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Creighton University Nursing Pharmacotherapy exam 1 learning quiz. This quiz might NOT simulate any case/scenario exam questions. Rather, it is only meant to reinforce the basics and the details that exam scenario questions would be built on.
So as not to discourage anyone from adding good questions, let's just say that as long as you are close in the "fill in the blanks" answers (you decide) count yourself right. Otherwise, the question creator will have to try to think of every possible way a quiz taker might type in a right answer, Read moreand that is too much to require of us.
Questions and Answers
1.
Which drugs select α1 receptors and indicate whether agonistically or antagonistically.
A.
LABETALOL
B.
CARVEDILOL
C.
PHENTOLAMINE
D.
PHENOXYBENZAMINE
E.
TAMSULOSIN
F.
YOHIMBINE
G.
PROPRANOLOL
H.
TIMOLOL
I.
PINDOLOL
J.
ATENOLOL
K.
METOPROLOL
L.
Agonistically
M.
Antagonistically
Correct Answer(s) A. LABETALOL B. CARVEDILOL C. PHENTOLAMINE D. PHENOXYBENZAMINE E. TAMSULOSIN M. Antagonistically
Explanation The drugs LABETALOL, CARVEDILOL, PHENTOLAMINE, PHENOXYBENZAMINE, and TAMSULOSIN select α1 receptors antagonistically. This means that they block or inhibit the activity of the α1 receptors.
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2.
Which drugs select α1 receptors and indicate whether agonistically or antagonistically.
A.
Epinephrine
B.
Norepinephrine
C.
Phenylephrine
D.
Oxymetazoline
E.
Clonidine
F.
Isoproterenol
G.
Dobutamine
H.
Albuterol
I.
Salmetertol
J.
Agonistically
K.
Antagonistically
Correct Answer(s) A. Epinephrine B. Norepinephrine C. Phenylephrine J. Agonistically
Explanation Epinephrine, Norepinephrine, and Phenylephrine select α1 receptors agonistically. These drugs bind to α1 receptors and activate them, leading to vasoconstriction and increased blood pressure.
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3.
Ephedrine and Pseudo-Ephedrine are called mixed acting drugs for what reason?
Correct Answer(s) They antoagonistically bind yet stimulate their receptor at the same time
Explanation Ephedrine and Pseudo-Ephedrine are referred to as mixed acting drugs because they exhibit both antagonistic and stimulatory effects on their receptor simultaneously. This means that while they bind to the receptor in an antagonistic manner, they also stimulate the receptor at the same time. This dual action of the drugs on the receptor is what classifies them as mixed acting drugs.
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4.
Clonidine uniquely stimulates α2 receptors, yet affects the heart rate which is normally affected by beta receptors. Why can this drug affect the heart rate by affecting alpha instead of beta receptors?
Correct Answer(s) Because it crosses the blood-brain barrier so that the the alpha receptors it binds are ones in the CNS instead of on the effector organ.
Explanation Clonidine is able to affect the heart rate by stimulating α2 receptors instead of β receptors because it has the ability to cross the blood-brain barrier. This means that the alpha receptors it binds to are located in the central nervous system (CNS) rather than on the effector organ, which in this case is the heart. By binding to α2 receptors in the CNS, clonidine can modulate the release of norepinephrine, resulting in a decrease in sympathetic outflow and ultimately leading to a decrease in heart rate.
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5.
Some drugs with names ending in -stigmine are acetylcholinesterase inhibitors. Two diseases we discussed could be treated in their beginning stages with these drugs. One was Alzheimer's. the other, in which nicotinic receptors get destroyed by autoimmune process, is:
Correct Answer(s) Myasthenia gravis
Explanation Myasthenia gravis is a disease in which the body's immune system mistakenly attacks and destroys nicotinic receptors, which are responsible for transmitting nerve signals to muscles. Drugs ending in -stigmine, such as acetylcholinesterase inhibitors, can help treat the symptoms of myasthenia gravis by increasing the levels of acetylcholine, a neurotransmitter that is crucial for muscle function. Therefore, the given answer is correct as myasthenia gravis is one of the diseases that can be treated with drugs ending in -stigmine.
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6.
Random questions not having time to make them into quiz questions:
What is pharmokinetics?
how the body
handles drug absoption, distribution metabolism and excretion.
What is pharmacodynamics?
a
study of the vast majority of drugs exert their effects by interacting with
target cells
What is a receptor?
Most
drugs produce their efects by interacting w/ specific proteins that are
usually located on a cells outer membrane.
Named according to the type of drug that it interacts with.
What is the ED-50?
Effective
dose 50%: a dose that produces one half the maximal response
What is the LD-50?
The
dose that kills 50% of the animals given the drug.
What are adverse effects?
effects
of the drug that are not intentional or expected
What is the therapeutic index?
a
rough indicator of the drugs margin of saftey, where the ratio of the LD50
and the ED50 are compared (margin of safety)
Why is it important to understand the relationship between dose
and response from a drug?
What is a dose response curve?
a
curve that shows the relationship between the drug response and the amount
(dose) of a drug given
What are the 3 routes that a drug can take into the cell?
passage
thru the membrane (most common), passage thru channels or pores, or passage
with the aid of the transport system
What is the combination of excretion and metabolism called?
elimination
Why arent more drugs made to travel thru the pores of a cell?
b/c
the pores are very small and made for only certain substances
What does it take to make a drug able to penetrate the cell
membrane?
they
have to be lipid soluble (lipophilic)
What are the 2 routes of administration?
enteral
(via the GI tract), or parenteral which means by either IV, IM or Sub Q
What is chemical equivelence?
drug
preparations are considered chemically equivelant if the have the EXACT same
chemical compound
What is bioavailability?
if
the drugs are absorbed at the same rate and in the same context
What are the 6 possible consequences of drug metabolism?
accelerated
renal excretion, drug inactivation, increased theraputic action, increased
toxicity, decreased toxicity
What kind of things can cause variation in drug effects?
body
weight/composition, age, pathophysiology, tolerance, placebo affect,
variability in absorption, gender, race, diet, drug interactions, failure to
take meds as prescribed
What are the four ways the body processes a drug?
Absorption,
excretion, distribution and liver metabolism
Discuss the oral (PO) route of administration and name a drug
given this way.
variable
abdsorption, best for self admin. but requires good compliance, ibuprofen.
Discuss the IM route of administration and name a drug given
this way.
rapid
if aqueous solution. Requires admin.
by nursing staff, only suitable for small volumes, painful, may cause muscle
damage, penicillin G.
Discuss the IV route of administration and name a drug given
this way.
absorption
is immediate, ideal for emergency, adverse affects appear rapidly, effects
may be short duration: epinephrine
Discuss the sub Q route of administration and name a drug given
this way.
same
as IM. rapid if aqueous solution.
Requires admin. by nursing staff, only suitable for small volumes,
painful, may cause muscle damage: insulin
Discuss the Inhalation route of administration and name a drug
given this way.
rapid
absorption unless specifically designed for resp. tract., common route for
bronchiodiltors or any gaseous liquid drug that cant be given any other way
like anesthesias. Drugs must be admin.
properly for proper effect (requires manual dexterity): albuterol
Discuss the transdermal route of administration and name a drug
given this way.
incomplete/erradic
unless drug spec. designed for local effects. Offer concenience for and
acceptance by many pt's., limited volume: scopolopine
Discuss the rectal route of administration and name a drug given
this way.
absorption
may be erratic, useful for small children or unconscious pt. (local; or
systemic drugs), uncomfortable, require time to dissolve: colace
Discuss the sublingual (buccal) route of admimnistration and
name a drug given this way.
Absorption
is usually rapid (complete), preffered route for drugs that are inactivated
by first pass metabolism. Efficacay,
speed, duration of effects depend on keeping tablet at admin. site:
nitroglycerin
Discuss the topical route of admimnistration and name a drug
given this way.
Generally
incomplete absorption, useful to treat derm problems, prolonged use may cause
allergic rxns, rashes. Precise dose
hard to achieve: lubraderm
How can kidney failure or liver disease alter the the drug
levels?
if
the kidneys aremnt functioning properly, then the drug can stay in the system
much longer causing toxicity
What is glomerular filtration?
filtration
moves drug from the blood to the urine, but drugs bound to proteins will not
be filtered
What is tubular
secretion?
depends
on proximal parts of of kidney tubules which contain pumps or transport
system to secrete drugs. Elimination will be impaired by drugs that
compete for the same transport system=>increase the tixicities of these
drugs
What can hamper tubular secretions and etherfore limit the
amount of the drug that leaves the body?
tubular
sreabsorption: high lipid solubility and non ionized molecules will be
readily absorbed and not be eliminated
How are drugs removed from
the body?
the two major processes are glomerular filtration and tubular
secretion
What is
drug tolerance?
a
decrease in responsiveness to a drug due to repeat exposure to the drug
What are the 3 categories of drug tolerance?
pharmacodynamic
tolerance, metabolic tolerance and tachyphylaxis (occurs quickly)
What is the placebo effect?
that
copmponent of a drug response that is caused by psycholgical factors and not
the physiological properties of the drug
What are the FDA pregnancy risk categories?
ABCDX,
X is the one that drugs are KNOWN to do harm to the fetus
What are the functions of the thyroid hormone?
stimulation
of energy use, stimulation of the heart and promotion of growth and
development, regulates fetal development, metabolic rate, cardiac rate,
peripheral vasodilation, hepatic metabolic enzymes, bone turnover
How do thyroid hormones produce their effects?
by
modulating the activity of certain genes
What are some indications for hypothyroidism?
decreased
metabolic rate, lethargy, weight gain, decraesed CO, BP and HR
What are some indications for hyperthyropidism?
warmth,
sweating, increased CO, BP, HR, nervous, irritable or insomnia,increased
metabolic rate, goiter, weight loss, hyperglycemia
How does the release of thyroid hormone happen?
the
hypothalamus secretes thyrotropin-releasing hormone (TRH) which acts on the
pituitary gland to secrete thyrotropin (TSH).
The TSH then acts on the thyroid to stimulate all aspects thyroid
function, which release the thyroid hormones T3 and T4 until blood levels go
up
What are the 2 forms of hyperthyroidism?
Graves
disease and toxic nodular goiter (Plummers disease)
What is the class of drugs that are antithyroid drugs?
thionamides
What 2 active hormones does the thyroid produce?
triiodothyronine
(T3) and tertraiodothyronine
What are the 4 steps of thyroid hormone synthesis by the
thyroid?
uptake
of iodide by thyroid, conversion of iodide to iodine, linking of iodine to
tyrosine and coupling of 2 iodinated tyrosines to form T3 or T4.
Whats the difference between glucocorticoids and
mineralcorticoids?
mineral
corticoids such as aldosterone influence renal procssing of Na, K and H, but
the main function of glucocorticoids is to influence the carbohydrate
metabolism (cortisol)
Whats the advantage to an alternate day regimen schedule?
reduced
adrenal suppresion, reduced risk of growth retardation, reduced toxicity
overall
Whats the difference between high and low doses of
glucocorticosteroids?
the
low dose has a physiological effect by modulating glucose metabolism. A pharmacological effect is given by high
doses for inflammatory disorders
What is the recommended method for corticosterioid withdrawl?
should
be done slowly, tap[er the dosage to physiological range within 7 days,
switch from multiple daily doses to single doses in the morning, taper to 50%
of physiological values over next month, and monitor for endogenous cortisol,
when basal levels return to normal cease routine steroid admin.
What nursing interventions should be done for glucocorticoid
use?
measure
baseline data and monitor changes with
therapy. Advise pt of problems with NA
and water retention, hyperglycemia and
glycosuria
What is the principle effect of low dose glucocorticoids?
the
elevation of blood glucose
How are glucocorticoids different from other drugs?
1)they
have the receptors on the inside of the cell, 2) they modulate the production
of regulatory proteins, rather than the actiity of signal pathways
How are glucocorticoids produced and regulated?
a
stimuli from the CNS or stress activate the hypothalamus to
producecorticotropin-releasing hormone (CRH) which goes to the anterior
pituitary gland which then produces adrenocorticotropic hormone. This acts on the adrenal cortex to produce
glucocorticoids until the blood levels of them shut off the production of
both ACTH and CRH.
What are some adverse reactions of glucocorticoids?
adrenal
insufficiency, osteoporosis, increased vulnerability to infection, muscle
wasting, thinning skin, fluid and electrolyte imbalance, glucose intolerance
and peptic ulcer disease.
What are some special barriers to drug entry?
blood-brain
barrier, placental barrier
What are some specialized sites for drug uptake and storage?
fat,
bone and teeth, kidneys
What drugs are best absorbed?
non-ionized
and lipophillic
How are some drugs stored?
by
being bound to the protein Albumin in our blood, then these drugs get
distributed to the body via the capillaries
What does the liver do for drug metabolism?
hepatocytes
conain microsomal enzymes that metabolize the drugs
What happens to drugs in the liver?
many
drugs get broken down and metabolized, but sometimes nothing happens
What are the factors that effect plasma concentration of a drug
over time?
age,
nutritional status, gentic makeup, liver disease and hormones
What is the onset of action?
the
time needed for the drug to reach minimum levels
What is the therapeutic range?
a
range from MEC to toxic levels in which there is enough drug to produce
therapteutic effects but not enough to produce toxicity
What is the duration of action?
the
time during which blood concentrations of the drug are above the minimum
effetive concentration
What is drug half-life?
the
time required for the amount of drug in
the body to reduce by 50%
What are the 4 main areas of distribution for drugs?
cells,
capillaries, liver and kidneys
What are the ways that drugs get into the cell?
passive
diffusion (only if uncharged), active transport (minor), pinocytosis (minor),
filtration through pores (minor)
What is the oral route of administration?
variable,
depends on composition of drug and gut pH,
What does the liver do for drug metabolism?
hepatocytes
conain microsomal enzymes that metabolize the drugs
What is the IM route of
administration?
rapid
if aquueous solutions used, slow and prolonged if oily or other depot
preparation
What is the IV route of administration?
absoprbtion
is immediate into blood
What is the Sub Q route of administration?
much
like IM
What is the inhalation route of administration?
rapid
absorption unless drug is specifically formulated for local effects
What is the transdermal route of administration>?
incomplete,
irratic unless drug specifically formulated for this route.
What is the rectal route of administration?
absorption
may be erratic
Ewhat is the sublingual,buccal route of administration?
absorbtion
is usually rapid, complete
What is the topical route of administration?
generally
incomplete, erratic
What is the proper drug solubility in water and lipids?
rate
and amount of drug absorbed from admin site depends on chemical nature of drug. Need to be soluble in water and lipids
What happens to proteins and hormones in the stomach?
the
are destroyed by the stomach acid
How is the destruction of hormones/proteins prevented?
enteric
coating or time release capsules to get into the small intestine
What are some other fcators for drug absorbtion in GI tract?
motility
(diarhea and vomiting), drugs which irritate the stomach can be taken with
food, some foods can inhibit absorption(milk binds to tetra cycling)
What is local blood flow?
flow
affects the amount of blood reaching organs
Which drugs are able to absorb into the blood?
only
those drugs that are NOT bound to plasma proteins are able to produce a
pharmocological effect, be metbolized, excreted or be accumulated
What arte the metabolic fates of a drug?
excretion
w/o metabolism, inactivated drug, less activated drug, more active drug
What is the first pass effect?
when
the drug is taken via the gi tract the active drug is then in a higher
concentration in hepatic portal vein than in the arteries or venous circ. So
drug effects are minimal. Large
initial doses can overcome this
What is responsible for breaking down the drugs in the liver?
P450
enzymes, hepatocytes contaoin microsomial enzymes that metabolize drugs
What is a prodrug?
a
drug that is initially inactive but is activated by the liver metabolism
(L-dopa)
What organs are involved in metabolism of drugs?
primarily
in the liver and to a lesser extent the lungs, GI mucosa, kidneys and blood,
sweat and saliva
Why is nitroglycerine given sublingually?
to
get it directly in the blood stream and bypass the first pass effect
What is inhibition?
competition
of one drug with another for microsomial enzymes. Hepatic substances such as large amounts of
alcohol or monamine oxidase inhibitors
What is stimulation?
some
drugs such as birbiturate sedative phenobarbital and anticonvulsant drugs
phenytoin and small amounts of alcohol will stimulate the livers ability to
metabolize other drugs by increasing the amounts of drug metabolizing enzymes
How are drugs eliminated?
glomerlar
filtration and tubular secretion
What is plasma half life?
the
time needed for the plasma concentration of a drug to fall to 50% of its
previous concentration
What is the plateau principle?
it
takes about 4-5 half lives for
average blood concentration and the related intensity of response to reach
steady level
What are second messengers?
the
binding of a drug molecule to its receptor is the first step leading to a
response. Is a chemical synthesized that links the drug binding response
(cAMP)
What is an agonist?
drugs
that bind to a receptor and then after some biologica funtion to produce an
effect, or response
What are the two properties of an agonist?
affinity
and efficacy
What is affinity and efficacy?
affinity:
the ability to interact with or bind to or occupy a specific receptor site in
a reversible manner. Efficacy: a measure of the abiolity of the agonist to
cause a response
What is an antagonist?`
drugs
which can interact with the cell recpetors but do not cause a response
Why are there so many different receptor subtypes?
the
sligfhtly different shapes allow more selective or specific interactions with
either antagonist or agonists.
What is a dose response curve?
shows
the relationship between drug response and the amount of drug given
What is the effective dose?
ED50
a dose that produces on half the maximum response
What is potency?
the
dose of drug needed to produce a response, compared with the dose of another
drug needed to cause the same response
What is the difference between efficacy and potency?
efficacy
provides info about intensity of the response. Potency can ofetn be
misleading and in general effciacy is more important than potency
What is the lethal dose?
a
dose that kills 50% of the animals its given to
What is a therapeutic index?
a
rough indicator of the drugs margin of saftey, where the ratio of the LD50
and the ED50 are compared
What are the 2 hormones that the thyroid gland synthesizes?
T3,
triodothyronine: T4 Thyroxine (converted in body to T3)
What are the drugs to treat hypothyropidism?
levothyroxine
(T4)preferred, liothyronine (T3), liotrix (T4 and T3, 4:1)
What are the mechansims of action for thyroid meds?
supplement
of bodys supply of thyroid hormone
What are the 3 classes of steroid hormones are there?
gucocorticoids,
mineralocorticoids, androgens
What are the physiological effects of of glucocorticoids?
carb
metabolism, protein metabolism, fat ,etabolism, maintains integrity of
vascular system, support striated muscle function, enhances CNS
excutablitily, cause increase secretions of glucocorticoids and epi to
maintain BP and glucose, debvelopment of respiratory system of full term
fetus
Cholineric Neurotransmission
Cholineric
Neurotransmission
What is the difference between afferent and efferent?
afferent
are sensory nerves that transmit to the brain, efferent nerves transmit out
of the brain to peripheral organs and tissues
What do somatic nerves do?
inervate
the skeletal muscles (voluntary movement).
1 neuron system travel directly to inervate skeletal muscle.
Neurotransmitter is acetylcholine for ALL somatic nerves
What does the autonomic nervous system do?
inervate
(control or contact) smooth muscle, cardiac muscle, and certain glands
What are the effectors of the autonomic nervous system?
smooth
muscle, cardia muscle and glands
What is the neuro muscular junction?
the
contact between the nerve and the skeletal muscle
What does the autonomic nervous system do for us?
it
maintains the involuntary functions of the body..It is a 2 nerve system. The preganglionic nerves are before the
ganglia. And a post-ganglionic nerve
which inervate the effectors
What is the difference between pre and post ganglionic nerves?
pre
ganlionic are mylenated and faster…But acetylcholine is always the neuro transmitter in the ganglia for both
Where do parasympathetic nerves pathways originate from?
cranial
or sacral areas of the spinal cord
What is the function of the parasympathetic nervous system?
conserve
energy, rest and digest nervous system.
What are features of the parasympathetic NS?
the
neurotransmitter is acteylcholine, the pre ganglionic nerve is longer
Where do sympathetic NS nerves originate?
thoracic
or lumbar
What are the features of the sympathetic NS?
short
pre ganglionic nerve, ALL POST ganlionic sympathetic neurotransmitter is
NOREPINEPHRINE
What is the function of the sympathetic NS?
helps
body deal with stress, fight or flight NS,
What is the sympathoadrenal branch?
acteylcholine is used in the adrenal medulla, which contact chromaffin cells
to release epi and norepi to stimulate cardiac muscle smooth muscle and
glands
What is the neuroeffector junction?
the
contact between a nerve and its effector
What are the sites for acetylcholine is the neurotransmitter?
neuromucular
junction, parasymapathetic neuroeffector junction, parasympathetic ganglia,
sympathetic ganglia, adrenal medulla
Where is Norepinephrine the neurotransmitter?
sympathetic
neuroeffector junction
What are cholinoceptors?
stimulated
by acetylcholine
What are adrenergic receptors?
all
receptors stimulated by epinephrine, alpha and beta
What are the drugs that ineract with alpha receptors?
Phentolamine α1 – Phenylephrine, α2 – Clonidine
What are the drugs that interact with beta receptors?
Isoproterenal β1 – Dobutamine β2 – Albuterol
Where are alpha and beta receptors?
only
on effectors
Where are the Nicotinic receptors?
parasympathetic
ganglia, sympathetic ganglia, skeletal muscle,
Where are the muscarinic receptors?
parasympathetic
effectors
Where are alpha and beta receptors?
effectors
inervated by sympathetic nerves
What is the only body part that ONLY has parasympathetic NS?
blood
vessels
What are muscarinic receptors stimulated by?
methacholine
What is Alzheimers caused by and what drugs treat it?
Degeneration
of nerves in the brain including many cholinergic nerves. Many drugs approved
to treat Alzheimer’s are cholinesterase inhibitors like:Donepezil (Aricept)
Rivastigmine(Exelon), Galantamine(Razadyne)
What are the adverse effects of cholinesterase inhibitors?
Similar
to direct acting muscarinic receptor agonists: Ocular: miosis, loss of
accommodation of the lens for far vision. Respiratory: bronchoconstriction,
increased secretions. Cardiovascular: bradycardia. GI: diarrhea, nausea,
vomiting, sialorrhea.GU: urination
What are the adverse effects that are UNIQUE to cholinesterase
inhibitors?
Medium
dose -Muscle fasciculation, tremor. High dose -Desensitization, flaccid
paralysis, respiratory collapse.
What is the overdose treatment for cholinesterase inhibitors?
Intermediate-acting
cholinesterase drugs: give atropine to
block muscrinic receptors and respiratory support. Long acting irreversible
organophosphate
inhibitors: atropine and slow
infusion of pralidoxime (within 6 hours of exposure)
Pralidoxime reactivates the cholinesterase enzyme
What are Muscarinic Receptor Antagonists also called?
antimuscarinics
What is the mechanism of action for antimuscarinics?
Competitive
antagonism of muscarinic receptors. Pharmacological effects: Blockade of
parasympathetic nerve signals, Tissue sensitivity = glands > heart >
eye > GU > GI > lung > stomach.
CNS actions
What are the Ocular Effects and Uses of Antimuscarinics ?
Effect:
Iris muscle relaxation: mydriasis.
Effect: Cycloplegia-lens is fixed to focus for far vision. Therapeutic
use: pupillary dilatation
(tropicamide)
What are the CV uses of antimuscarinics?
Effect:
Tachycardia, Therapeutic use to treat:
bradycardia, cardiac arrest,
Atropine
What are the effects on and therapeutic uses for antimuscarinics
in the respiratory system?
Effect:
Bronchodilation, Inhibition of respiratory secretions, Some reduced ciliary
clearance of mucous Therapeutic use: Tiotropium and ipratropium in
COPD.
What are the GI effects and use for antimuscarinics?
Gastrointestinal
effects: Xerostomia, reduced GI
motility, reduced gastric acid secretion • Therapeutic uses: antimotility,
antidiarrheal – dicyclomine
What are the GU effects and use for antimuscarics?
Genitourinary
effects: Block detrusorcontraction, block relaxation of sphincters
Therapeutic use: incontinence, overactive bladder - tolterodine(Detrol),
Solifenacin(Vesicare) etc.
How are antimuscarinics used for respiratory system?
Effect: Bronchodilation, Inhibition of respiratory secretions, Some reduced
ciliary clearance of mucous. Thera