A nurse is preparing to administer epinephrine to a patient who is having a severe allergic reaction. Which route of administration should the nurse use to provide the fastest and most complete absorption of epinephrine? - intravenous Intravenous Rationale: Intravenous administration results in the fastest and most complete absorption of a drug. When preparing to administer a sustained-release capsule to a patient, the nurse understands that which of the following is true for sustained-release capsules?
- They are usually most costly than pills. They are usually most costly than pills Rationale: A capsule may cost more than a pill. Sustained-release formulations are capsules filled with tiny spheres
that contain the actual drug; the individual spheres have coatings that dissolve at variable rates. Because some spheres dissolve more slowly than others, drug is released steadily throughout the day. These capsules should not be crushed. The primary advantage of sustained-release preparations is that they permit a reduction in the number of daily doses. These formulations have the additional advantage of producing relatively steady drug levels over an extended time (much like giving a drug by
infusion). The major disadvantages of sustained-release formulations are their high cost and their potential for variable absorption. The nurse identifies which patient as being at highest risk for slow drug metabolism? A 56-year-old man who has chronic hepatic disease Rationale: Drug metabolism, which is also known as biotransformation, is the enzymatic alteration of drug structure. Most drug metabolism takes place in the liver. Digoxin has a half-life of 36 to 48
hours. Because of the length of the half-life, the nurse expects dosing to occur how often? Once a day Rationale: The concept of the half-life tells us that, no matter what the amount of drug in the body may be, half (50%) will leave during a specified period of time (i.e., the half-life). The
actual amount of drug that is lost during one half-life depends on just how much drug is present: The more drug that is in the body, the larger the amount lost during one half-life. If a long dosing interval were used, drug levels would fall below the minimum effective concentration between doses, and therapeutic effects would be lost. Conversely, if a drug has a long half-life, a long time can separate doses without a loss of benefits. When teaching a patient who has a gastric ulcer about cimetidine (a histamine H2 antagonist) therapy, the nurse should include which information about antagonists? An antagonist prevents receptor activation in the stomach. A new drug is being considered for approval by the FDA. What is the first criteria that is considered as part of the approval process? - ability to be reversed The drug works, it does what it is supposed to do. Which of the following are part of the original “5 Rights” of Medication Safety? SATA MFrs - right assessment - right patient What is the difference between a medication technician and an RN who is giving a medication? - Patient education Prior to 1990’s who was excluded from clinical trials? - individuals who are pregnant What is the purpose of the Controlled Substances Act (1970) passed by Congress? - Identify medications that have potential for abuse. Identify medications that have potential for abuse. Which Controlled Substance Schedule is marijuana? - Schedule I The name acetaminophen is considered which type of name? - brand name What is phase 4 of drug approval? - pre-clinical investigation Post-marketing surveillance True/false: If a drug is approved by the FDA, it is considered safe. True/false: A generic drug and brand drug are exactly the same. False Rationale: The active ingredients should be the same, but inactive substances are different. The rate and extent of absorption can be different. When a nursing student is discussing the medication ibuprofen with the clinical instructor, which description is most helpful? - "Ibuprofen is a pain medication" "Ibuprofen is a non-steroidal anti-inflammatory (NSAID) medication that is used for pain management." Which name is used on NCLEX for drug names? - brand name Which of the following drugs would be considered the least safe medication? - ibuprofen (Motrin) Furosemide (Lasix) Rationale: Going with the basis that OTC medications should be safer than prescription medications. The drug acetaminophen has a half-life of 2 hours. The drug is ordered every 4 hours and the first dose was taken at 8am today. When will the drug become therapeutic (reach plateau) in the bloodstream? - 4 pm today If all of the following drugs are equal in their ability to provide relief of seasonal allergies. Which of the following is most potent? - 10 mg
cetirizine (Zyrtec) 4mg chlorpheniramine (Chlor-Trimeton) A patient has chronic kidney disease stage 5. The nurse recognizes which aspect of pharmacokinetics is most impacted? - absorption The nurse notices that the dosage for a medication is much larger when it is ordered via the oral route (Morphine sulfate 30 mg oral tablet) versus the IV route (Morphine sulfate 1mg IV). What explains this difference? - half-life of the medication A patient has been given an agonist drug. What response does the nurse expect to occur after agonist drug binds with the receptor? - Acceleration of body’s normal response. Mimic of the body’s normal response. A drug is available over the counter. The nurse expects this medication to have what characteristic? - Drug peak is close to the LD50 Which of the following drugs has the quickest absorption? - 8mg intravenous ondansetron (Zofran) 8mg intravenous ondansetron (Zofran) A drug with a lot of interpatient variability, such a vancomycin has peak and trough levels ordered. The nurse understands that the trough level will provide what information? - The highest drug concentration in the bloodstream. The lowest drug concentration in the bloodstream prior to the next dose. If a drug is bound to the protein albumin, how will this affect distribution of the drug? - The drug will easily pass through cell membranes to
the site of action. Only the free drug will have an effect at the site of action. Which of
the following will affect the distribution of a drug for a patient with brain cancer? A patient has been on warfarin (Coumadin) a highly protein bound (99% protein bound) drug and has just been prescribed phenytoin (Dilantin) for a new onset seizure disorder. Why does this cause concern? A. The potential for increased levels of warfarin or increased levels of phenytoin is possible. The potential for increased levels of warfarin or increased levels of phenytoin is possible. A patient with cancer is receiving morphine for pain control. The patient calls the nurse to report that the morphine is no longer controlling his pain. What is the most appropriate response by the nurse? - “Increasing the dose of morphine will make you so sleepy that you will not be able to function.” - “This means that you have developed a psychological addiction to morphine.” - “You have developed a tolerance to morphine and will need a higher dose.” - “It is recommended that we wait to increase the morphine until the pain is more severe.” “You have developed a tolerance to morphine and will need a higher dose.” Rationale: Tolerance is a decreased responsiveness to a drug as a result of repeated drug administration. Patients who become tolerant to a drug require higher doses to produce effects equivalent to those that could be achieved with lower doses before the tolerance developed. The nurse is preparing to administer warfarin [Coumadin] to a patient. The nurse notes that the patient has altered CYP2D6 genes. It is most important for the nurse to do which of the following? - Check for signs of a transient ischemic attack. Examine the patient’s stools for the presence of blood. Rationale: Variants in the gene that codes for CYP2C9 can increase the risk of toxicity (i.e., bleeding) when taking warfarin [Coumadin], an anticoagulant with a narrow therapeutic index. The nurse should assess the patient for the presence of bleeding. A patient was discharged from the hospital with instructions to take an antibiotic for 7 days to treat a bladder infection. Twelve days later, a home care nurse visits the patient and finds that the symptoms have not resolved. What is the most important question for the nurse to ask? - “Do you think you have another bladder infection?” “Have you taken all of the antibiotics as directed?” Rationale: The failure to take medications as directed is a common cause of persistent infection. The nurse is assessing an infant delivered by a patient who is suspected of regularly using alcohol and cocaine during pregnancy. It is most important for the nurse to observe the infant for which clinical symptoms? - Lethargy, hypothermia, and weight gain High-pitched cry, vomiting, and jitteriness Rationale: Symptoms in an infant who develops withdrawal syndrome (from alcohol, barbiturates, or heroin) may include a shrill cry, vomiting, and extreme irritability. A patient is taking a Category A drug during pregnancy. Which statement by the nurse is accurate? - “The risk of harm to the fetus is remote.” “The risk of harm to the fetus is remote.” Rationale: Category A drugs are the least dangerous to the fetus. A patient is 2 months into pregnancy and complains of gastric distress. Which action is most
appropriate for the nurse to take? Instruct the patient to avoid acidic foods such as orange juice and tomatoes. No rationale. Just do it. A patient has chronic kidney disease stage V and the nurse is concerned about excretion. What resource is going to give the best information to ensure safe dosing? - BEERs criteria An individual has taken medication during pregnancy. Which time period would pose the greatest risk of teratogens that would cause gross malformations? - embryonic period An individual is breastfeeding and needs to take a medication. What is the best time to take the medication to decrease the risk of the medication passing to the baby through breast milk? - early in the morning immediately after breastfeeding Based on your understanding of how kids metabolize medications, what changes are made to how medications are prescribed for children? -Transdermal route is an ideal and easy to use route for medication administration. Shortened frequency may be required (ex: twice a day dosing instead of once a day). An 82-year-old is post-surgery from a hip replacement and requesting their first dose of pain medication. The nurse has a PRN (as needed) order range for Morphine 1-4 mg. What dose of morphine should the nurse administer? - 2mg A patient had a pulmonary embolism and the provider is going to start the patient on warfarin (coumadin) as the medication therapy. How would pharmacogenomics be applied to this patient? The patient is tested to see if he has genetic variations that will alter how he responds to the medication. A patient is given a placebo instead of the actual medication and has a positive response (eg. Feels better). What does this mean? The placebo has a positive effect that can be contributed to the psychological effect. The home health nurse is reviewing an older adult client’s medications and identifies that he is taking medications that are on the BEERs criteria. What concern does the nurse have? - Medications
on the BEERS criteria list should not be given to older adults because of the risk of increased adverse reactions. Medications on the BEERS criteria list should not be given to older adults because of the risk of increased adverse reactions. Which of the following has the greatest impact on the adherence of medications in older adults? The patient doesn’t believe that the medication is needed as prescribed (the dose, frequency or the medication itself). Which individual is at the highest risk for a drug drug interaction?Drug-drug interactions — Older adults are particularly vulnerable to drug-drug interactions because they often have multiple chronic medical conditions requiring multiple drug therapies. The risk of an adverse event due to drug-drug interactions is substantially increased when multiple drugs are taken [97-101].
Which factors decrease drug metabolism?Physiological factors that can influence drug metabolism include age, individual variation (e.g., pharmacogenetics), enterohepatic circulation, nutrition, intestinal flora, or sex differences. In general, drugs are metabolized more slowly in fetal, neonatal and elderly humans and animals than in adults.
What are three factors that affect the metabolism of medication?Individual drug metabolism rates are influenced by genetic factors, coexisting disorders (particularly chronic liver disorders and advanced heart failure), and drug interactions (especially those involving induction or inhibition of metabolism).
Which factors decrease drug metabolism quizlet?Which factors decrease drug metabolism? Malnutrition can result in impaired liver metabolism, altered oxidation, and conjugation of drugs, leading to the potential for drug accumulation and toxicity. Kidney disease decreases drug excretion, leading to the potential for drug accumulation and toxicity.
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