NUR-641E Mid-Term Exam Study Guide
Note: Read the questions: the questions only have one answer unless the question specifically states there is more than one correct answer.
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Understand what a prodrug is, and activation/inactivation by liver enzymes, and how it differs from active drugs.
The liver is the principal site of drug metabolism. Although metabolism typically inactivates drugs, some drug metabolites are pharmacologically active—sometimes even more so than the parent compound. An inactive or weakly active substance that has an active metabolite is called a prodrug, especially if designed to deliver the active moiety more effectively.
Know what Bioavailability (BA)
a term used in pharmacology and nutritional and environmental sciences. In pharmacology, it refers to the degree and rate at which an administered drug is absorbed by the body’s circulatory system, the systemic circulation. Bioavailability is an essential measurement tool since it determines the correct dosage for non-intravenous administration of a drug availability means
Bioavailability. In pharmacology, bioavailability (BA or F ) is a subcategory of absorption and is the fraction of an administered dose of unchanged drug that reaches the systemic circulation
Bioavailability is affected by chemical instability, solubility and first-pass metabolism
The first pass effect- is a phenomenon of drug metabolism whereby the concentration of a drug is greatly reduced before it reaches the systemic circulation. It is the fraction of drug lost during the process of absorption which is generally related to the liver and gut wall.
Bioequivalence does not affect bioavailability
Bioequivalence is the similarity of two drugs that share the same desired outcome for patients. Pharmaceutical equivalence means two drugs release the active ingredient into the bloodstream at the same amount and same rate. When assessing how well a generic drug works, scientists evaluate its bioequivalence to the name-brand version.
Understand what the Cytochrome P450 system is in the liver
Cytochrome P450 enzymes are primarily found in liver cells but are also located in cells throughout the body. … Cytochrome P450 enzymes account for 70 percent to 80 percent of enzymes involved in drug metabolism. Cytochrome P450 enzymes also function to metabolize potentially toxic compounds, including drugs and products of endogenous metabolism such as bilirubin, principally in the liver.
Clopidogrel (Plavix) is a prodrug and must be activated by hepatic CYP2C19 metabolism; individuals who are poor metabolizers may not form the active metabolite and have reduced antiplatelet response.
A drug’s half-life determines how often the drug is administered?
The elimination half–life of a drug is a pharmacokinetic parameter that is defined as the time it takes for the concentration of the drug in the plasma or the total amount in the body to be reduced by 50%. In other words, after one half–life, the concentration of the drug in the body will be half of the starting dose.
Steady state of a drug is reached in approximately 5 to 6 times the half-life
Inhalation, oral and parenteral drug action and onset of effects?
Inhalational administration can be used. The lungs serve as an effective route of administration of drugs. The pulmonary alveoli represent a large surface and a minimal barrier to diffusion. The lungs also receive the total cardiac output as blood flow. Thus, absorption from the lungs can be very rapid and complete.
Bioavailability of drugs administered orally varies greatly.
Parenteral administration refers to any routes of administration that do not involve drug absorption via the GI tract (par = around, enteral = gastrointestinal), including the IV, intramuscular (IM), subcutaneous (SC or SQ), and transdermal routes
Know the mechanism of action of anticoagulants (e.g., warfarin, apixaban, heparin).
Warfarin competitively inhibits the vitamin K epoxide reductase complex 1 (VKORC1), which is an essential enzyme for activating the vitamin K available in the body. Through this mechanism, warfarin can deplete functional vitamin K reserves and therefore reduce the synthesis of active clotting factors
Heparin produces rapid anticoagulation by binding with antithrombin III, and inhibits factors IXa, Xa, XIIa, and XIII.
Monitor heparin with a PTT (low dose SC heparin [5000 units BID] does not require aPTT monitoring).
Warfarin inhibits vitamin K-dependent blood factors II, VII, IX and X; takes several days for its anticoagulant effect.
Monitor the International Normalized Ratio (INR) when warfarin is used.
Blood Factor IIa inhibitor (direct thrombin inhibitor): dabigatran (Pradaxa).
An antidote to dabigatran-induced hemorrhage is idarucizumab.
Blood Factor Xa inhibitors: apixaban (Eliquis), edoxaban (Savaysa), rivaroxaban (Xarelto), fondaparinux (Arixtra).
Know what pulmonary emboli are, where they come from and what these emboli do in the body
Pulmonary embolism is a blockage in one of the pulmonary arteries in your lungs. In most cases, pulmonary embolism is caused by blood clots that travel to the lungs from the legs or, rarely, other parts of the body (deep vein thrombosis).
Know the risk factors for cerebrovascular accident (CVA)
Some stroke risk factors, such as gender, age and family history, can’t be controlled. Lifestyle factors that increase your risk of stroke include high blood pressure, smoking, diabetes, high blood cholesterol levels, heavy drinking, high salt and high fat diet and lack of exercise.
Know the elements involved in the action potential of myocardial tissue
Calcium…??
Know what tuberculosis is and its epidemiology in the world.
Tuberculosis (TB) is one of the top 10 causes of death worldwide.
In 2017, 10 million people fell ill with TB, and 1.6 million died from the disease (including 0.3 million among people with HIV).
In 2017, an estimated 1 million children became ill with TB and 230 000 children died of TB (including children with HIV associated TB).
TB is a leading killer of HIV-positive people.
Isoniazid (INH) is famous for causing jaundice when combined with other drugs in a multidrug combination for treating TB.
Be able to explain the side effects of multidrug therapy/polypharmacy
3.1 Increased Healthcare Costs. Polypharmacy contributes to health care costs to both the patient and the healthcare system. …
3.2 Adverse Drug Events. …
3.3 Drug-Interactions. …
3.4 Medication Non-adherence. …
3.5 Functional Status. …
3.6 Cognitive Impairment. …
3.7 Falls. …
3.8 Urinary Incontinence.
Know the difference between vertical and horizontal transmission of organisms
In general, transmission of viruses can occur through two pathways: horizontal and vertical transmission. In horizontal transmission, viruses are transmitted among individuals of the same generation, while vertical transmission occurs from mothers to their offspring.
Know how empiric antimicrobial therapy is selected
Empiric therapy or empirical therapy is medical treatment or therapy based on experience and, more specifically, therapy begun on the basis of a clinical “educated guess” in the absence of complete or perfect information.
Antibiotic drugs that inhibit cell wall integrity include penicillins, ampicillin, cephalosporins, and carbapenems
Antibiotic drugs that inhibit bacterial protein synthesis include the aminoglycoside, tetracyclines, fluoroquinolondes and tetracyclines.
The antibiotic penicillin works by keeping a bacterium from building a cell wall. Bacteria and human cells also differ in the structure of their cell membranes and the machinery they use to build proteins or copy DNA. Some antibiotics dissolve the membrane of just bacterial cells.
Endotoxic and exotoxic bacteria
Exotoxins are toxic substances secreted by bacteria and released outside the cell. Whereas Endotoxins are bacterial toxins consisting of lipids that are located within a cell.
Invasion period is when the immune and inflammatory responses are initiated
Explain the cause of upper and lower respiratory tract infections, especially pneumonia
Pneumonia is an infection that inflames the air sacs in one or both lungs. The air sacs may fill with fluid or pus (purulent material), causing cough with phlegm or pus, fever, chills, and difficulty breathing. A variety of organisms, including bacteria, viruses and fungi, can cause pneumonia.
List the antibiotics that should and should not be used in children
SHOULD:
Penicillins (amoxicillin and penicillin G). …
Beta-lactamase inhibitors (amoxicillin-clavulanic acid or Augmentin). …
Cephalosporins (cefdinir, ceftibuten, etc.). …
Macrolides (azithromycin and erythromycin). …
Sulfa drugs (trimethoprim-sulfamethoxazole).
SHOULD NOT:
fluoroquinolones and tetracyclines.
Be able to discuss antibodies in newborns.
During the last 3 months of pregnancy, antibodies from the mother are passed to her unborn baby through the placenta. This type of immunity is called passive immunity because the baby has been given antibodies rather than making them itself. Babies produce their own antibodies every time they are exposed to a virus or germ, but it takes time for this immunity to fully develop.
Know what pathophysiologic factors increase respiratory rate
Conditions That May Result in Tachypnea. A wide range of medical conditions can result in tachypnea. … The rapid breathing rate is the body’s way of trying to increase oxygen or lower carbon dioxide levels in the blood.
Know how to interpret an arterial blood gas
Use pH to determine Acidosis or Alkalosis. ph. < 7.35. 7.35-7.45. …
Use PaCO2 to determine respiratory effect. PaCO2. < 35. …
Assume metabolic cause when respiratory is ruled out. You’ll be right most of the time if you remember this simple table:
R
O
M
E
Use HC03 to verify metabolic effect. Normal HCO3- is 22-26.
Know the ABGs for metabolic acidosis, metabolic alkalosis, respiratory alkalosis, and respiratory acidosis
Know the causes of respiratory acidosis
Be able to explain COPD and stepwise therapy (additions to current COPD medications) in its treatment
Be able to explain hypoxemia at altitude (reduced oxygen inspiration)
Discuss how pulmonary arterial hypertension is associated with right ventricular hypertrophy and an enlarged pulmonary artery
Be able to explain fluid and electrolyte disorders
Know the laboratory values of magnesium, calcium, sodium and potassium.
Be able to explain how aldosterone affects sodium and water
Know the effects of atrial natriuretic factor (ANF)
Be able to explain the relationship between edema and oncotic pressure
Be able to differentiate corticosteroids by potencies, mechanism of action and pharmacokinetics.
Be able to explain how angiotensin and affects the cardiovascular system
Know the unique pharmacokinetics of amiodarone
Amiodarone can cause thyroid and pulmonary toxicity.
Know what drugs are used for angina: beta-adrenergic antagonists (beta-blockers), angiotensin converting enzyme inhibitors (ACEIs), angiotensin receptor blockers (ARBs), nitrates, calcium channel blockers (CCBs).
Remember that many heart failure patients have more than just heart failure; look for underlying hypertension, angina, etc.
Be able to describe how electrolyte serum levels affect digoxin serum levels
Know how hyperkalemia is caused by renal failure and Addison’s Disease.
Know how hypercalcemia is treated with calcitonin salmon and Kayexalate (sodium polystyrene sulfate)
What is compensatory hyperplasia
What are the effects of Nonsteroidal anti-inflammatory drugs (NSAIDs)
An NSAID safe for use in CAD patients is naproxen
NSAIDs can cause GI bleeding (indicated by darkening of stools and epigastric pain); one recommendation is switch to a COX-2 inhibitor (i.e., celecoxib).
Corticosteroids include glucocorticoids (e.g., prednisone, prednisolone, dexamethasone, hydrocortisone, methylprednisolone) and mineralocorticoids (e.g., aldosterone).
Patients on corticosteroids should be monitored for changes in skin, muscle wasting, blood pressure, weight gain, blood glucose and vitamin D levels, and any vision changes.