Pharmacological Principles

Question 1

An older adult woman took a prescription medication to help her to sleep; however, she felt restless all night and did not sleep. Which term describes her response?

a) Allergic reaction
b) Mutagenic reaction
c) Synergistic reaction
d) Idiosyncratic reaction

Answer 1

d) Idiosyncratic reaction

Question 2

In which phase of pharmacokinetics may patients with cirrhosis or hepatitis have abnormalities?

a) Absorption
b) Distribution
c) Metabolism
d) Excretion

Answer 2

c) Metabolism

Question 3

A patient who has advanced cancer is receiving opioid medications around the clock to ‘keep him comfortable’ as he nears the end of his life. Which term best describes this type of therapy?

a) Palliative
b) Maintenance
c) Supportive
d) Supplemental

Answer 3

a) Palliative

Question 4

The nurse is giving medication to a patient in cardiogenic shock. The IV route has been chosen instead of the IM route. Which patient factor most influences this decision?

a) Altered biliary function
b) Diminished circulation
c) Reduced liver metabolism
d) Increased glomerular filtration

Answer 4

b) Diminished circulation

Question 5

A patient has just received a prescription for an enteric coated stool softener. Which of the following statements is most important to include in patient teaching?

a) “Take the tablet with 60-90mL”
b) “Be sure to swallow the tablet whole without chewing it”
c) Avoid taking all other medications with any enteric coated tablet”
d) “Crush tablet before swallowing if you have problems swallowing”

Answer 5

b) “Be sure to swallow the tablet whole without chewing it”

Question 6

Your patient tells you during the nursing assessment that he experiences some ‘strange’ problem with drug metabolism that he was born with, so he is not to take certain medications. What type of disorder do you think the patient is referring to, and what problems can it cause in the patient when specific medications are taken?

Answer 6

1. The particular disorder may be glucose-6-phosphate dehydrogenase deficiency (G6PD deficiency). It is a pharmacogenetic disease that is transmitted as a sex-linked trait and affects approximately 100 million people. It produces drug-induced hemolysis of the red blood cells if exposed to highly oxidizing agents such as those listed in Box 2-3 (see p. 39 in the text).

Question 7

Mr. L is admitted to the trauma unit with multi system injuries as a result of an automobile accident. He arrived at the unit with multiple abnormal findings including shock, decreased cardiac output, and urinary output of less than 30mL/hr. Which route of administration would be indicated for any medications for this patient? Explain reasoning.

Answer 7

2. Intravenous therapy would be most appropriate because it allows immediate access of the drug to the bloodstream. With intramuscular (IM) or subcutaneous (SC) injectable forms of medications, absorption of the drug from the vascular area within a muscle or within subcutaneous tissues is required before absorption into the bloodstream. With clients who are in shock or who have decreased cardiac output or decreased peripheral circulation, these forms would not be so well absorbed. Last, oral forms may not be appropriate because of the longer absorption time via the gastrointestinal tract, and the patient may not be conscious enough to take oral drugs owing to his critical condition.

Question 8

Explain the difference between medication’s action and effect.

Answer 8

3. A drug’s mechanism of action is the way in which it can produce therapeutic responses. The effects of a drug depend on the cells or tissues targeted by that drug. The drug has to go through its mechanism of action prior to having an effect.

Question 9

Explain the importance of each phase of pharmacokinetics.

Answer 9

4. A medication must go through the phases of pharmacokinetics before it can exert its mechanism of action and have its effect on the body. The phases of pharmacokinetics are absorption (the drug gets into the systemic circulation once the dosage form is administered), distribution (the drug is distributed or transported to the site of action), metabolism (the drug is biotransformed into an inactive metabolite, a more soluble compound, or a more potent metabolite), and excretion (the drug is eliminated from the body). Understanding all these phases and subsequent principles related to each phase, as well as their altering factors, is critical.