NRNP 6566 WEEK1-5 Midterm Latest (Answered) 100% Verified
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 ...
NRNP 6566 WEEK1-5 Midterm Latest (Answered)
100% Verified
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.
Describe how aging can affect absorption, distribution, metabolism and excretion
Answer: decreased organ function, poorly tolerate drugs that require metabolism,
lower rates of excretion
decrease in small-bowel surface area, slowed gastric emptying, increase in gastric
PH, changes in drug absorption
With age, body fat generally increases and total body water decreases. Increased fat
increases the volume of distribution for highly lipophilic drugs (for example,
diazepam and chlordiazepoxide), which may increase their elimination half-lives.
Serum albumin decreases and alpha 1 acid glycoprotein increases -- Phenytoin and
warfarin are examples of medications with a higher risk of toxic effects when serum
albumin increases
hepatic metabolism of many drugs through cytochrome P enzyme system decreases
with age; decreasing 30-40%
decreased renal elimination
Identify 1eeeeeeeee heart block
Answer: cardiologist consult
Order echo to rule out structural diagnosis, check thyroid levels, medications,
electrolytes and identify and treat cause
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