Unit 1 Chapter 3 Pharmcaokinetics and Phamadynamics

Question 1

What is Pharmacikinetics?

Answer 1

Pharmacokinetics is the process of drug movement throughout the body necessary to achieve drug action. The four processes are
(1) absorption,
(2) distribution,
(3) metabolism (or biotransformation), and
(4) excretion (or elimination).

WHAT THE BODY WILL DO THE DRUG

Question 2

What two organs are essential to drug metabolism and drug excretion?
A. Anus and esophagus
B. Heart and rectum
C. Liver and kidneys
D. Urethra and oral cavity

Answer 2

C. Liver and kidneys

First pass occurs in liver

Question 3

What is Drug Absorption

Answer 3

Drug absorption is the movement of the drug into the bloodstream after administration.

Question 4

What is Disintegration, Dissolution,

Answer 4

Disintegration
 Breakdown of oral drug form into small particles
. The rate of dissolution is the time it takes the drug to disintegrate and dissolve to become available for the body to absorb it. Drugs in liquid form are more rapidly available for GI absorption than are solids.
-taken by mouth

 Dissolution
 Process of combining small drug particles with
liquid to form a solution
For the body to use drugs taken by mouth, a drug in solid form (e.g., tablet or capsule) must disintegrate into small particles and combine with a liquid to form a solution, a process known as dissolution (drugs in liquid form are already in solution), to be absorbed from the gastrointestinal (GI) tract into the bloodstream.

 Drug absorption
 Drug movement from GI tract into bloodstream

Question 5

Liver Failure

Answer 5

Medication is absorbed slowly (Jaundice)

Question 6

Kidney Failure

Answer 6

Drug toxicity can occur (Overdose) .Medication stays longer in the body.

Question 7

What is half-life

Answer 7

The drug half-life (t1⁄2) is the time it takes for the amount of drug in the body to be reduced by half. The amount of drug administered, the amount of drug remaining in the body from previous doses, metabolism, and elimination affect the half-life of a drug.

For example, with liver or kidney dysfunction, the half-life of the drug is prolonged, and less drug is metabolized and eliminated.

the amount of time it takes a half of the drug to be gone in the body

The shorter the half life the more often the drug is administered

the longer the half life the least often the drug will be administered

Question 8

What factor affect drug absorption?

Answer 8

Blood flow, pain, stress, hunger, fasting, food, and pH affect drug absorption. Poor circulation to the stomach as a result of shock, vasoconstrictor drugs, or disease hampers absorption. Pain, stress, and foods that are solid, hot, or high in fat can slow gastric emptying time, so drugs remain in the stomach longer. Exercise can decrease gastric blood flow by shunting blood flow to peripheral muscles, thereby decreasing blood circulation to the GI tract.

Question 9

Which of the following affects drug absorption?
A. food
B. sleep
C. rest
D. adequate nutrition

Answer 9

A. food

Blood flow, pain, stress, hunger, fasting, food, and pH affect drug absorption. Poor circulation to the stomach as a result of shock, vasoconstrictor drugs, or disease hampers absorption. Pain, stress, and foods that are solid, hot, or high in fat can slow gastric emptying time, so drugs remain in the stomach longer. Exercise can decrease gastric blood flow by shunting blood flow to peripheral muscles, thereby decreasing blood circulation to the GI tract.

Question 10

Different routes of drug absorption

Answer 10

Drugs given intramuscularly are absorbed faster in muscles that have increased blood flow (e.g., deltoid) than in those that do not (e.g., gluteus maximus).

Subcutaneous tissue has decreased blood flow compared with muscle, so absorption is slower when drugs are given subcutaneously.predictable rate of absorption than those given by mouth.

Drugs given rectally are absorbed slower than drugs administered by the oral route. Absorption is slower because the surface area in the rectum is smaller than the stomach, and it has no villi. Additionally, the composition of the suppository base (e.g., fa y bases or water-soluble bases) affects drug absorption.

Question 11

Where does first pass occur?
A.from the portal vein to the Liver
B. from the esophagus to the Stomach
C. Oral cavity
D. Kidney

Answer 11

A.from the portal vein to the Liver

FIRST PASS ONLY OCCURS IN ORAL MEDICATIONS

After absorption of oral drugs from the GI tract, they pass from the intestinal lumen to the liver via the portal vein. In the liver, some drugs are metabolized to an inactive form and are excreted, thus reducing the amount of active drug available to exert a pharmacologic effect. This is referred to as the first-pass effect or first-pass metabolism.

Most oral drugs are affected to some degree by first-pass metabolism. Lidocaine and some nitroglycerins, for example, are not given orally because they have extensive first-pass metabolism, and most of the drug is inactivated. Drugs that are delivered by other routes (IV, IM, SQ, nasal, sublingual, buccal) do not enter the portal circulation and are not subjected to first-pass metabolism.

Question 12

Why are some drugs not given orally due to the mechanism of the first pass that takes place in the Liver?
A. The liver metabolizes the drug to an inactive form, causing the therapeutic effect of the drug to be lessened.
B. The liver metabolizes the drug which causes a greater effect that can lead to a toxic effect or overdose
C.To create a therapeutic effect
D.To decrease the therapeutic effect

Answer 12

A. The liver metabolizes the drug to an inactive form, causing the therapeutic effect of the drug to be lessened.

Most oral drugs are affected to some degree by first-pass metabolism. Lidocaine and some nitroglycerins, for example, are not given orally because they have extensive first-pass metabolism, and most of the drug is inactivated. Drugs that are delivered by other routes (IV, IM, SQ, nasal, sublingual, buccal) do not enter the portal circulation and are not subjected to first-pass metabolism.
PG 22 PHYSICAL BOOK

Question 13

What is bioavailability?

Answer 13

Bioavailability refers to the percentage of administered drug available for activity.

For orally administered drugs, bioavailability is affected by absorption and first-pass metabolism.

The bioavailability of oral drugs is always less than 100% and varies based on the rate of first-pass metabolism

(i.e., the bioavailability of rosuvastatin is 20%, whereas the bioavailability of digoxin ranges from 70% to 85%). The bioavailability of intravenous (IV) drugs is 100%(
IV drugs does not have contact with first pass metabolism)

Question 14

What can liver failure do to an oral drug that is ingested and metabolized in the liver?
A. can increase the bioavailability of the oral medication
B. can decrease the bioavailability of the oral medication
C. can increase urine output
D. Can make the patient cry

Answer 14

A. can increase the bioavailability of the oral medication

A decrease in liver function or a decrease in hepatic blood flow can increase the bioavailability of a drug, but only if the drug is metabolized by the liver. Less drug is destroyed by hepatic metabolism in the presence of a liver disorder.

Question 15

FACTORS AFFECTING
BIOAVAILABILITY

Answer 15

FACTORS AFFECTING
BIOAVAILABILITY
 Absorption
 First-pass metabolism
 Drug form
 Route of administration
 Gastric mucosa and motility
 Administration with food and other drugs
 Changes in liver metabolism

Question 16

What is Drug Distribution?

Answer 16

Distribution is the movement of the drug from the circulation to body tissues.

from blood to organs, fat, and muscles

Drug distribution is influenced by vascular permeability and permeability of cell membranes, regional blood flow and pH, cardiac output, tissue perfusion, the ability of the drug to bind tissue and plasma proteins (Fig. 3.3), and the drugs lipid solubility. Drugs are easily distributed in highly perfused organs such as the liver, heart, and kidney. Tissues with decreased perfusion, such as muscle, fat, and peripheral organs, result in decreased drug distribution.

Question 17

As a nurse would you administer two protein binding drugs at the same time?
A. Yes
B. No

Answer 17

B. No

When two highly protein-bound drugs are administered together, they compete for protein-binding sites, leading to an increase in free drug being released into the circulation. For example, if warfarin (99% protein bound) and furosemide (95% protein bound) were administered together, warfarin —the more highly bound drug—could displace furosemide from its binding site. In this situation, it is possible for drug accumulation to occur and for toxicity to result.

Question 18

What two protein binding drugs should you not give at the same time?

Answer 18

Aspirin and Ibuprofen and warfarin

When a drug(ibuprofen) is binded to a protein there is no action (no therapeutic effect)

The part or percentage of the drug that is not binded to a protein is free to cause an action (therapeutic effect)

If a patient doesn’t have enough protein (Albumin) when taking a protein binding medication it can lead to drug toxicity / overdose

Question 19

What is a free drug

Answer 19

Free drugs are able to exit blood vessels and reach their site of action, causing a pharmacologic response. TOXIC OR OVERDOSE when using two protein binding drugs

Question 20

What do older adults have that put them at risk for drug toxicity when it comes to ingesting protein binding medications?
A. hypoalbuminemia
B. hyperalbuminemia
C.hypercalcemia
D. Hypotension

Answer 20

A. hypoalbuminemia

Another factor that may alter protein binding is low plasma protein levels, which potentially decrease the number of available binding sites and can lead to an increase in the amount of free drug available, resulting in drug accumulation and toxicity.

Patients with liver or kidney disease and those who are malnourished may have significantly lower serum albumin levels.

Additionally, older adults are more likely to have hypoalbuminemia, particularly if they have multiple chronic illnesses.

With these factors in mind, it is important for nurses to understand the concept of protein binding and check their patient’s protein and albumin levels when administering drugs.

Question 21

Why is drug metabolism or biotransformation crucially important?
A. it allows fat-soluble drugs to be altered to water soluble drugs in order to be excreted by the kidneys.
B. it distributes the drug across the body and liver
C. it allows hyperinsulinism
D. it creates a safe space for drug absorption

Answer 21

A. it allows fat-soluble drugs to be altered to water soluble drugs in order to be excreted by the kidneys.

is the process by which the body chemically changes drugs into a form that can be excreted. The liver is the primary site of metabolism.

A large percentage of drugs are lipid soluble, thus the liver metabolizes the lipid-soluble drug substance to a water-soluble substance for renal excretion.

Liver diseases such as cirrhosis and hepatitis alter drug metabolism by inhibiting the drug-metabolizing enzymes in the liver. When the drug metabolism rate is decreased, excess drug accumulation can occur and can lead to toxicity.

Question 22

What is the half-life of a drug

Answer 22

The drug half-life (t1⁄2) is the time it takes for the amount of drug in the body to be reduced by half.

For example, with liver or kidney dysfunction, the half-life of the drug is prolonged, and less drug is metabolized and eliminated.

By knowing the half-life, the time it takes for a drug to reach a steady state (plateau drug level) can be determined.

A drug goes through several half-lives before complete elimination occurs, and drug half-life is used to determine dosing interval.
This is best understood with an example: ibuprofen has a half-life of about 2 hours. If a person takes 200 mg, in 2 hours, 50% of the drug will be gone, leaving 100 mg. Two hours later, another 50% of the drug will be gone, this time leaving 50 mg; in another 2 hours, 50% more will be gone, so only 25 mg will remain.
This process continues such that 10 hours after 200 mg of ibuprofen has been taken, if no additional doses are administered, 6.25 mg of the drug remains

Question 23

What is a loading dose

Answer 23

By giving a large initial dose, known as a loading dose, that is significantly higher than maintenance dosing, therapeutic effects can be obtained while a steady state is reached. It bears repeating that the loading dose is larger than the dose needed to maintain the drug at steady state; it would produce toxic side effects if given in repeated doses. After the loading dose, maintenance dosing is begun; this is the dose needed to maintain drug concentration at steady state when given repeatedly at a consistent dose and constant dosing interval.

Question 24

NORMAL RANGE OF BLOOD UREA NITROGEN

Answer 24

Both Sexes: 10-20 mg/dL
Common tests used to determine renal function include creatinine and blood urea nitrogen (BUN).

Question 25

NORMAL RANGE FOR CREATNINE

Answer 25

Male: 0.6-1.2 mg/dL Female: 0.5-1.1 mg/dL
Common tests used to determine renal function include creatinine and blood urea nitrogen (BUN).

Question 26

WHAT DOES AN ELEVATED BLOOD UREA NITROGEN INDICATE

Answer 26

Acute glomerulonephritis
Congestive heart failure
Diabetes mellitus
High-protein diet
Nephrotic syndrome
Renal disease
Severe dehydration
Severe infection
Shock

Question 27

WHAT DOES AN DECREASE BLOOD UREA NITROGEN INDICATE

Answer 27

Alcohol abuse
Diet inadequate in protein
Hepatitis
Liver failure
Malnutrition

Question 28

WHAT DOES AN ELEVATED CREATNINE INDICATE

Answer 28

Congestive heart failure
Dehydration
Diabetes mellitus
Glomerulonephritis
Renal failure
Rheumatoid arthritis
Shock
Uremia

Serum creatinine is a waste product of skeletal muscle metabolism. It is excreted by the kidneys. Because creatinine is excreted at a more consistent rate than BUN, serum-level values tend to be more sensitive in detecting renal impairment.

Question 29

WHAT DOES AN DECREASED CREATNINE INDICATE

Answer 29

Atrophy of muscle
Pregnancy

Serum creatinine is a waste product of skeletal muscle metabolism. It is excreted by the kidneys. Because creatinine is excreted at a more consistent rate than BUN, serum-level values tend to be more sensitive in detecting renal impairment.

Question 30

Which routes can drug be excreted?

Answer 30

The main route of drug excretion, elimination of drugs from the body, is through the KIDNEYS to become urine.
Drugs are also excreted through
bile,
the lungs,
saliva,
sweat, and
breast milk.

Question 31

What is Pharmacodynamics

Answer 31

Pharmacodynamics is the study of the effects of drugs on the body.

Drugs act within the body to mimic the actions of the body’s own chemical messengers.

Question 32

A drugs Primary effect is..

Answer 32

A drug’s primary effect is the desirable response
THERAPEUTIC EFFECT
example

An example of a drug with a primary and secondary effect is diphenhydramine, an antihistamine. The primary effect of diphenhydramine is to treat the symptoms of allergy;. desired effect, ,at bedtime it could be desirable because it causes mild sedation.

Question 33

A drugs Secondary effect is..

Answer 33

secondary effect may be desirable or undesirable.
SIDE EFFECT
An example of a drug with a primary and secondary effect is diphenhydramine, an antihistamine. the secondary effect is a central nervous system (CNS) depression that causes drowsiness. The secondary effect is undesirable when the patient drives a car

Question 34

Primary and Secondary effect of a drug

Answer 34

Drug response can cause a primary or secondary physiologic effect or both. A drug’s primary effect is the desirable response, and the secondary effect may be desirable or undesirable.

An example of a drug with a primary and secondary effect is diphenhydramine, an antihistamine. The primary effect of diphenhydramine is to treat the symptoms of allergy; the secondary effect is a central nervous system (CNS) depression that causes drowsiness. The secondary effect is undesirable when the patient drives a car, but at bedtime it could be desirable because it causes mild sedation.

Question 35

what is the Potency of a drug

Answer 35

Potency refers to the amount of drug needed to elicit a specific physiologic response to a drug.

Question 36

High Potency Drug and effect

Answer 36

A drug with high potency, such as fentanyl, produces significant therapeutic responses at low concentrations;

Question 37

Low Potency Drug and effect

Answer 37

a drug with low potency, such as codeine, produces minimal therapeutic responses at low concentrations

Question 38

What is a Therapeutic Index

Answer 38

Is a small window where the drug or medication is effective (JUST THE RIGHT DOSE)

Question 39

Narrow Therapeutic Index

Answer 39

If the ED50 and TD50 are close, the drug is said to have a narrow therapeutic index. Drugs
with a narrow therapeutic index—such as warfarin, digoxin, and phenytoin —require close monitoring to ensure patient safety

Question 40

What is a Therapeutic Range

Answer 40

The therapeutic range is a range of doses that produce a therapeutic response without causing significant adverse effect in patients.

Question 41

What are the Mechanism of a drug action/What drugs can do and its effect on the body?

Answer 41

Mechanisms of drug action – what drugs can do
 Stimulation
 Depression
 Irritation
 Replacement
 Cytotoxic action
 Antimicrobial action
 Modification of immune status

Question 42

Onset action of a drug

Answer 42

Other important aspects of pharmacodynamics to understand include a drug’s onset, peak, and duration of action. Onset is the time it takes for a drug to reach the minimum effective concentration (MEC) after administration.

Question 43

Peak action of a drug

Answer 43

A drug’s peak occurs when it reaches its highest concentration in the blood.

Question 44

Duration action of a drug

Answer 44

Duration of action is the length of time the drug exerts a therapeutic effect. Fig. 3.8 illustrates the areas in which onset, peak, and duration of action occur.

Question 45

Why is Therapeutic Index monitoring so important?

Answer 45

it closely monitors the drug levels in the body to make sure the amount left in the body is not a toxic amount which can lead to overdose. MAINLY FOR ANTIBIOTIC MEDICATIONS

Once a steady state has been achieved, drug concentration can be determined by measuring peak and trough drug levels. Peak and trough levels are requested for drugs that have a narrow therapeutic index and are considered toxic.

Question 46

Are Peak and Trough labs that can be pulled from a patient?
A. Yes
B. No

Answer 46

A. Yes

Peak and trough (name of a lab)

Question 47

What is the Peak

Answer 47

The peak drug level is the highest plasma concentration of drug at a specific time, and it indicates the rate of drug absorption.

Question 48

What is the Trough

Answer 48

The trough drug level is the lowest plasma concentration of a drug, and it measures the rate at which the drug is eliminated. Trough levels are drawn just before the next dose of drug regardless of route of administration.

Question 49

When are Peak labs drawn for an IV medication?
A. 30-60 minutes after drug administration
B. 1 hour - 2 hours after drug administration
C. immediately after drug administration
D. immediately before the next dose of a medication

Answer 49

A. 30-60 minutes after drug administration

If the drug is given intravenously, the peak time is usually 30 to 60 minutes after the infusion is complete.

If the drug is given intramuscularly, the peak time is usually 2 to 4 hours after injection.

If the drug is given orally, the peak time is usually 2 to 3 hours after drug administration.

Question 50

What does it mean when a Peak lab is low?
A. If the peak is too low, effective concentration has not been reached.
B. If the peak is too low, effective concentration has been reached.
C. Effective concentration is defective leading to diaphoresis
D. the concentration of the drug is the highest

Answer 50

A. If the peak is too low, effective concentration has not been reached.

Question 51

What is Trough?

Answer 51

The trough drug level is the lowest plasma concentration of a drug, and it measures the rate at which the drug is eliminated

Question 52

When would you pull a Trough lab when a patient has been receiving antibiotic medication?
A. immediately before the next dose of drug regardless of route of administration.
B. just after the next dose of drug regardless of route of administration.
C. 30 -60 minutes after drug administration
D. 1 hour before the next dose of the antibiotic medication

Answer 52

A. immediately before the next dose of drug regardless of route of administration.

The trough drug level is the lowest plasma concentration of a drug, and it measures the rate at which the drug is eliminated. Trough levels are drawn just before the next dose of drug regardless of route of administration.

Question 53

What drugs require both Peak and Through Labs to be pulled?
A. Calcium Channel
B. Betablockers
C. NSAIDS
D. aminoglycoside antibiotics

Answer 53

aminoglycoside antibiotics

Most drugs only require trough concentration levels to be drawn (the exception is aminoglycoside antibiotics, which require both peak and trough levels).

Question 54

What is Receptor Theory

Answer 54

Drugs bind to receptors to cause or block an
action

Drugs act by binding to receptors. Binding of the drug may activate a receptor, producing a response, or it may inactivate a receptor, blocking a response.

The four receptor families (Fig. 3.10) include
(1) cell membrane–embedded enzymes,
(2) ligand-gated ion channels,
(3) G protein–coupled receptor systems, and
(4)transcription factors.

Question 55

What are Agonist drugs

Answer 55

Drugs that activate receptors and produce a desired response are called agonists.

Activate receptors

Question 56

What are Antagnoist drugs

Answer 56

Drugs that prevent receptor activation and block a response are called antagonists.

Prevent receptor activation

Question 57

Are Side Effects expected?

Answer 57

Side effects- are mild
 Secondary drug effects
 Usually get better with continued use

All drugs have side effects. Even with correct drug dosage, side effects occur that can be predictable and range from inconvenient to severe or life threatening.

some instances, the side effects may be desirable (e.g., using diphenhydramine at bedtime, when its side effect of drowsiness is beneficial). Chronic illness, age, weight, gender, and ethnicity all play a part in drug side effects.

NURSING INTERVENTION

It is important to know that the occurrence of side effects is one of the primary reasons patients stop taking their prescribed medications. An important role of the nurse includes teaching patients about a drug’s side effects and encouraging them to report side effects. Many can be managed with dosage adjustments, changing to a different drug in the same class, or implementing other interventions.

you can treat side effects

Question 58

Are Adverse Effects planned?

Answer 58

Adverse reactions
 Severe
 Undesirable effects
 Usually get worse with continuing use

are unintentional, unexpected reactions to drug therapy that occur at normal drug dosages. The reactions may be mild to severe and include anaphylaxis (cardiovascular collapse)

STOP DRUG IMMEDIATELY

Question 59

What is Drug toxicity?

Answer 59

Drug toxicity occurs when drug levels exceed the therapeutic range; toxicity may occur secondary to overdose (intentional or unintentional) or drug accumulation. Factors that influence drug toxicity include disease, genetics, and age.

Question 60

What is Drug Interaction

Answer 60

A drug interaction is defined as an altered or modified action or effect of a drug as a result of interaction with one or multiple drugs.

Question 61

Pharmokinetic Changes

Answer 61

Pharmacokinetic interactions are changes that occur in the absorption, distribution, metabolism, and excretion of one or more drugs.

Question 62

Why are Additive Drug effects awesome?

Answer 62

When two drugs are administered in combination, and the response is increased beyond what either could produce alone, the drug interaction is called an additive effect; it is the sum of the effects of the two drugs.

GOOD example

Additive effects can be desirable or undesirable. For example, a desirable additive drug effect occurs when a diuretic and a beta blocker are administered for the treatment of hypertension.

As another example, aspirin and codeine are two analgesics that work by different mechanisms but can be given together for increased pain relief.

BAD example

Aspirin is directly irritating to the stomach; it causes platelet dysfunction, and it inhibits prostaglandin-mediated mucus production of the gastric mucosa that protects the underlying tissues of the stomach.

Alcohol disrupts the gastric mucosal barrier and suppresses platelet production. Both aspirin and alcohol can prolong bleeding time and, when taken together, may result in gastric bleeding.

Question 63

Synergistic

Answer 63

Synergistic
 Effect is much greater than effects of either drug
alone.

When two or more drugs are given together, one drug can have a synergistic effect on another. In other words, the clinical effect of the two drugs given together is substantially greater than that of either drug alone.

2 drugs work together to do a better effect

Question 64

Antagonistic

Answer 64

Antagonistic
 One drug reduces or blocks effect of other drug.

When drugs with antagonistic effects are administered together, one drug reduces or blocks the effect of the other. In some situations, antagonistic effects are desirable.

In morphine sulfate overdose, naloxone is given as an antagonist to block the narcotic effects of morphine sulfate.

Question 65

Drug-nutrient interactions

Answer 65

Food may increase, decrease, or delay the body’s pharmacokinetic response to drugs.

Question 66

Would you give Agonist and Antagonist drugs together?
A. Yes
B. No

Answer 66

B. No

Question 67

Drug-laboratory interactions

Answer 67

Drugs often interfere with clinical laboratory testing by cross-reaction with antibodies, interference with enzyme reactions, or alteration of chemical reactions. Drug-laboratory interactions may lead to misinterpretation or invalidation of test results, resulting in additional health care costs associated with unnecessary repeat laboratory testing or additional testing. Drug-laboratory interactions may also lead to missed or erroneous clinical diagnosis

example
how furosemide effects potassium labs

Question 68

Drug-induced photosensitivity

Answer 68

A drug-induced photosensitivity reaction is a skin reaction caused by exposure to sunlight. It is caused most often by the interaction of a drug and exposure to ultraviolet A (UVA) light, which can cause cellular damage; however, ultraviolet B (UVB) light may also contribute to drug-induced photosensitivity reactions.

Skin reaction caused by sunlight exposure,
which can cause a burn to the skin

Question 69

1. Which components of pharmacokinetics does the nurse need to understand before administering a drug? (Select all that apply.)
   a. Drugs with a smaller volume of drug distribution have a longer half-life.
   b. Oral drugs are dissolved through the process of pinocytosis.
   c. Patients with kidney disease may have fewer protein- binding sites and are at risk for drug toxicity.
   d. Rapid absorption decreases the bioavailability of the drug.
   e. When the drug metabolism rate is decreased, excess drug accumulation can occur, which can cause toxicity.

Answer 69

C,E

Question 70

2. The nurse will question the health care provider if a drug with a half-life ( t 1⁄2) of more than 24 hours is ordered to be given more than how often?
   a. Once daily
   b. Every other day
   c. Twice weekly
   d. Once weekly

Answer 70

A

Question 71

3. The nurse is explaining drug action to a nursing student. Which statement made by the nurse is correct?
   a. Water-soluble and ionized drugs are quickly absorbed. b. A drug not bound to protein is an active drug.
   c. Most receptors are found under the cell membrane.
   d. Toxic effects can result if the trough level is low.

Answer 71

B

Question 72

4. A Native American patient is newly diagnosed with type 2 diabetes mellitus and is prescribed the antidiabetic drug metformin 500 mg by mouth with morning and evening meals. Which statement best indicates to the nurse that the patient will adhere to the therapeutic regimen?
   a. I will no longer put sugar on my cereal because that will help me be healthier.
   b. If I take this medicine, I will feel be er soon and won’t have to take it anymore.
   c. To reduce the possibility of damage to my body, I must take the medicine as scheduled.
   d. I have diabetes because of my ancestry, so there’s not much I can do about it.

Answer 72

A

Question 73

5. The nurse is aware that the rate of absorption can be changed by which actions? (Select all that apply.)
   a. Modifying gastric emptying time b. Changing gastric pH
   c. Decreasing inflammation
   d. Forming drug complexes
   e. Eating too slowly

Answer 73

A

Question 74

6. The nurse is meeting with a community group about medication safety. The nurse must emphasize that patients at high risk for drug interactions include which groups? (Select all that apply.)
   a. Older patients
   b. Patients with chronic health conditions
   c. Patients taking three or more drugs
   d. Patients dealing with only one pharmacy e. Patients covered by private insurance

Answer 74

A,B,C

Question 75

7. The nurse recognizes that when a patient takes a hepatic enzyme inducer, the dose of warfarin is usually modified in which way?
   a. It is increased.
   b. It is decreased.
   c. It remains the same. d. It is unpredictable.

Answer 75

A

Question 76

8. The nurse is describing to a patient the synergistic effects of two of his medications. Which statement by the nurse is correct about synergistic drug effects?
   a. Two drugs have antagonistic effects on each other.
   b. The action of a drug is nullified by another drug.
   c. One drug acts as an antidote to the side effects of another drug.
   d. A greater effect is achieved when two drugs are combined.

Answer 76

D

Question 77

9. A patient asks the nurse about drug interactions with over-the-counter preparations. What is the nurse’s best response?
   a. Discuss this with the health care provider.
   b. There are not many interactions, so don’t worry about it.
   c. Read the labels carefully, and check with your health care provider.
   d. Avoid over-the-counter preparations.

Answer 77

C

Question 78

10. Codeine is an example of a(n) _______________ as the cytochrome P450 system metabolizes the drug to facilitate receptor affinity.
    a. agonist
    b. prodrug
    c. antagonist
    d.enzyme

Answer 78

B

Question 79

A patient has liver and kidney disease. He is
given a medication with a half-life of 30 hours.
The nurse expects the duration of this
medication to
A. increase.
B. decrease.
C. remain unchanged.
D. dissipate.

Answer 79

ANS: A
Metabolism and elimination affect the half-life of a drug. With
liver or kidney dysfunction, the half-life of the drug is
prolonged, and less drug is metabolized and eliminated.

Question 80

Which nursing actions would be most
appropriate for ensuring patient safety with a
medication that has a low therapeutic index?
A. Monitoring a patient’s urine output
B. Assessing vital signs hourly
C. Maintaining strict isolation precautions
D. Monitoring serum peak and trough levels

Answer 80

ANS: D
 Serum peak level is the highest plasma concentration of a drug at a specific time, indicating rate of absorption. Serum trough level is the lowest plasma concentration of a drug. They are drawn immediately before the next dose of the drug is to be administered. Trough levels indicate the rate of elimination of the drug. If either the peak or the trough level is too high, toxicity can occur. If the peak is too low, no therapeutic effect is achieved.

Question 81

Most drugs are metabolized in the
A. kidney.
B. small intestine.
C. liver.
D. brain.

Answer 81

C. liver.

Question 82

Would you give another medication with an antacid?
A. No
B.Yes

Answer 82

A. No

You should give an antacid medication 1 hour before or after giving another medication.

Another medication may alter the Ph of the med

Question 83

Tolerance

Answer 83

Tolerance refers to a decreased responsiveness to a drug over the course of therapy; an individual with drug tolerance requires a higher dosage of drug to achieve the same therapeutic response