Pharm Exam 1 (CH 4, 5, 6, 16)

_____ is a huge difference between children and adults.

metabolism

_____ changes throughout development influence both the pharmacodynamic and pharmacokinetic actions of medications.

physiological

Variables in absorption, distribution, metabolism, and excretion further complicate the _____.

medication process

Calculating drug dosages is highly dependent on…

growth and development changes

T or F: the basis of pediatric drug dosing is weight.

True (The basis of pediatric drug dosing is weight, and determining drug dosages is highly dependent on the growth and development changes that occur across the lifespan. The prescriber uses weight alone to calculate pediatric dosages in an expression such as gentamicin 5 mg/kg/24 h or determines the body surface area (BSA).)

What are the pharmacodynamics in pediatrics?

\-involves drug actions on target cells

\-immature organ systems

\-body composition

\-genetic makeups

What are the pharmacokinetics in pediatrics?

\-absorption (very fast absorption)

\-distribution (blood-brain barrier)

\-metabolism (hypermetabolic)

\-elimination

_____ requires a lower dose more frequent.

pediatrics

Elimination slows down at _____ age.

school

What are the medication administration concepts in pediatrics?

\-communication (bring parents in, some kids may communicate/understand differently)

\-cooperation

\-adherence (parents responsibility)

What is the age range of infants?

0-12 months

How do you give correct dosages to babies?

weigh the baby

Infants require _____ care.

comfort (caregiver, sucking, food, etc)

Infants _____ get injections in the arm.

shouldn’t

What is the age range of toddlers and preschoolers?

2-5 years old

What are some things to do for toddlers and preschoolers?

\-involve this group with their medication administration by having them hold items or choosing a bandage

\-explanations should be short and simple

\-adults need to control administration

What should you do for school-aged children and adolescents?

\-explain medication use in more detail

\-can take medications independently, but they need supervision

\-educate on safe medication practices

T or F: Self-care related to medication administration is a good teaching point for adolescents.

True (Adolescents should be made aware of self-care related to medication administration)

Aging is a natural process that begins at _____.

birth

Age related changes begin in the _____ years.

adult (19-64 years of age)

What is the age range of older adults?

65 years and older

T or F: cardiovascular disease is the number one cause of death in adults, including older adults.

True (Cardiovascular disease is the number one cause of death in adults, including older adults. In patients with hypertension, the control of blood pressure is key to the prevention of cardiovascular disease.​)

What are the pharmacodynamics in older adults?

\-involves drug action on target cells and resulting alterations in cellular reactions and functions

\-prone to adverse drug reactions

\-beers criteria

What is Beers Criteria?

\-potentially inappropriate medication for use in older adults

\-updated every 3 years

\-based on kidney functions and drug-drug interactions

As you get older, some _____ functions don’t work anymore.

cellular

What are strategies to prevent adverse drug reactions in older adults?

\-assess if medication therapy is appropriate (look up previous medical records and why they are there

\-assess kidney and liver function (creatine, BUN, AST, ALT)

\-assess therapeutic drug levels

\-patient and family education

What are the pharmacokinetics in older adults?

\-absorption is decreased

\-distribution is decreased

\-metabolism is decreased

\-excretion is decreased

What happens to older adults because absorption is decreased?

\-gastric acidity (increased pH)

\-blood flow (meds are slowly absorbed)

\-surface area (skin has decreased absorption and is thicker)

\-greater dosages to produce therapeutic effects

What are the pharmacokinetics in older adults?

\-lipid soluble drugs stay in body longer

\-water soluble drugs are decreased to total body weight and can be toxic

\-serum albumin is needed for drugs to bind to. If drug does not bind, the drug is free and toxic and potentially more intense

\-medications are not distributed adequately due to the decreased circulation and diminished cardiac output

What are the metabolism pharmacokinetics in older adults?

\-liver decreases in size and mass

\-decrease in hepatic circulation, slowing metabolism

\-slower hepatic enzymes and inability to remove metabolic by-products

\-reduced metabolism = long half lives and will remain in the body longer

What are the excretion pharmacokinetics in older adults?

\-decreased renal blood flow, number of functioning nephrons, GFR, and tubular secretion

\-creatine clearance is an important indicator of renal system in an older adult

\-GFR is overstimulation of the CrCL because creatine is then secreted by the proximal tubule and filtered by the kidneys

What is creatine clearance?

\-24 hr urine test

\-not always done unless on a specialty floor

What is polypharmacy?

use of several drugs during the same period

What are the medical adherence and aging fators of older adults?

\-polypharmacy

\-economic factors (EX: fixed income)

\-starting slow with low doses

\-asymptomatic (they are more confused and get a urinary tract infection because they forget to drink and use the bathroom)

T or F: Economic factors may contribute to nonadherence.

True (Economic factors may also contribute to nonadherence. Some older adults may have to choose between the cost of their medications and the ability to purchase food or pay for utilities.​)

What is the age range of premature infant?

What is the age range of neonate?

full term newborn to 4 weeks

What is the age range of child?

from >1 to 12 years of age

What is the age range of adolescent?

13-18 years old

Billy’s medications should be individualized to ensure the best outcome. Individualizing drug therapy for a child involves which one of the following?

A) assessing the child’s age and development level

B) administering an adult drug selection and dosage and observing for adverse reactions

C) deferring treatment until a better pediatric drug is developed

D) determining the child’s diet and exercise needs

assessing the child’s age and development level

Billy is unable to tolerate montelukast (Singulair) for his asthma and had a rash and abdominal pain. However, this drug works well for his father, who experiences no adverse effects. Billy’s physician is aware that the boy’s reaction to the medication is most likely a reflection of his

A) inability to understand the purpose of the drug

B) hope that he will not have to take the drug

C) inability to swallow pills

D) genetic variability

inability to swallow pills

For Billy’s asthma, a prescriber has ordered albuterol (Proventil). Which one of the following important factors related to growth and development is most likely to affect absorption of this beta2-adrenergic agonist?

A) the ability of Billy to cough up his secretions

B) the need to decrease the dose as Billy’s age increases

C) the need to monitor Billy for hypotension

D) the ability of Billy and his caregivers to understand how to use the inhaler and spacer to administer the albuterol

the ability of Billy and his caregivers to understand how to use the inhaler and spacer to administer the albuterol

A 3-month-old infant who receives fosphenytoin (Cerebyx) for a seizure disorder does not process this drug in the same way as an adult. Alterations in infant pharmacokinetics that influence drug action include which of the following concepts?

A) drug response in infants is slower and less rapid than that in adults.

B) neonates have a decreased response to drugs that affect the CNS.

C) infants have a decreased response to water-soluble drugs and an increased response to protein-bound drugs.

D) by 3 months of age, drug response in infants is similar to that of adults.

drug response in infants is slower and less rapid than that in adults

When administering a beta-adrenergic agonist to a patient older than 65 years of age, what response do you anticipate?

A) the drug will work very rapidly to decrease blood pressure.

B) the dosage will need to be increased to provide an effective response.

C) the drug should be combined with atropine to enhance effectiveness.

D) the dosage will need to be titrated over 20 minutes to increase blood pressure.

the dosage will need to be increased to provide an effective response

A 75-year-old woman is having difficulty remembering to take all of her medications. Which of the following nursing interventions will assist her to improve adherence to the medication schedule?

A) have her daughter administer the medications.

B) decrease the number of medications administered.

C) evaluate her ability to care for herself.

D) provide a medication administration aid.

provide a medication administration aid

A 68-year-old woman has been prescribed digoxin 0.125 mg. Based on her age, what condition is she at risk for developing?

A) diarrhea

B) digoxin toxicity

C) edema

D) pulmonary embolism

digoxin toxicity

A 68-year-old woman is receiving chemotherapy. What is the rationale for teaching her to drink eight glasses of water throughout the day following the administration of chemotherapy?

A) chemotherapy is toxic to the liver, and the water will reduce the adverse effects.

B) the water will prevent the body from rejecting the medication.

C) chemotherapy is excreted in the kidneys and urine. The water will help eliminate it from the body.

D) the water will prevent dehydration, an adverse effect of the medication.

chemotherapy is excreted in the kidneys and urine. The water will help eliminate it from the body

A 78-year-old man is receiving treatment for hypertension. He has been having persistent headaches and difficulty with the medications he has been prescribed. This is the third prescription he has received. He states, “I can’t afford to get this filled and then stop it in a few days.” Which statement is most appropriate for the nurse to communicate to the patient?

A) have the pharmacist give you a few pills to start.

B) take your other medication and then switch.

C) take the other medications back to the pharmacy for a refund.

D) save all your pills; you may need them again.

have the pharmacist give you a few pills to start

In general, medication use during pregnancy and lactation should be _____.

avoided

During pregnancy, physiologic changes can alter drug _____.

pharmacokinetics

During pregnancy, drug effects are _____.

less predictable

T or F: Only the stron medications should be avoided during pregnancy and lactation.

False (Drug use before and during pregnancy and during lactation requires special consideration and, in general, should be avoided or minimized when possible.​)

Maternal-placental-fetal circulation (fully established placenta) is complete approximately at the…

3rd week after conception

Drugs cross into fetal circulation via placenta, where…

relatively large amounts are pharmacologically active

Drugs are metabolized _____ in fetal liver.

slower

Drugs enter fetal brain _____.

easily

Excretion is _____ due to immature fetal kidneys.

slow and inefficient

Drug effects on the fetus are determined mainly by:

\-type and amount of drugs

\-duration of exposure

\-level of fetal growth and development when exposed to medications

Maternal medications taken on regular scale result in fetal blood containing _____ of drug amount in maternal blood.​

50-100%

What are major concerns of drugs on the fetus?

\-teratogenicity (birth defects)

\-fetotoxicity

\-brain effects

When are birth defects more likely to occur?

during first trimester of pregnancy

Second/third trimester drugs manifest adverse effects in the…

neonate or infant

When can brain effects on the fetus occur?

can occur with medications taken any time during pregnancy

T or F: Maternally ingested medications, at any time during the pregnancy, can result in adverse effects to the brain of the neonate or infant.

True (Drugs taken at any time during pregnancy can affect the baby’s brain because brain development continues throughout pregnancy and after birth.​)

What are some drugs that are administered to the mother to treat the fetus?

\-digoxin (fetal tachycardia or heart failure)​

\-levothyroxine (hypothyroidism)​

\-penicillin (exposure to maternal syphilis)​

\-corticosteroids (decrease respiratory distress syndrome in preterm infants)​

Drug therapy is an integral part of treating _____.​

fertility

Drugs prescribed for infertility will increase...

follicular maturation and promote ovulation

What is Clomiphene citrate?

is an ovarian stimulator and selective estrogen receptor modulator. This drug increases the amount of follicle-stimulating hormone (FSH) and luteinizing hormone (LH) secreted by the pituitary gland, thus inducing ovulation for women who have infrequent or absent menstrual periods. Health care providers use it for the treatment of ovulatory failure in women who have tried to become pregnant but have failed. Ovulation occurs 5 to 10 days after the course of clomiphene treatment has been completed. Prior to beginning the drug regimen, the nurse instructs the woman about taking her basal temperature 5 to 10 days following administration. An incremental rise in temperature is an indication that ovulation has recently occurred.

Clomiphene is a mixture of zuclomiphene and enclomiphene. Metabolized by the liver, the drug has a half-life of 5 days. It is excreted in the feces and urine.

Possible adverse effects of clomiphene include ovarian enlargement, hot flashes, breast pain and tenderness, and uterine bleeding. Some women have reported visual disturbances, abdominal discomfort, and headaches. Contraindications include liver disease, thyroid or adrenal disease, intracranial lesions, ovarian cysts, and abnormal uterine bleeding.

What are tocolytics?

drugs given to inhibit/stop labor and maintain pregnancy​

What is Indomethacin?

\-NSAID which inhibits uterine prostaglandins that initiate contractions of normal labor​

\-decreases inflammation

What is Nifedipine?

\-calcium channel blocker which decreases uterine contractions and blood pressure (block calcium channel so it is an antagonist)

\-smooth muscle relaxer

\-decrease blood pressure (adverse effect that can kill the patient)

What is the nursing implication for Nifedipine?

check BP first and after (when systolic BP is under 90 that is a problem)​

What is Terbutaline?

\-beta-adrenergic agent inhibits uterine contractions 

\-open up lungs and make you breath better and heart rate might come down a little. (don’t want HR any lower than 60)​

What is Magnesium sulfate?

smooth muscle relaxer and brings blood pressure down​

_____ try to postpone birth long enough to reduce problems associated with prematurity.

tocolytics

Slowing contractions _____ blood pressure​.

lowers

What are the reasons to induce labor?

\-complications

\-over due date

What are drugs to induce labor?

\-prostaglandins

\-oxytocis (pitocin)

What are prostaglandins?

chemical mediators, such as uterotonics, that help initiate uterine contractions

What are oxytocics?

drugs that initiate uterine contractions, thus inducing childbirth (induces labor or augments weak, irregular uterine contractions during labor)

What do prostaglandins do?

\-promote cervical ripening​

\-promote uterine contractility​

\-increase uterine contractions​

\-decrease uterine bleeding in the postpartum period

_____ produces a rhythmic uterine contraction-relaxation pattern.

oxytocin

In pregnancy, _____ drugs are safe.

no

The placent is a ___ __and not a__ ___.

membrane; filter

While lactating, what should you do first?

breast feed and then take medications

A couple has been trying to conceive for the past 8 months without success. Which of the following medications is the first drug of choice?

A) leuprolide

B) human chorionic gonadotropin

C) follitropin beta

D) clomiphene citrate

clomiphene citrate

A woman diagnosed with anovulation receives a prescription for menotropin to be administered subcutaneously. When providing education about medication administration, the nurse should teach the woman to:

A) massage the area prior to administering the drug

B) administer the drug at a 90-degree angle

C) alternate the sides of the abdomen for the injection sites

D) take human chorionic gonadotropin before the menotropin

alternate the sides of the abdomen for the injection sites

A woman with a seizure disorder has been taking phenytoin since she was 6 years old. She has recently married and wants to start a family. She understands the risk related to the use of phenytoin during pregnancy. What should the nurse advise the woman about pregnancy?

A) she should discuss her concerns with her gynecologist and neurologist.

B) she should stop the phenytoin and take folic acid.

C) she should begin to take prenatal vitamins.

D) she should consult a genetic counselor about her seizure disorder.

she should discuss her concerns with her gynecologist and neurologist

The nurse is providing immunization education to a pregnant woman. She should receive which of the following vaccines during cooler seasonal temperatures?

A) rubella

B) mumps

C) influenza

D) tetanus

influenza

A nurse knows that teaching was successful when expectant parents give which of the following rationales for administering folic acid supplements?

A) prevent hydrocele

B) increase absorption

C) prevent neural tube deformity

D) decrease blood glucose

prevent neural tube deformity

A nurse is providing prenatal teaching in the obstetric clinic. Which of the following herbal supplements helps in the prevention of nausea and vomiting?

A) St. John’s wort

B) ginger

C) black cohosh

D) garlic

ginger

A woman is receiving intravenous (IV) magnesium sulfate to control symptoms of preeclampsia. Which of the following signs or symptoms indicates a need for the administration of IV calcium gluconate?

A) urine ketosis

B) respiratory rate of 36 breaths/min

C) anuria

D) loss of deep tendon reflexes

loss of deep tendon reflexes

A woman experiencing preterm labor receives terbutaline sulfate. Which of the following adverse effects should the nurse tell her to expect?

A) headache

B) edema

C) hand tremors

D) shortness of breath

hand tremors

Our bodies become inflamed when the immune system _____. 

jumps to action

When injuries or infections occur; this series of events signifies a _____ immune system response

healthy

When does chronic inflammation occur?

when swelling sticks around and doesn’t let the healing process begin. It often rears its ugly head in the gut (or gastrointestinal tract), resulting in painful bloating, alternating diarrhea and constipation, gas, and a distended tummy

What are mediators of inflammation?

\-histamine​

\-leukotrienes​

\-prostaglandins​

\-kinins​

\-platelet activating factor​

\-cytokines and chemokines

Inflammation can occur _____.

anywhere

_____ are chemical mediators found in most body tissues.

prostaglandins

Prostaglandins assist in regulating many _____.

body functions