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NURS 615 PHARM EXAM 1 MARYVILLE
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NURS 615 PHARM EXAM 1 MARYVILLE
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NURS 615 PHARM EXAM 1 MARYVILLEWhat factors are associated with clinical judgment when prescribing medications? -
Answers-Prescribing a drug is based on a thorough assessment of the patient and the
patient's environment. The determination of potential medical and nursing diagnoses, a
review of the potential alternative therapies, specific knowledge about the drug chosen,
and the disease process it is going to treat, known as patient centered care. The best
therapy is usually the least invasive, least expensive, and the least likely to cause
adverse reactions
What are the criteria for choosing an effective drug? - Answers-Multiple drugs may be
able to treat a specific condition. You must consult nationally recognized guidelines for
disease management to determine the most effective drug.
How does hypoalbuminemia affect the process of prescribing? - Answers-Many drugs
that carry an electric charge are bound to albumin in the blood. The distribution of the
drug to target tissues may be affected if hypoalbuminemia is present.
What is the drug's half-life? - Answers-In clinical practice it takes about four to five times
the half-life for a drugs concentration to read steady state after a drug is started,
stopped or changed. Hal life is the amount of time for a drug to be half cleared.
What is meant by the onset of action, peak of action, duration of action of medications?
- Answers-The onset of action is the time between the drug administration and the time
that you see the drugs minimum effect. Onset is the first sign of a drugs therapeutic
effect. Peak of action is the time of the maximum concentration of the drug in the blood.
Duration of action is the onset of action and the metabolism of the drug below the dose
needed for an effect.
Explain first pass metabolism. - Answers-This occurs when the concentration of the
drug is greatly reduced before it reaches the systemic circulation. It is the portion of the
drug lost during absorption. Generally, occurs in the liver or gut wall. After a drug is
swallowed it is absorbed by the digestive system and enters the hepatic system. It is
then carried by the portal vein to the liver before it reaches the rest of the body. The liver
metabolizes many drugs to such an extent that only a small portion of the drug reaches
the rest of the body. bioavailability of the drug thus is greatly reduced by the liver.
Sublingual administration can bypass the first pass system plus it is also faster than oral
route.
Cytotoxic hypersensitivity the antibodies produce an immune response that binds to
antigens (allergens) at the surface of the cell. Antigens can be either intrinsic (apart of
the body)or extrinsic (outside of the body). ABO blood incompatibility where the blood
cells have a different antigen on them. B cell proliferation will take place, and antibodies
to foreign blood types are produced. IgG and IgM bind to these antigens to form
complexes that activate the pathway of the complement activation to eliminate cells
, presenting as foreign antigens. That is mediators of acute inflammation are generated
at the site and membranes attack cause cell lysis and death. This reaction takes hours
to a day. - Answers-Type 2 hypersensitivity
accumulation of immune complexes or antigen-antibody complexes that may not have
been adequately cleared by innate immune cells giving rise to an inflammatory
response and attraction of leukocytes. Such reactions that progress to disease
produces immune complex diseases. The reaction can take hours, days, or weeks
depending on whether or not there is an immunologic memory of the precipitating
antigen. Typically clinical features begin a week following the initial antigen challenge
causing the immune complexes to cause an inflammatory response. - Answers-Type 3
hypersensitivity
delayed this reaction takes 2-3 days to begin. Unlike other types of reaction, it is not
antibody meditated but a cell-mediated response. - Answers-Type 4 hypersensitivity
Which medications interact with St. John's Wort? - Answers-A medicinal herb with
antidepressant effects and potent anti-inflammatory properties. St Johns wort interacts
with SSRIs, warfarin, and birth control. Taking with SSRIs can lead to an increased
serotonin level causing serotonin syndrome. Combining estrogen contraceptives with st
johns wort can lead to decreased efficacy of the contraceptive. Decreases the efficacy
of HIV meds, cholesterol meds, and transplant meds.
How does doxazosin work? - Answers-It is an alpha one adrenergic blocker that inhibits
the binding of norepinephrine released from the sympathetic nerve terminals to the
alpha one receptors and then to the membrane of vascular smooth muscle cells. The
primary effect of this inhibition is relaxed vascular smooth muscle tone or vasodilation
which increases peripheral vascular resistance leading to decreasing blood pressure. It
is used to treat high blood pressure and urinary retention associated with benign
prostatic hyperplasia (BPH). Also shows potential to treat erectile dysfunction and
chronic epididymitis. Adverse effects include orthostatic hypertension and reflex
tachycardia.
What is the action and effect of beta blockers? - Answers-Beta blockers are a drug class
used to manage cardiac arrhythmias. Used to prevent a second attack after the first
heart attack this is called secondary prevention. They have been used in hypertension
but are no longer the first choice of treatment. Beta blockers block the action of
endogenous catecholamines (epi & nor-epi) on adrenergic beta receptors of the
sympathetic nervous system which mediates the fight or flight response Some block all
activation of beta-adrenergic receptors and some are selective. The three types of beta
receptors are known as beta 1, beta, 2, and beta three receptors. Beta 1 adrenergic
receptors are mainly located in the heart and kidneys. Beta 2 receptors are mainly in the
lungs, gi tract, liver, uterus, vascular smooth muscle and skeletal muscle. Beta 3
receptors are located in fat cells. Beta receptors are found in cells on the heart muscle,
smooth muscle, airways arteries, kidneys and other tissues that are apart of the
sympathetic nervous system and lead to stress responses especially when stimulated
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