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NSG6020 Week 1-9 Quiz With Practice Exam with Answers (336 Solved Questions)

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    NSG 6020 Week 1-9 Quiz With Complete Solutions BUN - requires adequate protein ingestion serum creatinine levels - requires adequate muscle mass unreliable in older adults topical medication absorption - much higher in infants and young children due to thin stratum leads to potential systemic toxicity infants younger than 6 months - decreased plasma proteins for drug binding--increased plasma levels of drug avoid NSAIDs and monitor for drug toxicity pediatric OTC considerations - no ASA no alternation between APAP and ibuprofen in outpatient setting state board of nursing - determine legal APN scope of practice and prescriptive authority FDA, NPI, DEA - federal level agencies affecting prescribing factors contributing to scheduled drugs - currently accepted medical use in treatment in

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    US relative abuse potential likelihood of causing dependence when abused schedule 1 drugs - no accepted medical use in the US high potential for abuse heroin, LSD, ecstasy schedule 2 drugs - high potential for abuse which may lead to severe psychological or physical dependence

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    Dilaudid, Demerol, oxycodone, fentanyl, morphine, codeine, hydrocodone, amphetamines schedule 3 drugs - potential for abuse less than substances in schedule 1 or 2 and abusemay lead to moderate or low physical dependence or high psychological dependence products not containing 90 mg of codeine per dosage unit, suboxone, Tylenol w/ codeine, testosterone schedule 4 drugs - low potential for abuse relative to substances in schedule 3 Xanax, Soma, Klonipin, Valium, Ativan, Versed, Restoril, Halcion schedule 5 drugs - low potential for abuse related to substances in schedule 4 and consistprimary of preparations containing limited quantities of certain narcotics cough preparations not containing more than 200mg of codeine per 100 ml or per 100 grams Robitussin AC or Phenergan w/ Codeine medication error - any mistake occurring in the medication use process, regardless of whether an injury occurred or whether the potential for injury was present

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    adverse drug event - any harmful/undesirable event resulting from med use categories of adverse drug events - preventablenon-preventable--adverse reactions potential--near miss errors or close calls drug classes consistently associated with ADEs - anticoagulantsdiabetes meds antibiotic s sedative s narcotic s

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    antipsychotics chemo agents MedWatch - FDA Safety Info and Adverse Event Reporting program voluntarily report a serious adverse event, product quality problem, product use error, or therapeutic inequivalence/failure that you suspect is associated with use of FDA regulated drug, biologic, medical device, dietary supplement or cosmetic Strategies to prevent ADE - review med list and allergies with each encounterbe vigilant with high-risk drugs discontinue unnecessary drugs make sure patients are clear on new medications if intended to add or replace old medavoid treating side effects with another drug address non- adherence EMR/e- scribe hypertriglyceridemia - Fish oil indication depression - St. John's wort indication dementia - Ginkgo biloba indication

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    heart failure - CoQ10 indication antibiotic associated diarrhea - probiotic indication most common medication malpractice errors - prescribing wrong med prescribing wrong dose failing to properly discontinue a med prescribing an incompatible, contraindicated, interactive med

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    adherence - extent to which a person's behavior--taking medication, following a diet, or making healthy lifestyle changes--corresponds with agreed-upon recommendations from a healthcare provider medication adherence - patient's conformance with the provider's recommendation with respect to medication: timing dosage frequenc y for prescribed length of time high risk for medication non-adherence - asymptomatic diseases (HTN) cognitive impairment psychiatric illness complex regimens common non-adherent behaviors - took less often smaller doses stopped sooner delayed fill failed to fill barriers to medication adherence - perceived/actual adverse reactions asymptomatic conditions

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    knowledge deficit/health literacy health beliefs cognitive impairment and psychiatric illness communication difficulties cost acces s chronic conditions (esp >3) complexity of drug regimen multiple providers recent hospital discharge

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    SIMPLE - Simplify the regimen Impart knowledge Modify patient beliefs and behavior Provide communication and trust Leave the bias Evaluate adherence pharmacokinetics - drug absorption, distribution, binding affinity, metabolism, and excretion going in and coming out of body what body does to drug pharmacodynamics - interactions within body tissue what drug does to body pharmacogenetics - variability in drug response/toxicity due to genetic factors how our DNA affects the way drugs work seeks to guide the design of optimal medication regimens for individual patients

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    genetic polymorphisms in targets of drug therapy can greatly influence efficacy and toxicity of medications pharmacogenomics - development and use of medications applying genetic info to deciding which drug to use 3 phases of drug action - 1. pharmaceutical--how drug comes out of delivery form-- breakdown of tablet/capsule 2. pharmacokinetic

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    3. pharmacodynamic basic pharmacokinetic processes - 1. absorption--with or without food 2. distribution--protein binding/hypoalbuminemia 3. metabolism--primarily liver 4. elimination--urine and feces best absorbed drug form - non-ionized, lipid-soluble form water-soluble drugs - cannot pass through lipid membranes lipid-soluble drugs - more easily pass through cell membranes CNS drugs high ionization - more difficult time crossing lipid membranes acid drug and base media or base drug and acid media ileum - most drugs absorbed here d/t microvilli--increased surface area albumin - most common site of plasma protein binding Warfarin - 97% protein bound drug--only 3% free drug urine elimination - requires drug to be water-soluble--if not must be biotransformed

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    CYP450 enzyme locations - liver, intestines, lungs, other organs CYP450 inducer - speeds up enzyme activity increased metabolism=decreased drug level phenobarbs, Rifampin, cigarette smoke, anticonvulsants CYP450 inhibitor - decreases enzyme activity decreased metabolism=increased drug level

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    cimetidine, omeprazole, macrolides, antifungals, St. John's Wort grapefruit juice - common CYP450 inhibitor after 1 glass, statin level doubled urine excretion - increased ionization=increased excretion weak base drug+acidic urine=increased excretion of amphetamines creatinine clearance - Cockcroft-Gault used to estimate--can overestimate in frail elders package inserts base renal dosing on half-life - time for plasma concentration of drug to be reduced by 50% hepatic first-pass effect - amount of drug liver metabolizes on first pass before drug gets toblood stream in oral administration can be bypassed by IV, transdermal, rectal delivery prodrug - administered drug is metabolized to another active drug with intended purpose

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    decreased liver fxn can prevent conversion to active/desired drug metabolite - end product of metabolism--can be active or inactive Prilosec-->Nexium zero-order elimination - drug is metabolized at constant amount per unit of time, regardless of concentration

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    set number of drug receptors available--when receptor enzymes become saturated, moredrug is being put in than can be metabolized--increased blood levels of drug first-order elimination - constant proportion of the drug is eliminated per unit of time50% of drug eliminated with each half-life linear process 5 - number of half-lives needed to reach steady state number of half-lives needed to completely eliminate drug steady state - each administered dose produces consistent increase and decrease inplasma drug concentration therapeutic range loading dose - administering large amount of drug to immediately achieve therapeutic steady state drug agonist - binds to receptor and produces effect drug antagonist - binds to receptor and produces no effect

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