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NUR 3145 EXAM 1 | QUESTIONS AND ANSWERS | RATED A+ Therapeutic drug serum levels - narrow range of medication in bloodstream, for desired results; clinical status of patient is appropriate for condition; peak and trough levels (measured by serum blood levels) nontherapeutic drug serum ...

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  • September 28, 2024
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NUR 3145 EXAM 1 | QUESTIONS AND
ANSWERS | RATED A+

Therapeutic drug serum levels - narrow range of medication in bloodstream, for desired
results; clinical status of patient is appropriate for condition; peak and trough levels
(measured by serum blood levels)

nontherapeutic drug serum levels can be either: - undertherapeutic or toxic

toxic drug serum levels - greater than therapeutic dose range; increased adverse
effects

under-therapeutic drug serum levels - not enough drug for desired effect; may
contribute to drug-resistant organisms

o Drug Bioavailability - % of active drug absorbed that reaches target tissues

o Drug Bioavailability: determinants - route/form of drug; blood flow; liver/kidney
function; acid-base environment; presence of food, resident bacteria, motility in GI tract;
presence of pain/stress; other drugs

o Oral Absorption (PO): - absorbed from GI tract to body tissues; slower
-Diffuses across cell membrane; assisted by carrier enzymes or proteins; engulfed by
cellular membranes (pinocytosis)
-Easier, more convenient, less expensive; safer than injection; dosage easier to
reverse through intervention in case of accident

o Parenteral Absorption: - by injection; bypass GI tract

Intravenous - absorbed directly into bloodstream
• Rapid onset, since drug is administered directly to bloodstream
• Allows for more direct control of drug level in blood; Gives option of larger fluid volume,
therefore diluting irritating drugs
• Avoids first-pass metabolism

Intramuscular - : absorbed from blood supply of muscles
• Good for poorly soluble drugs, often given in "depot" preparation form and then
absorbed over a long period of time
• Onsets of action depend on route

,Subcutaneous: - absorbed through capillaries
• Same benefits as IM

o Other routes:
Topical - : transdermal
• Delivers medication directly to affected area; decreases likelihood of systemic drug
effects

o Other routes: Inhalational - • Provides rapid absorption; drug delivered directly to lung
tissue, where most of these drugs exert their action

o Other routes: Sublingual, buccal - • Absorbed more rapidly from oral mucosa, leading
to a more rapid onset; avoids breakdown of drug by stomach acids; avoids first-pass
metabolism

o Other routes: Rectal (Suppository) - • Relatively rapid absorption, good alternative
when oral route is not available; good for local or systemic drug delivery; usually leads
to mixed first-pass and non-first-pass metabolism

What does the protein-binding ability level of a drug mean? How do albumin levels
affect drug levels in the bloodstream? - o Lower albumin (protein) levels increase drug
levels in the bloodstream, because there are less proteins available to create bound,
drug-protein complexes (inactive drugs, too large to pass through capillary walls of
tissues)

4. Why is cytochrome P-450 so important? - o Microsomal enzymes; aid in metabolism
of medications; target lipid soluble (non-polar, lipophilic, fat-loving) drugs, which are
typically difficult to eliminate

What happens when grapefruit juice is taken with a drug that interacts with cytochrome
P-450? -

o Side effect: - : expected averse drug reaction
Undesirable = unexpected (i.e. allergic reaction: hypersensitivity response involving
immune system)

o Adverse reaction: - : any undesirable drug occurrence

Adverse reaction: Idiosyncratic reaction: - occurs unexpectedly in individual patient;
genetically inherited traits

Idiosyncratic reaction:
• Glucose-6-Phosphate Dehydrogenase Deficiency (G6PD): - ): when exposed to drugs
such as sulfonamides, anti-malarials, and aspirin, patients may suffer life-threatening

, hemolysis of RBCs; (13-20%) African-American, Kurdish Jewish (50%), Sardinians
(14%)

adverse reaction: Drug-induced teratogenesis - : cause fetal structural defects; BLACK
BOX WARNING

adverse reaction: Mutagenic effects: - permanently changes genetic composition of
living cells

Adverse reactions: carcinogenic reactions - cancer causing


adverse mreactions: mdrug-drug minteractions m- m mwhen mtwo mor mmore mdrugs mcome mtogether
mand meither mwork mtogether mto mcreate ma msynergistic, mantagonistic, mor madditive meffect




o mAgonist: m- m mdrug mbinds mto mthe mreceptor, mthere mis ma mresponse

m Ex: mmorphine mstimulates mopioid mreceptors

Partial mAgonist: m- m mdrug mbinds mto mreceptor, mdiminished mresponse

o mAntagonist: m- m mdrug mbinds mto mreceptor; mthere mis mno mresponse. mDrug mprevents
mbinding mof magonist.

mEx: mNarcan m(naloxone) mdisplaces mmorphine




Competitive mantagonist: m- m mcompete mwith magonist mfor mbinding; mif mit mbinds, mthere mis mno
meffect




Non-competitive mantagonist: m- m mcombine mwith mdifferent mparts mof mreceptor mto minactivate
mit




o mSynergists: m- m mdrug mmolecules mwork mwith mother mdrug mmolecules
mProduces mgreater meffects mthan msum mof mindividual mdrug mactions

• m1+1 m> m2
mCan mproduce mtoxic meffects

mETOH m+ mtranquilizer m= mtoxicity!




How mare mdrugs mmetabolized? m- m mo mMetabolism m= mBiotransformation: mdrugs mare
mtransformed minto minactive mmetabolites, mmore msoluble mcompound, mmore mpotent mactive

mmetabolite m(ex: mconversion mof mprodrug minto mactive mform), mor mless mactive mmetabolite

mPrimarily min mliver; malso min mkidney, mlungs, mskin m

mLiver mmetabolizes mdrug mfrom mGI mtract, mreducing mbioavailability m(< m100%) min mfirst-pass

meffect; mthen, mexcretes munchanged mdrug mto mgallbladder

• mGallbladder mbile m+ mdrug mare mreabsorbed minto mgut

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