Pharmacology Midterm

Which site is the major site of drug excretion?

Kidney (urine)

Which of the following statements is TRUE regarding steady-state (or plateau concentration)? ~Administering drugs by continuous infusion will reduce the fluctuation in drug levels. ~Steady state is when the amount of drug eliminated between doses is greater than the dose administered ~When a drug is administered repeatedly in the same dose, steady-state will be reached in approximately 3 half-lives

Administering drugs by continuous infusion will reduce the fluctuation in drug levels.

True or False. Reversibility is almost always possible with a drug administered intravenously.

False.

True or False. Drug Z induces enzyme production in the liver; clinically this means that after two weeks or so, there will be an increased amount of drug Z available to perform the therapeutic effect.

False. more enzymes means more breakdown leading to less drug

True or False. The objective of drug dosing is to maintain plasma drug levels slightly above therapeutic range.

False. you want levels within the range

Which medication order is MISSING an ESSENTIAL piece of information? ~Heparin 5000 units every 8 hours ~AmLODIPine 10 mg PO daily ~Atorvastatin 40mg PO daily ~Ertrapenem 1g IVPB every 24 hours

Heparin 5000 units every 8 hours. Doesn't give ROUTE.

Which of the following routes of administration IS NOT affected by the 'first pass' effect? ~intramuscular ~nasogastric tube feedings ~oral ~percutaneous gastric tube

IM is not effected by first pass effect

What does this abbreviation mean? IM

Intramuscular injection

Which of the following is NOT a "right" of drug administration? Right Nurse Right Patient Right Drug Right Dose Right Route Right Time Right Documentation

Right Nurse - is NOT a right.

What does this abbreviation mean? PO

by mouth

All of the following are disadvantages of the IV route of drug administration EXCEPT: ~incomplete absorption ~difficult to correct overdose or errors in delivery ~difficult to self administer ~need for asepsis with administration

incomplete absorption is not a disadvantage.

An effective drug is one that ___________?

induces the intended therapeutic response.

What is the meaning of efficacy?

is an index of the maximal response a drug can produce

What does this abbreviation mean? subcut

subcutaneous

What is the meaning of agonist?

the body's own regulatory molecules (neurotransmitters, hormones, and other signaling/regulatory molecules) that normally

Definition of absorption

the movement of a drug from its site of administration into the bloodstream

Definition of Distribution

the movement of the drug from the blood to the interstitial space, to and from cells, and back into bloodstream

A young adult is in clinic with you today and receives a prescription for the following antibiotic: Doxycycline 100 mg orally twice a day for 7 days. He asks you where he should store the medication between doses. Of the following possible responses, which is the best response by the nurse? "A good place to store medications is __________________________ ."

... in a cool, dry place where you will remember to take it. Would a drawer in the bedside table work for you?

What is the meaning of intrinsic activity?

Ability of the drug to activate a receptor upon binding

If a person inhaled one puff of medication, waited 5 minutes and then took another puff, what would be the total dose inhaled by patient?

180mcg

What is the meaning of antagonist?

A drug that blocks-prevents other molecules from binding to the receptor.

Which of the following regarding therapeutic index is FALSE? ~A drug with a therapeutic index of 5 is safer than a drug with a therapeutic index of 20 ~is an index of drug safety ~The ED50 is considered to be the standard dose and frequently used for initial dosing of the medication ~For a drug to be relatively safe, the highest dose required to produce therapeutic effects should be substantially lower than the lowest dose capable of causing death

A drug with a therapeutic index of 5 safer than a drug with a therapeutic index of 20 (you want a high index)

What is the meaning of affinity?

Degree of attraction of the drug to bind to its receptor

What is the meaning potency?

Dose of drug needed to produce an effect compared with the dose of another drug

Which statement is FALSE? ~Drugs only bind to receptors if the drug is potent ~Receptors may be located in the cell membrane surface or intracellularly ~Receptors serve as normal/usual points of physiologic control ~When a drug binds to a receptor it either ACTIVATES or BLOCKS the receptor

Drugs only bind to receptors if the drug is potent. This is False. Drugs will bind even if low potency.

True or False. A drug is defined by U.S. law as "any substance (other than food or device) intended for use in the diagnosis, cure, relief, treatment, or prevention of disease or intended to affect the structure or function of the body.

TRUE

True or False. Drug therapy should ALWAYS consider individual patient-specific factors such as age, pregnancy/lactation, body size, history of allergic rxns, co-morbid illnesses, liver and renal function.

TRUE

True or False. In the human body, each type of receptor participates in the regulation of just a few processes.

TRUE

True or False. "Inducing agents" refer to drugs (or other substances) that induce synthesis of enzymes in the cytochrome P450 system

True

True or False. Enzyme inhibition happens relatively quickly, whereas it can take quite a few days until the effect of an inducing agent develops.

True

True or False. Genetic variants exist for many cytochrome P450 enzymes; one important example of variation is the amount of activity of the CYP3A4 group of enzymes.

True

True or False. Metabolic enzyme "inhibition" occurs when a drug binds to the enzyme and decreases its activity.

True

True or False. Pharmacogenomics will serve increasingly important roles in drug therapy in the future.

True

True or False: Cytochrome P450 3A4 is responsible for the metabolism of more than 50% of medicines

True

True or False: Drug A has greater efficacy than Drug B. This means that no matter how much of Drug B is administered to the patient, it will not have the same amount of therapeutic effect as Drug A.

True

When discussing drug with another health professional, the nurse will use the drug name ______ to avoid confusion?

albuterol sulfate

Definition of metabolism

also known as biotransformation, enzymatically mediated alteration of drug structure

A patient used opioid drugs for post-operative pain, and the pain has now completely resolved. He wants to know how he should dispose of the remaining tablets in the container. Of the following possible responses, which response is the best response by the nurse?

You can mix them with kitty litter or coffee grinds and throw them in the trash.

Due to the low amount of blood flow to the tissue, it is hard to effectively treat _______________________

abscesses and solid tumors

What is a disadvantage to topical?

may be irritating, may cause local rash

What is a disadvantage to IM?

may cause pain or bleeding

Definition of excretion

movement of drugs and their metabolites out of the body

A parent is told to give 5 mL of Drug Y to his child each morning after breakfast for the next two weeks and then come back to clinic. To help the parent understand how much "5 mL" is, the nurse says, "5 milliliters is the same amount as ____________ ."

one teaspoon

What does this abbreviation mean? NG

per nasogastric tube

What is a disadvantage to oral?

variable absorption; also subject to first pass effect

What is a disadvantage to IV?

whole dose is absorbed relatively quickly (can be an advantage or disadvantage).

Which medication order (listed below) contains an official "Do Not Use" abbreviation, symbol or dose designation from The Joint Commission? ~Melatonin 6.0 mg PO once nightly PRN insomnia ~OxyCODONE 5 mg PO every 6 hours PRN pain ~Methocarbamol 500 mg PO every 6 hours PRN musculoskeletal pain/relaxant ~Ondansetron 4-8 mg PO every 8 hours PRN for nausea/vomiting

~Melatonin 6.0 mg PO once nightly PRN insomnia No trailing zeros allowed.

When a drug is bound to a plasma protein, it has all of the following characteristics EXCEPT: ~it does not get metabolized ~it is active ~it cannot exit the vasculature ~it cannot be excreted

~it is active When bound to a plasma protein a drug is INactive