Exam (elaborations)
NRNP 6566 WK1-5 MIDTERM QUESTIONS AND ANSWERS WITH SOLUTIONS 2024
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NRNP 6566 WK1-5 MIDTERM QUESTIONS AND ANSWERS WITH SOLUTIONS 2024
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NRNP 6566 WK1-5 MIDTERMQUESTIONS AND ANSWERS WITH
SOLUTIONS 2024
Describe cytochrome p450 system - ANSWER Cytochrome p450 system is a series of enzymes used to
metabolize medications
Inhibitors - ANSWER block metabolic activity from one or more CYP450 enzymes
Inducers - ANSWER 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 - ANSWER 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 - ANSWER malnutrition, chronic illness
Highly protein bound drugs can lead to - ANSWER 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 -
ANSWER 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: - ANSWER 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 - ANSWER half life
plasma concentration
Be familiar with the beers criteria and how to use it - ANSWER 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 - ANSWER 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 - ANSWER low albumin levels, body composition, cardiac
decompensation (heart failure), age
Describe the factors that affect metabolism - ANSWER genetics, age, organ function
Describe factors that affect excretion - ANSWER 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? -
ANSWER 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.
You will need to monitor blood tests to monitor blood concentrations and dose adjustments accordingly.
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