Pharmacology and Drug Metabolism, Exams of Nursing

Download Pharmacology and Drug Metabolism and more Exams Nursing in PDF only on Docsity! 553 Unit 2 examination test with correct marking scheme for 2024 candidates  For a drug to produce an effect it must overcome an individual's - Correct Answers Homeostasis: physio processes meant to maintain internal cell environment  What is a graded drug response? Examples? - Correct Answers Biological effects that can be measured (blood pressure, HR, diuresis, pain, coma, bronchodilation)  What is a quantal drug response? Examples? - Correct Answers Effects that may or may not occur, not necessarily measured (pregnancy, seizures, rash, sleep, death)  _______ is the expression of how much drug is needed to produce a biological response - Correct Answers Potency  50mg drug that produces same response as 250mg drug is more potent  ________ is the ability of a drug to produce a maximum effect at any dosage - Correct Answers Efficacy  Morphine is more efficient at treating severe pain than Motrin. Expresses the maximum effect a drug is able to produce  ___________ is the ability of a drug to produce a large response once it has occupied specific receptors - Correct Answers Intrinsic activity  Does number of receptors occupied make difference in drug response?  Describe the ratio of selectivity - Correct Answers Dose or concentration producing undesired effect / dose or concentration producing desired effect  Ex: A med requires 1 tab to cause desired effect with no undesired effects. When 5 tabs are taken, undesired effects present. This drug has a selectivity ratio of 5  According to the FDA Orange Book, AB rated drugs are _____________ - Correct Answers Generic drugs that are considered similar enough to substitute brand names  How do brand and generic drugs differ? - Correct Answers Both contain same active ingredient. Different inactive ingredients (coloring, filler) that cause differences in absorption time  __________ are large molecules, usually proteins, that interact with and mediate the action of drugs - Correct Answers Receptors  Why are receptors important? - Correct Answers Determine dose/effect relationship  Determine drug selectivity  Determine actions of antagonists  Framework/predictor of drug actions related to dose  _________ is the correlation of chemical structure with pharmacological activity - Correct Answers Structure-activity relationship (SAR)  ____ are drugs that produce receptor stimulation and conformational change every time they bind - Correct Answers Agonists, or full agonists  _______ are drugs that bind to receptors but do not stimulate them - Correct Answers Antagonists  ________ are drugs that bind to receptors but stimulate only some of them - Correct Answers Partial agonists  The ____ of G-proteins recognizes and binds to drugs - Correct Answers Binding site  The __________ of G-proteins control what happens after the drug is bound - Correct Answers Intracellular proteins  Activation of receptors produce intracellular changes in the binding of the G- protein receptor to other proteins that control response through molecules called __________ - Correct Answers Second messengers  What enzyme so statin drugs inhibit? - Correct Answers HMG-Co-A  Controls cholesterol synthesis  Define pharmacokinetics - Correct Answers What the body does to a drug  Absorption, distribution, metabolism, excretion  How are oral meds absorbed? - Correct Answers Stomach > small and large intestines > pass through intestinal lining > possibly metabolized in liver > bloodstream  _______ refers to the point at which amount of drug being absorbed and distributed is equal to amount being metabolized and excreted (max concentration of drug) - Correct Answers Peak of action  ________ is the continued entry of a drug into the body with levels above minimum effective concentration - Correct Answers Duration of action  What is the minimum effective concentration? - Correct Answers Level below which therapeutic effects will not occur  What is the minimum toxic concentration? - Correct Answers Level above which toxic effects begin  What is the therapeutic index? - Correct Answers Minimum toxic concentration- minimum effective concentration  _________ is the percentage of a drug that is absorbed and available to reach tissues - Correct Answers Bioavailability  It takes _________ lives to get to a steady state blood level, and it takes _________ lives to totally eliminate drug from the body - Correct Answers 4-5.5  Describe relationship of distribution and blood supply - Correct Answers Drugs travel to areas of high blood supply first  Protein binding  Free drug + Bound drug =? - Correct Answers Drug-protein complex  Describe relationship of amount of plasma proteins with drug distribution - Correct Answers Low plasma proteins >> more free drug in circulation  Low plasma proteins leads to higher amounts of free drug. What can this cause? - Correct Answers Toxicity  More drug eliminated  __________ drugs deposit in bone and teeth - Correct Answers Tetracycline’s  Only ___________ drugs can cross blood-brain barrier - Correct Answers Lipid- soluble  Which variations can occur in isoenzymes, like CYP 450 enzymes? - Correct Answers Developmental and genetic differences.  Some disease processes can alter enzymes (i.e. CF alters CYP2D9)  For drug to be filtered by glomeruli, it must...? - Correct Answers Be unbound from protein (free)  Water-soluble  _________ involves filtrate moving through nephron, molecules reabsorbed into blood - Correct Answers Passive glomerular filtration  ________ involves the movement of ions, amino acids, and glucose back into circulation back into cells and into the plasma - Correct Answers Tubular reabsorption  Describe differences in gamete versus sperm cell production in males/females - Correct Answers Women are born with all their gametes. Men start producing sperm at puberty and continue into testosterone wanes (60s, 70s)  Gastric emptying time is ______ in females. Why? What does this affect? - Correct Answers Slower, likely r/t estrogen  Drugs absorbed in stomach will stay longer  Describe volume of distribution of lipophilic drugs in females - Correct Answers Females have more fat. Absorbed quickly and stay longer  Women have ____ rates of metabolism for CYP450 3A4 substrates - Correct Answers Higher, clear drugs faster  Describe opiates and women - Correct Answers Greater analgesic effect but more adverse reactions (n/v)  Women age 15-50 have __ QT intervals, making them prone to arrhythmias - Correct Answers longer  Describe Warfarin and Aspirin in women - Correct Answers Warfarin: less benefits with higher mortality r/t bleeding  Aspirin: Lowers risk for stroke but not MI  Describe woman and antipsychotic drugs - Correct Answers Most effective in women but more adverse reactions  Why do women experience adverse reactions with antipsychotic drugs? - Correct Answers R/t anti-dopaminergic actions of estrogen. Should prescribe lower doses for women  Antipsychotics: women respond better to __________ class, men to ________ class - Correct Answers Women: SSRIs  Men: Tricyclic antidepressants  Describe antiretroviral drugs and women - Correct Answers More severe adverse reactions, allergic reactions, etc.  What makes up the female athlete triad? - Correct Answers Amenorrhea  Osteoporosis  Disordered eating  Describe physiologic of female athlete triad - Correct Answers Poor eating/over exercise suppresses hypothalamic-pituitary-ovarian axis >> cause reduced estrogen, amenorrhea, osteoporosis  ______ is absence of menses for 6 months in a girl who has had a period - Correct Answers Secondary amenorrhea  ________ is absence of menses by age 13 or 15 with secondary sex characteristics - Correct Answers Primary amenorrhea  What are strategies to reduce osteoporosis in adolescent females? - Correct Answers Increase daily calcium to 1300 mg and vitamin D to 400  How can menses be resumed in adolescents? - Correct Answers Decrease exercise, increase PO intake, increase BMI  Describe bone formation pattern in women - Correct Answers 40% bone in adolescence, continues to age 30, then bone loss starts  Long-term Depo-Provera (injectable birth control) has been linked to - Correct Answers Significant bone density loss  Due to loss in bone density, Depo-Provera should not be used for longer than _______ - Correct Answers 2 years  In pregnancy, drug absorption from which sites increase? - Correct Answers Lungs and skin  Cardiac output in pregnancy may be _______% higher than prepregnancy - Correct Answers 30-50% higher  Drug clearance ____ in pregnancy - Correct Answers Increases  Why is iron deficiency anemia common in pregnancy? - Correct Answers Expansion of plasma volume without expansion of hemoglobin mass  What can iron deficiency anemia lead to in pregnancy? - Correct Answers Infection, fatigue, pre-eclampsia, post-part hemorrhage  Daily iron intake of ____ is needed during pregnancy - Correct Answers 30 mg, start at first visit  Define endometriosis - Correct Answers Presence of functioning endometrial tissue outside uterus. Inflammation leads to pain. Can cause fibrosis, scarring, infertility  Describe drug therapy for endometriosis - Correct Answers GnRH for 3 months or Diazole for 6 months  NSAIDs for pain  Birth control  It is recommended that those with endometriosis limit xenestrogen exposure. Which foods contain this? - Correct Answers Dairy, beef, chicken  Which supplements may help endometriosis inflammation? - Correct Answers Calcium, magnesium, omega-3  Which drug is recommended to reduce HIV Trans from mother to baby in pregnancy? - Correct Answers Zidovudine, triple combined antiretroviral  How is infertility defined? - Correct Answers Inability to conceive after trying for 1 year  Women over 35 should seek fertility evil if unable to conceive after ______ - Correct Answers 6-9 months  What does polycystic ovarian syndrome do? - Correct Answers Endocrine imbalance. High levels of estrogen, testosterone, LH  Low FSH  Impaired glucose tolerance>> risk of DM2  Ovaries double in size with cysts  What med could be used to treat symptom of hirsutism in polycystic ovarian syndrome? - Correct Answers Oral contraceptives  In PCOS, the prescription of _______ and _______ can manage DM2, lower testosterone, reduce acne, hirsutism, obesity, etc. - Correct Answers Insulin and metformin  At what age should mammograms start? - Correct Answers 40  At what age should colonoscopy be done? - Correct Answers Over 50  Bone mineral density testing is recommended for women over _____ - Correct Answers 65  What are the leading causes of death in men? - Correct Answers Heart disease, cancer, accidents  _______is failure of the testes to produce androgen, sperm, or both - Correct Answers Hypogonadism  How dose hypogonadism affect men's fertility? - Correct Answers Low testosterone lowers sperm production, deceases sex drive, and can cause ED  Describe relationship of testosterone to proteins - Correct Answers Largely protein-bound, small portion (2%) is active/free  ______ refers to testicular failure, characterized by low testosterone and elevated gonadotropins - Correct Answers Primary hypogonadism  _________ refers to hypothalamic-pituitary failure and is characterized by low testosterone and normal gonadotropins - Correct Answers Secondary hypogonadism  _______ refers to a condition in older men characterized by high gonadotropins and normal testosterone levels. Could represent compensation. - Correct Answers Third category of hypogonadism  Describe testosterone and aging - Correct Answers Testosterone production declines with age. Low levels can happen at any time  Describe early signs of congenital hypogonadism (at birth) - Correct Answers Improperly formed genitals and internal repro organs. Failure of testes to descend  A normally formed but hypotrophy penis could indicate an issue with ___________- - Correct Answers The hypothalamic-pituitary-gonadal axis  Describe signs of hypogonadism in puberty - Correct Answers Delayed or absent penile/testicular growth and secondary sex characteristics, voice never deepens, small muscles, disproportionate arms and legs compared to trunk  Describe s/s of hypogonadism in adulthood - Correct Answers Repro abilities may cease. Depression, male breasts, ED, failure of body hair to grow, increase in fat, loss of energy, low libido, hot flashes, mood swings  Spermatogenesis may continue into what age? - Correct Answers 80s or beyond  Testosterone replacement therapy may help with... - Correct Answers Improved bone density, CV disease, cognition, libido, muscle mass, mood, erythropoiesis  Which lab should be drawn to test for hypogonadism? - Correct Answers Serum testosterone: test in AM because T levels are higher  Free testosterone levels  Which levels of serum testosterone show hypogonadism? - Correct Answers <220-250 low  250-350 borderline low  Normal testosterone levels? - Correct Answers 300-1000  If gonadotropin levels are not high and testosterone levels are normal, anterior pituitary function should be determined by measuring ___________ - Correct Answers Free thyroxine  Thyroid-stimulating hormone levels  Morning cortisol  Consider MRI  What has TRT been shown to definitely improve? - Correct Answers Erythropoiesis  Bone mass  Insulin sensitivity  Cognitive functioning  Libido  TRT is still questionable in the treatment of what hypo gonadal symptoms? - Correct Answers Long-term bone density  No corr. between TRT and CV events  Variable with mood, energy  How does testosterone improve insulin sensitivity? - Correct Answers Increases lean body mass, reduces fat, lowers risk of metabolic syndrome  Dose and frequency of Depo (Depo-Testosterone) for hypogonadism? - Correct Answers 200 mg IM every 2 weeks  What is the testosterone goal for men getting Depot injections? - Correct Answers Mineral 400-600 levels after 1 week or low normal 250-350 levels after 2 weeks, before next injection  Dosage of the transdermal or buccal TRT result in the systemic absorption of _______mg daily - Correct Answers 2.5-10  What is testosterone goal of buccal or transdermal TRT? - Correct Answers 400- 600 (mineral)  Risks of TRT? - Correct Answers Erythrocytosis: check H/H  Prostate cancer: digital exam  Infertility/lower sperm  In children, oral bioavailability of acid labile is _____ - Correct Answers Increased (beta-lactams)  In pads, oral bioavailability of weak organic acids is ______ - Correct Answers Decreased (phenobarbital, phenytoin)  In pads, basic drugs like diazepam and theophylline have _________ absorption - Correct Answers Increased  Why is pediatric intestinal absorption of drugs unpredictable? - Correct Answers Most are absorbed in small intestine  Infants have larger intestinal surface area  Why are children at risk for topical toxicity? (lidocaine, diphenhydramine) - Correct Answers Absorb topical more than adults  Infants have increased intestinal motility. How does this affect drug absorption? - Correct Answers Altars absorption of drugs with limited water solubility (phenytoin, carbamazepine)  Blood-brain barrier in newborns is _______ - Correct Answers Incomplete and permeable  Infants <6 mo. have ______ plasma proteins available for drug binding - Correct Answers Decreased, more unbound/free med  Newborns have total body water of 80%, therefore require higher doses of _______ drugs - Correct Answers Hydrophilic  __________ is the most active isoenzyme at birth - Correct Answers CYP 3A7, goes away after first weeks of life  Explain newborn/adult levels of CYP 1A2 - Correct Answers Reaches adult level at 4 mo.  Exceeds adult level at 1-2 yrs.  Reaches adult level at puberty  Diseases like CF can affect _________ enzyme activity - Correct Answers CYP 1A2  Theophylline, erythromycin, cimetidine, phenobarbital, phenytoin, carbamazepine, and clarithromycin are drugs metabolized by the _________ enzyme - Correct Answers CYP 1A2  Foods metabolized by __________ enzyme include grapefruit juice, cruciferous veggies, charbroiled foods - Correct Answers CYP 1A2  Doses of CYP 1A2 should be adjusted through childhood. Higher doses may be needed from 1 yr. until __________ - Correct Answers Puberty  Adult levels reached at puberty  Ultra metabolizers of ________ enzyme may be at risk for rasp depression after taking codeine due to higher metabolism of codeine to morphine - Correct Answers CYP 2D6  The enzyme _________ is most abundant - Correct Answers CYP 3A4  Explain levels of CYP 3A4 through childhood - Correct Answers Low at birth  30-40% of adult by 1 mo.  Full adult at 6 mo.  Exceeds adult at 1-4 yrs.  Decreases to adult level after puberty  __________ enzyme is used to metabolize >20 pad meds, including NSAIDs, prednisone, oral contraceptives, macrolides, antihistamines, carbamazepine - Correct Answers CYP 3A4  Implications for practice for CYP 3A4? - Correct Answers Monitor when on 1 or more drug metabolized by it  Monitor through developmental changes (levels change through childhood)  Phase II enzymes are responsible for synthesis of _________ compounds - Correct Answers Water-soluble  Phase II enzymes reach adult activity by age _______ - Correct Answers 3-4 yrs.  Explain relationship of Koreans and thiopurine methyltransferase (TPMT) - Correct Answers Do not reach adult activity levels until 7-9 yrs.  Common medications metabolized by phase II enzymes? - Correct Answers Acetaminophen, morphine, protocol, caffeine  Patients with low TPMT (thiopurine methyltransferase) activity, such as Koreans, are at risk for ______________ - Correct Answers Hepatic toxicity with some chemo drugs (thiopurines)  Patients with low levels of TPMT experience __________ when treated with standard doses of thiopurines - Correct Answers Myelosuppression  Patients with high levels of TPMT will have _____________ with thiopurine treatment - Correct Answers Reduced response  Glomerular filtration rate/renal blood flow reaches adult levels by ___________ - Correct Answers 9 months  Meds should be adjusted beforehand to account for decreased renal fox  By year 2030, __ of the population will be >65 - Correct Answers 1/5  With aging, the GI tract produces less acid as fewer _________ cells are generated - Correct Answers Parietal  Low acid production in the elderly is significant unless __________ drugs are used concurrently - Correct Answers PPIs, which further lower acid  Drugs distributed in lean body mass or water may reach _____ serum concentrations in older adults - Correct Answers Higher, resulting in magnified effects from drug  With normal aging, serum albumin levels can decrease by ___% - Correct Answers 20  What does low serum albumin cause in older adults? - Correct Answers Fewer proteins for meds to bind with >> more free drug, increased toxicity  The phase 1 enzymes (CYP 450 agents) decrease with aging. What can this cause? - Correct Answers Decreased clearance of drugs metabolized by phase 1 enzymes.  In older adults, less hepatic blood flow can cause _____ of drugs - Correct Answers Decrease drug clearance and increase half-life of drugs which rely on liver for excretion (morphine, propranolol)  Phase ___ enzymes are unchanged by aging - Correct Answers 2  Drugs metabolized by phase 2 enzymes (lorazepam, temazepam) are better tolerated by older pts than phase 1 (diazepam)  In older adults, lipid-soluble drugs have _________ volume of distribution - Correct Answers Greater, more fat stores  Benzos stay in adipose tissue > less in serum > longer, unpredictable half-life  In older adults, water-soluble drugs have ______ volume of distribution - Correct Answers Smaller  Total body water decreases  Ex: lithium and digoxin have smaller place to work, more concentrated/magnified effects  In late life, liver's capacity for metabolism via CYP 450 system is __________ - Correct Answers Reduced by >30%, decreases drug clearance