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NURS 5334 EXAM WITH ACTUAL CORRECT QUESTIONS AND VERIFIED DETAILED ANSWERS |FREQUENTLY TESTED QUESTIONS AND SOLUTIONS |ALREADY GRADED A+$17.49
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NURS 5334 EXAM 1 2024-2025 WITH ACTUAL CORRECT
QUESTIONS AND VERIFIED DETAILED ANSWERS
|FREQUENTLY TESTED QUESTIONS AND SOLUTIONS
|ALREADY GRADED A+
First Pass Effect - ANSWER...Rapid hepatic inactivation of certain oral drugs
After GI absorption, carried directly to liver through hepatic portal vein
Results in complete inactivation upon first pass through liver
No drug is then passed into systemic circulation
Nutritional status - ANSWER...Hepatic drug metabolism requires various cofactors to function
Malnourished patients do not produce cofactors in sufficient amounts compromising drug
metabolism
Competition among drugs - ANSWER...two drugs that follow same metabolic pathway will
compete
will decrease metabolic rate of one or both drugs leading to accumulation/toxicity
Enterohepatic Recirculation - ANSWER...Repetitive cycle that transports drug from liver
through bile duct to duodenum and back to liver via portal blood
Only glucuronidated drugs
Glucuronidation: binding of lipid soluble drugs to glucuronic acid to convert to water-soluble
drugs allowing passage into duodenum with bile
Excretion of drugs - ANSWER...Removal of drugs from the body
Exit the body via urine, bile, sweat, saliva, breast milk or expired air
Kidney is most important organ in drug excretion
Renal routes of drug excretion - ANSWER...Are the kidneys healthy?
,Poor kidney function may increase duration and intensity of drug responses
Steps:
1) glomerular filtration
2) passive tubular reabsorption - lipid soluble drugs passively move through tubule membrane
into blood due to concentration gradient; non lipid soluble drugs remain in urine to be excreted
3) active tubular secretion - pump drugs from blood to tubular urine; relatively high capacity
Varies from person to person
Factors that may modify renal drug excretion:
1) pH-dependent ionization
2) Competition for active tubular transport
3) Age - may need to consider renal dosing
Nonrenal Routes of Drug Excretion - ANSWER...Breast milk
Bile - Enterohepatic recirculation
Lungs (especially anesthesia and alcohol)
Sweat/saliva (toxicologically insignificant)
Plasma Drug Levels - ANSWER...Titration
Seems odd since drug responses are related to site of action concentration; for most drugs site of
action is not the blood - site of action drug concentration usually not measurable
For most drugs, plasma levels and therapeutic effect/toxicity directly correlated
Important plasma drug levels:
1) minimum effective concentration (MEC) - just below where drug effects occur
2) toxic concentration
therapeutic range: between MEC and toxicity
narrow therapeutic range increases difficulty of safe administration
Single-Dose Time Course - ANSWER...Latent period between administration and onset
determined by rate of absorption
Duration of effect determined by combination of metabolism and excretion
, Half-life - ANSWER...Time required for amount of drug in body to decrease by half; percentage
not amount
Takes 4.5-5 half-lives for drug to reach steady state
Determines dosing interval; the shorter the half life the more frequent the dosing
Drug levels produced with repeated doses - ANSWER...in order to achieve plateau drug levels
with succeeding doses, drug levels climb to a steady state whereby the amount of drug
eliminated is equal to the dose administered
Plateau is achieved in approximately 4 half lives
If plateau must be achieved quickly, a loading dose or large initial dose is used followed by
maintenance dosing
Generally takes approx. 4 half lives for drug to be eliminated from body
Pharmacodynamics - ANSWER...Study of biochemical and physiologic effects of drugs and the
molecular mechanisms by which those effects are produced
Study of what drugs do to the body and how they do it
Dose-Response relationship - ANSWER...Relationship between size of administered dose and
intensity of response
Determines:
1) minimum amount to elicit response
2) maximum response possible
3) Amount to increase dosage to produce desired response
3 phases:
1) Too low to elicit response
2) Increasing dose=increasing response
3) Regardless of increasing dosage no further response is achieved
Maximal Efficacy/Relative Potency - ANSWER...Maximal Efficacy: largest effect possible
(height of curve), match intensity with need, very high maximal efficacy may not be desirable
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