1. If two drugs have the same bioavailability and same concentration of _active_ ingredient, they are said to be _bioequivalent_ (e. g. , a grand-name drug and the same generic drug. 2. A drug’s _steady_state is the _________________ state in which the amount of drug removed via elimination is _half life_to the amount of drug ____________ from each dose. 3. Taking an _enteric_-coated medication (intended for _intestine_ dissolution and absorption) with a large amount of food may result in dissolution of the medication by acidic _food_ contents and reduce the amount of drug absorbed by the _small intestine__.
4. Palliative therapy is generally used in the _end_-stages of illness when all attempts at _curative_ therapy have failed. List some examples. 5. _Acute_ therapy often involves more intensive drug treatment and is implemented in the acutely ill (those with _rapid_ onset of illness) or even the _critically_ ill. List some examples. 6. In _enteral_ drug administration drugs are absorbed into the _systemic_ circulation through the mucosa of the _stomach__ and/or small or large _intestines__. 7. The _IV_ route is the fastest route for drug absorption.
This term is most commonly used to describe drugs entering the body directly into the circulatory system. Intravenous _injection__ delivers the drug directly into the blood stream. 8. Drugs that are bound to plasma _albumin_ are characterized by longer duration of _action__. 9. Pharmacokinetics is the study of what the _body_ does to the _drug_ and involves _absorption_, distribution, _metabolism_, and excretion of drugs. 10. Pharmacodynamics is the the study of what the _drug_ does to the _body_. 11. _excretions_ is the elimination of drugs from the body. The primary organ for elimination of drugs from the body is_kidney_.
Chapter 6 1. A medication error is defined as a _preventable_ adverse drug event that involves inappropriate medication use by a patient or health care provider. 2. When giving medications, the nurse should always listen to and _honor_ any concerns or doubts expressed by the patient 3.
If a prescriber writes an order that is _illegible__, the nurse should contact the prescriber for clarification. 4. Measures that prevent medication errors include using _____ patient identifiers, giving only medications that you have drawn up or _prepared_, and minimizing the use of _oral_ and telephone orders.
5. _77%_ of all preventable adverse drug events begin with an error at the medication order (prescribing) stage. 6. How would you write the drug dosage Levothyroxine ? mg in proper terms (decimal)? 7. _High_ Alert medications have been identified as those medications that, because of their potentially _harmful_ nature, require special care when prescribing, dispensing, and/or administering. 8. Medication errors include any preventable adverse drug events involving inappropriate medication use by the patient or health care professional; they may or _has_ cause the patient harm.
Chapter 38 1. Allergy to _IgE__ may also result in hypersensitivity to cephalosporins. 2. Drug-related _photosensitivity__ occurs when patients take tetracyclines, and it may continue for several days after therapy.
3. Milk and cheese products result in _increased_ levels of tetracycline when the two are taken together. 4. _Folic acid_ also interfere with tetracycline absorption and should not be taken together. 5. Administering penicillin reduces the vitamin _K_ the gut (intestines); therefore, enhanced anticoagulant effect of _warfarin_ may occur 6.
Hypersensitivity reactions are characterized by: _________________________________________________________ 7. If a hypersensitivity reaction occurs, the nurse should immediately _discontinue_ the antibiotic infusion, _call_ the prescriber, and _stay_ with the patient to monitor the patient’s vital signs and condition. 8. _Urine_ specimens should be obtained before initiating drug therapy; otherwise, the presence of antibiotics in the tissues may result in misleading culture and _urine__ results. 9. The effectiveness of _oral_ contraceptives may be decreased with certain antibiotics.
10. Decreased _white blood cell counts are an indication of reduction of infection and are a therapeutic effect of antibiotic therapy. 11. First-generation cephalosporins provide excellent coverage against gram-_positive_ bacteria but limited coverage against gram-_negative_ bacteria. 12. Prophylactic antibiotic therapy is used to ________ infection. Empiric therapy involves selecting the __________ that can best kill the microorganisms known to be the most common causes of an __________. ____________ therapy occurs once the culture and sensitivity results are known.
13. Normally occurring bacteria are killed during antibiotic therapy, allowing other flora to take over and resulting in _BV__. 14. Antiseptics primarily inhibit microorganisms but do not necessarily _destroy_ them. Disinfectants are able to kill organisms and are used only on _non-living_ objects. Iodine compounds are contraindicated in patients with allergies to seafood Chapter 39 1. Tinnitus and hearing loss could indicate _ototoxicity__, a potentially serious toxicity in a patient. _Nephrotoxicity_ is indicated by rising blood urea nitrogen and creatinine levels.
2. Adequate hydration (at least _2_ liters of fluid in 24 hours) during vancomycin therapy is important for the prevention of _nephrotoxicity. The medication should be infused during at least 60 minutes to reduce _red man_ syndrome. 3. Vancomycin is the drug of choice for the treatment of MRSA.
4. Amino glycosides are often used in combination with other antibiotics, such as beta-lactams or vancomycin, in the treatment of various infections because the combined effect of the two antibiotics is _greater_ than that of either 5.
Linezolid (Zyvox) may cause _seretonin_ syndrome when used concurrently with serotonergic drugs such as the selective serotonin-reuptake inhibitor antidepressants 6. A black-box warning is required by the U. S. Food and Drug Administration for all _antidepressant_ because of the increased risk for tendinitis and tendon rupture with use of the drugs.
7. Patients on aminoglycoside therapy must be monitored for signs of _toxicity_ (rising serum creatinine level) and _ototoxicity_ (hearing loss, dizziness). 8. Blood samples for measurement of trough levels should be drawn immediately _before_ administration of the next dose.
Chapter 23 1. Vaughan Williams class III drugs increase the ___action__ potential duration by _blocking delaying__ repolarization in phase 3. 2. _rash____ and myalgia are potential adverse effects of procainamide therapy. 3. Adverse effects of antidysrhythmics include __dizziness, rash, diarrhea__and orthostatic hypotension that may cause injury. 4. Quinidine, a cinchona alkaloid, may cause the symptoms of cinchonism, including _deaf, anorexia__, loss of _hearing__, slight blurring of _vision__, and gastrointestinal upset.
5. Lidocaine is the drug of choice for acute _ventricular__ dysrhythmias associated with myocardial infarction. 6. Adenosine has an extremely short half-life of less than 10 seconds; its onset occurs within 1 minute; and it must be given as a fast IV push injection. A very brief episode of _ventricular fibulation_ may occur after administration. 7. Because lidocaine is metabolized primarily by the _liver__, a __________ of the dosage by 50% may be necessary in cases of _liver_ failure or cirrhosis.
8. _CNS, twitch, confussion__ are possible if lidocaine reaches toxic levels. 9. Many antidysrhythmics are themselves capable of producing new _dysrhythmia__. 10. Diltiazem (Cardizem) is indicated for the temporary control of a _rapid__ ventricular response in a patient with atrial fibrillation or flutter and paroxysmal supraventricular _tachycardia_. Chapter 25 A patient who is starting _ACE__ should take her first dose while lying down because there is a first-dose effect with this medication. 2.
A __Vitamin D T4__ relies on a functioning liver to be converted to its active form 3. The physician would examine the_fundus___ of a patient’s eyes during antihypertensive therapy because it is a more reliable indicator than blood pressure readings of the _long__-_term__ effectiveness of treatment. 4. Blood pressure is determined by the product of _cardiac_ output and systemic __vascular___ resistance. 5. Sexual _dysfunction_ is a common complication of antihypertensive medications and may be manifested in men as decreased libido or impotence 6.
Calcium channel blockers and diuretics have been shown to be more effective in _African Americans___ than in white patients. 7. There is no cure for the hypertension and treatment will be________-_________ with ________________ or life-style modifications. 8. ACE inhibitors cause a characteristic dry, nonproductive cough that _reverses_ when therapy is stopped. 9. Methyldopa is used in the treatment of hypertension during _pregnancy_. 10. Prehypertension is defined as having systolic blood pressure between _120__and _139_ mm Hg and diastolic pressure between _80_ and _89_ mm Hg. 11.
ACE inhibitors have been shown to have a protective effect on the _kidneys__ because they reduce glomerular filtration pressure. This is one reason that they are among the cardiovascular drugs of choice for _hypertensive__ patients 12.
NSAIDs such as _ibuprofen__ can reduce the antihypertensive effect of ACE inhibitors. In addition, the use of NSAIDs and ACE inhibitors may also predispose patients to the development of acute _renal__ failure. Chapter 26 Spironolactone (Aldactone) is a _potassium__-sparing diuretic, and patients taking this drug must be monitored for signs of _serum potassium level___.
2. Orthostatic hypotension is a possible problem with _diuretic_ therapy. 3. The loop diuretics have a _rapid_ onset of action. Their effect lasts for about 2 hours, and a distinct advantage they have over thiazide diuretics is that their diuretic action continues even when _creatinine__ clearance decreases below 25 mL/min. 4. There is an increased risk for _digoxin___ toxicity in the presence of hypokalemia, which may develop with diuretic therapy. 5. Potassium supplements are often prescribed with _loop diuretic_ therapy to prevent _hypokalemia__.
6. Urinary intake and output and daily weights are the best reflections of a patient’s fluid _retention_ status. 7. Take the diuretic medication early in the _day__ to prevent _insomnia_ during the night. 8. The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure guidelines recommend _thiazine__ diuretics as the first-line treatment for hypertension. 9. _Mannitol_ , an osmotic diuretic, is commonly used to reduce intracranial pressure and cerebral edema resulting from head trauma.
10. Caution should be exercised in the administration of diuretics to the elderly because they are more sensitive to the therapeutic effects of these drugs and are more sensitive to the adverse effects of diuretics, such as dehydration, electrolyte loss, dizziness, and syncope. 11. Vomiting and diarrhea cause fluid and _electrolyte_ loss and should be checked for possible _hypo_-kalemia and dehydration. Chapter 27 1. Fresh frozen plasma is indicated to _increase_ clotting factor levels in patients with demonstrated deficiency. 2.
PRBCs are used to increase the _oxygen_-carrying capacity of the blood 3. Plasma protein fractions are used to _______ fluid volume. 4. Potassium supplements are ______________ in the presence of renal disease.
5. In a transfusion reaction, the infusion should be _stopped___ immediately and the physician _notified__. The intravenous line should be kept patent with isotonic ________ saline solution infusing at a ______ rate, and the facility’s protocol for transfusion _________ should always be followed. 6. Mild _dehydration_ is usually treated by oral administration of sodium chloride tablets.
Pronounced sodium depletion is treated by intravenous _isotonic_ saline or lactated Ringer’s solution. 7. _Muscle_ weakness is an early symptom of hypokalemia, as are hypotension, lethargy, mental confusion, and nausea. Cardiac _dysrhythmias_ are a late symptom of hypokalemia. 8. During the infusion of albumin, the development of fluid volume ________ must be monitored by the nurse, especially in those at risk for _______ failure. 9. Fresh frozen plasma is used as an adjunct to massive ________ transfusion in the treatment of patients with underlying ___________ disorders. 10.
Blood products should be given only with __________ saline 0. 9% because D5 11. A patient with a coagulation disorder or a clotting-factor deficiency would receive ________ _________ __________. W will also cause ___________ of the blood product. 12. A patient who has lost a _large__ amount of blood would receive whole blood. Chapter 28 1. Overlapping of heparin and __warfarin_ (Coumadin) coumadin is done purposefully to allow time for the blood levels of warfarin to rise, so that when the heparin is eventually discontinued, therapeutic _blood___ levels of warfarin will have been achieved. 2.
The full therapeutic effect of warfarin does not occur until 5_ to _7_ days after the first dose. 3. Bleeding, internal and superficial, as well as _intracranial___, is the most common undesirable effect of thrombolytic therapy. 4. Vitamin_K_ is given to reverse the anticoagulation effects of warfarin_________. 5. _Protamine__ _Sulfate_ is the antidote for heparin overdose. 6. Aspirin can alter liver, renal, and _kidney_ functions, and laboratory studies should be performed to ________ these functions. 7. Aspirin should be taken with food to reduce _stomach_ upset, and enteric-coated tablets should not be ________.
8. Risk for _GI bleeding_ increases with aspirin therapy, even at low-doses. 9. Thrombolytic drugs lyse, or _clots_, thrombi. 10. Ongoing aPTT values are used to monitor _unfractionated heparin_ therapy. 11. PT-INR is used to monitor _anticoagulent__ therapy. 12. Anticoagulants _slow_ thrombus formation but do not dissolve or stabilize an existing _clot___. 13. Capsicum pepper, feverfew, garlic, ginger, ginkgo, and ginseng are some herbals that have potential _interact__ with anticoagulants, especially with _warfarin_. 14.
Acetaminophen should be safe in _low_ doses; high doses, however, as well as other nonsteroidal antiinflammatory drugs and aspirin, may cause an _renal liver___ 15. A normal INR (without warfarin) is . 08-1. 2__, whereas a therapeutic INR (with warfarin) ranges from _2_ to _3__, depending on the indication for use of the drug (e. g. , atrial fibrillation, thromboprevention, prosthetic heart valve). Chapter 29 1. Possible adverse effects of nicotinic acid include pruritus, _cutaneous__ flushing, and gastrointestinal _mobility distress__.
2. Tinnitus, urine with a _burnt_ odor, and headaches are possible adverse effects of _bile acid sequesstrants__ 3. Headaches, myalgia, fatigue are also possible adverse effects of HMG_-_CoA_ _reductase inhibitors_ 4. Fibric Acid Derivative _ may cause abdominal discomfort, diarrhea, drowsiness, and dizziness. 5. The undesirable effects of nicotinic acid can be minimized by starting with a _low_ initial dose, taking the drug with _meals__, and taking small doses of aspirin with the drug to minimize _cutaneois_ flushing. 6.
When using garlic, it is recommended to avoid any other drugs that may interfere with platelet and _liver__ function. These drugs include antiplatelet drugs, anticoagulants, nonsteroidal anti-inflammatory drugs, and aspirin 7. HDLs are responsible for the “recycling” of cholesterol. HDLs are sometimes referred to as the _good lipid (or good cholesterol) because they are believed to be _cardioprotective_. LDLs are known as the “bad” cholesterol. 8. The maximum extent to which lipid levels are lowered may not occur until _6_ to _8_ weeks after the start of therapy.
9. _Myopathy_ (muscle pain) is a clinically important adverse effect that may occur with the HMG-CoA reductase. It may progress to a serious condition known as rhabdomyolysis. 10. Taking HMG-CoA reductase inhibitors with __grapefruit__ juice may cause complications. Components in the juice inactivate CYP3A4 in both the liver and intestines. This enzyme plays a key role in statin metabolism.
The presence of the juice in the body may therefore result in sustained levels of unmetabolized statin drug, which increases the risk for major _drug___ toxicity (e.g. , rhabdomyol Chapter 32 The onset of action for lispro insulin is _15_ minutes.
The peak plasma concentration is __ to ___ hours; the elimination half-life is _60_ minutes; and the duration is _3_ to _5_ hours. 2. Early symptoms of hypoglycemia include the central nervous system (CNS) manifestations of confusion, _weakness__, tremor, and _sweating_. 3. Patients should _not_ adjust their own insulin doses! 4. A fasting blood glucose level between _101_ and _126_ mg/dL indicates a good therapeutic response to glucose-reducing drugs. 5.
Glyburide should be taken in the_morning_, 30 minutes before _meals_. 6. When the diabetic patient is NPO, the prescriber should be _notified_for further _instructions_ regarding the administration of the oral antidiabetic drugs. 7. To treat hypoglycemia a quick source of _glucose__ should always be kept at hand. 8. Rapid-acting insulins, such as insulin_lispro_ and insulin _aspart_, are able to mimic closely the body’s natural rapid insulin output after eating a_meal_; for this reason, both insulins are usually administered within 15 minutes of the patient beginning a meal.
9. The hemoglobin __A1C_ level reflects the patient’s adherence to the therapy regimen for previous several _years_ . 10. Intravenous glucose can be used to raise blood glucose levels when the patient is __symptomatic_ and unable to take _oral_ forms of glucose. 11. Regular insulin is the usual insulin product to be dosed via _transdermal_ bolus, intravenous infusion, or even intramuscularly in cases of diabetic _Ketoacidosis__, or coma associated with _juvenile_ type 1 diabetes 12.
Corticosteroids can antagonize the _therapeutic_ effects of insulin, resulting in elevated blood _sugar_ levels. 12. When an alpha-glucosidase inhibitor is taken with the first bite of a meal, excessive __post-prandial_ blood glucose elevation can be reduced or prevented. 14. Metformin decreases glucose production by the ___________; decreases intestinal absorption of glucose; and improves insulin ______________ sensitivity in the liver, skeletal muscle, and adipose tissue, resulting in decreased insulin_______________.
Chapter 11 – Analgesics and Anesthesia Review – KEY Pharmcology 3342 1. Chronic pain is associated with _neuropathy_ and is characterized by slow onset, long duration, and dull, persistent aching. 2. Somatic pain, originating from _skeletal__ muscles, ligaments, and joints, usually ____________ to nonopioid analgesics, such as nonsteroidal antiinflammatory drugs (NSAIDs). 3. One of the most serious adverse effects of opioids is respiratory _insufficiency__. The nurse must assess the patient’s respiratory _________ before administering an opioid.
4. Naloxone, an opioid-reversal agent, is used to reverse the effects of acute opioid ____________ and is the drug of choice for reversal of opioid-induced respiratory depression. 5. Gastrointestinal adverse effects, such as nausea, vomiting, and constipation, are the most common adverse effects associated with _opioid_ analgesics. Physical dependence usually occurs in patients undergoing _long_-term treatment. 6. Patients with opioid tolerance require __larger__ doses of the opioid agent to maintain the same level of analgesia. 7.
Hepatic __necrosis_ is the most serious acute toxic effect of an acute overdose of acetaminophen. 8. If a patient is taking long-acting opioid analgesics, _breakthrough__ pain must be treated with an immediate- release dosage form that is given between scheduled doses of the long-acting opioid.
9. Feverfew is commonly used for _migraine_ headaches, menstrual problems, arthritis, and fever. 10. Acetylcysteine has the flavor of rotten _eggs__ and so is better tolerated if it is diluted and disguised by mixing with a drink such as cola or flavored water to help increase its palatability.
11 Anticonvulsants are often used as adjuvants for treatment of _neuropathic__ pain to enhance analgesic efficacy. 12 Constipation, lightheadedness , urinary retention, and itching are some of the common adverse effects that the patient may experience while taking _opioid__. Chapter 12 Anesthetics Review KEY Pharmacology 3342 1. Infiltration anesthesia is commonly used for minor surgical procedures. It involves injecting the local anesthetic solution _intradermally_, subcutaneously, or submucosally across the path of _nerve_ supplying the area to be anesthetized.
The local anesthetic may be administered in a circular pattern around the operative field 2. Vasoconstrictors such as _epinephrine___ are coadministered with local anesthetics to keep the anesthetic at its local site of action and to prevent systemic absorption.
3. After surgery and the termination of general anesthesia, the main concern is assessing the patient’s A_airway__, B_pain_, and C_mental_ status. 4. A sudden elevation in body temperature during the postoperative period may indicate the occurrence of _malignant hyperthermia_, a life-threatening emergency. 5.
The elderly patient is _more_ affected by anesthesia than the young or middle-aged adult patient because of the effects of aging on the hepatic, cardiac, respiratory, and renal systems. 6. Patients receiving neuromuscular blocking drugs require artificial _mechanical_ ventilation because of the resultant paralysis of the _flaccid__ muscles. In addition, they do not cause _sedation_ or pain relief.
They are used along with, not instead of, general anesthesia during surgery. 7. The antidote for neuromuscular blocking drugs is an anticholinesterase drug, such as _neostigmine / prostigmin__ that reverses the effects of neuromuscular blocking drugs.
8. Moderate sedation effectively reduces patient anxiety, sensitivity to _pain_, and _recall_ of the medical procedure, yet it preserves a patient’s ability to maintain his or her own _airway__ and respond to verbal commands. 9. Tachycardia, tachypnea, muscle __rigidity_, and raised ________________ are symptoms of malignant hyperthermia, which is treated with cardiorespiratory supportive care as needed to stabilize heart and lung function as well as with immediate treatment with the skeletal muscle relaxant _dantrolene__.