NR 406 Exam 1

First Pass Effect

The process in which a drug passes first through the liver after absorption

Define medication peak

The time it takes following administration of a drug to reach its highest blood concentration

Half life

The time it takes for one half of the drug concentration to be eliminated

What is P-Glycoprotein

Transports drugs out of cells

True or False: A person who is severely dehydrated will have a decrease in blood flow to the kidneys. This results in a decreased GFR and possible drug accumulation (toxicity).

True

True or False: Because children's skin is thinner than adults, absorption of topical creams will be enhanced.

True

True or False: Cost of meds is often a factor in nonadherence related to meds. Older adults often do not have the financial means to pay for meds.

True

True or False: Older adults are twice as likely as younger adults to visit the ED with adverse drug events and are seven times as likely to be hospitalized.

True

True or False: Polypharmacy refers to the use of more meds than in medically necessary. This is common in early adults. Can lead to confusion, falls, poor nutrition, nonadherence.

True

True or False: The calculation of pediatric med dosages is often done using dose per unit of weight calculation. Med dose determined by pt weight or body surface area

True

Are generic drugs approved by the FDA? If so, what criterium is required to say that a Generic Drug is equivalent to the original agent?

Yes. 80-125% of the brand drug

Adverse effect

secondary effect of the drug. Always undesirable.

Tolerance

A decrease in the responsiveness of the drug over the course of therapy

Toxic Effect

Adverse drug reaction from excessive dosing of the drug

Metabolism

Also call biotransformation, Altering drug structure accomplished by enzymes

Which of the following are accurate statements regarding the distribution of meds in children? Select all that apply. a. infants BBB is fully developed at birth and blocks most meds from entering CNS b. Neonates and young infants have greater amount of adipose tissue than do older children. Because of this, neonates require larger doses of meds that are fat soluble c. Until age 2, peds pts need higher doses of water soluble meds to reach theraputic levels d/t increase in body fluid proportion. d. infants and neonates have less albumin and fewer protein receptor sites than older pts. Leads to decrease in dosages needed in young pts to achieve theraputic levels

CD

Absorption

Movement of a drug from the site of administration into the blood stream

Excretion

Movement of the drug and their metabolites out of the body

Bioavailability

Percentage of the administered drug dosage that reaches the blood stream (systemic circulation) and is available for activity.

Side effect

Predictable secondary effect of the drug. Can be desirable or undesirable.

Placebo effect

Psychological benefit of a drug despite no chemical drug effect

What are the six rights of medication administration

Right... patient drug dose time route documentation

Therapeutic range (index)

An estimate of the margin of safety of a drug

Pharmacokinetics included the basic processes of: Select all the apply. A. Excretion B. Metabolism C. Distribution D. Absorption E. Disintegration F. Dissolution

ABCD

Which of the following are appropriate nursing considerations when administering medications to the pediatric patient? Select all that apply A. Allowing the pre-school aged child some level of choice and control will enhance cooperation with medication administration. B. Toddlers may react violently to medication administration. The nurse may use creative strategies such as imagination through play therapy to successfully administer the medications. C. When administering an oral medication to a child using an oral syringe, the nurse should point the syringe and administer the medication directly toward the back of the mouth. D. Most medications are administered via the oral route to children. The intravenous (IV) route is contraindicated (never used) in children because of safety considerations.

ABCD

Which of the following are true statements regarding protein binding? Select all that apply. A. An elderly pt or one who is malnourished may have a decreased serum albumin level. According to your text, the nurse must understand the concept of protein binding and monitor their patient's albumin levels when administering meds. B. Furosemide is a 95% protein bound drug. This means that 95% of drug is bound to protein and 5% of drug is free C. Warfarin is a highly protein bound drug D. It is only the bound drug that will be able to create a pharmacologic response. The free drug has no pharmacological action E. When two drugs are given together that are both highly protein bound drugs, the patient is at greater risk of drug accumulation (drug toxicity).

ABCE

Which of the following statements are accurate regarding absorption of meds? Select all that apply. A. Nonionized substances pass easily through the GI membrane B. Lipid soluble meds absorb easily through the GI membrane because the GI membrane is composed mostly of lipids C. Active transport occurs primarily through diffusion. Active transport does not require energy to move drugs across the membrane D. Water soluble meds require a carrier to pass through the GI membrane (active absorption).

ABD

Drugs pass from site to site in the body by (Select all that apply) a. Flying in an aircraft designed for transport b. Directly penetrating the membrane c. with the assistance of a carrier d. passing on the outside of the cell membrane e. running real fast

BCD

Which of the following are physiologic changes commonly seen in the older adult? Select all that apply. A. Increase in peristalsis and faster gastric emptying thus enhancing absorption B. Decrease in blood flow to the kidneys thus a decrease in GFR. Leads to decrease med excretion C. Gastric secretions become more acidic thus absorbing medication more rapidly D. Decrease in hepatic enzyme function thus reducing and slowing metabolism of medications

BD

The normal half-life of Ibuprofen is 2 hours. Which one of the following is a true statement regarding the administration of 400 mg Ibuprofen. a. Expect 90-95% of Ibuprofen would be cleared from the body in 4 hours (2 half lives) b. The half-life of ibuprofen would be decreased in the pt with liver or renal disease. The drug would be metabolized and eliminated faster than expected c. Normally, the nurse would expect that 50% (200mg) of the ibuprofen would remain in the pt 2 hours following administration. d. Because ibuprofen has a long half-life, the drug will remain in the systemic circulation for days following administration.

C

Distribution

Drug movement from the blood to the body tissues

Agonist

Drug that creates a response

Antagonist

Drugs that block a response

True or False: BBB is a semipermiable membrane that protects the brain from foreign substances such as meds. Drugs that are water soluble will easily cross the BBB, whereas drugs that are lipid soluble cannot pass into the CNS

False

True or False: Children have higher metabolic rates than adults and thus require lower dosages of meds or less frequent meds compared to adults

False

True or False: Older adults have an increase in protein binding sites for meds. Thus there is a decrease in circulation of free drug and a subsequent need for dosage increase.

False