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NRNP 6566 WK1-5 MIDTERM QUESTIONS AND ANSWERS
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NRNP 6566 WK1-5 MIDTERM QUESTIONS AND ANSWERS
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NRNP 6566 WK1-5 MIDTERMQUESTIONS AND ANSWERS
Describevcytochromevp450vsystemv-vans--
Cytochromevp450vsystemvisvavseriesvofvenzymesvusedvtovmetabolizevmedications
Inhibitorsv-vans--blockvmetabolicvactivityvfromvonevorvmorevCYP450venzymes
Inducersv-vans--increasevCYP450venzymevactivityvbyvincreasingvenzymevsynthesis
Describeveffectvonvlowvandvhighvalbuminvlevelsvonvactivevdrugvlevelsvespeciallyvforvdrugsvth
atvarevhighlyvproteinvboundv-vans--
Albuminvisvthevplasmavproteinvwithvthevgreatestvcapacityvforvbindingvdrugs.vBindingvplasma
vproteinsvaffectvdrugvdistributionvintovtissues,vbecausevonlyvdrugvthatvisvnotvboundvisvavaila
blevtovpenetratevtissues,vbindvtovreceptors,vandvexertvactivity.vAsvfreevdrugvleavesvthevblood
vstream,vmorevboundvdrugvisvreleasedvfromvbindingvsites.
Lowvalbuminvlevelsv-vans--malnutrition,vchronicvillness
Highlyvproteinvboundvdrugsvcanvleadvtov-vans--
toxicityvinvpatientsvwithvlowvalbuminvlevels,vexamplevmalnutritionvorvchronicvillness.vThisvisv
becausevtherevarevfewervthanvthevnormalvsitesvforvthevdrugvtovbind
Describevthevwaysvthevhepaticvfirstvpassveffect-
vwhichvisvmetabolismvduringvfirstvpassvthroughvthevliverv-vans--Alternativevroutesvinclude:
suppository
intravenous
intramuscular
inhalationalvaerosol
transdermal
sublingual
Thesevallowvdrugsvtovbypassvthevfirst-
passveffectvandvbevabsorbedvdirectlyvintovsystemicvcirculation
BevablevtovcalculatevcreatininevclearancevusingvCockgraftvGaultvequation:v-vans--
Malev=v140-agevtimesvweightvinvkilogramsvdividedvbyvserumvcreatininevtimesv72.
Womenv=vCRCLv(male)vtimesv0.85
Describevwhatvdeterminesvthevfrequencyvofvdrugvadministrationv-vans--halfvlife
plasmavconcentration
, Bevfamiliarvwithvthevbeersvcriteriavandvhowvtovusevitv-vans--
PotentiallyvInappropriatevMedicationvUsevinvOldervAdults
tovcallvattentionvtovmedicationsvthatvarevmostvcommonlyvproblematicvandvthusvshouldvbevav
oidedvinvoldervadults
Describevfactorsvthatvaffectvabsorptionv-vans--
lowvbloodvstatev(shockvorvarrest),vcontactvtimevwithvGIvtractvtoovfastv(diarrheav=vcantvabsorb
),vdelayedvstomachvemptyingv(largevmealv=vdelayedvabsorption)Drug-
vtovdrugvorvdrugvtovfoodvinteractions
Describevthevfactorsvthatvaffectvdistributionv-vans--
lowvalbuminvlevels,vbodyvcomposition,vcardiacvdecompensationv(heartvfailure),vage
Describevthevfactorsvthatvaffectvmetabolismv-vans--genetics,vage,vorganvfunction
Describevfactorsvthatvaffectvexcretionv-vans--
affectedvbyvabnormalvkidneyvorvlivervfunction,vage,vdrugvinteractions
Definevnarrowvtherapeuticvindex.vHowvwouldvyouvmonitorvavpatientvwithvavnarrowvtherapeu
ticvindex?v-vans--
Therapeuticvindexvisvthevdosevrangevofveffiencyvofvmedvisvoptimizedvwhilevsideveffectsvarev
minimized
Narrowvtherapeuticvindexvdrugsvarevdefinedvasvthosevdrugsvwherevsmallvdifferencesvinvdos
evorvbloodvconcentrationvmayvleadvtovdosevandvbloodvconcentrationvdependant,vseriousvth
erapeuticvfailuresvorvadversevdrugvreactions.
Youvwillvneedvtovmonitorvbloodvtestsvtovmonitorvbloodvconcentrationsvandvdosevadjustment
svaccordingly.
Describevhowvagingvcanvaffectvabsorption,vdistribution,vmetabolismvandvexcretionv-vans--
decreasedvorganvfunction,vpoorlyvtoleratevdrugsvthatvrequirevmetabolism,vlowervratesvofvex
cretion
decreasevinvsmall-
bowelvsurfacevarea,vslowedvgastricvemptying,vincreasevinvgastricvPH,vchangesvinvdrugvabs
orption
Withvage,vbodyvfatvgenerallyvincreasesvandvtotalvbodyvwatervdecreases.vIncreasedvfatvincr
easesvthevvolumevofvdistributionvforvhighlyvlipophilicvdrugsv(forvexample,vdiazepamvandvchl
ordiazepoxide),vwhichvmayvincreasevtheirveliminationvhalf-lives.
Serumvalbuminvdecreasesvandvalphav1vacidvglycoproteinvincreasesv--
vPhenytoinvandvwarfarinvarevexamplesvofvmedicationsvwithvavhighervriskvofvtoxicveffectsvwh
envserumvalbuminvincreases
hepaticvmetabolismvofvmanyvdrugsvthroughvcytochromevPvenzymevsystemvdecreasesvwithv
age;vdecreasingv30-40%
decreasedvrenalvelimination
Identifyv1stvdegreevheartvblockv-vans--cardiologistvconsult
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