State the three most important characteristics of any drug. |
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Effectiveness, safety, and selectivity |
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Is it possible to have a selective drug? |
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No, all drugs can cause side effects |
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Define pharmacokinetics: |
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how much of the drug gets to the site of action via Absorption, distribution, metabolism, and excretion. |
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Define pharmacodynamics. |
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Determines nature and intensity of the response after binding to receptors |
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Who is the most likely member of the health care team to observe and evaluate drug responses and to intervene if required? |
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the nurse |
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What are the three basic goals of pre administration assessment of medications |
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Collecting baseline data (therapeutic and adverse responses), identify high-risk patients, assessing capacity for self-care. |
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State the factors that can predispose an individual to adverse reactions from drugs |
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Pathophysiology (liver and kidney dysfunction), genetics, allergies, pregnancy, age (very young/old). |
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What are measures to reduce adverse effects of medication administration? |
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Identify high-risk patients, ensure proper administration, educate patients that might precipitate an adverse reaction. |
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Which Amendment strengthened drug regulation after the thalidomide tragedy in Europe? |
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The Harris-Kefauver Amendments in response to a sedative that caused the birth defect phocomelia). |
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What type of research is required to assess drug therapies? |
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Randomized controlled trials |
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What is a “blinded” study? |
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People involved do not know to which group subjects have been randomized. Single: subjects blinded Double: researchers and subjects are blinded |
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What is the purpose of having a trade name for a drug? |
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Easy recall and pronunciation |
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What is the problem with trade names? |
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Clouds communication of the drug and promotes medication errors. |
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What are the limitations of the testing procedures used to bring drugs to market? |
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Testing is limited on women of childbearing age and children and the failure to detect all adverse effects. |
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How much does it cost to develop a new drug in the US? |
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$800 million |
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State the four basic pharmacokinetic processes. |
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Absorption, distribution, metabolism, excretion |
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Highly lipid-soluble drugs are absorbed more (rapidly or slowly) than drugs whose lipid solubility is low? |
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rapidly |
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Define the term parenteral. |
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Outside of the GI tract (sub-Q, IV, IM) |
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At what rate should (intravenous) IV drugs be administered? |
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Over 1 minute or more |
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How long does it take an IV drug injected in the anti-cubital space to reach the brain? |
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15 secs |
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What are depot preparations? |
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Releases drugs slowly and steadily (EC, SR, ER) |
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What types of compounds pass freely from the maternal bloodstream into the blood of the fetus? |
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Lipid-soluble, non-ionized |
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What kinds of compounds do not pass freely across the placenta? |
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Ionized, protein bound, highly polar compounds |
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What can occur when two highly protein bound drugs are given together? |
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Faster metabolism of one or both of the drugs |
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Give an example of a drug that is highly bound to protein. |
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Warfarin (Coumadin) |
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Drugs that are highly bound to protein may exhibit_____ levels in the blood when the patient is found with low albumin levels. |
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Decreased |
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Define biotransformation. |
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metabolism |
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Where does most drug biotransformation (metabolism) occur? |
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liver |
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If two drugs are given that both utilize p450 hepatic microsomal system, the drug level in the blood of the drug that is not metabolized ________. |
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decreases |
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At what age does hepatic maturation occur? |
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1 years old |
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Drug metabolizing capacity in infants is (decreased or increased)? |
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decreased |
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How is the first-pass effect circumvented? |
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Parental administration |
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Define therapeutic range |
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Between the minimal effective concentration and toxicity |
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What aspect of pharmacokinetics primarily affects patients with kidney disease? |
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excretion |
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A drug with a narrow therapeutic range is (more or less) dangerous |
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more |
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Define drug half-life. |
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The time required for amount of drug in the body to decrease by ½ |
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How many half lives does it take for a drug to reach plateau? |
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4 half-lives |
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Drugs that have a long half-life need to be administered (more or less) frequently than drugs that have a short half-life. |
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less |
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Agonists are molecules that (prevent or activate) receptor response? |
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Activate |
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Antagonists (activate or prevent) receptor activation? |
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prevent |
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Drugs that mimic the body’s own regulatory molecules are called |
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agonist |
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Define down-regulation and give an example of a medication that may lead to this effect. |
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When a receptor has become less responsive to agonist Narcotics have that affect. |
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Define ED-50 |
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average effective dose |
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What is the therapeutic index? |
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Measure of a drug’s safety, a ratio of lethal dose/effective dose averages |
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A drug with a high therapeutic index is considered (safe, or unsafe)? |
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safe |
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Laxatives (reduce or increase) absorption? |
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reduce |
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Drugs that depress peristalsis (reduce or increase) absorption? |
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morphine and atropine |
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When an inducing drug (phenobarbital) is taken with another medication, the metabolism of the other medication is |
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increased |
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Accelerated metabolism would lead to (increased or decreased) levels of the other drug? |
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decreased |
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(More or less) of the other medication would be needed? |
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more to maintain blood levels |
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Grapefruit juice can (inhibit or induce) the metabolism of certain drugs, thereby (raising or lowering)their blood levels? |
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inhibit, raising |
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What are the potential consequences when calcium channel blockers are taken with grapefruit juice? |
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More intense effects on the blood pressure causing hypotension, tachycardia, headache, and flushing. |
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How would you administer a drug “on an empty stomach”? |
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1 hr before or 2 hrs after a meal |
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Patients over what age account for greater than 50% of adverse drug reactions (ADRs)? |
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60 |
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When do side effects usually occur? |
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Soon after onset of drug use |
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Can an allergic reaction occur without prior sensitization? |
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no |
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Define an idiosyncratic effect from a drug and give an example. |
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Uncommon response resulting from a genetic predisposition |
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Define anaphylaxis |
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A life threatening response characterized by brochospasm, laryngeal edema, and drop in blood pressure |
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Why is abrupt discontinuation of a medication discouraged? |
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physical dependence, and the withdrawal symptoms can be harmful if not fatal. |
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What is the potential consequence of a medication that prolongs the QT interval? |
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causing serious dysrhythmias |
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Why are women at more risk for QT prolongation? |
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Because their normal QT interval is longer than those in men. |
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What is the most common cause of acute liver failure and hepatotoxicity? |
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medications |
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Define teratogenic. |
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Drug-induced birth defect |
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Define iatrogenic |
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Disease produced by drugs |
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What are the three most common causes of fatal medication errors? |
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Human factors, miscommunication mistakes, and name confusion |
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Why are the elderly more sensitive to drugs? |
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Organ degeneration, hypersensitivity, severity of illness, polypharmacy, multiple pathologies. |
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A patient with kidney or liver disease would require (higher or lower) dosages of a medicine? |
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lower |
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Define bioavailability |
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Ability of a drug to reach circulation from site of administration |
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Define the placebo effect. |
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Component of drug response caused by psychological facts |
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Define tachyphylaxis |
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Form of tolerance caused by repeated doses of a short time frame (Nitro patch) |
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Define tolerance |
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Decreased responsiveness to a drug, resulting from repeated drug administration. |
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A patient with glucose-6-phosphate dehydrogenase (G6PD) deficiency that takes aspirin or a sulfanilamide is at risk for what disorder? |
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Hemolysis or destruction of red blood cells |
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During pregnancy, increased renal blood flow leads to accelerated excretion of drugs. This process may require______in drug dosages? |
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increase |
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What class of blood pressure medication should not be taken during pregnancy? |
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ACE-inhibitors |
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Which FDA pregnancy risk category shows risk of fetal harm in women or animals whereby the risks clearly outweigh benefits? |
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Category X |
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Which antibiotics should not be taken during pregnancy? |
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Tetracycline |
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When is the best time to take a medication if breast feeding? |
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After breastfeeding to reduce concentrations in the next feeding |
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A neonate is defined as (less than or greater than) 4 weeks of age? |
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less than |
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Protein or albumin is (higher or lower) in and infant which might lead to_____ levels of a drug bound to protein? |
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lower, decreased |
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Hepatic metabolism and renal excretion in infants is (high or low)? |
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Low in the beginning; newborn and through mid infancy, but reaches maturation by one year. (94) |
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Why are neonates especially sensitive to drugs that affect the CNS |
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The blood-brain-barrier is not fully developed |
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The rate of drug absorption in the elderly is (slow or accelerated)? |
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Slow because of delayed gastric emptying or reduced blood flow. (96) |
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Drugs last longer in the elderly due to (decreased or increased) liver function |
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Decreased, which causes longer ½ lives and decreased metabolism. |
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What is creatinine clearance and why is it important in the elderly? |
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It’s the proper index to assess renal function. This is important to assess because some drugs are excreted through the kidneys. |
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What is the Beers criteria? |
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Not needed, has a narrow therapeutic range, slowly excreted, and exclusively excreted through kidneys |
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