Pharm quiz 2

When do adverse drug reactions occur more often? [Select all that apply] A. When a drug error occurs. B. When patients take potent drugs. C. When patients are younger than 1 year old. D. When patients have multiple chronic illnesses. E. When patients take multiple drugs.

C, D, E

A patient is prescribed abacavir [Ziagen] to treat human immunodeficiency virus (HIV) infection. To reduce the potential fatal hypersensitivity reaction, what action will the nurse take prior to initiating abacavir drug therapy? Administer a test dose Obtain liver function studies Assist with drug skin testing Check results of genetic screening

Check results of genetic screening Gene variants that affect the immune system can increase the risk of severe hypersensitivity reaction to the drug abacavir [Ziagen]. The U.S. Food and Drug Administration (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.

A patient who takes oral contraceptives is prescribed phenobarbital. Both drugs are known to induce cytochrome P450 (CYP) isoenzymes. What patient teaching should the nurse provide? "Continue taking your medications as prescribed." "Plan to use another form of birth control while taking phenobarbital." "Condoms are not necessary while taking phenobarbital. It is not an antibiotic." "Your dose of birth control pills will be reduced while you are taking phenobarbital."

"Plan to use another form of birth control while taking phenobarbital." Phenobarbital induces cytochrome P450 (CYP) isoenzymes that act on oral contraceptives; therefore, it will increase the metabolism of these drugs resulting in decreased blood levels. The patient should use another form of birth control while taking phenobarbital.

A patient who is breast-feeding her newborn infant is prescribed an antibiotic to take after discharge. Which statement should the nurse include when providing discharge instructions? 1. "Drink plenty of fluids to dilute the drug in your breast milk." 2. "Take the drug at night with a full glass of water." 3. "Pump your breasts, and then discard all of the milk." 4. "Take the antibiotic immediately after breast-feeding."

"Take the antibiotic immediately after breast-feeding."

The nurse is caring for a patient who has been prescribed a nonsteroidal anti-inflammatory drug (NSAID). The patient is also taking warfarin. How does taking these drugs in combination affect their distribution to the tissues? Select all that apply. 1. There is a decrease in gastric emptying time. 2. There is an increase in the volume of distribution. 3. There is a decrease in protein binding of the drugs. 4. There is an increase in free drug levels in the plasma. 5. There is a change of the drugs to passive metabolites.

2,3,4 Both the anticoagulant warfarin (Coumadin) and nonsteroidal anti-inflammatory drug (NSAIDs) are highly protein-bound drugs. They compete to bind with proteins in the plasma. This results in a decrease in protein binding for one or both drugs, which affects the distribution of the drugs. A large amount of free drug is released in the plasma leading to an increase in the volume of distribution. This increases the anticoagulant effect of warfarin (Coumadin), which can result in excess bleeding. Certain drugs, when taken together with a second drug, can block, increase, or decrease the rate of absorption of one or both drugs by increasing or decreasing gastric emptying time; however, neither warfarin nor NSAIDs have the effect of decreasing gastric emptying time. When drugs interact in the liver during the metabolism or biotransformation phase, they may be changed to passive or active metabolites.

An older adult with liver disease is receiving several drugs that are normally highly protein bound. The patient's serum albumin is 2.8 mg/dL (normal 3.5 to 5 mg/dL). The nurse is most concerned about: A. Excessive action of the drugs. B. Drug adherence. C. Malnutrition. D. Inadequate action of the drugs.

A Feedback: Reduced concentration of serum albumin can alter drug distribution in older adults. Due to reduced albumin levels, sites for protein binding of drugs decrease, causing levels of free drug to rise. As a result, drug effects may be more intense.(Lehne pg 92)

There are multiple factors that affect medication response. The nurse recognizes which factors as having a possible effect on medication response? Select all that apply. A. Body composition B. Sexual orientation C. Level of education D. Genetic influences E. Use of alternative therapies F. Patient compliance with therapy

A, c, d, e, f Many factors influence medication response for various reasons. There are data that demonstrate the impact of genetic factors on drug response. A patient's age, gender, size, and body composition can also have an effect on drug response. Medication response depends greatly on the level of the patient's compliance with the therapy regimen. Yet, compliance may vary depending on the patient's cultural beliefs, experiences with medications, personal expectations, family expectations and influence, and level of education. Prescribers must also be aware that some patients use alternative therapies such as herbal and homeopathic remedies that can inhibit or accelerate drug metabolism and therefore alter a drug's response. A patient's sexual orientation does not influence medication response.

A 2-year-old child is prescribed an oral drug that is eliminated by metabolism in the liver. Based on the child's age, the nurse would expect to make which adjustment? a. The drug may need to be administered more frequently. b. The dosage of the drug may need to be decreased. c. The route should be changed from oral to intramuscular. d. The drug should be administered on an empty stomach.

A, they metabolize drugs quickly so we may need to give the drug more often

Based on the physiologic changes in the hepatic function of older adult patients, which adjustment should the nurse expect for oral medications that undergo extensive first pass metabolism? A. A higher dose should be used with the same time schedule. B. The interval between doses should be increased. C. No change is necessary; metabolism will not be affected. D. The interval between doses should be reduced.

B Feedback: The interval between doses should be increased. Rationale: The hepatic function of older adults begins to decline with age, reducing its metabolic capacity. Therefore, a drug that might normally be rapidly metabolized in first pass, may not be effectively metabolized due to reduced hepatic function leaving more active drug in the plasma. One way to address this, is to allow more time between doses for the liver to metabolize.

Which of the following P450 cytochrome families are most commonly associated with metabolism of OTC drugs? [select all that apply] A. CYP2F9 B. CYP2D6 C. CYP3A4 D. CYP3B4

B, C Feedback: CYP2C9, CYP2C19, CYP2D6 and CYP3A4 are involved in the metabolism of 80% of OTC medications. [refer to pharmacogenetics lecture from 2-15]

The nurse is administering medication to an older adult with altered renal function. This patient's renal system will likely have which effect on the medication? A. The medication will be excreted quicker. B. The medication will be metabolized quicker. C. The medication will be excreted more slowly. D. There will be no change in how the medication will be excreted.

C Feedback: Due to a decrease in renal function, older adults excrete drugs more slowly than younger patients. Metabolism and excretion is not increased in older adults.

Which types of drugs taken by a pregnant patient are most likely to have effects on a fetus? A. Protein-bound drugs B. Drugs that are highly polar. C. Lipid-soluble drugs D. Ionized drugs

C Feedback: Lipid-soluble drugs cross the placenta readily, whereas drugs that are ionized, polar, or protein bound cross with difficulty. (Lehne pg 86)

An older adult patient frequently forgets to take an oral medication that has been prescribed to be taken three times per day. Which action by the nurse is best? Assess the patient's ability to swallow the medication. Arrange for a neighbor to call the patient three times a day. Call the prescriber for a sustained-release form of the drug. Give the patient verbal and written instructions about the drug.

Call the prescriber for a sustained-release form of the drug.

Which concept guides the nurse's care of infants receiving a variety of medications? 1. The blood-brain barrier protects the infant's brain from toxic drugs. 2. Gastric emptying time is shorter in infants than in children and adults. 3. Drugs given intravenously (IV) leave the body more quickly in infants than in adults. 4. Drugs given subcutaneously (SC) remain in the body longer in infants than in adults.

Drugs given subcutaneously (SC) remain in the body longer in infants than in adults. The very young are at risk for drug effects that are more intense and prolonged than those seen in adults. Drugs given subcutaneously (SC) reach higher levels and remain in the system longer than in adults. Drugs given intravenously (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.

When assessing for drug effects in the older adult, which phase of pharmacokinetics is the greatest concern? Excretion Absorption Distribution Metabolism

Excretion, Although pharmacokinetic changes in older adults affect all phases of kinetics, drug accumulation secondary to reduced renal excretion is the most important cause of adverse drug reactions in the older adult.

Which science provides primary healthcare providers the opportunity to individualize drug therapy based on a patient's genetic makeup? 1. Pharmacokinetics 2. Pharmacogenetics 3. Pharmacodynamics 4. Pharmacogenomics

Pharmacogenomics Pharmacogenomics is a science that involves pharmacology and genomics and gives primary healthcare providers an opportunity to individualize drug therapy based on a patient's genetic makeup instead of giving a standard drug to all patients. Pharmacogenetics is the study of genetic variation in drug response and focuses on single gene variations. Pharmacodynamics refers to the physiological effects of a drug in the body. Pharmacokinetics refers to the study of what the body does to a drug.

The nurse is caring for a patient who has a respiratory rate of 6 breaths/min following a large dose of pain medication. Which term most accurately describes this reaction? Toxicity Side effect Allergic reaction Idiosyncratic effect

Toxicity is the degree of detrimental physiologic effects caused by excessive drug dosing. A side effect is a nearly unavoidable secondary drug effect produced at a therapeutic dose. An allergic reaction is an immune response. An idiosyncratic effect is an uncommon drug response resulting from a genetic predisposition.

Which questions will a nurse ask in order to obtain information that is important for the medication history? Select all that apply. Do you use any herbal supplements during the day? How many alcoholic drinks do you consume in a day? What kind of food do you prefer to eat when dining out? How often do you visit your family members and friends? How often do you take over-the-counter products for common ailments?

When eliciting a patient's drug history, the nurse should ask questions related to the use of herbal supplements, alcohol, and over-the-counter (OTC) drugs. Asking questions about herbal supplements helps the nurse to know whether the patient needs to change any current drugs or whether any teaching is needed for safe use. All can cause interactions with selected drugs. Alcohol may affect the metabolism of many OTC drugs and herbs; therefore, it is important to know whether the patient takes alcohol with these drugs. The frequency of OTC drugs is important to decide whether the patient is using them safely. Asking about family and friends and food preferences may not be helpful in describing the patient's use of OTC medications.

Which statements by a student nurse about the effect of pregnancy on medication action indicate effective learning? Select all that apply. A. "There is increased gastrointestinal motility during pregnancy." B . "The liver decreases metabolism of medications during pregnancy." C . "The maternal circulating blood volume concentrates the medications." D. "There is a more rapid renal excretion of medications during pregnancy." E . "The serum and tissue concentrations of the medications decrease during pregnancy."

d, e The serum and tissue concentrations of medications decrease during pregnancy because of an alteration in the clearance of the medications. There is also a more rapid excretion of medications during pregnancy due to an increased glomerular filtration rate and an increase in renal perfusion. The expanded maternal circulating blood volume during pregnancy results in the dilution of medications. There is reduced gastrointestinal motility due to the hormonal changes during pregnancy. For some drugs, hepatic metabolism increases during pregnancy.

Premature and newborns are at risk for what kind of response to drugs? A. Intense and prolonged response B. Intense but short lived response C. Inadequate and short-lived response D. Inadequate but prolonged response

A

A prescriber has ordered a medication for a newborn. The nurse caring for the newborn knows that the medication is eliminated primarily by hepatic metabolism, so she/he would expect the prescriber to: A. Order a dose that is lower than an adult dose. B. Order a dose that is higher than an adult dose. C. Discontinue the drug after one or two doses. D. Increase the frequency of medication dosing.

A Feedback: The drug-metabolizing capacity of neonates is low, so neonates are especially sensitive to drugs that are eliminated primarily by hepatic metabolism. (Lehne pg 91)

You are caring for a patient in the ER who is being treated for a fractured ankle. Codeine has been ordered every 4-6 hours for this patient. You are about to administer a second dose when you review her chart and see that she is an ultrarapid metabolizer of codeine. Knowing this, you would take which action? A. Hold the dose and notify the prescriber. B. Call the provider and suggest a higher dose. C. Administer the drug as ordered. D. Change the order to oxycodone.

A Feedback: Ultrarapid metabolizers carry two or more copies of the functioning allele responsible for metabolizing the prodrug codeine into morphine. Because ultrarapid metabolizers metabolize codeine faster and more completely into morphine, more drug ends up in the plasma and increases the risk for toxicity among individuals with this phenotype. [refer to pharmacogenomics lecture from 2/15]

A nurse is teaching a group of nursing students about adherence to medication in older adults. Which statement by the student indicates an understanding of the teaching? A. "The majority of older patients who do not adhere to drug regimens do so intentionally." B. "Most issues associated with nonadherence among older adults would be resolved with simplified drug regimens." C. "Inability to pay for medications contributes to most intentional nonadherence among older adults." D. "Nonadherence in older adults always results in drug toxicity and adverse drug effects."

A Feedback: Correct: "The majority of older patients who do not adhere to drug regimens do so intentionally." Rationale: About 75% of non adherence in older adults is intentional, with most citing that they don't believe the drug is necessary. [p 95] Incorrect: "Most issues associated with nonadherence among older adults would be resolved with simplified drug regimens." Rationale: there are many factors beyond the complexity of a drug regimen that contribute to an older adult's non intentional adherence such as financial difficulties, or intellectual or physical impairment. As nurses, we should be alert to these contributing factors and be certain that we question our patients about the reasons they may not be adhering to a prescribed regimen. [pg. 94]

What is an important role for a nurse when a pregnant patient has an exposure to a known teratogen during week 4 of the pregnancy? A. Providing information and emotional support. B. Recommending termination of pregnancy if a severe malformation is detected. C. Ordering an ultrasound. D. Providing the diagnosis from the ultrasound to the parents.

A Feedback: Fetal sensitivity to teratogens changes during development, and the effect of a teratogen is highly dependent upon when the drug is given. The embryonic period (first trimester) is weeks 3 to 8, and gross malformations are produced by exposure to teratogens during this period. This is the time when the basic shape of internal organs and other structures is being established. The fetus is especially vulnerable during the embryonic period. (Lehne pg 82)

A pediatric nurse is teaching nursing students about medication administration in children. Which statement by a student indicates an understanding of the teaching? A. "Drugs effective in adults may not work in children, even if the dose is proportional for weight and size." B. "Side effects of drugs in children are similar to side effects of drugs in adults." C. "Infants metabolize drugs more quickly than do older children and adults." D. "The known differences in drug effects in children versus those in adults are related to the size of the patient."

A Feedback: Pediatric patients are vulnerable to unique adverse effects related to organ system immaturity and to ongoing growth and development. Pediatric doses—whether based on established pediatric doses or extrapolated from adult doses—are approximations. Future doses are adjusted especially in neonates and younger infants due to clinical outcome and plasma drug concentrations. The patient should be monitored for therapeutic and adverse responses. (Lehne pg 90)

Which of the following explains why neonates and infants are more sensitive to drugs that affect central nervous system (CNS) function? A. The blood-brain barrier is not fully developed at birth. B. The blood-brain barrier is weakened significantly by the birth process. C. The blood-brain barrier is especially strong in infants. D. The blood-brain barrier does not exist until 1 year of age.

A Feedback: The blood-brain barrier is not fully developed at birth. The other statements are not true.

The nurse working with elderly patients is concerned about the number of medications each patient is taking. Which should the nurse assess as the highest priority for the patients related to polypharmacy? A. Drug interactions B. Nonadherence to drug regimen C. Cost of medications D. Schedule of medications

A Feedback: The highest priority for patients with multiple medications (polypharmacy) is the assessment for drug interactions. The more medications a patient takes, the higher is the risk of drug interactions.

When providing patient teaching regarding breastfeeding, the nurse should be sure to include which information? [SELECT ALL THAT APPLY] A. Avoid drugs that have a long half-life. B. Use sustained-release formulas of drugs. C. Take drugs immediately after breastfeeding. D. Avoid taking all drugs while breastfeeding.

A, C Feedback: If the nursing patient can avoid drugs, she should. However, when drugs must be used, the following steps should be taken to minimize risk: Dosing immediately after breast-feeding; avoiding drugs that have a long half-life; avoiding sustained-release formulations; choosing drugs that tend to be excluded from milk; and choosing drugs that are least likely to affect the infant. (Lehne pg 86)

Little is known about the way drugs impact pregnancy. Which of the following factors contribute to this gap in our knowledge? (Select all that apply) A. Drugs are not typically tested on pregnant women. B. Animals may not respond the same way to a drug that humans will. C. The long term effects of drugs are not always known.

A, b, c We cannot do experiments on humans to see if a drug meets the criteria for a teratogenic. The best we can do is systematically collect and analyze data on drugs taken during pregnancy in the hope that useful information on teratogenicity will be revealed. Studies in animals may be of limited value, in part because teratogenicity may be species-specific. (Lehne pg 84)

Which patient does the nurse identify as being at highest risk for the development of an adverse drug reaction? - A 1-month-old patient whose mother has allergies to penicillin, aspirin, and codeine - A 16-year-old patient with multiple traumatic injuries who is taking morphine and an antibiotic - A 54-year-old patient with multiple sclerosis who has been enrolled in a clinical trial of a new drug - An 84-year-old patient with diabetes, heart failure, and hypertension who takes seven prescription medications each day

An 84-year-old patient with diabetes, heart failure, and hypertension who takes seven prescription medications each day

Grapefruit juice inhibits the CYP ___ isoenzymes. For someone with very little of this metabolizing enzyme, this could result in a large ______ in the drug concentration of the plasma.

Answer Key: 3A4, increase Feedback: Grapefruit juice inhibits CYP3A4 and raises drug levels by inhibiting metabolism. In patients with very little CYP3A4, inhibition by grapefruit juice may be sufficient to stop metabolism completely. As a result, large increases in drug levels may occur. (Lehne pg 59)

If a patient takes a teratogenic drug during the embryonic stage of pregnancy, _____________ malformations may occur. However, if a patient takes a teratogenic drug during the fetal period, ________________ anomalies are more likely to occur. A. neurobehavioral; lethal B. gross physical; neurobehavioral C. neurobehavioral; gross physical D. lethal; gross physical

Answer Key: B Feedback: Embryonic Period (3-10 weeks): Gross malformations are produced by exposure to teratogens. This is the time when the basic shape of internal organs and other structures is being established. The fetus is especially vulnerable during the embryonic period. Fetal period (10-40 weeks): Teratogen exposureusually disrupts function rather than gross anatomy. Of the developmental processes that occur in the fetal period, growth and development of the brain are especially important. (Lehne pg 82)

A patient is prescribed a medication that is potentially hepatotoxic. Before administering the medication, it is most important for the nurse to assess what? A. Blood urea nitrogen and serum creatinine B. Aspartate aminotransferase and alanine aminotransferase C. Prolonged QT interval on the electrocardiogram D. Serum potassium, serum sodium, and serum magnesium

Answer: B Rationale: Hepatotoxic means that it can be damaging to the liver. The nurse should assess the liver function tests of patients who are taking hepatotoxic drugs. When liver cells are injured, two liver enzymes (aspartate aminotransferase [AST] and alanine aminotransferase [ALT]) will be elevated.

Which statement about drug use among older adults is true? A. Older patients are less sensitive to drugs than younger adults. B. Drug use among older adults is disproportionately high. C. Older adults require higher doses of most drugs. D. Older adults experience fewer adverse drug reactions.

B Feedback: 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.

Which of the following best defines a drug-drug interaction that is "potentiative"? A. A combination of two drugs resulting in a new response. B. One drug intensifies the effect of another. C. One drug broadens the effect of another. D. One drug reduces the effect of another.

B Feedback: When a patient is taking two medications, one drug may intensify, or potentiate, the effects of the other. This type of interaction is often termed potentiative. Potentiative interactions may be beneficial or detrimental. Examples of beneficial and detrimental potentiative interactions follow. [Lehne, p. 55]

A 16 year old adolescent is 6 weeks pregnant and the pregnancy has exacerbated her acne. She asks the nurse if she can resume taking her acne medication known to be a category X drug. What is the best response by the nurse: A. "Since you already have a prescription, you may resume taking it." B. "This medication is known to cause birth defects so it shouldn't be taken during pregnancy." C. "You should check with your healthcare provider at your next visit." D. "You should be ok if you take half the dose."

B Feedback: Drugs should always be used with caution during pregnancy due to potential harm to the developing fetus. Category X drugs are known to be teratogenic in pregnancy and therefore should not be used.

Before administering lovastatin [Mevacor], a drug known to be toxic to the liver, the nurse reviews a patient's laboratory tests. The tests include elevated alanine aminotransferase (ALT) and aspartate aminotransferase (AST) levels. Which action taken by the nurse is most appropriate at this time? A. Assess vital signs, and if stable, administer the drug. B. Hold the dose and contact the prescriber. C. Administer the drug as ordered. D. Hold the drug and ask provider to increase the dose.

B Feedback: The nurse is administering a drug that is known to be toxic to the liver. Knowing this, the nurse should assess liver function before administering the drug in order to reduce the likelihood of ADRs. This patient has elevated liver enzymes indicating possible hepatic impairment, so the nurse should hold the dose and contact the provider.

When evaluating kidney function in the older debilitated adult, it is a priority for the nurse to review the results of which test? A. Serum blood urea nitrogen (BUN) B. Serum creatinine. C. Creatinine clearance. D. Renal ultrasound.

C Feedback: Renal function, and hence renal drug excretion, undergoes progressive decline beginning in early adulthood. Drug accumulation secondary to reduced renal excretion is the most important cause of adverse drug reactions in older adults. For older adults, the proper index of renal function is creatinine clearance, instead of serum creatinine because the source of creatinine declines with kidney function. Creatinine levels may be normal even though renal function is greatly reduced. (Lehne pg 92)

A mother of a 1-month-old infant calls the clinic and asks the nurse if the medication she is taking can be passed to her infant during breast-feeding. What is the appropriate response for this patient? A. "Only certain medications pass to infants while breast-feeding." B. "I will leave the doctor a message to return your call." C. "Drugs can cross from mother to infant in breast milk, so it will depend on the drug you are taking." D. "You should not take any medication while breast-feeding."

C Feedback: The nurse is aware that medications can pass in breast milk, but each medication is different. Women who take medication while breast-feeding should be assessed on a case-by-case basis, including assessment of the medication the patient is taking.

The nurse is assessing an 82-year-old patient before the administration of medications. Which laboratory result would provide the best index of renal this patient's function? Serum creatinine Blood urea nitrogen Urinalysis Creatinine clearance

Creatinine clearance

Which of the following is the best way for a nurse to minimize and prevent adverse drug reactions in the clinical setting? A. Enlist another nurse to watch for ADRs. B. Inform the patient about potential ADRs before being discharged. C. Monitor the patient following administration of the drug. D. Anticipate ADRs that a drug can produce before administration of the drug.

D Feedback: Anticipating ADRs can help minimize them. Nurses and patients should know the major ADRs that a drug can produce. This knowledge allows early identification of adverse effects, thereby permitting timely implementation of measures to minimize harm. [Lehne, p. 66]

An infant has allergies and often develops a pruritic rash when exposed to allergens. The infant's parents ask the nurse about using a topical antihistamine. What should the nurse tell them? A. The child will also need oral medication to achieve effective results. B. Antihistamines given by this route are not absorbed as well in children. C. Topical medications have fewer side effects than those given by other routes. D. Applying an antihistamine to the skin can cause toxicity in this age group.

D Feedback: Drug absorption through the skin is more rapid and complete in infants than in older children and adults. 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. (Lehne pg 89)

An older patient has arthritis in her hands and takes several prescription drugs. What statement by this patient requires further assessment by the nurse? A. "I can fill my prescriptions once a month." B. "My arthritis medicine helps the stiffness in my hands." C. "I care for my 2 year old grandson once a week." D. "I sometimes have difficulty opening the child-proof caps of my pill bottles."

D Feedback: Older patients may be unintentionally non-adherent to their medication regimen putting them at risk for ADRs and therapeutic failure. This patient is arthritic and has potential issues with dexterity that may prevent her from adhering to her drug regimen. The nurse should further assess the patient's dexterity and provide suggestions for improving access to her medication such as twist off caps.

A nurse is caring for a patient in the ER and has just administered codeine for pain. Two hours later, the patient asks for more pain medication stating, "it feels like the codeine hasn't touched the pain." The nurse suspects that the patient is most likely which type of metabolizer? A. Intermediate metabolizer B. Extensive metabolizer C. Ultrarapid metabolizer D. Poor metabolizer

D Feedback: Poor metabolizers lack the functioning alleles needed to metabolize the prodrug codeine into morphine. Therefore, the patient who is a poor metabolizer will experience little to no relief when given codeine. [refer to pharmacogenomics lecture on 2/15]

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] A. Increase in lean body mass B. Reduction in body fat content C. Increase in protein-binding sites D. Decreased serum albumin E. Relative increase in body fat

D, E

Toxic dose-related adverse drug reactions (ADRs) may occur as a result of which of the following? [Select all that apply] A. Drug-drug interactions. B. Age. C. Renal or hepatic impairment. D. Existing underlying illness.

a.b.c.d