Chapter 3

Question 1

What are the 4 life span considerations?

Answer 1

Pregnancy
Breast-feeding
Neonatal and Pediatric
Elderly

Question 2

In pregnancy the _____ trimester is the period of greatest danger for drug-induced developmental defects

Answer 2

First

Question 3

Drugs cross the placenta by

Answer 3

Diffusion

Question 4

During the _____ trimester the greatest % of maternally absorbed drug gets to the fetus

Answer 4

last

Question 5

What are the categories of the pregnancy safety categories?

Answer 5

A
B
C
D
X

Question 6

Category A

Answer 6

Safest - no risk
Adequate and well-controlled studies have failed to demonstrate a risk
to the fetus in the first trimester of pregnancy (and there is no evidence
of risk in later trimesters)

Question 7

Category B

Answer 7

No risk to fetus - not available for humans
Animal reproduction studies have failed to demonstrate a risk to the
fetus and there are no adequate and well-controlled studies in pregnant
women.

Question 8

Category C

Answer 8

Animal reproduction studies have shown an adverse effect on the fetus
and there are no adequate and well-controlled studies in humans, but
potential benefits may warrant use of the drug in pregnant women
despite potential risks

Question 9

Category D

Answer 9

There is positive evidence of human fetal risk based on adverse
reaction data from investigational or marketing experience or studies
in humans, but potential benefits may warrant use of the drug in
pregnant women despite potential risks.

Question 10

Category X

Answer 10

Studies in animals or humans have demonstrated fetal abnormalities
and/or there is positive evidence of human fetal risk based on adverse
reaction data from investigational or marketing experience, and the
risks involved in use of the drug in pregnant women clearly outweigh
potential benefits

Question 11

Breast-fed infants are at risk for exposure to _____ consumed by the mother

Answer 11

drugs

Question 12

What are the 3 absorption for neonatal and pediatric considerations in pharmacokinetics?

Answer 12

Gastric pH less acidic
Gastric emptying is slowed
Intramuscular absorption faster and irregular

Question 13

What are the 4 distribution for neonatal and pediatric considerations in pharmacokinetics?

Answer 13

The younger the person, the greater the % of total body water
Greater TBW means fat content is lower
Decreased level of protein binding
Immature blood-brain barrier - more drugs enter the brain

Question 14

What are the 2 metabolism for neonatal and pediatric considerations in pharmacokinetics?

Answer 14

Liver immature, does not produce enough microsomal enzymes

Oder children may have increased metabolism requiring higher dose than infants

Question 15

What are the 2 excretion for neonatal and pediatric considerations in pharmacokinetics?

Answer 15

Kidney immaturity affects glomerular filtration rate and tubular secretion
Decreased perfusion rate of the kidneys may reduce excretion of drugs

Question 16

What are the factors affecting pediatric drug dosages

Answer 16

Skin is thin and permeable
Stomach lacks acid to kill bacteria
Lungs have weaker mucus barriers
Body temperatures less well regulated and dehydration occurs easily
Liver and kidneys are immature, impairing drug metabolism and excretion

Question 17

The 2 methods of calculation for pediatric patients

Answer 17

Body surface area - scientific - Using the West nomogram

Body weight dosage calculations - common - Using mg/kg

Question 18

What age group is considered elderly?

Answer 18

Older then 65

Question 19

What are the 4 physiologic changes in the elderly patients?

Answer 19

Cardiovascular
Gastrointestinal
Hepatic
Renal

Question 20

What are the absorption for the elderly in pharmacokinetics?

Answer 20

Gastric pH less acidic
Gastric emptying slowed
Movement through GI tract slowed
Blood flow to GI tract reduced
Use of laxatives may accelerate GI motility

Question 21

What are the distribution for the elderly in pharmacokinetics?

Answer 21

Lower total body water %
Increase fat content
Decreased production of proteins by the liver, resulting in decreased protein binding of drugs

Question 22

What are the metabolism for the elderly in pharmacokinetics?

Answer 22

Aging liver produces fewer microsomal enzymes, affecting drug metabolism
Reducing blood flow to the liver

Question 23

What are the excretion for the elderly in pharmacokinetics?

Answer 23

Decreased glomerular filtration rate

Decreased number of intact nephrons

Question 24

When calculating pediatric dosages, what will the nurse take into consideration?

Answer 24

Dosage calculation by body surface area is the most accurate method because it takes into account the difference in size of the child and/or neonate.

Question 25

When teaching a pregnant mother about the effects of medication on the fetus, the nurse recognizes that the greatest harm from maternally ingested medications occurs during which time period?

Answer 25

First trimester

Question 26

Knowing that the albumin in neonates and infants has a lower binding capacity for medications, a health care provider would do which of the following to minimize the risk of toxicity?

Answer 26

Decrease the amount of drug given

Question 27

The physiologic changes that normally occur in the older adult have which of the following implications for the nurse who is assessing drug response in this patient?

Answer 27

Drug half-life is lengthened

Question 28

The nurse is admitting an 82-year-old patient for treatment of heart failure. During assessment of the patient’s history, the nurse notes a subjective complaint of chronic constipation. Of the prescribed medications the patient was taking prior to admission, which would the nurse suspect might contribute to this gastrointestinal complaint?

Answer 28

verapamil (Calan), a calcium channel–blocking drug

Question 29

The nurse working in a prenatal clinic recognizes that the safety or potential harm of drug therapy during pregnancy relates to which factor?

Answer 29

Drug properties

Question 30

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?

Answer 30

“Drugs can cross from mother to infant in breast milk, so it will depend on the drug you are taking.”

Question 31

A nurse working with elderly patients is concerned with the number of medications each patient is taking. Which will the nurse assess as highest priority for her patients related to polypharmacy?

Answer 31

Drug interactions