MIDTERM EXAM

Question 1

Define Pharmacokinetics

Answer 1

Describes the process of drug absorption, drug distribution, drug metabolism, and drug execration

Study of metabolism an action of drugs within the body including absorption, duration of action, distribution of drug in the body and method of excretion.

Question 2

Know the difference between antagonists and agonists

Answer 2

Antagonist – drug that binds to a receptor and interferes (blocks) with other drugs or substances from producing a drug effect

Agonist - Drug that binds to a receptor and activates a physiologic response or drug action

Question 3

Know the difference between the generic name and brand name of drugs

Answer 3

Generic Name- the official established Nonproprietary name of a drug and is descriptive of its chemical structure.

(Nonproprietary -not registered or protected as a trademark or brand name; generic.)

Brand Name (Trade Name)- Patented proprietary name of a drug sold by a specific drug manufacturer; also referred to as the brand name

(Proprietary- trade name and is protected by a patent)

Question 4

Know which Act was designed to regulate the dispensing of drugs that have the potential to be misuse

Answer 4

Federal Comprehensive Drug Abuse Prevention and Control act. This act, commonly referred to as the CONTROLLED SUBSTANCES ACT, was started in 1970-amdended in 1990.

This act is designed to regulate the dispensing of drugs called controlled substances that have a potential for abuse. The controlled drugs are assigned to one of 5 schedules, depending on their medical usefulness and potential for abuse. This act is enforced by the DEA.

Question 5

Define teratogens

Answer 5

Cause birth defects // an agent or factor which causes malformation of an embryo

Question 6

Define the different pharmacokinetic processes: drug absorption, drug distribution, drug metabolism, and drug excretion

Answer 6

Drug absorption- entrance of a drug into the blood stream from its site of administration

Drug distribution-passage of a drug from the blood to the tissues and organs of the body// moving from the blood to the organ

Drug metabolism-the enzymatic biotransformation of a drug into metabolites// conversation of the drug into its metabolites (metabolites cause action)

Drug excretion- elimination of the drug from the body

Question 7

Understand that the factor that plays the biggest role in drug distribution to overcome the blood-brain barrier is lipid solubility of the drug

Answer 7

Because the brain is composed of a large amount of lipid (nerve membranes and myelin) Lipid soluble drugs easily cross the blood brain burrier. As a general rule- then, a drug must have a certain degree of lipid solubility if it is to penetrate this barriers and gain access to the brain

• Cell membranes are composed of a significant amount of lipid material
• In general, the more lipid soluble a drug is, the faster it will pass through a lipid substance like the cell membrane.

Question 8

What is the difference between a loading dose and maintenance dose

Answer 8

Loading dose- initial drug dose administered to rapidly achieve therapeutic drug concentrations

Maintenance dose-dose administered to maintain drug levels in the blood in the therapeutic range

Question 9

Identify the different routes of drug administration

Answer 9

Nonparental administration- oral medications, liquid, ophthalmic, inhalation, supposit rectally, nasal, transdermal (patch), (everything other than a needle)

Parenteral Administration- (injection) Intramuscular (IM), Intravenous (IV), Subcutaneous, Intradermal, Subdermal

Question 10

Determine the main effect aging has on drug distribution

Answer 10

• Because cardiac output decreases by 1% each year after turning 25 or 30 years of age. This means by the age of 65 the liver and kidneys for example are receiving significantly less blood per minute than they did 40 years ago at age 25.
• the percentage of lean body mass (muscle) and the percentage of total body water decrease with age. As the percentage of water decreases the same dose will produce higher concentration of drug in the body. As one becomes older the same dosage of drug given to a younger adult will produce a higher drug concentration in elderly
• the percentage of body fact increases with age, causing lipid-soluble drugs to be more widely distributed to the body organs that have a high fat content, such as adipose tissue and muscle and away from the liver and kidneys. – since the liver and the kidneys are responsible for the drug metabolism and execration of the drug from the body. The drug will have a longer half life and duration of action
• overall effects of aging on drug distribution is to generally make any adult drug dosage produce greater pharmacological effects in the elderly if the drug is given in the same dosage so a smaller dosage is required for elderly.

Question 11

Define the following – drug tolerance, drug dependence

Answer 11

Drug Tolerance- decreased drug effect occurring after repeated drug administration

Drug Dependence- condition of reliance on the use of a particular drug characterized as physical and/or psychological dependence

Question 12

Know the difference between the sympathetic and parasympathetic nervous system- what occurs in the body with each

Answer 12

Sympathetic Nervous system- part of the autonomic nervous system causing increased heart rate, increased blood pressure, increased breathing rate, and will decrease digestion. All in which help us run away from a tiger. Coined as fight or flight.

Parasympathetic Nervous system- is part of the autonomic nervous system coined as rest and digest. Decreases heart rate, decreases blood pressure, decreased breathing rate, increases digestion

Question 13

Know which muscles are affected by norepinephrine

Answer 13

Smooth Muscle (vasoconstrict- decrease the lumen)

(Lumen- lumen is the inside space of a tubular structure, such as an artery or intestine. It comes from Latin lumen ‘an opening’. It can refer to: The interior of a vessel, such as the central space in an artery, vein or capillary through which blood flows.)

Cardiac Muscles(increase contraction)

Question 14

Know the correct use of and EpiPen auto injector

Answer 14

Orange tip against the middle of the outer thigh at a right angle push auto injector firmly until it clicks and hold in place for three seconds and then massage injection sight for 10 seconds.

Question 15

Most common side effect of decongestants

Answer 15

Irritation of the nasal sinuses or eyes due to excessive dryness caused by the vasoconstrictive decrease in blood flow.

Question 16

Understand the difference between the neurotransmitter of the parasympathetic system and the neurotransmitter of the sympathetic system

Answer 16

Norepinephrine (NE)- neurotransmitter of sympathetic (adrenergic) nerves that stimulates the adrenergic receptor.

Acetylcholine (ACH)- neurotransmitter of parasympathetic (cholinergic) nerves; stimulates the cholinergic receptor.

Question 17

Acetylcholine is stored in nerve endings, what causes it to be released

Answer 17

Stimulation of the preganglionic nerve fibers cause ACH to be released

Question 18

What can excessive CNS depression produce in an individual

Answer 18

Slow speech, Lethargy, uncoordinated movements, but extreme would be death.

Question 19

Advantages of benzodiazepines over barbiturates

Answer 19

Benzodiazepines Don’t interfere with rem sleep, they produce less tolerance, therefore are effective for a few weeks longer, less physical dependence.

Question 20

Define automatism

Answer 20

Drug induced confusion that can cause increased drug consumption

an action performed unconsciously or involuntarily.

Question 21

What are some patient instructions for antianxiety drugs

Answer 21

Don’t drive, drink alcohol, no cns depressants, no barbiturates,

Instruct patient to report excessive sedation, mental disturbances, or loss of memory

Question 22

What effect do benzodiazepines have on patients

Answer 22

Produce skeletal muscle relaxation in various musculoskeletal disturbances, as anti convulsant and antiepileptic drugs, and as sedatives and hypnotics// feel calm and relaxed without excessive sedation

Question 23

Name the 4 classes of antipsychotic drugs

Answer 23

1. Phenothiazines (typical)
2. Butyrophenones(typical)
3. Thioxanthene’s (typical)
4. atypical

Question 24

What has been found to be the cause of mental depression

Answer 24

Deficiencies of Norepinephrine (NE) and Serotonin in the brain are the cause of mental depression

Question 25

What kind of foods should be avoided while taking MAOIs and why

Answer 25

Foods that normally contain thyramine, including wine, beer, herring, and certain cheeses

-can cause dangerously high blood pressure in people taking a monoamine oxidase inhibitor.

Question 26

What disorders are SSRIs indicated

SSRIs - Selective Serotonin Reuptake Inhibitors

Answer 26

Anxiety disorder, depression disorders, Obsessive compulsive disorder, panic disorder, chronic pain disorder, and fibro myalgia

Question 27

What does patient monitoring include for Lithium?
What patient instructions need to be given?
(Side effects? onset of action? ect.)
Can pregnant patients take Lithium?

Answer 27

Explain to the patient that the therapeutic effects of lithium may require 1-2 weeks of treatment

Explain to the patient that side effects are common and usually include nausea or vomiting

Explain to the patient that lithium is a salt and that increased thirst and frequency of urination are common

Instruct patient on the importance of adequate fluid and sodium intake

Instruct patient to report excessive nausea and vomiting excessive CNS stimulation, dizziness, abnormal muscle movements, low blood pressure

Explain to the patient that periodic drug blood levels may be required

Lithium is pregnancy category D- DO NOT TAKE DURING PREGNANCY

Question 28

Define dependency, designer drug, and drug tolerance

Answer 28

Drug Dependence- condition of reliance on the use of a particular drug characterized as physical and/or psychological dependence

Designer Drug – chemically altered form of an approved drug that produces similar effects and that is sold illegally

Drug Tolerance- decreased drug effect occurring after repeated drug administration

Question 29

State pharmacological effects of marijuana

Answer 29

Reddening of the eyes and increased heart rate, mental relaxation, euphoria, increased sociability

Moderate intoxication is drowsiness, impairment of
memory, lapses in attention

Low doses- slight bronchodilation

High doses- reflexes are slowed muscle coordination decreases, ataxia is evident and speech and ability to concentrate become more difficult. Psychic effects also may include dysphoria acute panic-anxiety reactions, and psychotic episodes. Marijuana psychosis may in part be caused by unmasking of latent psychiatric disorders

Question 30

State the difference between anticonvulsant drugs and antiepileptic drugs

Answer 30

Anticonvulsant Drug- usually administered IM or IV that stops a convulsive seizure. // they have a selected effect at lower doses to prevent seizures
(sedation and hypnosis are common pharmacological effects produced by barbiturates. However, in the treatment of epilepsy, excessive sedation or hypnosis is an unwanted side effect).

Antiepileptic Drugs- usually administered orally, can be used prophylactically to reduce or prevent epileptic seizures.//decrease the excitability of brain cells and, consequently, reduce the incidence and severity for seizures.

(Prophylactically- Intend to prevent disease)

Question 31

Common adverse effects of phenytoin (Dilantin)

A Seizure Medication

Answer 31

The most common adverse effects involve the cerebellum.

Symptoms are

dizziness
ataxia
visual disturbances
postural imbalance
skin rashes
hirsutism
gingival hyperplasia

It’s been associated with birth defects referred to as the fetal hydantoin syndrome-defects include craniofacial abnormalities, growth retardation, cardiac defects, learning and developmental problem

Question 32

If a person has a grand mal seizure, what do they experience

Answer 32

Grand Mal Seizure (aka Tonic-clonic)- most dramatic in appearance and involve loss of consciousness.

begin with tonic followed by clonic muscle contractions.
Individual appears to jerk around due to the alternating muscle contractions and relaxations.

Increases in blood pressure and heart rate
urination
defecation
tongue biting are common

Usually lasts several minutes.

Following the seizure is
confusion
fatigue
muscle soreness.

Question 33

While taking levodopa, why would a patient experience orthostatic hypotension

(AKA- L-DOPA - is a Parkinson’s/seizure medication)

Answer 33

In the brain, HIGH LEVELS OF DOPAMINE interfere with cardiovascular reflexes that maintain blood pressure. Consequently some patients experience orthostatic hypotension or fainting.

Question 34

Since injecting dopamine in Parkinson’s patients does not help to increase dopamine levels, what drug can be converted to dopamine

Answer 34

In the dopaminergic neurons of the substantia nigra, levodopa is converted to dopamine

Question 35

Name drug interactions of levodopa

Parkinson’s/seizure medication

Answer 35

A Number of drugs interfere with the action of levodopa.

• Antipsychotic drugs
• MAO-A inhibitors
• Vitamin B6 or pyridoxine

Question 36

Which drug aids levodopa from converting to dopamine too soon? What is the trade name?

(Parkinson’s/seizure medication)

Answer 36

In order to minimize this premature conversion, levodopa is usually given along with another drug- Carbidopa (Lodosyn) inhibits the enzyme DOPA decarboxylase that converts levodopa to dopamine peripherally so that more levodopa passes into the brain before being converted to dopamine.

A combination of levodopa and Carbidopa is available under the trade name of Sinemet, and is the most widely used drug preparation.

Question 37

State the difference between induction of general anesthesia and maintenance of general anesthesia

Answer 37

Induction of General Anesthesia- is the time required to take a patient from consciousness to Stage III

Maintenance of General Anesthesia- is the ability to keep a patient safely in Stage III.

Question 38

State the objective of using anesthesia during surgical procedures

Answer 38

The ideal general anesthetic would produce rapid induction (from stage I to stage III) and slow maintenance (stage III) without entering Stage IV anesthesia. In addition recovery from the ideal general anesthesia would occur rapidly without side effects.

Question 39

Opioid analgesics are primarily used for what kinds of pain

Answer 39

Opioid analgesics are first-line therapy for pain associated with procedures (bone marrow biopsy), pain due to trauma (burns, vehicular accident), cancer, or visceral pain (internal organs including pancreatitis, appendicitis).

• can relieve virtually any type of pain.
• relieve moderate to severe acute and chronic pain- such as pain often associated with myocardial infraction, post-trauma injury’s, and cancer.
• drug of choice in treating acute postoperative pain, including dental pain because there is no increased risk of bleeding as with (NSAIDs)

Question 40

Why would fentanyl be given to a patient prior to surgery

Answer 40

Opioids (such as fentanyl) are frequently used during MAC (monitored anesthesia care) because they are able to suppress transmission of sensory information associated with moderate to severe pain of any origin. They depress transmission in the spinal cord by interacting with mu opioid receptors. // they block pain associated with the procedure and or condition during surgery

-opiates are not anesthetics at any dose// do not produce amnesia even at doses that create sedation. Sedation is more of a liability than a clinical benefit with opioid analgesics because the dose to produce sedation usually requires some degree of CNS and respiratory depression. For this reason and because they produce nausea and vomiting, opioid analgesics are seldom used alone in MAC

Question 41

Codeine, hydrocodone, morphine, oxycodone, fentanyl, along with others, are all schedule ????? Controlled Substances (I, II, III, IV, or V)

Answer 41

Schedule II – because of their high abuse potential, most opioids used as analgesics or adjuncts to anesthesia are restricted to Schedule II. Schedule II requires that listed drugs must have a new prescription written for each refill.

Except for- Heroin (I) Buprenophine(III) Butorphanol (III) Butophanol nasal spray (IV) Nalbuphine (***) Pentazocine (IV)

Question 42

Opioid analgesics are called central analgesics. Why?

Answer 42

Because they selectively act within the CNS to reduce the reaction to pain. Opioid

Question 43

List the cardinal signs of inflammation

Answer 43

Redness, swelling (edema), warmth, pain, and loss of function

Question 44

Why would a patient be told to take acetaminophen instead of aspirin or an NSAID?

Answer 44

If the patient has a fever, headache, minor musculoskeletal pain, and discomfort associated with the common cold and flu in adults and children.

• the drug of choice (not aspirin) for reducing fever and aches (minor pain) in children.
• particularly indicated for use in patients allergic to aspirin- those receiving anti-coagulant therapy for coagulation disorders, or patients who have upper GI disease and for whom aspirin therapy is not an option.
• its recommended for patients who experience GI upset from aspirin or non steroidal anti-inflammatory drugs (NSAIDs) however it is not interchangeable with these products for chronic therapy of inflammatory conditions such as osteoarthritis.

Question 45

What can excessive use of acetaminophen cause

Answer 45

Toxicity may develop from chronic use of large doses of acetaminophen as well as acute overdose from a single episode of ingestion of a large dose.

Question 46

What does aspirin inhibit, giving anticoagulant benefits

Answer 46

Aspirin permanently hinders the access of achidonic acid to the active site on the COX-1 enzyme. Aspirin irreversibly blocks COX-1, THROMBOXANE is not generated and clotting is suppressed (anti-coagulant). This effect continues until new COX enzymes are synthesized. As a result, even low doses of aspirin increase bleeding time. In large doses, salicylates may depress the formation of other coagulation factors (prothrombin), thus increasing bleeding time

Question 47

Determine the main therapeutic effect of diuretics

ELMINATE?
(CHF)

Answer 47

The main therapeutic effect produced by diuretics is the elimination of excess sodium and water by the kidneys. Sodium and water retention are the main causes of edema and congestion in CHF.

Question 48

What are ACE inhibitors mechanisms of action

ACEI- angiotensin-converting enzyme inhibitor

Answer 48

ACEIs inhibit the formation of angiotensin II and decrease the release of aldosterone and antidiuretic hormone.

These actions LOWER BLOOD PRESSURE by causing a BALANCED VASODILATION of both ARTERIES AND VEINS.

In addition, ACEIs also INHIBIT INACTIVATION OF BRADYKININ, which also PRODUCES VASODILATION

(Aldosterone- causes the retention of sodium ions and excretion of potassium ions)

(Bradykinin- endogenous vasodilator)

Question 49

What are the therapeutic action of beta blockers

Answer 49

Beta Blockers antagonize the effects of norepinephrine and epinephrine at the beta-1 receptors, beta blockers decrease heart rate, AV conduction, and automaticity of SA and AV nodes, and of atrial and ventricular muscle.

-are mainly indicated for supraventricular arrhythmias and for prevention of recurrent myocardial infraction.

Question 50

CHF can be treated with beta blockers – name the preferred beta blockers

Answer 50

Metoprolol (lopressor), bisoprolol (zebeta), nebivolol (Bystolic) and carvedilol (Coreg) are usually the preferred treatment of CHF.

Question 51

Diuretics work on different parts of the nephron within the kidney. State what part of the nephron the thiazide diuretics, loop diuretics, and aldosterone antagonists act on

Answer 51

Thiazide diuretics- Thiazide and thiazide-like diuretics are similarly acting drugs that block the reabsorption of sodium in the DISTAL TUBULES of the kidney nephrons

Loop diuretics- The organic acids are commonly referred to as the loop diuretics because the site of diuretic action in the kidney nephrons is the THICK ASSENDING LIMB OF THE LOOP HENLE

Aldosterone antagonist- are weak diuretics that act on the COLLECTING DUCTS of the nephron.

Question 52

In general, how do anti-arrhythmic work

What affect do they have?

Answer 52

Most anti-arrhythmic drugs affect the movement of one or more specific ions and exert their major antiarrhythmic action on a specific phase of the action potential.

Question 53

How do calcium channel blockers work as anti-arrhythmics

Answer 53

They decrease the entry of calcium into cells whose electrophysiologic actions depend on the influx of calcium through the slow-type calcium channels.

In the heart, the depolarization (contraction) of SA (Sinoatrial)and AV (atrioventricular) nodal cells is highly dependent on the influx of calcium ions.

The effect of calcium channel blockers on the SA node is to SLOW DEPOLORIZATION AND DECREASE HEART RATE. The effect on the AV node is to SLOW CONDUCTION. These actions REDUCE the ventricular rate during fast supraventricular arrhythmias.

-Calcium channel blockers also affect the contraction of cardiac and smooth muscle. Entry of calcium during Phase 2 of the action potential is important for regulating the force of myocardial contractions.
INTERFERENCE WITH CALCIUM ENTRY into the CARDIAC MUSCLE REDUCES MYOCARDIAL CONTRACTILITY. This is usually not a desired therapeutic action and may precipitate heart failure in patients with CHF. The calcium channel blockers also DECREASE THE ENTRY OF SMOOTH MUSCLE to RELAX smooth muscle and cause VASODILATION, which is useful in the treatment of angina pectoris and hypertension.

They are divided into two groups:

-Dihydropyridines/ nondihydropyridines -
only block calcium in smooth muscle to cause arterial vasodilation. They do not have direct effects on the heart and are mainly used in the treatment of angina pectoris and hypertension.

-miscellaneous drugs – 
include verapamil (calan) and diltiazem (Cardizem) These two drugs are also arterial vasodilators and in addition have direct antiarrhythmic effects on the heart to slow heart rate (SA node) and slow AV conduction (AV node). Consequently, verapamil and diltiazem are the only calcium channel blockers used for their antiarrhythmic.

Question 54

Name side effects of nitroglycerin. What is the most serious adverse side effect?

Answer 54

Related to vasodilating action

Cutaneous flushing
dizziness
headache
weakness
fainting

Sudden or excessive drops in blood pressure can cause

reflex tachycardia.

Question 55

Define angina

Answer 55

Angina- Chest pain or discomfort that occurs when the heart muscle does not get enough blood and oxygen.

Question 56

How do beta blockers help patients with angina

Answer 56

The therapeutic action of beta- blockers in the treatment of angina lies in the ability of these drugs to
decrease heart rate and force of contractions. These changes decrease cardiac work and therefore oxygen consumption. Decreasing oxygen consumption often prevents development of myocardial ischemia and pain.

Question 57

Does cardiac work increase or decrease with the use of nitrates

Answer 57

The main effect of the nitrates is to produce a general vasodilation of systemic veins and arteries. This reduces venous return, cardiac work and oxygen consumption. Reduction of cardiac work and oxygen consumption provides relief of ischemia and pain.

Question 58

If a patient has a sudden attack of angina, which route of administration of nitrates would work faster, and is the most common route

Answer 58

Fastest route of administration for Angina- Sublingual 1-3 Minutes-peak effect in about 5 minutes. The duration of action is approximately 30 Minutes.

Most common route of administration for Angina- Sublingual

Question 59

Know patient instructions that should be given to a patient about nitroglycerin

Answer 59

• it is important for paitents to carry the prescribed medication at all times
• Nitroglycerin is volatile, and tablets lose potency if exposed to air or light. Therefore, it is important that tablets be carried in light- resistant, airtight containers.
• standard practice is not to use nitroglycerin tablets that are more than 6 months old since there may be significant loss of potency
• when patients experience angina they should be instructed to sit down, place a nitroglycerin tablet under the tongue, and allow it to dissolve without swallowing. Relief should occur within 5 minutes. If it does not they should repeat the process with another tablet. If there is no relief after three tablets, patients should notify the physician or seek medical assistance.
• side effects cutaneous flushing, headache, dizziness- should be advised to lay down if they feel faint. These effects are expected and only last a few minutes
• patients should become aware of the activities that cause angina (overexertion, emotional upset, or overeating) and try to avoid these situations if possible.

Question 60

Name drug interaction of levodopa and Anti Psychotic Drugs

Parkinson’s/Seizure Drug

Answer 60

(phenothiazines, haloperidol, drugs that block DA) decrease the effectiveness of levodopa because they block dopamine receptors. This may cause symptoms of Parkinson’s disease, referred to as parkinsonism.

Question 61

Name drug interaction of levodopa and MAO-A Inhibitors

Parkinson’s/Seizure Drug

Answer 61

used in treating mental depression also should not be taken with levodopa. They can produce high levels of norepinephrine and may cause a hypertensive crisis and other adverse effects.

Question 62

Name drug interaction of levodopa and Vitamin B6 or pyridoxine

(Parkinson’s/Seizure Drug)

Answer 62

may increase the rate of metabolism of levodopa if the patient is not also taking carbidopa. When used as a vitamin supplement, vitamin B6 may decrease the effectiveness of levodopa.