NRNP 6566 WK1-5 Midterm ( A+ GRADED 100% VERIFIED) LATEST 2024
Describe cytochrome p450 system
Cytochrome p450 system is a series of enzymes used to metabolize medications
Inhibitors
block metabolic activity from one or more CYP450 enzymes
Inducers
increase CYP450 enzyme activity by inc...
Describe cytochrome p450 system
Cytochrome p450 system is a series of enzymes used to metabolize medications
Inhibitors
block metabolic activity from one or more CYP450 enzymes
Inducers
increase CYP450 enzyme activity by increasing enzyme synthesis
Describe effect on low and high albumin levels on active drug levels especially
for drugs that are highly protein bound
Albumin is the plasma protein with the greatest capacity for binding drugs. Binding
plasma proteins affect drug distribution into tissues, because only drug that is not bound
is available to penetrate tissues, bind to receptors, and exert activity. As free drug
leaves the blood stream, more bound drug is released from binding sites.
Low albumin levels
malnutrition, chronic illness
Highly protein bound drugs can lead to
toxicity in patients with low albumin levels, example malnutrition or chronic illness. This
is because there are fewer than the normal sites for the drug to bind
Describe the ways the hepatic first pass effect- which is metabolism during first
pass through the liver
Alternative routes include:
suppository
intravenous
intramuscular
inhalational aerosol
transdermal
, sublingual
These allow drugs to bypass the first-pass effect and be absorbed directly into systemic
circulation
Be able to calculate creatinine clearance using Cockgraft Gault equation:
Male = 140-age times weight in kilograms divided by serum creatinine times 72.
Women = CRCL (male) times 0.85
Describe what determines the frequency of drug administration
half life
plasma concentration
Be familiar with the beers criteria and how to use it
Potentially Inappropriate Medication Use in Older Adults
to call attention to medications that are most commonly problematic and thus should be
avoided in older adults
Describe factors that affect absorption
low blood state (shock or arrest), contact time with GI tract too fast (diarrhea = cant
absorb), delayed stomach emptying (large meal = delayed absorption)Drug- to drug or
drug to food interactions
Describe the factors that affect distribution
low albumin levels, body composition, cardiac decompensation (heart failure), age
Describe the factors that affect metabolism
genetics, age, organ function
Describe factors that affect excretion
affected by abnormal kidney or liver function, age, drug interactions
Define narrow therapeutic index. How would you monitor a patient with a narrow
therapeutic index?
Therapeutic index is the dose range of effiency of med is optimized while side effects
are minimized
Narrow therapeutic index drugs are defined as those drugs where small differences in
dose or blood concentration may lead to dose and blood concentration dependant,
serious therapeutic failures or adverse drug reactions.
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