Studies of Nursing Pharmacology Quiz 1

❖ Chapter 1 – 10 questions ⮚ Each studies of pharmacology – medicine great advances ▪ 2) Although all areas of medicine, including pharmacology, have made great advances in the past century, the early roots of pharmacology still apply for the nurse and other health professionals. What were the early roots of pharmacology? ● 1. Applying products to relieve human suffering ● 2. Creating new drugs as quickly as possible ● 3. Finding medicinal alternatives to plants ● 4. Understanding how drugs cause their effects ● Answer: 1 ⮚ Pharmacotherapy (slide 17; pg 4) ▪ Pharmacotherapeutics ▪ Critical intervention for many conditions ▪ The application of drugs for prevention or treatment of suffering ▪ The application of drugs for the purpose of disease prevention and treatment of suffering. ▪ Rationale for pharmacotherapy: a partnership between the patient and the healthcare provider. ▪ Pharmacotherapy has become a mainstay of modern medical treatment, and a thorough understanding of expected drug effects, the associated monitoring required, and the care and teaching associated with drugs that are prescribed in patient care is crucial to effective nursing practice. (pg 9) ▪ Effective pharmacotherapy depends on a nurse’s understanding of pharmacology as well as interprofessional practice with other members of the healthcare team. ▪ 4) Pharmacotherapy is a critical intervention for many conditions, and a key part of nursing intervention. Which statement best describes pharmacotherapy? a) 1. The study of medicine and drug therapy b) 2. The application of natural substances to cure diseases c) 3. The application of drugs for the prevention and treatment of disease and human suffering d) 4. Understanding the difference between trade and generic medications ● Answer: 3 ⮚ Nursing interventions w/ medications ▪ Monitoring the patient’s condition before and during drug use, evaluating drug effects, teaching the patient about self administration, and conducting a medication reconciliation are key nursing responsibilities. (pg 9) ▪ A major goal in studying pharmacology is to eliminate medication errors and to limit the number and severity of adverse drug events. ▪ 3. As a member of an interprofessional team, what key responsibilities does the nurse have to ensure effective pharmacotherapy? (Select all that apply.) (pg 11) ● 1. Monitoring the patient’s condition before and during pharmacotherapy ● 2. Teaching the patient about self-administration and any required monitoring of drug effects ● 3. Ensuring that all drug and treatment options have been considered before beginning pharmacotherapy ● 4. Frequently conducting a medication reconciliation to verify current medications in use ● 5. Determining the ideal drug to be prescribed to the patient to treat the current condition ♦ Answer: 1, 2, 4 ⮚ Trade names; what do nurses need to know? ▪ Trade names are a challenge for students to learn because there may be dozens of products that contain the same drug. ▪ May contain one or more active ingredient ▪ If the nurse is looking for diphenhydramine, it may be listed under many trade names such as Benadryl, Nytol QuickCaps, Sominex, and Unisom, formulated alone or in combination with other active ingredients. ▪ 10) The trade name for a drug is usually selected to be short and easy to remember. What is the reason the nurse does not use the trade name for a drug? ● 1. There are no trade names for combination drugs. ● 2. A drug can have more than one trade name. ● 3. The trade name will expire and no longer be used. ● 4. A company might change the trade name for a drug. Answer: 2 ⮚ Prototype; why need to know? (pg 7) ▪ A prototype drug is the agent to which all other medications in a class are compared. ▪ Single drug from each class ▪ May compare all other medications in the class to the prototype ▪ Usually oldest and best understood drug in its class ▪ Can be combination of traditional and new drugs ▪ Helps with learning pharmacology ▪ 8) A prototype drug is a single drug in a class and can be compared with all other medications in the class. By studying a prototype drug, the nurse would gain what knowledge for predicting the characteristics of other drugs in the same class? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. ● 1. The drugs with the most favorable safety profile ● 2. The drug's therapeutic indications ● 3. The drug's actions and adverse effects ● 4. The drug's specific clinical use ● 5. Contraindications specific to any drug in that group Answer: 2, 3, 4 ⮚ Chemical drug names; do nurse use chemical drug names? ▪ Standard nomenclature established by IUPAC ▪ Each drug has only one chemical name. ▪ Clear, concise meaning of the nature of the drug ▪ Often difficult to remember and pronounce ▪ it is unlikely that the nurse would remember that the chemical name for alprazolam (Xanax) is 8chloro-1-methyl-6- phenyl-4H-s-triazolo[4,3-α][1,4]-benzodiazepine. In only a few cases, usually when the name is brief and easily remembered, will nurses use chemical names. Examples of easy to remember chemical names of common drugs include lithium carbonate, calcium gluconate, and sodium chloride. ▪ 9) Chemical names are assigned to each drug. What are the major reasons for why nurses usually do not use the chemical names of drugs? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. ● 1. They are usually not brief or easy to remember. ● 2. They are often difficult to pronounce. ● 3. There is no standard for assigning names. ● 4. They do not explain the nature of the drug. ● 5. There is only one chemical name for each drug. Answer: 1, 2 ❖ Chapter 2 – 5 questions ⮚ Drug legislation in America; what is the problem? ▪ 20th century ● Extensive standards and regulations developed to protect public from unsafe and ineffective products ▪ Regulation was needed when drugs could be synthesized. ▪ 1) Which was the greatest problem with patent medicines in early America that led to drug legislation? ● 1. They were only distributed in elixir formulation. ● 2. They had dangerous or addictive substances. ● 3. They smelled like medicine. ● 4. They could only be made out of natural products. ● Answer: 2 ⮚ What to say when patient does not want to use commercial drug? ▪ 4) A client is talking to the nurse and is expressing doubt about whether to take a drug that is advertised on television. The client does not believe that commercials for drugs tell the truth. Which rationale will the nurse use when responding to the client? ● 1. Advertisements are not legally binding and can be misleading. ● 2. All drugs must be advertised in the media to inform the public. ● 3. Manufacturers have some ability to change things when advertising drugs. ● 4. False claims of a drug's therapeutic effect are prohibited by law. ● Answer: 4 ⮚ Food and drug administration ▪ The U.S. Food and Drug Administration (FDA) was established by the PFDA of 1906 and later expanded to carry out the provisions of the FDCA of 1938. ▪ Its mission: ● Protecting the public health by ensuring the safety, efficacy, and security of human and veterinary drugs, biologic products, medical devices, the nation’s food supply, cosmetics, and products that emit radiation ● Advancing the public health by helping to speed innovations that make medicines and foods more effective, safer, and more affordable ● Helping the public get the accurate, science-based information they need to use medicines and foods to improve their health ▪ organized around seven branches ▪ Regardless of the path to discovery, all drugs must be approved by the FDA before they can be sold in the United States. ▪ The FDA also oversees the administration of herbal products, dietary supplements, and cosmetics through the Center for Food Safety and Applied Nutrition (CFSAN). ▪ 8) A pharmaceutical representative comes to the primary care office and states that his company is marketing a new drug that does not need approval by the Food and Drug Administration (FDA). What is the best response of the nurse? ● 1. "Is this a drug in clinical trials? Those are the only drugs that don't have to have FDA approval." ● 2. "Is this an over-the-counter drug? Over-the-counter drugs do not need FDA approval." ● 3. "Your company must be involved in academic research if the drug doesn't need FDA approval." ● 4. "Any pharmaceutical company must have FDA approval before marketing a drug." ● Answer: 4 ▪ 9) Nursing students are studying which drug types must have Food and Drug Administration (FDA) approval before being marketed. The students know that which drugs must have approval from the FDA before being marketed? ● 1. Biologics ● 2. Cosmetics ● 3. Herbal preparations ● 4. Dietary supplements ● Answer: 1 ▪ 10) Which statements regarding the role of the U.S. Food and Drug Administration (FDA) are true? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. ● 1. The FDA is responsible for ensuring the security of human drugs. ● 2. The FDA publishes a summary of the standards of drug purity and strength. ● 3. The FDA ensures the availability of effective drugs. ● 4. The FDA takes action against any supplement that is deemed to be unsafe. ● 5. The FDA facilitates the availability of safe drugs. ● Answer: 1, 3, 4, 5 ⮚ How to facilitate the availability of drugs? ▪ The Center for Drug Evaluation and Research (CDER) states its mission as facilitating the availability of safe, effective drugs; keeping unsafe or ineffective drugs off the market; improving the health of Americans; and providing clear, easily understandable drug information for safe and effective use. ▪ 17) The client was taking a prescription medication that is now available over the counter. The client asks the nurse, "Why do some medications become available over the counter and other medications remain prescription drugs?" Which response by the nurse is the most appropriate? ● 1. "Drugs with the least amount of side effects can become over-the-counter drugs." ● 2. "Drugs that have a high safety margin may be reclassified to over-the-counter drugs." ● 3. "The longer the drug is on the market, the better its chance of becoming an over-the-counter drug." ● 4. "If the pharmaceutical company pays the FDA a large amount of money, it can have its drug reclassified." ● Answer: 2 ⮚ Placebo; what kind of teaching? ▪ the effectiveness of the new drug is compared to an inert substance, or placebo, which serves as a control “nontreatment” group ▪ 14) Clients enrolled in a clinical drug trial are told that they might receive a placebo drug as part of a control group. A client asks the nurse what a placebo is. Which response by the nurse is the most appropriate? ● 1. "A placebo is a substance that has no therapeutic effect." ● 2. "A placebo is a similar drug that is safe." ● 3. "A placebo is a drug that has been tested before." ● 4. "A placebo is an over-the-counter drug." ● Answer: 1 ▪ 22) The nurse is teaching a client the importance that a placebo plays in drug research. Which items are appropriate for the nurse to include in the teaching session? ▪ Note: Credit will be given only if all correct choices and no incorrect choices are selected. ▪ Select all that apply. ● 1. The research drug must be compared to an inert substance to determine effectiveness. ● 2. The placebo will be given to a control group, and those results will be compared to the group taking the research drug. ● 3. During the trials, neither group will know if they have the placebo drug or the research drug. ● 4. The research drug will be considered for a New Drug Application (NDA) if it is found to be effective and safe when compared to the placebo drug. ● 5. Before the clinical trials, the research drug will be tested on select clients against another standard drug used for the same condition. ● Answer: 1, 2, 3, 4 ❖ Chapter 3 ❖ Define pharmacokinetics ▪ What the body does to drugs ▪ the study of drug movement throughout the body ▪ allows nurses to better understand and predict the actions and adverse effects of medications in their patients ⮚ 1) What are the four phases of pharmacokinetics that a drug goes through? 1. Absorption, distribution, ionization, and metabolism 2. Diffusion, bioavailability, metabolism, and excretion 3. Absorption, distribution, metabolism, and excretion 4. Active transport, ionization, diffusion, and excretion ♦ Answer: 3 Explanation: A drug undergoes the pharmacokinetics of absorption, diffusion, metabolism, and excretion.  The nurse is teaching a client the importance of taking the medication as prescribed. Client teaching is guided by the nurse's knowledge of which principles of pharmacokinetics? Select all that apply. 1. A medication taken by injection must cross the membranes of the gastrointestinal tract to get to the bloodstream before it can be distributed throughout the body. 2. A drug may be exposed to several physiologic processes while en route to target cells. 3. Liver enzymes may chemically change the drug. 4. Excretion organs such as kidneys and intestines must be healthy enough to eliminate the drug. 5. Many processes to which drugs are exposed are destructive, thereby helping facilitate the drug's movement throughout the body. Answer: 2, 3, 4, 5 Explanation: Drugs taken orally are often exposed to physiologic processes such as stomach acid and digestive enzyme effects. Enzymes in the liver may chemically change some drugs.Drugs will continue to act on the body until they are either metabolized to an inactive form or are excreted. Pathologic states such as kidney disease can increase the drug's action on the body. Many destructive processes, such as when stomach acid breaks down food, can break down the drug molecule before it can reach the target cells. This will facilitate the drug's movement throughout the body. ⮚ Route of administering ⮚ Facilitated, passive diffusion, etc. ▪ 3) When administering an intravenous (IV) medication to a client, the nurse understands that the medication has a high concentration in the blood and will move into areas of lower concentration by which action? ● 1. Facilitated diffusion ● 2. Active diffusion ● 3. Absorption ● 4. Simple diffusion ● Answer: 4 ▪ 4) When the nurse administers a drug that must move from an area of low concentration to an area of high concentration, what will the drug require? ● 1. Simple diffusion ● 2. Active transport ● 3. An intravenous route ● 4. A transdermal delivery system ● Answer: 2 ⮚ Role of diffusion ▪ 5) The nurse is reviewing the role of diffusion in the distribution of medications. Drugs that cannot be distributed by simple diffusion include those with which characteristics? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. ● 1. Large molecules ● 2. Ionization ● 3. Water-soluble agents ● 4. Alcohol ● 5. Urea Answer: 1, 2, 3 ⮚ Distribution of medication ▪ 10) A client is receiving antibiotic treatment for a wound abscess. For the drug to be effective, what does the nurse recognize that drug distribution to this area requires? ● 1. The drug to be lipid soluble ● 2. Adequate blood perfusion to the area ● 3. The drug to be bioavailable in an acidic environment ● 4. Use of a topical antibiotic ● Answer: 2 ⮚ Route of administration, lipid soluble (slide 23) ▪ 11) The nurse is caring for a client with obesity who has received thiopental (Pentothal), a lipidsoluble drug, during surgery. Of which fact about the drug should the nurse be aware? ● 1. It will need to be given at higher than normal doses. ● 2. It will be stored in adipose tissue. ● 3. It may have difficulty being distributed to body tissues. ● 4. It is often ineffective. ● Answer: 2 ▪ 12) The nurse recognizes that when a client is receiving a lipid-soluble medication, higher concentrations will accumulate in which tissues? ● 1. Cardiac muscle ● 2. Liver ● 3. Bone marrow ● 4. Skeletal muscle ● Answer: 3 ⮚ Agonist and antagonist (agree and disagree); Narcan is which? ⮚ Overdose, what is going on w/ patient? ⮚ Route of medication ▪ 23) The nurse recognizes that medications can be excreted by which routes? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. ● 1. Fecal ● 2. Gastric ● 3. Glandular ● 4. Pulmonary ● 5. Renal ● Answer: 1, 3, 4, 5 ⮚ Glandular secretion ❖ A client asks the nurse why he experiences a metallic taste after taking certain medications. The nurse explains that a medication may cause glandular secretions that occur by which routes? ▪ Select all that apply. 1. Saliva 2. Sweat 3. Breast milk 4. Urine 5. Feces ❖ Answer: 1, 2, 3 Explanation: Water-soluble drugs may be secreted into the saliva, which can cause a "funny taste" after the administration of a medication. Water-soluble drugs may be secreted into the sweat, which may cause an odor to be omitted by the person who has taken a medication. Water-soluble drugs may be secreted into the breast milk. Breastfeeding mothers must use caution in regards to medications while lactating because medications can be passed to their infants via breast milk. ⮚ Protein binding, molecules? What to expect to happen? ❖ Chapter 4 – 6 questions ⮚ Medium effective dose (Slide 10) ▪ The nursing instructor is teaching student nurses about how the median effective dose of a medication is related to clinical practice. Which statement reflects the correct understanding by the student? 1. "About 50% of clients will experience severe side effects from the drug." 2. "About 50% of clients will not experience any effect from the drug." 3. "Some clients will respond differently, depending on their ethnic background." 4. "Some clients will require more or less than the average dose of the drug." ● Answer: 4 Explanation: The median effective dose is the dose required to produce a specific therapeutic response in 50% of a group of clients. ⮚ Medium Lethal dose ▪ A client looks up the drug he is taking in a drug guide and asks the nurse why the healthcare provider prescribed a medication that has a lethal dose measure. Which response by the nurse is the most appropriate? 1. "Lethal dose just refers to what is done in research; it is not used by doctors to prescribe drugs." 2. "The lethal dose is a value determined in research that helps to establish the safe dose." 3. "All that means is that the drug could be lethal, but I will closely monitor you for side effects." 4. "Don't worry about that. I will have your doctor explain it to you." ● Answer: 2 Explanation: The difference between the median effective dose and the median lethal dose is measured to determine the drug's safety margin as well as the safe effective dose. ⮚ Preclinical Trials ▪ The nurse explains to a student nurse that the median lethal dose of a drug is often determined in laboratory preclinical trials. Which rationales best support why this is done? Select all that apply. 1. It would be unethical to determine these values in human participants. 2. The safety of the medication must be determined prior to clinical trials. 3. It is difficult to obtain sufficient participants for clinical trials. 4. Clinical trials determine only the effective dose of a drug. 5. It is too costly to conduct the studies during clinical trials. ● Answer: 1, 2 Explanation: Laboratory animals are used in clinical trials to determine the LD50, or the dose that kills 50% of the participants. It would be unethical to kill human participants. Before a drug is released for trials in human participants, its safety must be determined. ⮚ “LD 50” what it means; 50% of? Lethal to 50% of test subjects (slide 12) ▪ The nurse is researching a drug recently released on the market to determine what the median lethal dose (LD50) was in preclinical trials. The nurse recognizes that this number reflects which fact? 1. The dose at which 50% of the research animals died 2. A measurement of the potency of the drug 3. The value of relative safety of the drug 4. The dose that produced signs of toxicity in 50% of lab animals ● Answer: 1 Explanation: The dose at which 50% of animals in the preclinical trials are killed is the median LD50 dose. ⮚ Calculate therapeutic index - Identifies safety index of drugs - Ratio of a drug's median lethal dose (LD50) to its median effective dose (ED50) ▪ The nurse is educating a client who is participating in a drug study and describes the median toxicity dose as the dose that will produce toxicity in ________% of a group of clients. Record your answer rounding to the nearest whole number. ● Answer: 50 Explanation: The median toxicity dose (TD50) is the dose that will produce a given toxicity in 50% of a group of clients. ⮚ What to do when giving new meds? Check previous meds? ▪ Prior to administering medications, the nurse reviews the therapeutic index. What is the therapeutic index used to identify? 1. Whether the healthcare provider has prescribed the best drug for the client 2. When a client will begin to experience toxic drug effects 3. Interactions among the drugs the client is receiving 4. Clients who will need to have serum blood levels monitored ● Answer: 4 Explanation: Drugs with a narrow therapeutic index have low margins of safety and need to be monitored through serum drug levels. ⮚ Calculate therapeutic index ▪ The nurse is researching a drug that has a median effective dose (ED50) of 5 mg and a median lethal dose (LD50) of 20 mg. Which therapeutic index (TI) calculated by the nurse is correct? 1. 5 2. 4 3. 1 4. 10 ● Answer: 2 Explanation: The TI is calculated by dividing the median LD by the median ED. Twenty divided by 5 equals 4. ▪ The nurse is preparing to administer a medication to a client on a medical-surgical unit. The median lethal dose of the drug is 40 mg, and the median effective dose is 10 mg. The nurse calculates the therapeutic index to be ________. ● Answer: 4 Explanation: The therapeutic index is calculated by dividing the median lethal dose (LD50) by the median effective dose (ED50). ⮚ Narcotic antagonist: Narcan ▪ The healthcare provider has ordered naltrexone (ReVia), a narcotic antagonist, for a client in rehabilitation who is recovering from heroin addiction. The nurse explains that if heroin is used while taking the naltrexone, the client could experience which effect? 1. Severe nausea and vomiting 2. Lack of euphoria 3. Anger and rage 4. A severe craving for more heroin ● Answer: 2 Explanation: Euphoria will not occur.