiveness d/t genetic variation CYP2D6. Has a BLACK BOX warning.
tolerance
______ is a decreased responsiveness to a drug as a result of repeated drug administration. ** these patients require higher doses to produce effects equivalent to those that would be achieved with lower doses previously. 3 categories: - pharmacodynamic - metabolic - tachyphylaxis
plavix
______ is an antiplatelet medication that has a lower than normal effect if the patient has the genetic variant CYP2C19. FDA requires thorough info be given to patient prior to taking.
tachyphylaxis
________ is a reduction in drug responsiveness brought on by repeated drug dosing over a short time (like in 24 hours). Ex: transdermal nitroglycerin - loses effectiveness if worn continuously in 24 hours.
body surface area
a measure used for dosage that is calculated from the height and weight of a person and measured in square meters
prodrug
an inactive drug dosage form that is converted to an active metabolite by various biochemical reactions once it is inside the body Ex: Prednisone
D (Renal function declines in older adults, leading to decreased excretion and potential drug accumulation. Although absorption may be delayed in older adults, the percentage absorbed does not change. Most older adult patients have increased body fat and decreased lean mass. Hepatic metabolism tends to decline with age.)
2. The nurse is caring for a group of older adult patients who are all receiving multiple medications. The nurse understands that it is essential to individualize each patient's therapy. Which is the best rationale for this practice? a The percentage of drug absorbed often is decreased in older adults. b Most older adults have decreased body fat and increased lean mass. c Hepatic metabolism tends to increase in older adults, resulting in decreased drug levels. d Renal function declines with age, leading to decreased drug excretion.
A (The albumin in neonates and infants has a lower binding capacity for medication. A lower binding capacity leaves more of the free drug available for action; therefore, a lower dose is required to prevent toxicity.)
2. Which intervention would the nurse choose to minimize the risk of drug toxicity in neonates and infants? a Reduce the amount of drug given. b Administer the medication before meals. c Shorten the interval between doses. d Administer the medication intravenously.
slowed, increased, decreased, declined, reduced
20. In general, pharmacokinetic changes in the elderly include: Absorption rate ___________________ Distribution may be ____________________or __________________________. Metabolism is __________________________ Excretion is ____________________________
A (For most drugs, not much is known about gender-related differences, because until recently all drug research was done in men.)
4. The nurse is caring for a group of female patients receiving medication therapy. Which factor is of greatest concern with regard to drug therapy in these patients? a Most drug research has been carried out exclusively in male subjects. b Hormonal differences make managing drug therapy more difficult in most women. c Overall, women tend to be less compliant with medication therapy. d Women tend to be caregivers and may not take time to care for themselves.
B (Dosing immediately after breast-feeding minimizes the drug concentration in milk. Drugs with a shorter half-life are excreted by the mother more quickly. If possible, drugs should be avoided during breast-feeding; however, patients with chronic illnesses, such as epilepsy, may require medication for their own health. The maternal fluid intake is not related to medication safety during breast-feeding.)
4. The nurse is caring for a patient with epilepsy who is on anticonvulsant therapy and is also breast-feeding. Which patient teaching instruction should minimize the risk to the baby? a "Give the dose just before breast-feeding." b "Avoid drugs that have a long half-life." c "Discontinue the drug until you have stopped breast-feeding." d "Increase your fluid intake."
D (Although pharmacokinetic changes in older adults affect all phases of kinetics, drug accumulation secondary to reduced renal excretion is the most important cause of ADRs in the older adult.)
4. When assessing for drug effects in the older adult, which phase of pharmacokinetics is the greatest concern? a Absorption b Distribution c Metabolism d Excretion
C (Adult levels of renal function are achieved by 1 year. Renal blood flow, glomerular filtration, and active tubular secretion are low during infancy. Renal drug excretion is significantly reduced at birth. Drugs that are eliminated primarily by renal excretion must be given in reduced dosage and/or at longer dosing intervals.)
4.Which statement about renal excretion in infants is true? a Renal blood flow is high during infancy. b Renal drug excretion is significantly increased at birth. c Adult levels of renal function are achieved by 1 year. d Drugs that are eliminated primarily by renal excretion must be given in higher doses.
B (Category X means that the drug will be harmful to the fetus if the patient is pregnant. The patient may not know she is pregnant; therefore, asking her when her last menstrual period occurred gives the nurse a better indication of whether the patient might be pregnant.)
5. A nurse prepares to administer a newly prescribed medication to a 22-year-old woman. The insert in the medication package states, "Category X." Select the nurse's best action. a Ask the patient, "Have you been sexually active during the past year?" b Ask the patient, "When was your last menstrual period?" c Inform the patient of the primary actions of the medication. d Assess the patient for a history of sexually transmitted disease.
D (Gene variants that affect the immune system can increase the risk of severe hypersensitivity reaction to the drug abacavir [Ziagen]. The FDA recommends screening for the variant gene code HLA-B*5701 before a patient uses this drug. If the test is positive, abacavir should be avoided.)
5. The nurse is caring for a patient prescribed abacavir [Ziagen] to treat human immunodeficiency virus (HIV) infection. To reduce the potential fatal hypersensitivity reaction, which recommendation is suggested prior to initiating abacavir drug therapy? a Administer a test dose b Obtain liver function studies c Drug skin testing d Genetic screening
C (As a rule, the percentage of an oral dose that becomes absorbed does not usually change with age.)
5. Which statement about the percentage of oral drug absorption is true? a The percentage absorbed increases with age. b The percentage absorbed decreases with age. c The percentage absorbed does not usually change with age. d The percentage absorbed severely declines with age.
D (Pediatric doses have been established for a few drugs but not for most. For drugs that do not have an established pediatric dose, dosage can be extrapolated from adult doses. The method of conversion employed most commonly is based on body surface area.)
5.For medications that do not have established pediatric doses, the most common method of extrapolating the appropriate dose is based on which measurement? a Age b Weight c Height/length d Body surface area
a, b, c, d, e (All of the responses are examples of individual variations in drug responses.)
6. The nurse understands drug response varies from one individual to another. What are examples of individual variations? (Select all that apply.) a Age b Genetic makeup c Gender d Diet e Failure to take medication as prescribed
D (Rates of hepatic drug metabolism tend to decline with age. Principal reasons are reduced hepatic blood flow, reduced liver mass, and decreased activity of some hepatic enzymes. Diet is important but is not a principal reason for reduced hepatic drug metabolism.)
6. Which is not a reason for the decline in hepatic drug metabolism with age? a Reduced hepatic blood flow b Reduced liver mass c Decreased activity of some hepatic enzymes d Poor diet
E (Drugs in Category X are the most dangerous; these drugs are known to cause human fetal harm, and their risk to the fetus outweighs any possible therapeutic benefit. Drugs in Categories B, C, and D are progressively more dangerous than drugs in Category A and less dangerous than drugs in Category X.)
6.According to the FDA Pregnancy Risk categories, which category represents the greatest risk for fetal harm? a A b B c C d D e X
D (Drug absorption following IM injection in the neonate is slow and erratic. Delayed absorption is due in part to low blood flow through muscle during the first days of postnatal life. By early infancy, absorption of IM drugs becomes more rapid than in neonates and adults.)
6.Which statement about intramuscular (IM) administration is incorrect? a Drug absorption following IM injection in the neonate is slow and erratic. b Absorption of IM drugs becomes more rapid in infancy than in neonates. c Neonates experience low blood flow through muscle during the first days of postnatal life. d Absorption of IM drugs becomes slower and more erratic in infancy than in neonates.
a, c (A variant in the gene code for CYP2C19 reduces clopidogrel antiplatelet effects, which increases the patient's risk of cardiovascular events such as stroke and myocardial infarction.)
7. The nurse is reading a genetic research study. The study discusses how genetic variants can directly affect the metabolism of clopidogrel [Plavix], reducing the antiplatelet response. The nurse understands reduced efficacy of clopidogrel can increase the risk of which cardiovascular event? (Select all that apply.) a Stroke b Cancer c Myocardial infarction d Pulmonary embolism e Palpitations
D (Less than 1% of all birth defects are caused by drugs. All of the other statements are true.)
7. Which statement regarding adverse reactions during pregnancy is false? a Not only are pregnant women subject to the same adverse effects as everyone else, but they may also suffer effects unique to pregnancy. b Drugs taken during pregnancy can adversely affect the patient as well as the fetus. c The drug effect of greatest concern is teratogenesis. This is the production of birth defects in the fetus. d One in five children is born with a malformation related to drug use during pregnancy.
C (The blood-brain barrier is not fully developed at birth. The other statements are not true.)
7. Why are infants especially sensitive to drugs that affect CNS function? a The blood-brain barrier is especially strong in infants. b The blood-brain barrier does not exist until 1 year of age. c The blood-brain barrier is not fully developed at birth. d The blood-brain barrier is weakened by the birth process.
B (The Beers list identifies drugs with a high likelihood of causing adverse effects in older adults.)
7.What is the Beers list? a Drugs with a low likelihood of causing adverse effects in older adults b Drugs with a high likelihood of causing adverse effects in older adults c Drugs with zero likelihood of causing adverse effects in older adults d Drugs that are recommended to be used for older adults
placebo
A ____ is a preparation that is devoid of intrinsic pharmacologic activity - Its primary use is as a control prep during clinical trials.
tachyphylaxis
A patient who has been placing nitroglycerin patches on his body every twenty-four hours for prevention of angina chest pain is no longer getting any pain response from the drug. This is called: ________________________________________
pharamacodynamic tolerance
A patient who has been taking morphine sulfate for the last 6 months for pain control from cancer has needed repeated doses to achieve the same level of pain relief. This is called: ____________________________________
Pregnancy
examples of how _______can have an effect on the body (liver, kidney, GI) related to drug pharmacokinetics? - Renal blood flow doubles causing large increase in GFR which accelerates drug clearance for drugs that are eliminated by glomerular filtration. - Tone and motility of bowel decreased which causes an increase in intestinal transit time, allowing more time for drugs to be absorbed. - More time is available for reabsorption of drugs that undergo enterohepatic recirculation - so effects of certain drugs may be prolonged - Hepatic metabolism increases- phenytoin, valproic acid
placebo effect
experimental results caused by expectations alone; any effect on behavior caused by the administration of an inert substance or condition, which the recipient assumes is an active agent.
pharmacodynamic
familiar TYPE OF TOLERANCE associated with long term administration of drugs (such as morphine, heroin). -- It is the result of adaptive processes that occur in response to chronic receptor occupation. -- the minimal effective concentration (MEC) becomes abnormally high d/t need for increased drug levels to achieve effective response.
BEERS criteria
long list of drugs that are NOT okay for the geriatrics population - high likelihood of causing adverse effects
C
pregnancy category ___ Animal studies show a risk of fetal harm, but no controlled studies have been done in women. Or, no studies have been done,
B
pregnancy category ___ Animal studies show no risk to fetus AND there are no studies in pregnant women
A
pregnancy category ___ No risk in 1st trimester and possible fetal harm is remote
X
pregnancy category ____ Positive evidence of human fetal risk AND benefits do NOT outweigh risks (use is absolutely contraindicated)
D
pregnancy category ____ Positive evidence of human fetal risk BUT benefits outweigh risks
creatinine clearance
test of kidney function. creatinine is a waste product cleared from the bloodstream by the kidneys. for this test, urine is collected for 24 hours and the amount of creatinine in the urine is compared to the amount of creatinine that remains in the bloodstream
pharmacogenomics
the study of the relationship between genetic variations and how our bodies respond to medications
extensive
"Normal" drug metabolizer = _______ metabolizer: should respond to standard dosages of a drug; has two copies of normal alleles; most people have this
D (Essentially all drugs can cross the placenta. Renal blood flow increases during pregnancy, which increases the clearance of some drugs, such as lithium. Lack of proof of teratogenicity does not mean that a drug is safe; it only means that the available data are insufficient to make a definitive judgment. Uncontrolled maternal asthma is more dangerous to the fetus than the drugs used to treat it.)
1. The nurse is caring for a pregnant patient who has chronic asthma. When administering medications to this patient, the nurse should do what? a Give the medications as ordered, because most drugs do not cross the placenta. b First assess the creatinine level, because renal blood flow decreases during pregnancy. c Hold the medications and notify the ordering physician, because drugs that are not known teratogens may not be safe during pregnancy. d Advise the patient that taking asthma medications during pregnancy improves fetal outcomes.
B (Drug accumulation secondary to reduced renal excretion is the most important cause of ADRs in the elderly. Creatinine clearance, not serum creatinine levels, is the proper index of renal function in older adult patients.)
1. The nurse will monitor which laboratory result closely when administering medications to an older adult patient while assessing for adverse drug reactions (ADRs)? a Serum creatinine levels b Creatinine clearance c Serum albumin levels d Liver function tests
A, B, E (To prove that a drug is a teratogen, three criteria must be met: The drug must cause a characteristic set of malformations; the drug must act only during a specific window of vulnerability (eg, weeks 4 through 7 of gestation); and the incidence of malformations should increase with increasing dosage and duration of exposure. Drugs are not tested in pregnant women. Studies in animals may be of limited value, in part because teratogenicity may be species-specific.)
10. For a drug to be a proven teratogen, which criteria must be met? (Select all that apply.) a The drug must cause a characteristic set of malformations. b The drug must act only during a specific window of vulnerability. c The drug should be tested in pregnant women. d The drug causes malformation in animal testing. e The incidence of malformations should increase with increasing dosage and duration of drug exposure.
a, b, d (Forgetfulness, failure to comprehend instructions (because of intellectual, visual, or auditory impairment), and inability to pay for medications can contribute to unintentional nonadherence. Unpleasant side effects and the belief that the drug is not needed are factors that contribute to intentional nonadherence.)
10. Which factors may contribute to unintentional nonadherence? (Select all that apply.) a Forgetfulness b Failure to comprehend instructions c Unpleasant side effects d Inability to pay for medications e Belief that the drug is not needed
a, c, d, e (Drug absorption through the skin is more rapid and complete with infants than with older children and adults because the stratum corneum of the infant's skin is very thin and blood flow to the skin is greater in infants than in older patients. Because of this enhanced absorption, infants are at increased risk of toxicity from topical drugs.)
10. Which statements about transdermal absorption are correct? (Select all that apply.) a The stratum corneum of the infant's skin is very thin. b Transdermal administration is the safest route of administration. c Blood flow to the skin is greater in infants than in older patients. d Infants are at increased risk of toxicity from topical drugs. e Absorption through the skin is more rapid and complete with infants.
D (Pharmacodynamic tolerance is the phenomenon of decreased responsiveness to a drug as a result of repeated drug administration. A: Tachyphylaxis is a reduction in drug responsiveness as a result of repeated dosing over a short time. B: Metabolic tolerance results from accelerated drug metabolism and not repeated dosages; therefore, the minimum effective concentration is not affected. C: The placebo effect is a drug response caused by psychologic factors and not by the drug's biochemical or physiologic properties.)
3. A nursing student is caring for a patient who has been taking morphine sulfate for pain for 2 weeks. The nursing student shows an understanding of pharmacodynamic tolerance by describing it to the instructor in what way? a "It is a form of tolerance that is a reduction in drug responsiveness brought on by repeated dosing over a short period." b "It affects the minimum effective concentration." c "It is a drug response caused by psychologic factors, not by biochemical or physiological properties." d "It is a condition in which the patient requires increased doses of morphine sulfate to achieve pain relief."
A (Many drugs are not classified according to the U.S. Food and Drug Administration (FDA) Pregnancy Risk Categories. These drugs were in use before the classification system came into use in 1983. They are considered safe but may not have been studied in controlled trials. The pharmacy cannot assign a pregnancy risk category to a drug.)
3. The nurse is preparing to give a drug that is not classified according to a Pregnancy Risk Category. What should the nurse do? a Administer the medication, because the nurse knows that it was in use before 1983. b Notify the healthcare provider before administering the drug, because it should be considered a teratogen. c Hold the medication, because the drug has a proven risk of fetal harm. d Return the medication to the pharmacy to be assigned a Pregnancy Risk Category.
A (Neonates are especially sensitive to drugs that are eliminated primarily by hepatic metabolism. When these drugs are used, dosages must be reduced. The capacity of the liver to metabolize many drugs increases rapidly about 1 month after birth and approaches adult levels a few months later. The liver has matured completely by 1 year of age.)
3. When administering a medication known to be metabolized by the liver, the nurse will closely monitor for adverse drug reactions in which patient? a A 3-month-old infant b A 12-month-old infant c An 18-month-old toddler d A 13-year-old adolescent
A (Underdosing, with resulting therapeutic failure, is much more common (90%) than overdosing among the elderly. In most cases (75%), the nonadherence is intentional because of the patient's conviction that the drug is simply not needed or because of unpleasant side effects. Using multiple pharmacies should be avoided, as should doubling missed doses. Doubling a dose could result in intentional overdosing. Reducing protein intake can result in decreased drug binding to albumin; consequently, the amount of free drug is increased, which could result in drug toxicity.)
3.When preparing a teaching session for residents at an assisted living facility, the nurse will include what? a The importance of avoiding intentional underdosing b The importance of using multiple pharmacies for cost-effective savings on prescription drugs c The importance of taking double amounts of missed doses to maintain therapeutic levels of medications d The importance of reducing protein intake while taking prescription medications
distribution
4 major factors that can alter drug ____ is older adults: 1- increased percent body fat 2 - decreased percent lean body mass 3 - decreased total body water 4 - reduced concentration of serum albumin
Not fully developed
C. How is the blood brain barrier different in child then in adults?
A, B, D (Drugs taken by lactating women can be excreted in breast milk. If drug concentrations in milk are high enough, a pharmacologic effect can occur in the infant, raising the possibility of harm. Unfortunately, very little systematic research has been done on this issue. Most drugs can be detected in milk, but concentrations are usually too low to cause harm. Although nearly all drugs can enter breast milk, the extent of entry varies greatly.)
8. A nurse is educating a breast-feeding patient about her medications. Which statements by the nurse are true? (Select all that apply.) a "Drugs taken by lactating women can be excreted in breast milk." b "If drug concentrations in milk are high enough, a pharmacologic effect can occur in the infant." c "There is a lot of research regarding drugs taken by lactating women." d "Most drugs can be detected in milk, but concentrations are usually too low to cause harm." e "Nearly all drugs can enter breast milk, and the extent of entry is the same for all drugs."
D (Like adults, pediatric patients are subject to adverse reactions when drug levels rise too high. In addition, pediatric patients are vulnerable to unique adverse effects related to organ system immaturity and to ongoing growth and development. Among these age-related effects are growth suppression (caused by glucocorticoids), discoloration of developing teeth (caused by tetracyclines), and kernicterus (caused by sulfonamides).)
8. Which of the following is not an example of age-related adverse drug effects? a Growth suppression b Discoloration of developing teeth c Kernicterus d Toxicity
A (Drug use among older adults is disproportionately high. Older adults consume 33% of the nation's prescribed drugs. Older patients are more sensitive to drugs than are younger adults. Older adults experience more adverse drug reactions.)
8. Which statement about drug use among older adults is true? a Drug use among older adults is disproportionately high. b Older adults consume 20% of the nation's prescribed drugs. c Older patients are less sensitive to drugs than younger adults. d Older adults experience fewer adverse drug reactions.
a, b, d, e (A thorough drug history and careful monitoring can help reduce ADRs. Nurses should help patients use the simplest regimen possible to reduce the risk of ADRs. Monitoring patients for interactions reduces ADRs. The Beers list identifies drugs with a high likelihood of causing adverse effects in the elderly.)
9. Older adult patients are at high risk for adverse drug reactions (ADRs). Which measures can reduce the incidence of ADRs? (Select all that apply.) a Taking a thorough drug history, including over-the-counter (OTC) medications b Monitoring clinical response and laboratory results to help determine proper dosage c Using as many drugs as possible to reduce symptoms and improve outcome d Regularly monitoring patients for drug-drug and drug-nutrient interactions e Helping patients to avoid prescriptions for drugs on the Beers list
a, b (When a pregnant woman has been exposed to a known teratogen, the first step is to determine exactly when the drug was taken and exactly when the pregnancy began. Other information is helpful but not necessary.)
9. When a pregnant woman has been exposed to a known teratogen, what is the first step in identifying risks for malformation? (Select all that apply.) a Determine exactly when the drug was taken. b Determine exactly when the pregnancy began. c Determine why the woman was taking the medication. d Determine who prescribed the medication.
a, c, d (Spills and spitting are common causes of inaccurate dosing in children. It is often helpful to mix medication with food or juice to mask the taste when allowed. Calibrated spoons and medication records can improve accuracy. To prevent overdosing, parents should estimate the amount a child spits out and replace only that amount.)
9.The nurse is teaching young parents about medication administration in their child. Which statements are appropriate to include in the teaching plan? (Select all that apply.) a "Guard against spills and spitting to ensure that your child gets an accurate dose." b "Do not mix your child's medication with food or drink." c "This calibrated spoon will help your child get an accurate dose." d "Keep a medication record to make sure you do not give more than one dose at a time." e "If your child spits some medication out, give another full dose at that time."
spontaneous abortion (fetal death)
A. Teratogenic exposure during the preimplantation/presomnic period (conception through week 2) often results in ___________________.
active drug
Active form of the medication after it has been processed by the body and needs no conversion once inside the body. Ready to work and needs no conversion (CYP2C9, Ibuprofen)
C
Albuterol (asthma) is pregnancy category ____
faster
As a general rule kids metabolize drugs ___________________than adults. It is markedly elevated by age 2, and then gradually declines.
slower
When a drug is administered IV in an infant, the levels decline _____ that in an adult - so drug levels remain above MEC longer.
ph partitioning
By altering ___ _____, changes in acid-base balance can alter absorption, distribution, metabolism and excretion - this is due to a drug accumulating on the side of the membrane whose pH most favors its ionization. Acidic drugs -> alkaline media, and vice versa.
underdosing (90%)
Is underdosing or overdosing the more common reason for therapeutic failure r/t nonadherence to drug regimen?
excretion
Kidney disease can decrease drug ____ causing drugs to accumulate in the body. Dosage must be lowered, or could cause toxicity.
decline
Main reasons for hepatic drug metabolism in older adults to _____: - reduced hepatic blood flow - reduced liver mass - decreased activity of hepatic enzymes - Half lives of drugs may be increased = prolonged response
X
Oxytocin (induce labor) is pregnancy category ____
pharmacogenomics
Patients with G6PD deficiency develop hemolytic anemia after the ingestion of certain foods and drugs. This occurs in 1 in 10 African-American males in the US because of genetic differences. What is the study of how genes affect individual drug responses called?
D
Phenytoin (seizure disorder) is pregnancy category ____
longer
When a drug is administered SQ, levels in an infant remain above the MEC _____ that in a adult, but these levels also right higher - causing effects to be more intense.
low
When potassium levels are ___, the ability of digoxin to induce potentially fatal dysrhythmias is increased.
elderly
Reasons why adverse drug reactions are much more common in _____: - altered pharmacokinetics - multiple/severe illnesses - multi drug therapy - poor adherence - drug accumulation d/t reduced renal function - low therapeutic index drugs - inadequate supervision of long term therapy
B
Regular insulin is pregnancy category ____
reduced
Renal drug secretion is significantly ____ at birth - so drug must be given at lower doses and/or longer dosing interval.
T
T/F Drug accumulation secondary to reduced renal excretion is the most important cause of adverse drug reactions in older adults.
F
T/F The blood brain barrier is fully developed at birth
F
T/F ____A. The use of placebos is ethical in everyday patient care.
T
T/F: Clinicians should assume all drugs taken during pregnancy will reach the fetus.
F
T/F: ____B. If a patient says a drug works and it was a placebo, it means the patient didn't really have a problem.
T
T/F: _____C. If a patient believes a drug won't work, it won't.
T
T/F: _____D. Placebos are used routinely in clinical trials as a control mechanism to compare the action of the experimental drug.
iPledge
The __ program is a mandatory distribution program for isotretinoin (Accutane), intended to ensure woman is not pregnant prior to first dose and to prevent pregnancy during treatment. - 2 pregnancy tests - 2 forms of BC
bioavailability
The amount of active drug that reaches systemic circulation from its site of administration is ____.
low
The drug metabolizing capacity of newborns is ____ = sensitive to drugs that are primarily eliminated by hepatic metabolism = Dosage must be reduced.
metabolic tolerance
The form of drug tolerance the results from accelerated drug metabolism - brought about by ability of certain drugs to induce synthesis of hepatic dug-metabolizing enzymes - causing rate of metabolism to increase - Dosage must be increased to maintain therapeutic levels - DOES NOT effect MEC
teratogenesis
The production of birth defects in the fetus
warfarin
There is an increased risk of bleeding in patients on _____ d/t genetic variations VKORC1 and CYP2C9. The FDA recommends testing prior to admin.
Herceptin
This medication only works for breast cancer if have genetic variant on HER2 - FDA requires testing prior to admin. This genetic variant increases effectiveness of the drug.
teratogen
To prove that a drug is a _____ 3 criteria must be met: - drug must cause characteristic set of malformations - Must act only during a specific window of vulnerability - incidence of malformations should increase with increasing dosage and duration of exposure.