Pharmacokinetics and Pharmacodynamics in Drug Response, Exams of Nursing

Download Pharmacokinetics and Pharmacodynamics in Drug Response and more Exams Nursing in PDF only on Docsity! 553 Unit 2 examination test with correct marking scheme 1. For a drug to produce an effect it must overcome an individual's - Correct Answers Homeostasis: physio processes meant to maintain internal cell environment 2. What is a graded drug response? Examples? - Correct Answers Biological effects that can be measured (blood pressure, HR, diuresis, pain, coma, bronchodilation) 3. What is a quantal drug response? Examples? - Correct Answers Effects that may or may not occur, not necessarily measured (pregnancy, seizures, rash, sleep, death) 4. _______ is the expression of how much drug is needed to produce a biological response - Correct Answers Potency 5. 50mg drug that produces same response as 250mg drug is more potent 6. ________ is the ability of a drug to produce a maximum effect at any dosage - Correct Answers Efficacy 7. Morphine is more efficient at treating severe pain than Motrin. Expresses the maximum effect a drug is able to produce 8. ___________ is the ability of a drug to produce a large response once it has occupied specific receptors - Correct Answers Intrinsic activity 9. Does number of receptors occupied make difference in drug response? 10.Describe the ratio of selectivity - Correct Answers Dose or concentration producing undesired effect / dose or concentration producing desired effect 11.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 12.According to the FDA Orange Book, AB rated drugs are _____________ - Correct Answers Generic drugs that are considered similar enough to substitute brand names 13.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 14.__________ are large molecules, usually proteins, that interact with and mediate the action of drugs - Correct Answers Receptors 15.Why are receptors important? - Correct Answers Determine dose/effect relationship 16.Determine drug selectivity 17.Determine actions of antagonists 18.Framework/predictor of drug actions related to dose 19._________ is the correlation of chemical structure with pharmacological activity - Correct Answers Structure-activity relationship (SAR) 20.____ are drugs that produce receptor stimulation and conformational change every time they bind - Correct Answers Agonists, or full agonists 21._______ are drugs that bind to receptors but do not stimulate them - Correct Answers Antagonists 22.________ are drugs that bind to receptors but stimulate only some of them - Correct Answers Partial agonists 23.The ____ of G-proteins recognizes and binds to drugs - Correct Answers Binding site 24.The __________ of G-proteins control what happens after the drug is bound - Correct Answers Intracellular proteins 25.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 26.What enzyme so statin drugs inhibit? - Correct Answers HMG-Co-A 27.Controls cholesterol synthesis 28.Define pharmacokinetics - Correct Answers What the body does to a drug 29.Absorption, distribution, metabolism, excretion 30.How are oral meds absorbed? - Correct Answers Stomach > small and large intestines > pass through intestinal lining > possibly metabolized in liver > bloodstream 31.How do enteric-coated meds work? - Correct Answers Protect medication in the stomach and only disintegrate in the gentler intestine. Keeps meds from being absorbed too rapidly by stomach 67.________ is the continued entry of a drug into the body with levels above minimum effective concentration - Correct Answers Duration of action 68.What is the minimum effective concentration? - Correct Answers Level below which therapeutic effects will not occur 69.What is the minimum toxic concentration? - Correct Answers Level above which toxic effects begin 70.What is the therapeutic index? - Correct Answers Minimum toxic concentration- minimum effective concentration 71._________ is the percentage of a drug that is absorbed and available to reach tissues - Correct Answers Bioavailability 72. 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 73.Describe relationship of distribution and blood supply - Correct Answers Drugs travel to areas of high blood supply first 74.Protein binding 75.Free drug + Bound drug =? - Correct Answers Drug-protein complex 76.Describe relationship of amount of plasma proteins with drug distribution - Correct Answers Low plasma proteins >> more free drug in circulation 77.Low plasma proteins leads to higher amounts of free drug. What can this cause? - Correct Answers Toxicity 78.More drug eliminated 79.__________ drugs deposit in bone and teeth - Correct Answers Tetracycline’s 80.Only ___________ drugs can cross blood-brain barrier - Correct Answers Lipid- soluble 81.Which variations can occur in isoenzymes, like CYP 450 enzymes? - Correct Answers Developmental and genetic differences. 82.Some disease processes can alter enzymes (i.e. CF alters CYP2D9) 83.For drug to be filtered by glomeruli, it must...? - Correct Answers Be unbound from protein (free) 84.Water-soluble 85._________ involves filtrate moving through nephron, molecules reabsorbed into blood - Correct Answers Passive glomerular filtration 86.________ involves the movement of ions, amino acids, and glucose back into circulation back into cells and into the plasma - Correct Answers Tubular reabsorption 87.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) 88.Gastric emptying time is ______ in females. Why? What does this affect? - Correct Answers Slower, likely r/t estrogen 89.Drugs absorbed in stomach will stay longer 90.Describe volume of distribution of lipophilic drugs in females - Correct Answers Females have more fat. Absorbed quickly and stay longer 91.Women have ____ rates of metabolism for CYP450 3A4 substrates - Correct Answers Higher, clear drugs faster 92.Describe opiates and women - Correct Answers Greater analgesic effect but more adverse reactions (n/v) 93.Women age 15-50 have __ QT intervals, making them prone to arrhythmias - Correct Answers longer 94.Describe Warfarin and Aspirin in women - Correct Answers Warfarin: less benefits with higher mortality r/t bleeding 95.Aspirin: Lowers risk for stroke but not MI 96.Describe woman and antipsychotic drugs - Correct Answers Most effective in women but more adverse reactions 97.Why do women experience adverse reactions with antipsychotic drugs? - Correct Answers R/t anti-dopaminergic actions of estrogen. Should prescribe lower doses for women 98.Antipsychotics: women respond better to __________ class, men to ________ class - Correct Answers Women: SSRIs 99.Men: Tricyclic antidepressants 100. Describe antiretroviral drugs and women - Correct Answers More severe adverse reactions, allergic reactions, etc. 101. What makes up the female athlete triad? - Correct Answers Amenorrhea 102. Osteoporosis 103. Disordered eating 104. Describe physiologic of female athlete triad - Correct Answers Poor eating/over exercise suppresses hypothalamic-pituitary-ovarian axis >> cause reduced estrogen, amenorrhea, osteoporosis 105. ______ is absence of menses for 6 months in a girl who has had a period - Correct Answers Secondary amenorrhea 106. ________ is absence of menses by age 13 or 15 with secondary sex characteristics - Correct Answers Primary amenorrhea 107. What are strategies to reduce osteoporosis in adolescent females? - Correct Answers Increase daily calcium to 1300 mg and vitamin D to 400 108. How can menses be resumed in adolescents? - Correct Answers Decrease exercise, increase PO intake, increase BMI 109. Describe bone formation pattern in women - Correct Answers 40% bone in adolescence, continues to age 30, then bone loss starts 110. Long-term Depo-Provera (injectable birth control) has been linked to - Correct Answers Significant bone density loss 111. Due to loss in bone density, Depo-Provera should not be used for longer than _______ - Correct Answers 2 years 112. In pregnancy, drug absorption from which sites increase? - Correct Answers Lungs and skin 113. Cardiac output in pregnancy may be _______% higher than prepregnancy - Correct Answers 30-50% higher 114. Drug clearance ____ in pregnancy - Correct Answers Increases 115. Why is iron deficiency anemia common in pregnancy? - Correct Answers Expansion of plasma volume without expansion of hemoglobin mass 116. What can iron deficiency anemia lead to in pregnancy? - Correct Answers Infection, fatigue, pre-eclampsia, post-part hemorrhage 117. Daily iron intake of ____ is needed during pregnancy - Correct Answers 30 mg, start at first visit 118. Oral iron should be taken with ______ to increase absorption - Correct Answers Vitamin C, after meals to reduce GI irritation 163. Describe drug therapy for endometriosis - Correct Answers GnRH for 3 months or Diazole for 6 months 164. NSAIDs for pain 165. Birth control 166. It is recommended that those with endometriosis limit xenestrogen exposure. Which foods contain this? - Correct Answers Dairy, beef, chicken 167. Which supplements may help endometriosis inflammation? - Correct Answers Calcium, magnesium, omega-3 168. Which drug is recommended to reduce HIV Trans from mother to baby in pregnancy? - Correct Answers Zidovudine, triple combined antiretroviral 169. How is infertility defined? - Correct Answers Inability to conceive after trying for 1 year 170. Women over 35 should seek fertility evil if unable to conceive after ______ - Correct Answers 6-9 months 171. What does polycystic ovarian syndrome do? - Correct Answers Endocrine imbalance. High levels of estrogen, testosterone, LH 172. Low FSH 173. Impaired glucose tolerance>> risk of DM2 174. Ovaries double in size with cysts 175. What med could be used to treat symptom of hirsutism in polycystic ovarian syndrome? - Correct Answers Oral contraceptives 176. In PCOS, the prescription of _______ and _______ can manage DM2, lower testosterone, reduce acne, hirsutism, obesity, etc. - Correct Answers Insulin and metformin 177. At what age should mammograms start? - Correct Answers 40 178. At what age should colonoscopy be done? - Correct Answers Over 50 179. Bone mineral density testing is recommended for women over _____ - Correct Answers 65 180. What are the leading causes of death in men? - Correct Answers Heart disease, cancer, accidents 181. _______is failure of the testes to produce androgen, sperm, or both - Correct Answers Hypogonadism 182. How dose hypogonadism affect men's fertility? - Correct Answers Low testosterone lowers sperm production, deceases sex drive, and can cause ED 183. Describe relationship of testosterone to proteins - Correct Answers Largely protein-bound, small portion (2%) is active/free 184. ______ refers to testicular failure, characterized by low testosterone and elevated gonadotropins - Correct Answers Primary hypogonadism 185. _________ refers to hypothalamic-pituitary failure and is characterized by low testosterone and normal gonadotropins - Correct Answers Secondary hypogonadism 186. _______ refers to a condition in older men characterized by high gonadotropins and normal testosterone levels. Could represent compensation. - Correct Answers Third category of hypogonadism 187. Describe testosterone and aging - Correct Answers Testosterone production declines with age. Low levels can happen at any time 188. Describe early signs of congenital hypogonadism (at birth) - Correct Answers Improperly formed genitals and internal repro organs. Failure of testes to descend 189. A normally formed but hypotrophy penis could indicate an issue with ___________- - Correct Answers The hypothalamic-pituitary-gonadal axis 190. 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 191. 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 192. Spermatogenesis may continue into what age? - Correct Answers 80s or beyond 193. Testosterone replacement therapy may help with... - Correct Answers Improved bone density, CV disease, cognition, libido, muscle mass, mood, erythropoiesis 194. Which lab should be drawn to test for hypogonadism? - Correct Answers Serum testosterone: test in AM because T levels are higher 195. Free testosterone levels 196. Which levels of serum testosterone show hypogonadism? - Correct Answers <220-250 low 197. 250-350 borderline low 198. Normal testosterone levels? - Correct Answers 300-1000 199. If gonadotropin levels are not high and testosterone levels are normal, anterior pituitary function should be determined by measuring ___________ - Correct Answers Free thyroxine 200. Thyroid-stimulating hormone levels 201. Morning cortisol 202. Consider MRI 203. What has TRT been shown to definitely improve? - Correct Answers Erythropoiesis 204. Bone mass 205. Insulin sensitivity 206. Cognitive functioning 207. Libido 208. TRT is still questionable in the treatment of what hypo gonadal symptoms? - Correct Answers Long-term bone density 209. No corr. between TRT and CV events 210. Variable with mood, energy 211. How does testosterone improve insulin sensitivity? - Correct Answers Increases lean body mass, reduces fat, lowers risk of metabolic syndrome 212. Dose and frequency of Depo (Depo-Testosterone) for hypogonadism? - Correct Answers 200 mg IM every 2 weeks 213. 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 214. Dosage of the transdermal or buccal TRT result in the systemic absorption of _______mg daily - Correct Answers 2.5-10 215. What is testosterone goal of buccal or transdermal TRT? - Correct Answers 400-600 (mineral) 216. Risks of TRT? - Correct Answers Erythrocytosis: check H/H 217. Prostate cancer: digital exam 218. Infertility/lower sperm 219. Acne and male breasts (boys) 220. Adolescent aggressive behavior or early closure of epiphyses (low growth) 259. In children, oral bioavailability of acid labile is _____ - Correct Answers Increased (beta-lactams) 260. In pads, oral bioavailability of weak organic acids is ______ - Correct Answers Decreased (phenobarbital, phenytoin) 261. In pads, basic drugs like diazepam and theophylline have _________ absorption - Correct Answers Increased 262. Why is pediatric intestinal absorption of drugs unpredictable? - Correct Answers Most are absorbed in small intestine 263. Infants have larger intestinal surface area 264. Why are children at risk for topical toxicity? (lidocaine, diphenhydramine) - Correct Answers Absorb topical more than adults 265. Infants have increased intestinal motility. How does this affect drug absorption? - Correct Answers Altars absorption of drugs with limited water solubility (phenytoin, carbamazepine) 266. Blood-brain barrier in newborns is _______ - Correct Answers Incomplete and permeable 267. Infants <6 mo. have ______ plasma proteins available for drug binding - Correct Answers Decreased, more unbound/free med 268. Newborns have total body water of 80%, therefore require higher doses of _______ drugs - Correct Answers Hydrophilic 269. __________ is the most active isoenzyme at birth - Correct Answers CYP 3A7, goes away after first weeks of life 270. Explain newborn/adult levels of CYP 1A2 - Correct Answers Reaches adult level at 4 mo. 271. Exceeds adult level at 1-2 yrs. 272. Reaches adult level at puberty 273. Diseases like CF can affect _________ enzyme activity - Correct Answers CYP 1A2 274. Theophylline, erythromycin, cimetidine, phenobarbital, phenytoin, carbamazepine, and clarithromycin are drugs metabolized by the _________ enzyme - Correct Answers CYP 1A2 275. Foods metabolized by __________ enzyme include grapefruit juice, cruciferous veggies, charbroiled foods - Correct Answers CYP 1A2 276. Doses of CYP 1A2 should be adjusted through childhood. Higher doses may be needed from 1 yr. until __________ - Correct Answers Puberty 277. Adult levels reached at puberty 278. 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 279. The enzyme _________ is most abundant - Correct Answers CYP 3A4 280. Explain levels of CYP 3A4 through childhood - Correct Answers Low at birth 281. 30-40% of adult by 1 mo. 282. Full adult at 6 mo. 283. Exceeds adult at 1-4 yrs. 284. Decreases to adult level after puberty 285. __________ enzyme is used to metabolize >20 pad meds, including NSAIDs, prednisone, oral contraceptives, macrolides, antihistamines, carbamazepine - Correct Answers CYP 3A4 286. Implications for practice for CYP 3A4? - Correct Answers Monitor when on 1 or more drug metabolized by it 287. Monitor through developmental changes (levels change through childhood) 288. Phase II enzymes are responsible for synthesis of _________ compounds - Correct Answers Water-soluble 289. Phase II enzymes reach adult activity by age _______ - Correct Answers 3-4 yrs. 290. Explain relationship of Koreans and thiopurine methyltransferase (TPMT) - Correct Answers Do not reach adult activity levels until 7-9 yrs. 291. Common medications metabolized by phase II enzymes? - Correct Answers Acetaminophen, morphine, protocol, caffeine 292. Patients with low TPMT (thiopurine methyltransferase) activity, such as Koreans, are at risk for ______________ - Correct Answers Hepatic toxicity with some chemo drugs (thiopurines) 293. Patients with low levels of TPMT experience __________ when treated with standard doses of thiopurines - Correct Answers Myelosuppression 294. Patients with high levels of TPMT will have _____________ with thiopurine treatment - Correct Answers Reduced response 295. Glomerular filtration rate/renal blood flow reaches adult levels by ___________ - Correct Answers 9 months 296. Meds should be adjusted beforehand to account for decreased renal fox 297. By year 2030, __ of the population will be >65 - Correct Answers 1/5 298. With aging, the GI tract produces less acid as fewer _________ cells are generated - Correct Answers Parietal 299. Low acid production in the elderly is significant unless __________ drugs are used concurrently - Correct Answers PPIs, which further lower acid 300. Drugs distributed in lean body mass or water may reach _____ serum concentrations in older adults - Correct Answers Higher, resulting in magnified effects from drug 301. With normal aging, serum albumin levels can decrease by ___% - Correct Answers 20 302. What does low serum albumin cause in older adults? - Correct Answers Fewer proteins for meds to bind with >> more free drug, increased toxicity 303. 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. 304. 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) 305. Phase ___ enzymes are unchanged by aging - Correct Answers 2 306. Drugs metabolized by phase 2 enzymes (lorazepam, temazepam) are better tolerated by older pts than phase 1 (diazepam) 307. In older adults, lipid-soluble drugs have _________ volume of distribution - Correct Answers Greater, more fat stores 308. Benzos stay in adipose tissue > less in serum > longer, unpredictable half- life