Lehne's Pharmacology EAQ

The process in which the brain decreases the amount of dopamine produced and the number of dopamine receptors is known as what?

An important aspect of drug-induced remodeling is a phenomenon known as down-regulation, which serves to reduce the response to drugs. Because drugs release abnormally large amounts of dopamine, the reward circuit is put in a state of excessive activation. In response, the brain (1) produces less dopamine and (2) reduces the number of dopamine receptors. As a result, responses to drugs are reduced.

The nurse notes that the patient is prescribed diazepam. What does the nurse understand about the legal ramifications of this prescription? Select all that apply.

Any scheduled drug is a controlled substance. A Schedule IV drug is dispensed only by written or oral prescription to prevent abuse. The drug must have a warning label to educate the dispenser and the patient and prevent abuse. Scheduled drugs can be prescribed only by registered U.S. Drug Enforcement Administration prescribers. The prescription of a Schedule IV drug is valid for only 6 months with a maximum of five refills during that period. This helps to prevent drug abuse.

The nurse is explaining the changes in the distribution process of drugs occurring in elderly patients. Which pharmacokinetic changes occur in patients older than 60 years? Select all that apply.

Four major factors can alter drug distribution in older adults: (1) decreased concentration of serum albumin, (2) increased percent body fat,

For a drug to be a proven teratogen, which criteria must be met? Select all that apply

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 (e.g., 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. p. 85

Which statements accurately describe results of drug research in children? Select all that apply

It is true that about 30% of drugs cause unanticipated side effects, some of them potentially lethal, in the pediatric population. Traditionally, the pediatric population is subdivided into six groups: premature infants, full-term infants, neonates, infants, children, and adolescents

Which statements are true of the four primary receptor families? Select all that apply.

Norepinephrine, serotonin, histamine, and many peptide hormones act through G protein-coupled receptor systems. Insulin is an example of an endogenous ligand that acts through a cell membrane-embedded enzyme; in this receptor family, the binding of an endogenous regulatory molecule or agonist drug will activate the enzyme and increase its catalytic activity in seconds. Unlike other receptors, transcription factors are found within the cell rather than on the surface. Each ligand-gated channel is specific for a particular ion, such as calcium or sodium. The neurotransmitters acetylcholine and GABA act through ligand-gated ion channels.

Which statements are true regarding maximal efficacy and relative potency? Select all that apply.

Maximal efficacy is the largest effect that a drug can produce and potency is the amount of drug that must be administered to elicit an effect. The potency of a drug implies nothing about its maximal efficacy; potency and efficacy are independent qualities. Potency is rarely an important characteristic of a drug and is usually of no clinical concern. A drug with very high maximal efficacy is not always more desirable than a drug with lower efficacy.

What is the major neurotransmitter in the reward circuit of the brain that is related to addiction?

Molecular changes occur in the so-called reward circuit—a system that normally serves to reinforce behaviors essential for survival such as eating and reproductive activities. Their major transmitter is dopamine

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 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. Adding additional drugs promotes polypharmacy; the better solution is to substitute drugs that have fewer side effects.

Which statements are true regarding the average effective dose (ED 50) and the therapeutic index? Select all that apply.

A large (high or wide) therapeutic index indicates that a drug is relatively safe. Conversely, a small (low or narrow) therapeutic index indicates that a drug is relatively unsafe. The ED 50 is the dose that is required to produce a defined therapeutic response in 50% of the population.

A nurse is evaluating the effectiveness of a drug addiction treatment program. Which treatment programs address the complex nature of drug addiction treatment?

Because addiction is a complex illness that affects all aspects of life, the treatment program must be comprehensive and multifaceted. Techniques with proven success include group and individual therapy directed at resolving emotional problems that underlie drug use; threats and external pressure to discourage drug use; and use of pharmacologic agents to modify the effects of abused drugs. The most effective treatment programs incorporate two or more of these methods. A program with a single focus is ineffective.

The drug dobutamine acts as an agonist of norepinephrine (NE) receptors. Which effect is the nurse most likely to observe in a patient receiving this medication?

Dobutamine mimics the action of NE at receptors on the heart, thereby causing an increase (not decrease) in the heart's rate and force of contraction. It would lead to increased, not decreased, cardiac output. It does not prolong intervals on the electrocardiogram and would not cause heart block.

A teratogenic drug, such as methotrexate, is most likely to cause learning deficits during which phase of fetal development?

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 causes an "all-or-nothing" response that may result in fetal death. Exposure during the remainder of the first trimester may result in anatomic malformations.

The nurse is working on a unit in which patients regularly receive controlled substances. Which principles guide the appropriate care of patients receiving these drugs? Select all that apply.

Drugs considered controlled substances are categorized according to their potential for abuse and dependence. Each time a controlled substance is purchased or dispensed, that transfer must be recorded. Drugs in Schedule I have the highest potential for abuse. The more stringent law, whether state or federal, always takes precedence. Schedule I drugs have no approved medical uses in the United States and therefore cannot be prescribed legally.

Which statements should the nurse include when educating a breast-feeding patient about her medications? Select all that apply.

Drugs taken by lactating women can be excreted in breast milk. Most drugs can be detected in milk, but concentrations are usually too low to cause harm. If drug concentrations in milk are high enough, a pharmacologic effect can occur in the infant, raising the possibility of harm.

The nurse identifies which appropriate principle of drug addiction treatment based on the guidelines from the National Institute on Drug Abuse (1999)?

Effective treatment takes time, usually about 3 months or longer; therefore, individual needs will change. The treatment plan should be reassessed and modified regularly. No single treatment is appropriate for all individuals.

Which statement from the patient indicates psychological dependence?

In cases of psychological dependence, the patient feels an intense subjective need or craving for a particular psychoactive drug.

The nurse is meeting to review learning objectives proposed for those orientating to a clinical support role in medication sales. Which learning activity does the nurse question for compliance with the Food and Drug Administration (FDA) Modernization Act?

Publication of off-label drug use findings is permitted by the FDA Modernization Act. Entering serious side effects into the clinical trial database is required by this law. Connecting cancer patients with fast-tracked chemotherapy drugs is part of the FDA Modernization Act. Dissemination of a six-month notice from manufacturers discontinuing medication production is also a requirement of the FDA Modernization Act.

What are the provisions of the Food and Drug Administration Modernization Act of 1997? Select all that apply.

The Food and Drug Administration Modernization Act of 1997 permits the testing of new drugs in children before releasing them into the market. This helps ensure the safety of the medication in children because many drugs behave differently in children. According to this legislation, pharmaceutical companies should provide information on the cost and uses of non-U.S. Food and Drug Administration-approved drugs or "off-label" drugs in order to help regulate the cost of medications and ensure their proper usage. According to the Food and Drug Administration Modernization Act of 1997, drug companies should also notify patients and healthcare professionals 6 months before ceasing distribution of a drug. This helps prevent withdrawal symptoms in patients taking that medication. This Act does not promote the manufacture of orphan drugs and does not provide information on preventing drug dependence.

Which changes occur in the absorption process because of aging in elderly patients? Select all that apply.

The Food and Drug Administration Modernization Act of 1997 permits the testing of new drugs in children before releasing them into the market. This helps ensure the safety of the medication in children because many drugs behave differently in children. According to this legislation, pharmaceutical companies should provide information on the cost and uses of non-U.S. Food and Drug Administration-approved drugs or "off-label" drugs in order to help regulate the cost of medications and ensure their proper usage. According to the Food and Drug Administration Modernization Act of 1997, drug companies should also notify patients and healthcare professionals 6 months before ceasing distribution of a drug. This helps prevent withdrawal symptoms in patients taking that medication. This Act does not promote the manufacture of orphan drugs and does not provide information on preventing drug dependence.

What is a result of the Prescription Drug User Fee Act (PDUFA) of 1992?

The PDUFA was a response to complaints about the length of time required for approval of new drugs by the U.S. Food and Drug Administration (FDA). Under this act, drug sponsors pay fees to the FDA that are used to fund additional reviewers. The FDA then must adhere to strict turnaround times for drug review processes. There are other acts that address controlled substances, drug safety, and accelerated approval for drugs for AIDS.

The nurse is explaining to an older adult patient about age-related gastrointestinal changes that have an impact on drug action. What changes should the nurse include in the teaching?

The age-related physiologic change of the older adult patient results in delayed gastric emptying because of a decrease in peristalsis. As a result, the drug may take more time to bring about the therapeutic action.

During which gestational period is drug transfer to the fetus more likely to happen?

The drug transfer to the fetus is more likely during the last (third) trimester because of enhanced blood flow, increased fetal surface area, and increased amount of free drug in maternal circulation. The first trimester and second trimester of the gestational period are associated with less drug transfer to the fetus. The perinatal period is not a part of the gestational period.

Which actions should the nurse perform to ensure that the medication dose for a pediatric patient is correct? Select all that apply.

The patient's weight needs to be in kilograms, not pounds. All other information listed is correct and must be followed by the nurse to ensure the correct pediatric dosage.

Which factors are involved in the physiological changes that affect drug absorption among older adults? Select all that apply.

The reduced rate of medication among older adults is partly explained by reduced gastric acidity, delayed gastric emptying, and reduced splanchnic blood flow.

The nurse administers 100 mg of a drug by mouth. After the drug moves through the hepatic system, very little active drug is left in general circulation. What concept explains this occurrence?

The term first-pass effect refers to the rapid hepatic inactivation of certain oral drugs. Drugs that undergo the first-pass effect often are administered parenterally. The therapeutic range is the range of drug level between the minimum effective concentration and the toxic concentration. The drug half-life is the time required for the amount of drug in the body to decrease by 50%. Plasma protein binding is involved with the transport of drugs through the bloodstream.

Which concept guides the nurse's care of infants receiving a variety of medications?

The very young are at risk for drug effects that are more intense and prolonged than those seen in adults. Drugs given subQ 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, increasing the risks of absorption and toxicity within the central nervous system.

The nurse is caring for an adult patient who is prescribed a medication as an injection because it has extensive first-pass metabolism. What happens when a drug is affected by first-pass metabolism? Select all that apply.

When some medications are administered orally, the drug goes from the intestinal lumen to the liver via the hepatic portal vein. This process is called the first-pass effect or hepatic first pass. First-pass metabolism takes place in the liver, where the drug is metabolized to an inactive form that is excreted. This reduces the amount of active drug. Prodrugs are converted to their active form.

A nurse is administering two protein-bound drugs to a patient. Which is the safest course of action for the nurse to take?

When two protein-bound drugs are given concurrently, they compete for protein-binding sites, thus causing more free drug to be released into circulation. In this situation, drug accumulation and possible drug toxicity can result. Also, a low serum protein level decreases the number of protein-binding sites and can cause an increase in the amount of free drug in the plasma. Drug toxicity may then also result. Drug dose is prescribed according to the percentage of the drug that binds to protein.

According the Food and Drug Administration (FDA) Pregnancy and Lactation Labeling Rule, which content is considered part of the clinical considerations subsection? Select all that apply.

all except special treatment with multiple birth