Pharmacology for Nurses - Exam 1 (Chapters 1 - 5)

Pharmacology

pharmakon = "medicine"

logos = "study"

study with medicine

Aminoglycosides

class of antibiotics that are useful in the treatment of many infectious diseases

Therapeutics

concerned with the prevention of disease and treatment of suffering

Biosimilar drugs

are referred to as reference products. Biosimilars are not required to undergo the same rigorous preclinical and clinical testing as their reference products

complementary and alternative medicine (CAM)

involve natural plants extracts, herbs, vitamins, minerals, dietary supplements and additional techniques outside of the realm of conventional therapeutics

Chemical name

assigned using standard nomenclature established by the International Union of Pure and Applied Chemistry (IUPAC)

Generic name

assigned by the US Adopted Name Council. Less complicated and easier to remember than chemical name

Trade name

assigned by the company marketing the drug. Short and easier to remember.

Abuse Potential

Highest

Potential for Physical Dependency

High

Potential for Psychological Dependency

High

Examples

heroin, lysergic, acid diethylamide (LDS), marijuana (cannabis), peyote, methaqualone, and 3,4-methylenedioxy-methamphetamine ("ecstasy")

Therapeutic Use

Limited or no therapeutic use

Drug Schedule I

Abuse Potential

High

Potential for Physical Dependency

High

Potential for Psychological Dependency

High

Examples

hydromorphone, methadone, meperidine, oxycodone, and fentanyl; amphetamine, methamphetamine, methylphenidate, cocaine, amobarbital, glutethimide, and pentobarbital

Therapeutic Use

Limited or no therapeutic use

Drug Schedule II

Abuse Potential

Moderate

Potential for Physical Dependency

Moderate

Potential for Psychological Dependency

High

Examples

combination products containing less than 15 mg of hydrocodone per dosage unit, products containing not more than 90 mg of codeine per dosage unit, buprenorphine products, benzenediamine, phendimetrazine, ketamine, and anabolic steroids

Therapeutic Use

Used therapeutically with prescription; some drugs no longer used (schedules II, III, and IV)

Drug Schedule III

Abuse Potential

Lower

Potential for Physical Dependency

Lower

Potential for Psychological Dependency

Lower

Examples

alprazolam, clonazepam, clorazepate, diazepam, lorazepam, midazolam, temazepam, and triazolam

Therapeutic Use

Used therapeutically with prescription; some drugs no longer used (schedules II, III, and IV)

Drug Schedule IV

Abuse Potential

Lowest

Potential for Physical Dependency

Lowest

Potential for Psychological Dependency

Lowest

Examples

cough preparations containing not more than 200 mg of codeine per 100 mL or per 100 g

Therapeutic Use

Used therapeutically without prescription

Drug Schedule V

Responsibilities of the Nurse

~ What drug is ordered

~ Name (generic and trade) and drug classification

~ Intended or proposed use

~ Effects on the body

~ Contraindications

~ Special consideration (e.g., how age, weight, body fat distribution, and individual pathophysiologic states affects pharmacotherapeutic response)

~ Side effects

~ Why the medication has been prescribes for this particular patient

~ How the medication is supplied by the pharmacy

~ How the medication is to be administered, including dosage ranges

~ What nursing process considerations related to the medication apply to this patient

Black box warning

A type of warning that appears in a drug's prescribing information and is required by the U.S. Food and Drug Administration (FDA) to alert prescribers of serious adverse events that have occurred with the given drug.

Adverse Event (AE)

any undesirable experience associated with the use of a medical product in a patient

side effects

a non therapeutic reaction to a drug

Anaphylaxis

Severe allergic reaction

Rights of Drug Administration

1. Right patient

2. Right medication

3. Right dose

4. Right route of administration

5. Right time of delivery

Intravenous (IV) medications and fluids

administered directly into the bloodstream and are immediately available for use by the body

enteric coated

tablets are designed to dissolve in the alkaline environment of the small intestine

sustained release (SR)

a tablet or capsule are designed to dissolve very slowly

A patient wants to know how fast a particular medication will be eliminated from the body. An important pharmacokinetic parameter to review in this case would be the:

a. Bioavailability

b. Half-life

c. Volume of distribution

d. Active transport

b. Half-life

If a medication is described as highly protein bound, this means that:

a. A high percentage of drug is bound to the plasma protein albumin.

b. The drug binds tightly to proteins at the site of action.

c. The drug is combined with a protein to create a depot injection.

d. Most of the drug is eliminated by hepatic metabolism.

a. A high percentage of drug is bound to the plasma protein albumin.

The most common way for drugs to cross membranes is:

a. Active transport

b. Facilitated diffusion

c. Passive diffusion

d. Transport through ion channels

c. Passive diffusion

Exercise can increase the duration of action of some drugs that are metabolized by the liver because:

a. Hepatic blood flow increases during exercise.

b. Hepatic blood flow decreases during exercise.

c. The volume of distribution increases during exercise.

d. The volume of distribution decreases during exercise.

b. Hepatic blood flow decreases during exercise.

Medications that need to enter the central nervous system to reach their site of action should have what property?

a. They should be water soluble, so they are not substrates for cytochrome P450 enzymes.

b. They should be lipid soluble so they can cross the blood-brain barrier.

c. They should be water soluble, so they have a high degree of protein binding.

d. They should be lipid soluble so they will not distribute into fat tissue.

b. They should be lipid soluble so they can cross the blood-brain barrier.

When medications are applied to the skin to produce a systemic effect, the delivery type is best referred to as:

a. Transdermal

b. Topical

c. Intradermal

d. Subcutaneous

a. Transdermal

What is the advantage of sublingual drug administration compared with other routes of administration?

a. Sublingual drug administration can be used for the administration of drugs with low potency.

b. Sublingual drug administration allows for less frequent drug administration because the drug slowly enters the blood.

c. Sublingual drug administration has a high first-pass metabolism, making it ideal for the administration of prodrugs.

d. Sublingual drug administration is faster due to the rich supply of blood vessels under the tongue.

d. Sublingual drug administration is faster due to the rich supply of blood vessels under the tongue.

Which of the following oral dosage forms is a 2-phase system in which a solid is dispersed throughout a liquid?

a. Elixir

b. Syrup

c. Emulsion

d. Suspension

d. Suspension

The most common route for the excretion of drugs from the body is:

a. Renal excretion

b. Excretion through sweat

c. Biliary excretion

d. Excretion through saliva

a. Renal excretion

Some drugs have the ability to increase metabolic activity. This is known as:

a. enzyme induction

b. enzyme inhibitor

c. enzyme availability

d. enzyme affinity

a. enzyme induction

The provider has ordered atropine, a drug that will prevent the patient’s own chemical, acetylcholine, from causing parasympathetic effects. What type of drug would atropine be considered?

a) An antagonist

b) A partial agonist

c) An agonist

d) A protagonist

a) An antagonist

Atropine will unsensitized the body's receptor from reacting to Acetylcholine, thus making the body not respond to it.

The nurse looks up butorphanol (Stadol) in a drug reference guide prior to administering the drug and notes that it is a partial agonist.

What does this term tell the nurse about the drug?

a) It is a drug that produces the same type of response as the endogenous substance.

b) It is a drug that will occupy a receptor and prevent the endogenous chemical from acting.

c) It is a drug that causes unpredictable and unexplained drug reactions.

d) It is a drug that produces a weaker, or less efficacious, response that an agonist drug.

d) It is a drug that produces a weaker, or less efficacious, response that an agonist drug.

If agonist refers to a drug that produces the same response as substances, chemicals, or hormones created within our body. In that case, it makes sense that a partial agonist has a weaker or less efficacious response.

The nurse reads that the drug to be given to the patient has a “narrow therapeutic index.” The nurse knows that this means that the drug has what properties?

a) It has a narrow range of effectiveness and may not give this patient the desired therapeutic results.

b) It has a narrow safety margin and even a small increase in dose may produce adverse or toxic effects.

c) It has a narrow range of conditions or diseases that the drug will be expected to treat successfully.

d) It has a narrow segment of the population for whom the drug will work as desired.

b) It has a narrow safety margin and even a small increase in dose may produce adverse or toxic effects.

A drug with narrow therapeutic index, even the smallest increase in dosage can create a toxic effect on a patient. Narrow can be defining as a “small gap” in this case, a small gap between a safe therapeutic dosage and a toxic dosage.

What is the term used to describe the magnitude of maximum response that can be produced from a particular drug?

a) Efficacy

b) Toxicity

c) Potency

d) Comparability

a) Efficacy

Toxicity is a serious life-threatening adverse reaction, Potency is the amount or dose needed to create a desired response and Comparability is not used in pharmacology, according to the book.

Which of the following represents the dose in the middle of the frequency distribution curve?

Correct answer:

a) ED50

b) ED25

c) MED50

d) MED0.50

a) ED50

The median effective dose is represented by ED50, or 50% of a specific therapeutic response in a group of patients.

The provider is discussing drug absorption with a nursing student. The provider asks what route has the fastest absorption rate. Which is the correct response?

a) Intravenous Route (IV)

b) Oral Route (PO)

c) Intramuscular Route (IM)

d) Sublingual Route (SL)

a) Intravenous Route (IV)

Of the options listed, which administration would result in the fastest absorption?

a) Sublingual

b) Oral

c) Rectal

d) Sublingual

e) Transdermal

a) Sublingual

What components are considered processes under pharmacokinetics? Select all that apply.

a) Medication is excreted

b) Medication dissolves in stomach acid

c) Medication enters arterial circulation

d) Medication reaches target organs

e) Medication interacts with receptors

a) Medication is excreted

c) Medication enters arterial circulation

d) Medication reaches target organs

What pathological alteration requires dose adjustments for medications due to inadequate processing of medications? Select all that apply.

a) Endocarditis

b) Hypothyroidism

c) Stroke

d) Kidney Failure

e) Liver Disease

d) Kidney Failure

e) Liver Disease

A nurse receives a report from the Emergency Department regarding a patient receiving aminoglycosides. Upon reviewing the orders, the nurse sees an order to obtain a trough level prior to the next administration. Trough levels are used to confirm satisfactory clearance of:

a) Gastric

b) Liver

c) Renal

d) Exhalation

c) Renal

A unit practice council is review medication pharmacokinetics. What is not part of the medication’s pharmacokinetics? Select all that apply.

a) Biological barrier of an organ

b) Method of administration of the drug

c) Liver and kidney’s ability to metabolize and excrete from the body

d) Appearance of medication inside the bottle

a) Biological barrier of an organ

c) Liver and kidney's ability to metabolize and excrete from the body

Passive absorption of medications occurs by:

a) Enzyme transport

b) Protein transport

c) Active transport

d) Diffusion

d) Diffusion

Some medications experience the first-pass metabolism phenomenon, what route is the best for this phenomenon?

a) Rectal

b) Oral

c) Intramuscular

d) Sublingual

b) Oral

Upon discharge, the nurse notes that his or her patient is prescribed a topical glucocorticoid. Glucocorticoid cream has best absorption in which areas? Select all that apply.

a) Back

b) Ears

c) Face

d) Axilla

e) Feet

c) Face

d) Axilla

A nurse provided aluminum/magnesium antacid for gastritis to his or her patient. To encourage the greatest absorption, what is the best timeframe for administration. Select all that apply.

a) Bedtime

b) One hour prior to meals

c) One hour after meals

d) 5 minutes after meals

e) In the morning upon awaking

a) Bedtime

b) One hour prior to meals

c) One hour after meals

PM

in the afternoon

AC

before meals

PC

after meals

q8h

every 8 hours

tid

three times a day

gid

four times a day

h or hr

hour

IV

intravenous

IM

intramuscular

prn

as needed

PO

by mouth

gtt

drop

cap

capsule

Rx

treatment or take

Sub-Q

subcutaneous (under the skin)

Tab

tablet

SL

sublingual (under the tongue)

AM

in the morning

STAT

at once, immediately

What is the role of the nurse in medication administration? (Select all that apply.)

a. Ensure that medications are administered and delivered in a safe manner.

b. Be certain that healthcare provider orders are accurate.

c. Inform the patient that prescribed medications need to be taken only if the patient agrees with the treatment plan.

d. Ensure that the patient understands the use and administration technique for all prescribed medications.

e. Prevent adverse drug reactions by properly administering all medications.

a. Ensure the medications are administered and delivered in a safe manner.

d. Ensure the patient understands the use and administration technique for all prescribed medications

Ensuring patient safety when administering prescribed medications by following all medication administration procedures and providing patient education about the use and administration of the prescribed medications is the nurse's responsibility.

Before administering drugs by the enteral route, the nurse should evaluate which of the following?

a. ability of the patient to lie supine

b. compatibility of the drug with intravenous fluid

c. ability of the patient to swallow

d. patency of the injection port

c. ability of the patient to swallow

to prevent aspiration, the nurse should always assess to be sure that the patient can swallow

While the nurse takes the patient’s admission history, the patient describes having a severe allergy to an antibiotic. What is the nurse’s responsibility to prevent an allergic reaction? (Select all that apply.)

a. Instruct the patient to alert all providers about the allergy.

b. Document the allergy in the medical record.

c. Notify the provider and the pharmacy of the allergy and type of allergic reaction.

d. Place an allergy bracelet on the patient.

e. Instruct the patient not to allow anyone to give the antibiotic.

b. Document the allergy in the medical record.

c. Notify the provider and the pharmacy of the allergy and type of allergic reaction.

d. Place an allergy bracelet on the patient

Documenting the allergy in the medical record, notifying the provider and the pharmacy about the allergy and type of response, and applying an allergy alert band are all responsibilities of the nurse.

The order reads, “Lasix 40 mg IV STAT.” Which action should the nurse take?

a. Administer the medication within 30 minutes of the order.

b. Administer the medication within 5 minutes of the order.

c. Administer the medication as required by the patient’s condition.

d. Assess the patient’s ability to tolerate the medication before giving.

b. Administer the medication within 5 minutes of the order.

STAT means immediately and the drug should be given within 5 minutes or less of receiving the order.

Which medications would not be administered through a nasogastric tube? (Select all that apply.)

a. Liquids

b. Enteric-coated tablets

c. Sustained-release tablets

d. Finely crushed tablets

c. Sustained-release tablets

b. Enteric-coated tablets

c. Sustained-release tablets

c. Sustained-release tablets

Enteric-coated tablets are designed to dissolve in the alkaline environment of the small intestine. Sustained-release medications dissolve very slowly over an extended period for a longer duration. Crushing either of these types of medications will alter the absorption. IV medications are designed to enter directly into the bloodstream and, while liquid, maybe in a different dosage form or concentration that is not compatible with other types of administration.

A patient with diabetes has been NPO (nothing by mouth) since midnight for surgery in the morning. He usually takes an oral type 2 antidiabetic drug to control his diabetes. What would be the best action for the nurse to take concerning the administration of his medication?

a. Hold all medications as ordered.

b. Give him the medication with a sip of water.

c. Give him half the original dose.

d. Contact the provider for further orders.

d. Contact the provider for further orders.

While a patient who is NPO for surgery is not usually allowed anything to eat or drink, crucial medications, such as drugs to control blood glucose levels, may be allowed or a different form (e.g., insulin by injection) may be given. The nurse should contact the provider and check whether any additional orders are needed.

A patient has a new medication prescription and the nurse is providing education about the drug. Which statement made by the patient would indicate the need for further medication education?

a. “I can consult my healthcare provider if I experience adverse effects.”

b. “If I take more, I’ll have a better response.”

c. “Taking this drug with food will decrease how much drug gets into my system.”

d. “The liquid form of the drug will absorb faster than the tablets.”

b. “If I take more, I’ll have a better response.”

Although taking a larger dose of a medication usually results in a greater therapeutic response, the response also depends on the drug’s plasma concentration. If a toxic level is reached from too large a dose, the drug will have adverse effects instead of a better therapeutic response.

A combination of two different antihypertensive drugs in lower doses has been ordered for a patient whose hypertension has not been controlled by standard doses of either drug alone. The nursing student recognizes the interaction between these two drugs is known as what term?

a. Addition

b. Synergism

c. Antagonism

d. Displacement

b. Synergism

Synergism is an interaction of drugs that results in a potentiated (more than total) effect that is greater than would be expected from adding the two individual drugs’ response. Because the action is greater than one of the drugs alone could provide, lower doses of the drugs may sometimes be used than when using one drug alone.

A patient with cirrhosis of the liver has hepatic impairment. This will require what possible changes? (Select all that apply.)

a. A reduction in the dosage of the drugs

b. A change in the timing of medication administration

c. An increased dose of prescribed drugs

d. Giving all prescribed drugs by intramuscular injection

e. More frequent monitoring for adverse drug effects

a. A reduction in the dosage of the drugs

b. A change in the timing of medication administration

e. More frequent monitoring for adverse drug effects

The liver is the primary site of drug metabolism. Patients with severe liver damage, such as that caused by cirrhosis, will require reductions in drug dosage because of decreased metabolic activity. Even with decreased dosage, more frequent monitoring is required to detect adverse drug effects that may be related to impaired metabolism. A change in the timing (e.g., lengthening the time between doses) may be needed for some drugs, but not all, and a drug dosage that is too large for the liver to metabolize may still cause harm even if doses are spaced further apart.

The patient requires a drug that is known to be completely metabolized by the first-pass effect. What change will be needed when this drug is administered?

a. The drug must be given more frequently.

b. The drug must be given in higher doses.

c. The drug must be given in a lipid-soluble form.

d. The drug must be given by a non-oral route, such as parenterally.

d. The drug must be given by a non-oral route, such as parenterally.

Some oral drugs are rendered inactive by hepatic metabolic reactions, during the process known as the first-pass effect. An alternative route, such as parenteral, may need to be used.

A patient who has acute kidney injury (AKI) may have a diminished capacity to excrete medications. The nurse must assess the patient more frequently for what development?

a. Increased risk of allergy

b. Decreased therapeutic drug effects

c. Increased risk for drug toxicity

d. Increased absorption of the drug from the intestines

c. Increased risk for drug toxicity

The kidneys are the primary site of excretion. Renal failure increases the duration of the drug’s action because of decreased excretion. The patient must be assessed for drug toxicity.

What is the rationale for the administration of a loading dose of a drug?

a. It decreases the number of doses that must be given.

b. It results in lower dosages being required to achieve therapeutic effects.

c. It decreases the risk of drug toxicity.

d. It more rapidly builds plasma drug levels to a plateau level.

d. It more rapidly builds plasma drug levels to a plateau level.

Giving a loading dose of a drug more rapidly achieves a plateau level in the therapeutic range that may then be continued by maintenance doses.

Pharmacoeconomics

The cost for drug therapy - purchasing, dispensing, storage, administration, laboratory, tests, losses due to expiration, length of illness/hospital

Therapeutics (pharmacotherapeutics)

the treatment of disease; the science of healing

Prescription drugs

Requires a written order

OTC (over-the-counter) drug

a drug that does not require a prescription

FDA is the only one who can change a prescription drug to OTC

Additive effects

occurs when 2 drugs are taken together with similar pharmacologic actions --> he sum of the effect = the expectation of effect when each drug is taken individually (ex: alcohol & benzodiazepine = increased sedation)

Synergism

occurs when 2 drugs with different sites or MOA produce greater effects when taken together (acetaminophen + codeine)

Interference

of 1 drug with the metabolism of 2nd drug --> intensifies effects of 2nd

Displacement

of 1 drug from plasma protein-binding sites by a 2nd drug --. Intensifies effects of 1st drug

Local side effects

adverse effects at the site where drug was exposed

Systemic side effects

adverse effects that occur throughout the body

Allergic drug reaction

skin rash or hives itching, wheezing, and difficulty breathing, swelling, vomiting, dizziness

Therapeutic effect

desired response to a drug

Therapeutic range

that concentration of drug in the blood serum that produces the desired effect without causing toxicity

Therapeutic index

the ratio between the toxic and therapeutic concentrations of a drug

Hepatoxicity

liver damage

Nephrotoxicity

kidney damage

Ototoxicity

hearing loss

Carcinogenicity

the ability of a substance to cause cancer

Teratogenicity

Any drug that causes harm to the developing fetus or embryo

Toxicity/drug overdose

results from excessive amounts of a drug & may damage may damage tissues

Hypersensitivity

immune-medicated reaction to a drug

Absorption

time a drug enters the body & enters the bloodstream/serum