Exam 1

prototype drug

prototype drug

The first drug in a drug class to be developed

• Penicillin is the prototype of its drug class

generic vs trade names

• Generic name > Brand name  

• Either name could be used for a prescription or dispensing however it can cause confusion  

generic

• chemical/official name of the drug independent of the manufacturer- it can also indicate the drug group

  • Ibuprofen

trade

• manufacture's chosen name for a drug under a patent

  • Advil

controlled substances

DEA enforces the Controlled Substances Act registers individuals and companies legally empowered to handle controlled substances and regulates the documentation and handling of controlled substances

• Narcotics, depressants, Stimulants, hallucinogens, Anabolic steroids

• categorized by federal law due to the potential for abuse

• Limitations on how much and when a pt can get the drug

categories of drugs

schedule I-V

schedule I

no medical use/high abuse: Heroin

schedule II

high abuse opioids/stimulants: Oxycodone

schedule III

less abuse but risk of dependence: steroids, ketamine, codeine 

schedule IV

some abuse potential- benzodiazepines / phentermine

schedule V

contain a controlled in the product but small amount- Tylenol with codeine syrup, Lomotil 

safeguards

• Main goal of drug laws/standards is to protect the public, making sure drugs are safe and effective

• The Food, Drug, and Cosmetic Act (FDA) of 1938 requires that official drugs meet standards of purity and strength. 

  • Regulates manufacturing, distribution, advertising and labeling of drugs 

• The Durham-Humphrey Amendment designates which medications must be prescribed by a health care professional and dispensed by a pharmacist

  • Gives the FDA power to enforce this

  • Public Health service regulates biologic products and the Federal Trade Commission controls OTC products

pharmacology

study of drugs that alter functions of living organisms

pharmacotherapy

use of drugs to prevent, diagnose, or treat signs, symptoms, and disease processes

• includes lifelong therapy

drug safe administration

Regulated by:

• Quality and Safety Education for Nurses (QSEN) competencies

• National Patient Safety Goals from the Joint Commission

• The Institute for Safe Medication Practices (ISMP)


post marketing

Black Box Warning

• High alert medications with serious side effects, example: Accutane

• Additional steps involved to ensure safety

Look-alike drug errors

Beer’s criteria: Geriatric focused adverse effects

• Lots of drugs that have adverse effects in >65 years old

Pregnancy warnings

• X = no

10 rights of drug administration

Right drug

Right patient

Right route

Right dose

Right time

Right reason

Right documentation

Right patient education

Right evaluation

Right to refuse

drug development process

• Phase 1- healthy volunteers: determines dose, route, toxicity, absorption, metabolism, excretion

• Phase 2- few doses to those with the disease and compared to healthy people

• Phase 3- expands research pool to different populations, different doses (double-blind placebo-controlled and other methods) determines benefits vs risk

• Phase 4/Post-Marketing-drug is on the market with reporting on a larger scale, this is where you can find bigger issues

prescription

ordered in writing by licensed provider

over the counter

available for purchase without prescription

drug classification

Groups of medications are based on their effects on the body, their therapeutic use and chemical characteristics

ligand-gated ion channels

• Amlodipine (Ca2+ channel blocker)

• Antihypertensive

• Channel opens or closes after ligand binds to the channel

• Ca is important second messenger

GPCRs

• Losartan (Ang-11 receptor antagonist) 

• G protein coupled receptors 

• G protein in cytosol become activated and go down their resepctive pathways for response 

• Biggest class of drug protein targets (50-60% of small molecule drug targets) 

Enzyme coupled receptors

• Abrocitinib CIBINQO (tyrosine kinase inhibitor) 

• Enzymatic activity after binding 

nuclear receptors

• Activated vitamin-D (i.e., calcitriol) 

• Fat soluble (lipophilic) so it can travel through the membrane 

• Within the cell 

• Near the nucleus and when bound it goes into the nucleus and code for proteins that do something 

• VDR – vitamin D receptor  

pharmacokinetics

• How the body processes a drug over time through different processes 

• getting the drug to the site of action

• Kinetic – move 

• Drug moves through the body at different rates at the same time 

• Monitor PK through drug plasma concentrations 

• What the body does to the drug

Pharmacodynamics 

• How a drug affects the body at site(s) of action over time through different intensities 

• drug is at the site of action and how much is needed for the desired outcome

• What the drug does to the body

• At what dose do you see this specific response 

Clinical pharmacokinetics 

• The use of pharmacokinetics principles to ensure safe and effective therapeutic management of drugs in patients 

• Increase efficacy and reduce toxicity 

emax

• Parameter of efficacy 

• At a plasma concentration of 12 mg/L there is the maximum efficacy of the drug 

ec50

• Effective concentration 

• Parameter of drug potency 

• That dose at that concentration produces 50% of the response of that drug 

tolerance

• Pharmacologic mechanism where cells become overstimulated due to chronic repeated stimulation from drugs 

• Opioids  

• Oxycodone tolerance develops quickly 

• Right shift in the curves illustrates the increasing tolerance to a drug 

• You need a higher and higher dose to get the therapeutic effects 

• Stimulants 

• Ethanol (alcohol) 

  • Hepatocytes turn on transcription to make more alcohol dehydrogenase to breakdown the alcohol

absorption

• How is it getting to the plasma 

• Most oral drug absorption occurs in the small intestine (high SA and permeable membrane) 

• Two primary processes 

  • Active transport 

    • Done by a protein 

    • Goes against a gradient 

  • Passive diffusion 

    • High to low concentration 

    • Not required when a med is given IV 

factors affecting absorption

• Surface area

• Larger area -> higher drug absorption

• Nature of epithelial membranes

• Transport proteins can prevent absorption or kick out meds

• Presence of bile and mucus

  • Thicker mucus -> lower absorption

• Blood perfusion

  • Higher perfusion -> higher absorption

• Differences in luminal pH along the GI tract

  • Stomach (pH 1—2), duodenum (pH5-6), small intestine (pH ~7.5) and colon (pH 7-8)

• Ionized drug will not travel as fast as its unionized form

distribution

• In plasma where does it go  

• Out of vasculature? 

• What rate? 

• To what extent does it extend out the vasculature 

• The volume of distribution (Vd) = how large an area in the body the drug has been distributed into after the dose is given 

• Based on the properties of the drug 

• NOT ACTUAL VOLUME OF DRUGS OR TISSUES 

• Factors that affect distribution 

factors affecting distribution

• Physical and chemical properties 

• Lipophilicity: lipophilic vs hydrophilic 

  • Lipophilic easily go through the membrane and leave vasculature easily 

  • Will be drawn away from aqueous vasculature and be drawn to lipids especially into adipose tissue 

  • Small lipophilic drugs can penetrate the brain 

  • “Sticky icky” = lipophilic  

• Molecular weight: low vs high 

  • How big it is 

• Solubility: high aqueous solubility vs low aqueous solubility 

  • Does it have to go into a solution before absorption 

• Ionization status: ionization vs unionization 

• Interactions with membranes and tissues 

• Extent of protein binding 

  • Low protein binding vs. High protein binding 

  • Albumin binding drugs will not leave vasculature

metabolism

• Drug can accumulate in body if not metabolized 

  • Increases likelihood of side effect 

• CYP3A4 

  • Grapefruit juice can compete with medications 

• Process by which a drug is converted from its original chemical structure (parent drug) into other forms (metabolites) 

• Wants to keep the drug into the plasma so it can be excreted and no accumulate in the body 

• Gut and liver are primary sites for metabolism as they contain many metabolizing enzymes 

• First pass metabolism 

  • Blood from the stomach travels to the liver before it reaches the rest of the body 

  • Occurs in the liver 

  • Contains transporters and metabolizing enzymes that catalyze major reactions (i.e., oxidation, reduction, hydrolysis, conjugation) 

  • Dramatically reduces the bioavailability of oral drugs 

  • Certain drugs with extensive first pass metabolism can bypass by given non-oral routes 

phase 1 enzymes

• Conversion of parent drug to a more polar metabolite 

• Reactions 

  • Oxidation 

  • Reduction 

  • Hydrolysis (prodrug to active drug) 

• Catalyzed by cytochrome p450s, flavin containing monooxygenases, and epoxide hydrolases 

• Introduce functional groups to increase water solubility and drastically alter pharmacological activity 

CYP450 enzymes

• Superfamily with families and subfamilies with increasing gene sequence similarities 

• Work together with drug transporters to influence systemic bioavailability 

• CYP3A4/5 family is involved in the majority of Phase 1 metabolism 

phase 2 enzymes

• After phase 1 

• The metabolites need to have oxygen, nitrogen, or sulfur atoms to accept hydrophilic moiety 

• UGT and CYP3A4/5 are involved in the metabolism of more than 75% of drugs 

elimination

• Irreversible removal of drugs from the body 

• Excretion 

  • Pee or fecal elimination 

  • Exhalatory elimination 

  • Sweat elimination 

• More drug -> faster rate of elimination

• Up to a certain point

  • Rate of elimination will stop (point of saturation) -> accumulation in the body

clearance

rate of drug removal in a certain volume of plasma over a certain amount of time

bioavailibility

• Extent to which a drug is absorbed into the systemic circulation 

• Fraction of a dose PO that reaches systemic circulation 

• Percentage of drug absorbed from extravascular relative to IV administration 

• Drugs with good absorption = high bioavailability (> 70%) 

• Drugs with poor absorption = low bioavailability 

• Area under the curve (AUC) = most reliable measurement of a drugs bioavailability 

• Represents the amount of the drug that has reached the systemic circulation 

plasma concentration

• AUC = area under the curve 

  • total exposure measures bioavailability

• Cmax = maximum concentration of drug in the body 

• Tmax = time at which the drug concentration is at its maximum 

• There can be a lag time with oral meds

• Above minimum effective concentration and below minimum toxic concentration is the therapeutic window 

• Extended-release Cmax is lower and Tmax is later 

• Immediate release Cmax is higher and Tmax is quicker 

glomerular filtration

• Affects all solutes of appropriate size 

• Influenced by protein binding 

• Passive and unidirectional 

secretion

• Occurs mostly in the proximal tubule 

• Requires a carrier protein to bring drugs out 

• Saturable process 

• Not influences by protein binding  

reabsorption

• Occurs all along nephron 

• Passive by nature & active 

• Favors lipid soluble, unionized drugs 

• Weak acids & weak base depend on the urine pH and the pKa of the drug 

zero order elimination

• The rate of drug elimination is independent of drug concentration 

  • The concentration does not affect how long it will take to leave 

  • eg if 5mL takes 1 hour to leave 10mL will take one hour

• Dangerous 

• Alcohol zero order processes is vomiting (protective mechanism) 

first order elimination

The rate of drug elimination is dependent of drug concentration 

• eg if 5mL takes 1 hour to leave then 10mL will take 2 hours

• produces higher concentration

ANS

• It regulates involuntary physiologic processes: 

  • Heart rate 

  • Blood pressure 

  • Pupil diameter 

  • Respiration 

  • Digestion & Excretion 

  • Glandular activity 

  • Renal function 

  • Conversion of glycogen to glucose 

• Not under direct conscious control 

• Some features include: 

  • High-level integration in the brain 

  • The ability to influence processes in distant regions of the body 

  • Extensive use of negative feedback 

preganglionic fibers

• Located outside the CNS + exit from areas of the spinal cord

• Preganglionic fibers originate from cell located in the brainstem or spinal cord and project to a ganglion

• Apart of SNS and PNS 

• All preganglionic fibers use acetylcholine (ACh) as their neurotransmitter

  • The ACh acts on nicotinic receptors located on the ganglion cells. 

post ganglionic fibers

• Postganglionic fibers of the sympathetic NS

  • originate from ‘ganglia’ located either in a ‘chain’ next to the spinal cord (paravertebral) or located along the midline in front of the heart and spinal column (prevertebral).

  • These fibers project to the end organs.

    • Heart, stomach, etc.

• Postganglionic fibers of the parasympathetic NS originate from cells located near the end organ

• Neurotransmitters released determine the kind of response

  • Most postganglionic fibers of the SNS use norepinephrine (NE) as their neurotransmitter.

  • NE acts on adrenergic receptors located in the end organs.

    • One exception is SNS innervation of sweat glands which uses ACh

  • Postganglionic fibers of the PNS use ACh as their neurotransmitter

    • The ACh acts on muscarinic receptors located in the end organs 

ionotropic receptors

Form ion channel 

• Activation alters membrane conductance. 

metabotropic receptors

Act through G-proteins.  

• Can activate or inhibit second messenger systems. Also can be associated with an ion channel 

adernergic receptors

• All of the adrenergic receptors are metabotropic receptors. 

• Both adrenergic and cholinergic receptors have multiple receptor subtypes 

• Adrenaline (epinephrine) or norepinephrine are receptor ligands to either a1, a2, or ß adrenergic receptors

  • Anything that stimulates a1 causes increase of BP and inhibition causes decrease in BP 

    • increased intracellular Ca2+ and subsequent

      smooth muscle contraction when stimulated

  • B1 causes HR to increase which increases BP 

  • B2 in bronchial tubes – causes muscle relaxation (b2 agonist causes bronchial to relax and dilates blood vessels)

    • Opposes a1 effect 

cholinergic receptors

• Most of the cholinergic receptors are metabotropic receptors except the nicotinic receptors

• All nicotinic receptors are ionotropic.

• muscarinic are metabotropic

• Both adrenergic and cholinergic receptors have multiple receptor subtypes 

• Receptors also are classified as nicotinic or muscarinic, based on whether they have high affinity for nicotine or muscarine 

sympathomimetic agents

• mimic activation of the SNS by increasing adrenergic receptor activity. 

• Direct Agonists- Directly interact with and activate adrenoceptors (e.g., NE, Epi, clonidine (⍺ 2), isoproterenol (ß), albuterol (ß2), etc...) 

• Indirect Agonists - Dependent on ability to enhance the actions of endogenous catecholamines 

• By enhancing release from nerve terminals (e.g., reserpine, amphetamines, tyramine) 

• By blocking re-uptake/removal of the transmitter (cocaine, methylphenidate) 

• By preventing enzymatic degradation of the neurotransmitter (MAOIs, COMT inhibitors) 

sympatholytic agents

• reduce activation of the SNS by reducing adrenergic receptor activity, by blocking the actions of NE and Epi on adrenergic receptors. 

  • Beta blockers (propranolol, metoprolol, atenolol) 

  • ⍺1 (e.g., prazosin (Minipress®)) and ⍺ 2 (e.g., yohimbine) antagonist 

effects of SNS activation

• Increased heart rate, arterial blood pressure, and cardiac output 

• Increased blood flow to brain, heart, and skeletal muscles 

• Increased blood glucose 

• Pupil dilation 

• Increased sweating 

• Increased rate of cellular metabolism 

• Increased rate and depth of respiration 

• Reduced saliva production 

• Reduced gut motility and urine flow 

nicotinic receptors

• Nicotinic receptors are ionotropic and pentomeric

• Primarily act as sodium channels. 

• Can also increase permeability to Ca2+ 

• in skeletal muscle

muscarinic receptors

• There are 2 subtypes, M1 (includes M1, M3 and M5 receptors) and M2 (includes M2 and M4 receptors). 

• In the tissues 

• Ach acts on them

• anti-muscarinic drugs = dries out pt

parasympathomimetic agents

• mimic activation of the PNS by increasing muscarinic cholinergic receptor activity. 

• Direct Agonists- Directly interact with and activate muscarinic cholinergic receptors (e.g., ACh, methacholine, bethanechol, muscarine, pilocarpine, etc...) 

• Indirect Agonists – Enhance ACh effects by inhibiting cholinesterase thereby blocking degradation (e.g., neostigmine, physostigmine, donepezil, galantamine, rivastigmine, etc... 

parasympatholytic agents

• reduce activation of the PNS by: 

• Blocking the actions of ACh on muscarinic receptors (e.g., atropine, scopolamine, and other muscarinic receptor antagonists) 

• Block cholinergic effects 

effects of PNS

• Decreased heart rate, arterial blood pressure, and cardiac output 

• Decreased blood glucose 

• Pupil constriction 

• Increased sweating & tearing 

• Increased saliva production 

• Increased gut motility and urine flow 

• Decreased rate of cellular metabolism 

• Bronchoconstriction 

prefrontal cortex

• Regulates thought in terms of short-term and long-term decision making 

• Allows humans to plan and create strategies, and to adjust actions and reactions to situations 

• Connects emotions with decision-making 

• Allows humans to pull together disparate but related strands of thought when learning or evaluating complex concepts or tasks 

• Houses active, working memory, a form of short-term memory in which trial- unique events are temporarily stored and manipulated in consciousness 

• Essential for tasks in which memory for recent events is used in decision-making 

• Executes social judgements 

• Helps to focus thoughts 

• Enables humans to pay attention, learn, and concentrate on goals 

D

A nurse practitioner (NP) has just changed a patient’s medication from an oral form to a patch formulation to avoid the first-pass effect. The NP has explained it to the patient, but the patient still has questions and asks the nurse to explain again what is meant by the first-pass effect. The nurse would be most correct in explaining that this has to do with how  

• A.  drugs initially bind to plasma proteins 

• B.  initial renal function is involved in drug excretion 

• C.  the way drugs first reach their target cells 

• D.  initial metabolism of an oral drug occurs before it reaches the systemic circulation 

C

A nurse is reading a research report about use of a medication that describes the pharmacokinetics of a particular medication that a patient is taking. Pharmacokinetics involves 

• A.  drug effects on human cells 

• B.  drug binding with receptors 

• C.  drug absorption, distribution, metabolism, and elimination 

• D.  drug stimulation of normal cell functions 

C

A nurse is caring for a man who has worsening liver disease. In monitoring his medication, it is important to know that a patient with liver disease may have impaired drug 

• A.  absorption 

• B.  distribution 

• C.  metabolism 

• D.  excretion 

D

A nurse is looking up information about the effects of a drug on different receptors. Characteristics of receptors include which of the following? 

• A. They are carbohydrates located in cell membranes or inside cells 

• B. They are constantly synthesized and degraded in the body 

• C. They bind with molecules of any drug circulating in the bloodstream 

• D. They regulate the actions of all drugs. 

B

A patient with an overdose of an oral drug usually receives which of the following? 

• specific antidote 

• activated charcoal 

• syrup of ipecac 

• strong laxative 

D

The mother of a 14-month-old girl calls a nurse working in a pediatric clinic and reports that her daughter ingested an unknown number of sleeping pills about 4 hours ago and is now drowsy. The mother asks what she should do. The best response to give the mother is 

• “Administer a dose of syrup of ipecac to ensure vomiting” 

• “Call the Poison Control Center immediately” 

• “Administer a strong laxative and observe for a response” 

• “Call 911 to transport your daughter to the nearest emergency department” 

A, B, C

Differences in CYP-450 drug-metabolizing enzymes are known to cause genetic variation in the drug metabolism of certain drugs that increase the risk of adverse effects. These include which of the following? (Select all that apply.) 

• CYP2D6 metabolism of several antidepressant, antipsychotic, and beta-adrenergic blocker drugs that increases the risk of drug accumulation and adverse effects. 

• CYP2D6 metabolism of codeine in individuals who are ultrarapid metabolizers. The conversion of codeine to morphine occurs quickly and poses a risk of serious adverse effects, such as respiratory depression. 

• CYP2C19 metabolism in some individuals of Asian descent. This may cause decreased drug metabolism of diazepam, omeprazole, and some antidepressants leading to adverse effects. 

• Individuals with a deficiency of glucose-6-phosphate dehydrogenase, who may have hemolytic anemia when given antimalarial drugs, sulfonamides, analgesics, antipyretics, and other drugs. 

B

A physician writes an order using the abbreviation MS. The order states “MS 10 mg IV push every 6 hours as needed for pain.” According to The Joint Commission’s “Do Not Use” list, what is the potential problem in this order? 

A. The order does not include a dosage. 

B. The drug could be magnesium sulfate or morphine sulfate. 

C.  The potential problem is minimal, and the order is clear 

D. The order does not include the route. 

C, D

2.   A prescriber has written an order for an oral antihypertensive medication for a patient who is in rehabilitation following a stroke. Prior to administering the medication, which of the following nursing interventions is most important? (Select all that apply.) 

A.  allowing the patient to take the medication with thickened liquids 

B.  placing the patient in the sitting position 

C.  assessing the patient’s blood pressure 

D.  assessing the patient’s ability to swallow 

A

A prescriber has written an order for levothyroxine sodium 50 mg/day by mouth. The nurse knows that the standard dose is 50 mcg. What action should the nurse take? 

A. Call the prescriber and question the order. 

B. Administer 50 mcg instead. 

C. Consult the pharmacist about the order. 

D. Ask the patient what he or she usually takes. 

C

4.   The nurse is administering the first dose of an anti-infective agent. Which of the following assessments should the nurse make prior to administering the anti-infective agent? 

A. Assess the patient’s temperature. 

B. Assess the patient’s level of consciousness. 

C. Assess whether the patient is allergic to any anti-infective agent. 

D. Assess whether the patient has taken the medication previously. 

D

5.   Which of the following nursing actions will prevent adverse drug events? 

A. Use only the trade name when documenting medications. 

B. Crush long-acting medications if the patient has dysphagia. 

C. After receiving a verbal order, administer the medication and then write down the order. 

D.  Use bar code technology according to institutional policy 

C

A nurse is administering an elixir. Which of the following measures is appropriate? 

A.  microgram 

B.  milligram 

C.  milliliter 

D.  kilogram 

A

The nurse has administered lacosamide to the wrong patient. What is the first action the nurse should take? 

A. Assess the patient’s vital signs and level of consciousness. 

B. Notify the physician. 

C. Fill out an incident report. 

D. Call the respiratory therapist for administration of oxygen. 

C

A patient is to receive lamotrigine 300 mg by mouth two times per day. The pharmacy has delivered 50-mg tablets. How many tablets should the nurse administer each time? 

A.  2 tablets 

B.  4 tablets 

C.  6 tablets 

D.  8 tablets 

D

9.   A nurse is preparing to administer a subcutaneous injection. What size needle should the nurse use to administer the injection? 

A.  18 gauge 

B.  20 gauge 

C.  23 gauge 

D.  25 gauge 

B

10.   A patient is to receive an intramuscular injection of ketorolac. Which of the following muscles should be avoided? 

A.  deltoid 

B.  Dorso gluteal 

C.  ventrogluteal 

D.  vastus lateralis 

B, D

The patient receives regular insulin 5 units subcutaneously. To what degree is the syringe held for the injection? (Select all that apply.) 

A.  30 degrees 

B.  45 degrees 

C.  60 degrees 

D.  90 degrees 

D

How is a medication delivered by piggyback administered? 

A. It is pushed into the IV line. 

B. It is retrograded into the IV line. 

C. It is injected intramuscularly after another medication. 

D. It is mixed with 50 to 100 mL of IV fluid in a separate container. 

A

During an initial nursing assessment, the patient reports that he is allergic to a particular medicine. What should the nurse ask the patient? 

A. What symptoms occurred when you had the allergic reaction? 

B. Did you need to take epinephrine (Adrenalin)? 

C. Did your physician think this information needed to be communicated? 

D. Have you ever overdosed on this medication? 

C

14.   How do nursing interventions increase safety and effectiveness of drug therapy? 

A.  by avoiding the use of nondrug measures during drug therapy 

B.  by using multiple drugs to relieve most symptoms or problems 

C.  by teaching patients about their drug therapy 

D.  by avoiding excessive instructions 

B

What should the nurse keep in mind when evaluating a patient’s response to drug therapy? 

A.  Few drugs cause adverse effects. 

B.  Drugs may cause virtually any symptom or problem. 

C. Patients always report adverse effects. 

D. Therapeutic effects are more important than adverse effects. 

B

What should the nurse keep in mind when evaluating a patient’s response to drug therapy? 

A.  Few drugs cause adverse effects. 

B.  Drugs may cause virtually any symptom or problem. 

C. Patients always report adverse effects. 

D. Therapeutic effects are more important than adverse effects. 

A, B, C

Activation of the sympathetic nervous system will result in which of the following? (Select all that apply.) 

A.  increased rate and depth of respiration 

B.  pupil dilation to aid vision 

C.  increased blood pressure and heart rate 

D.  increased urine output 

A

2.   Which of the following statements is correct regarding the sympathetic and the parasympathetic nervous systems? 

A. Acetylcholine activates muscarinic receptors. 

B. Activation of the sympathetic nervous system causes a decrease in blood pressure. 

C. Acetylcholine activates adrenergic receptors. 

D. Norepinephrine activates cholinergic receptors. 

A

3.   The sympathetic nervous system is also called the 

A.  fight-or-flight system 

B.  eat-drink-and-rest system 

C.  autonomic nervous system 

D.  somatic nervous system 

A, B, C

A drug that has the same effects on the human body as stimulation of the sympathetic nervous system is called which of the following? (Select all that apply.) 

A.  sympathomimetic agent 

B.  adrenergic drug 

C.  beta-adrenergic agonist drug 

D.  alpha-adrenergic blocking agent 

A, B

When the body is exposed to high concentrations of substances that stimulate their function, the resulting decrease in beta-adrenergic responsiveness is called which of the following? (Select all that apply.)

A. desensitization

B. downregulation

C. fight or flight

D. norepinephrine reuptake

A

During a teaching session for a patient who is receiving a respiratory inhaler that stimulates beta2 receptors in the respiratory tract, the patient asks why he needs to take the inhaler. The best response by the nurse is that the effect of a beta2 receptor is 

A.  prevention of bronchospasm 

B.  reduction of sputum production 

C.  maintenance of respiratory rate 

D.  suppression of cough 

A, B, D

Functions stimulated by the parasympathetic nervous system include which of the following? (Select all that apply.) 

A.  digestion 

B.  excretion 

C.  catabolism 

D.  anabolism 

A

8.   A drug that has the same effects on the body as stimulation of the parasympathetic nervous system is described as 

A.  cholinergic 

B.  sympatholytic 

C.  antiadrenergic 

D.  parasympatholytic 

A, B, C, D

Activation of the parasympathetic system will result in which of the following? (Select all that apply.) 

A.  dilation of blood vessels in the skin 

B.  decreased heart rate 

C.  increased motility of the gastrointestinal tract 

D.  constriction of smooth muscle of bronchi 

when prefrontal cortex is damaged

• very susceptible to damage 

• Personality can change drastically 

• For example, someone who had been outgoing can become quiet and withdrawn after suffering injury to the pre-frontal cortex 

• Can negatively impact someone’s ability to assess situations or perform tasks, especially if they have a moral or ethical aspect to them 

• Can be unable to discern appropriate behavior, may experience reduced inhibitions, or may experience extreme emotional distress, such as paranoia, anxiety, euphoria, and irritability 

• Can produce impairments of working memory (i.e., ability to hold information online and use in decision-making) 

primary motor cortex

• precentral gyrus 

• Part of the Pyramidal Motor System 

• Provides direct innervation of motor neurons in spinal cord, brainstem, and cranial nerve nuclei 

• Is responsible for initiation of voluntary movements 

• Is a crossed system – cells on the right side of the brain control muscles on the left side of the body 

• Damage causes paresis or paralysis on the opposite side of the body

extrapyramidal motor system (EMS)

• Second motor system in the brain (unconscious system) 

  • Subcortical  

• Involves multiple structures 

• Responsible for modulating voluntary and involuntary movements 

• Postural adjustments 

• Fine-tuning motor movements 

• Motor learning (i.e., procedural memory) 

• Some extrapyramidal projections are crossed, and some are uncrossed 

EMS damage

• Some drugs can cause these symptoms

• Antipsychotic medications (more common with first generation) 

• Damage to EPS can result in very debilitating movement disorders 

  • Tremors 

  • Rigidity 

  • Loss of gait 

  • Uncontrolled movements (dyskinesias) 

  • Inability to make postural adjustments 

  • Disruption of autonomic functions 

hippocampus

• Located in medial temporal lobe 

• Required for declarative memory consolidation and the formation of long-term declarative memories 

• Implicated in maintenance of cognitive maps for navigation 

• Damage is associated with a profound anterograde amnesia (inability to learn new information) 

• Declarative memory 

  • Names, dates of exams, categories of things 

amygdala

• Two almond-shaped masses of neurons on either side of the thalamus at the lower end of the hippocampus 

• Involved in perceptions of fear and anxiety, defensive behaviors, emotional learning, and in social functions such as mating. 

• Heavily interconnected with hippocampus, hypothalamus, sensory nerves, and with insular cortex 

• Damage causes dysregulation of emotions and is associated with depression, aggression, anxiety, etc