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PC707 - FINAL EXAM (ALL MODULES) QUESTIONS
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PC707 - FINAL EXAM (ALL MODULES) QUESTIONS
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PC707 - FINAL EXAM (ALL MODULES) QUESTIONSWhat is prescriptive authority? - Answers- Legal right to prescribe drugs
Is the Physicians Desk Reference a reliable source to use when prescribing drugs? -
Answers- No--it is not evidence-based and it is not updated
What is the sunshine act? - Answers- -part of the affordable care act
-limits providers on accepting gifts from pharmaceutical companies
-reduces bias
What is pharmacology? - Answers- -study of the drugs and their actions and effects on
living things
-legal drugs, illegal drugs, prescription drugs, OTC drugs
How does the FDA define drugs that they approve? - Answers- -chemicals that have
been proved for safety and efficacy
What must providers consider when prescribing? - Answers- -the dose
-the route of administration
-indications
-side effects of consequence
-adverse effects
-contraindications
-significant drug-drug interactions
-appropriate monitoring
-treatment of side effects if necessary
What is pharmacokinetics? - Answers- -how drugs move in the body and what the body
does with it
How does pharmacokinetics influence prescribing? - Answers- -the route
-the dosage needed
-dosing intervals
What are the 4 aspects of pharmacokinetics? - Answers- -absorption
-distribution
-metabolism
-excretion
What affects bioavailability the most? - Answers- PO administration
What is a pro-drug? - Answers- -a drug that needs to be metabolized to become
"activated"
,What is the major organ of metabolism? - Answers- -Liver
-Uses enzymes called "CYPs"
-these enzymes can induce or inhibit metabolism
What is protein-binding? - Answers- -drugs that have a high affinity for proteins will bind
with them and therefore become unable to bind to receptor sites
-in order to activate receptors they must be free circulating molecules
What is the primary organ of excretion? - Answers- kidneys
What are other methods of excretion? - Answers- -saliva
-sweat
-breastmilk
-skin
-lungs
Why would the elderly have a smaller first-pass effect? Why is this important to know? -
Answers- -decreased liver mass
-decreased enzymes
-->this is important because with a smaller first pass effect higher drugs levels will reach
circulation
What does the rate of excretion depend primarily on? - Answers- -renal blood flow
-glomerular filtration rate
Can side effects be negative AND positive? - Answers- Yes
What is an adverse effect? - Answers- -negative side effect
-undesirable
-unintended
What are contraindications? - Answers- -do not give
-the risks outweigh the benefits
What are relative contraindications? - Answers- -the consideration that there are rare
exceptions to the rule
-the risk of NOT taking the medication potentially is greater than the risk of taking it
What are precautions? - Answers- -"warnings"
-clinically significant
-providers must weight the risks vs benefits
What is a black box warning? - Answers- -a potential adverse effect is serious enough
that the risk must be thoughtfully considered
,OR
-a potential adverse effect that can be reduced or eliminated by appropriate use
OR
-FDA has approved with restrictions to assure safe use
If a drug has a high protein affinity--the protein binding sites must saturated in order for
what to happen? - Answers- -free drug to be able to circulate and activate receptors
When taking two different drugs that are both highly protein bound, how does stopping
or starting a drug affect the levels of the other drug? - Answers- -if one drug is suddenly
stopped it opens up protein binding sites for the other drug to bind to--reducing plasma
drug levels
-if a new drug is started--it will replace some of the protein binding sites--which then
increases the plasma drug levels of the drug that was already present
What sources should providers use when prescribing? - Answers- -whenever possible
you must utilize the highest levels of evidence
-OR trusted experts in the field (ACOG, CDC, American Cancer Society, etc.)
What is an enzyme inhibitor? - Answers- -inhibits the enzyme action causing decreased
metabolism
-this can increase the drug levels
-it can affect all drugs that utilize the same metabolic pathway
What is an enzyme inducer? - Answers- -increases the enzymes that induces
metabolism
-this decreases drug levels
-it can affect all drugs that utilize the same metabolic pathway
What is an agonist? - Answers- -a drug that binds to AND activates a receptor
What is the half-life of a drug? - Answers- -how long it takes for a drug at its original
amount to be reduced by 50%
Why is it important to know the half-life of a drug? - Answers- -to help determine dosing
intervals to maintain therapeutic levels
What is the first-pass effect? - Answers- -alteration of the drug dose by metabolism
before it reaches systemic circulation
-only happens with PO medications
What are the genetic variances of metabolism? - Answers- -poor metabolizers (certain
enzymes are little to none)
-intermediate metabolizers
, -extensive metabolizers (NORMAL)
-ultra-rapid metabolizers (duplicate genes to make extra enzymes)
What is a partial agonist? - Answers- A drug that binds to and activates a receptor but
produces a smaller effect at full dosage than a full agonist
What is an antagonist? - Answers- -A molecule that binds to a receptor but does NOT
activate it--it blocks the activating drug from binding to the receptor
When is a drug-drug interaction risk the greatest? - Answers- -when a patient is taking
multiple medications (poly-pharmacy)
What is the most common cause of ER visits from an adverse drug reaction? -
Answers- -bleeding from anticoagulants
Why must a person limit or discontinue use of grapefruit juice when taking certain
drugs? - Answers- -it inhibits metabolism
-this can increase drug levels--potentially to dangerous levels
-one cup of juice can inhibit metabolism for up to 72 hours!
Rule of safe prescribing? - Answers- AVOID M pneumonic--Ask and Consider
A-Allergies
V-Vitamins & Herbs
O-old drugs, new drugs, over the counter drugs
I-interactions
D-dependence
M- Mendel "genetics" --family history of drug reactions
Type 1 allergic reaction? - Answers- -IgE mediated
-Immediate hypersensitivity
-antigen exposure--B cells stimulated--antibodies produced
-future exposure--antibodies bind to mast cells & basophils
-potential anaphylactic degranulation
-vasodilation, leaky vessel walls, smooth muscles spasm, itchy wheals, rash, edema,
bronchospasm, decreased blood pressure
-re-exposure is necessary
-epinephrine needed
-may need glucocorticoids, H1 blockers, bronchodilators
What is the difference between type 1 allergic rash and morbilliform rash? - Answers- -
type 1 allergic rash--hives, wheals, itchy, type 1 hypersensitivity
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