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EXAM 4: NUR 210/ NUR210 (LATEST 2023/ 2024)
PRINCIPLES OF PHARMACOLOGY EXAM| QUESTIONS
AND VERIFIED ANSWERS| GRADE A
“Types of viruses - CORRECT ANSWER Flu
Herpes Hepatitis A, B, & C"
"Most antivirals and antibiotics have what SE - CORRECT ANSWER GI distress"
"Nitrofurantoin SE - CORRECT ANSWER turns urine rust/brown"
"Urinary analgesic - CORRECT ANSWER Phenazopyridine"
"Phenazopyridine use - CORRECT ANSWER does not get rid of infection
relieves symptoms"
"Phenazopyridine SE - CORRECT ANSWER red-orange urine and secretions"
"inherent resistance - CORRECT ANSWER Ability of the host to resist the disease
independent of antibodies"
"acquired resistance - CORRECT ANSWER bacterial resistance to a drug to which they were
previously taking for long periods of time"
"When should C & S be done? - CORRECT ANSWER prior to starting antibiotic"
"Macrolide antibiotic - CORRECT ANSWER Azithromycin"
"Antacid administration with macrolides - CORRECT ANSWER 2 hr before or after macrolide
dose"
"Azithromycin use - CORRECT ANSWER -STI
-Chlamydia -when pts are allergic to PCN/cephalosporins for stronger bacterial infections"
"Azithromycin SE - CORRECT ANSWER blurred vision
headache
drowsiness fatigue photosensitivity"
"Azithromycin ADR - CORRECT ANSWER Superinfection
tinnitus hepatotoxicity (liver)"
"Azithromycin contraindications - CORRECT ANSWER hepatic/renal dysfunction
heart issues TYLENOL"
"Azithromycin nursing interventions - CORRECT ANSWER monitor for liver enzymes & for
s/s of liver issues"
"Glycopeptide antibiotic - CORRECT ANSWER Vancomycin"
"Vancomycin use - CORRECT ANSWER MRSA
serious infections"
"Vancomycin IV caution - CORRECT ANSWER give slowly to prevent redman syndrome"
"Vancomycin SE - CORRECT ANSWER chills
dizziness GI distress Thrombophlebitis (central IV)"
"Amoxicillin contraindications - CORRECT ANSWER allergy to other PCN or cephalosporins
decrease effect with acidic fruits/juices"
"Penicillin antibiotic - CORRECT ANSWER Amoxicillin"
"Amoxicillin use - CORRECT ANSWER bacterial infections"
"Amoxicillin ADR - CORRECT ANSWER C. diff associated diarrhea"
"Fluoroquinolones antibiotics - CORRECT ANSWER Ciprofloxacin
Levofloxacin"
"Ciprofloxacin & Levofloxacin use - CORRECT ANSWER severe infections"
"Erythropoietin stimulating agent - CORRECT ANSWER epoetin alpha"
"epoetin alpha SE - CORRECT ANSWER injection site reaction"
"epoetin alpha BB warning - CORRECT ANSWER if hemoglobin over 11:
hx MI, stroke, patient with cancer, increased risk of embolism have an increased risk of death with this drug"
"epoetin alpha use - CORRECT ANSWER treats anemia"
"epoetin alpha MOA - CORRECT ANSWER produces RBC"
"Granulocyte colony stimulating factor - CORRECT ANSWER filgrastim"
"filgrastim MOA - CORRECT ANSWER increases WBC to help prevent infection"
"Male hormone - CORRECT ANSWER testosterone"
"testosterone use - CORRECT ANSWER hypogonadism - delayed puberty"
"Sexual dysfunction - CORRECT ANSWER sildenafil"
"sildenafil MOA - CORRECT ANSWER increases blood flow to penis"
"sildenafil use - CORRECT ANSWER erectile dysfunction"
"sildenafil caution - CORRECT ANSWER do not take nitroglycerin within 24 hrs of this drug"
"Benign prostatic hyperplasia (BPH) - CORRECT ANSWER Tamsulosin"
"Tamsulosin MOA - CORRECT ANSWER Relaxes muscles in prostate"
"Tamsulosin use - CORRECT ANSWER Improves symptoms associated with BPH"
"Tamsulosin ADR - CORRECT ANSWER orthostatic hypotension"
"Tamsulosin therapeutic symptoms - CORRECT ANSWER not dribbling
increased urine flow"
"Menopause (HRT) - CORRECT ANSWER conjugated estrogen"
"Which abx can cause tendon rupture? - CORRECT ANSWER Fluoroquinolone: cipro"
"Which abx causes bradycardia - CORRECT ANSWER Fluoroquinolone: Cipro"
"Which abx cause crystalluria - CORRECT ANSWER Sulfamethoxazole; Crystalluria"
"Which abx is contraindication for anemia - CORRECT ANSWER sulfamethoxazole"
"Which abx is advise to avoid during 3rd Trimester - CORRECT ANSWER sulfamethoxazole"
"Nystatin is administered - CORRECT ANSWER topical"
"How is fluconazole administered? - CORRECT ANSWER PO or IV"
"What medication can cause peripheral neuropathy - CORRECT ANSWER Metronidazole"
"What can Metronidazole treat - CORRECT ANSWER H.Pylori or GU"
"What can Metronidazole cause - CORRECT ANSWER Metal taste"
"Which medication can cause Gingival hyperplasia - CORRECT ANSWER Acyclovir"
"If a patient is allergic to milk, which medication should be concern about - CORRECT
ANSWER acyclovir"
"What medication turns urine brown/red - CORRECT ANSWER nitrofurantoin"
"What is nitrofurantoin used for? - CORRECT ANSWER Acute or Chronic UTI"
"What medication reliefs S/S of UTI - CORRECT ANSWER PhenAZOpyridine"
"Phenazopyridine cause what color to urine - CORRECT ANSWER Orange-Red"
NSAID
ketorolac (Toradol) TUCA - CORRECT ANSWER T: Decrease pain, Decrease Inflammation,
Decrease Ocular Itching U: Mild-Moderate pain (short-term), decrease ocular itching in seasonal allergies
"Glucocorticoid
predniSONE (Deltasone) TUCA - CORRECT ANSWER T: Decrease inflammation, decrease
adrenal insufficiency U: Severe inflammation, neoplasms, MS, derm disorders, collagen disorders C: hypersensitivity A: Thrombophlebitis, embolism, GI hemorrhage, pancreatitis" "NSAID
celecoxib (CeleBREX) TUCA - CORRECT ANSWER T: Decrease pain, decrease inflammation
U: Acute and chronic rheumatoid arthritis, osteoarthritis, acute pain, primary dysmenorrhea, ankylosing spondylitis, JRA C: Prego (3T), hypersensitivity to salicylates, iodides, other NSAIDs, sulfonomines A: MI, Stroke, CHF" "Sulfonomides
sulfisoxazole (Gantrisin) TUCA - CORRECT ANSWER T: Broad antimicrobial spectrum
against gram positive and gram negative organisms U: acute, chronic and recurrent UTI, acute otitis media, used in treatment of conjuctivitis, chloroquine-resistant trains of malaria C: History of hypersensitivity to sulfonomides or salicylates, advanced kidney or liver disease, intestinal and urinary obstructions A: NVD, aplastic anemia, goiter, hypoglycemia" "Sulfonomides
trimethoprim-sulfamethoxazole TMP-SMZ (Bactrim, Septra) TUCA - CORRECT ANSWER T:
severe complicated UTI's due to most strains of Enterobacteria Ceae, gram negative and gram positive bacteria U: bacterial infections of middle ear, urine, respiratory, and intestinal, a certain type of pneumonia (pneumocyctitis) C: Hypersensitivity to TMP-SMZ, sulfonomides or biosulfites, megaloblastic anemia due to folate deficiency, infant <2mo A: toxic epidermal necrosis, NVD, hepatitis, allergic myocarditis, kidney failure, photosensitivity, aplastic anemia (rare)" "Sulfonomides
sulfasalazine (Azulfidine) TUCA - CORRECT ANSWER T: Antiinflammatory and
immunomodulatory properties effective in controlling S&S of uncerative colitis and RA, reduces clostridiun and E. Choli in the stools U: Ulcerative colitis and mild enteritis, RA, C: sensitivity ot sulfasalazine, sulfonomides and salicylates, <2yr, intestinal and urinary track obstruction A: NVD, bloody diarrhea, rash, liver injury"
"Sulfonomides
phenazopyridine hydrochloride (Pyridium) TUCA - CORRECT ANSWER T: topical analgesic,
anesthetic on urinary track mucosa *treats only symptoms and not underlying disease U: UTI, used with antiinfective, symptomatic relief of urinary burning C: hypersensitivity, renal insufficiency, hepatic disease, uremia A: hepatic and renal toxicity, anaphylaxis" "Sulfonomides
nitrofuantoin (Furandantin) TUCA - CORRECT ANSWER T: Active against variety of gram
negative and gram positive micro-organisms U: Pyelonephritis, pyelitis and cystitis caused by susceptible organisms C: significant impairment of kidney function, G6PD deficiency, prego (at term) A: peripheral neuropathy, hepatic necrosis, anaphylaxis, exfoliative dermatitis"
"pharmacokinetics - CORRECT ANSWER Pharmacokinetics is the process of drug movement
to achieve drug action. The four processes are absorption, distribution, metabolism (or biotransformation), and excretion (or elimination) *the affect the body has on the drug"
"pharmacodynamics - CORRECT ANSWER Pharmacodynamics is the study of the way drugs
affect the body. Drug response can cause a primary or secondary physiologic effect or both. The primary effect is desirable, and the secondary effect may be desirable or undesirable *the affect the drug has on the body"
"Nursing process ADPIE - CORRECT ANSWER Assessment
nursing Diagnosis Planning Implementation (nursing interventions) Evaluation"
"drug interaction - CORRECT ANSWER is defined as an altered or modified action or effect of
a drug as a result of interaction with one or multiple drugs"
"adverse drug reaction - CORRECT ANSWER is an undesirable drug effect that ranges from
mild untoward effects to severe toxic effects, including hypersensitivity reaction and anaphylaxis."
generated. The registered nurse formulates nursing diagnoses and uses them to guide the development of a care plan"
"agonists - CORRECT ANSWER Drugs that produce a response are called agonists"
"antagonists - CORRECT ANSWER drugs that block a response are called antagonists"
"Absorption
- direct penetration of the membranes
- channels and pores
3. transport systems - CORRECT ANSWER the movement of a drug from its site of
administration to the blood How do drugs cross membranes?"
"1. Direct penetration of the membranes - CORRECT ANSWER - use by MOST drugs
- most drugs to large to pass thru channels and pores
- most drugs lack transport systems
- drugs must be lipid soluble to be able to penetrate cellular membranes = lipophilic drugs"
"2. channels and pores - CORRECT ANSWER only very small ions such as potassium and
sodium can pass through cell membranes"
"3. transport systems - CORRECT ANSWER - are carriers that can move drugs from one side
of the membrane to the other
"Movement of drugs across membranes - CORRECT ANSWER -drugs must cross membranes
(pass through cells) to enter the blood from their site of administration
- drugs must then leave the blood (vascular systems) to get to their SITE OF ACTION
- drugs must then cross membranes again to be metabolized and excreted"
"pharmacokinetic phase: Absorption - CORRECT ANSWER process that occurs between the
time a drug enters the body and the time it enters the bloodstream to be circulated
- Rate of absorption -> depends on the formulation of drug (tablet, liquid, etc.)
- Amount of absorption -> how effective drug will be absorbed
Major determinants of rate of absorption:
- blood flow -> higher blood flow, the faster the drug is absorbed
- lipid solubility -> higher lipid soluble drugs faster than drugs whose lipid solubility is low
- pH -> acidity of the stomach can break down the drug"
"what is the first-pass effect? - CORRECT ANSWER affects amount of drug absorbed
- the metabolism of a drug by the liver BEFORE it reaches systemic circulation
- is the % of the drug that is broken down in the liver
- "bioavailability" : the fraction of administered drug that actually reaches systemic circulation
- IV bioavaiability= 100%
- oral bioavailability will vary"
"Three Routes of Absorption - CORRECT ANSWER 1. Enteral
2.Parenteral
- Topical"
"Enteral route of absorption - CORRECT ANSWER Defined by the way of GI tract
(oral/gastric mucosa, small intestine, rectum)
- any drug given via GI tract
- EC (enteric coated): intended to break down in the small intestine NOT the stomach --> must undergo the "first pass effect"
- PO --> portal circulation --> must undergo the first pass effect
- SL, buccal, rectal --> absorbed into highly vascular tissue under tongue or in the rectum (by passes liver so little to NO first pass effect)"
"Enteral routes of absorption - CORRECT ANSWER EC
PO
SL, buccal, rectal"
"Parenteral route of absorption - CORRECT ANSWER SQ, IM, IV, intrathecal (into special
cord), epidural (into spine) IV fastest route (NO barriers to absorption- absorption instant, complete, and irreversible) - most common route"
"Topical (transdermal) route of absorption - CORRECT ANSWER application of meds to body
surfaces
- skin, eyes, ears, nose, lungs"
"important - CORRECT ANSWER all meds given PO have some first pass effect"
"- abcesses
- tumors - CORRECT ANSWER blood flow is decreased by:"
"What is the protein binding effect? - CORRECT ANSWER TEMPORARY storage of drug
molecule allows drug to be available for longer period of time.
- drug ratio of bound to unbound (free) molecules varies
- binding is REVERSIBLE; very rapid process GOAL: maintain STEADY free drug concentration = STEADY STATE Only the UNBOUND drug is ACTIVE active = free to exert an effect"
"protein binding effect - CORRECT ANSWER Drugs circulate in plasma either bound or
unbound to protein (usually albumin)
- bound drug molecules are pharmacologically inactive ( too large to diffuse through the membrane of the blood vessel)
- bound drugs become a drug reservoir/storage depot Expressed in %
- ex: drug is 50% protein bound
- so..only 50% is active or able to exert effect"
"albumin - CORRECT ANSWER the most abundant PLASMA PROTEIN
- low levels = less protein for drugs to bind to
- a LARGE molecule and ALWAYS remains in the blood stream
- drugs bind to protein
- limited number of binding sites
- drug particles much smaller than albumin
- unbound drug can pass through cell membrane"
"Binding - CORRECT ANSWER - reversible
- limited number of binding sites
- some drugs have more ability to "bind" than others"
"Coumadin - CORRECT ANSWER drug that is very highly protein bound (97-99%)"
"Hypoalbuminemia - CORRECT ANSWER means that more free drug is available for
distribution to tissue site b/c or no binding sites to be "bound" or inactive--> possibility of overdose
- malnutrition or liver disease can cause"
"normal serum albumin levels - CORRECT ANSWER 3.5 - 5.5 g/dl"
"Drug-drug interactions may occur
- drugs compete for protein binding site -> causing more free drug to be released into circulation
- increased free drug many cause drug toxicity - CORRECT ANSWER what happens when 2 highly protein-bound drugs are given concurrently?"
"decreased b/c less binding sites for the drug to bind to - could lead to toxicity - CORRECT
ANSWER Thomas's labs come back and his albumin level is 2.0 g/dl. Considering his albumin
level is low, his does of treatment may need to be?"
"Pharmacokinetic phase: Metabolism or Biotransformation - CORRECT ANSWER - method
by which drugs are inactivated or biotransformed
- this new structure is called a METABOLITE
- LIVER is major site of drug metabolism (converts fat-soluble drugs into water soluble metabolites)
- KIDNEY can then excrete the metabolite"
"Pharmacokinetic phase: Metabolism or Biotransformation- FIRST PASS PHENOMENON -
CORRECT ANSWER happens during pharmacokinetic phase metabolism.
- liver function test (LFT)- important serum/blood value for the nurse to monitor
- normal aspirate aminotransferase = 0 -35 u/L
- normal alanine aminotransferase= 4 - 36 u/L" "AST= 0-35 u/L
ALT = 4-36 u/L - CORRECT ANSWER what are normal AST and ALT levels on a liver function
test"
"CYP450 system - CORRECT ANSWER drug metabolism via what system?"
"Cytochrome P450 - CORRECT ANSWER a FAMILY of enzymes that metabolize drugs in the
liver
- about 1/2 of all drugs on the market are metabolized by this system"
"drug drug interactions - CORRECT ANSWER what can occur when drugs which are
metabolized by the SAME isoenzyme are take concurrently?"
"Clinical Significance of P450 system - CORRECT ANSWER - some drugs are inducers of the
P450 system
"4-5 - CORRECT ANSWER it takes about how many half lives for a drug to be eliminated from
the body?"
"steady state - CORRECT ANSWER "intake of drug EQUALS amount metabolized/excreted"
half life determine dosing internal ex: QD, QID"
"Around the Clock Dosing (ATC) - CORRECT ANSWER used to create a 'steady state'
- usually take about 4 doses to achieve steady state"
"onset of action - CORRECT ANSWER LATENT period -> time it takes for the drug to elicit a
therapeutic response"
"peak effect - CORRECT ANSWER time it takes for a drug to reach its maximum therapeutic
response"
"duration of action - CORRECT ANSWER time that drug concentration is sufficient to elicit a
"therapeutic response""
"maximize therapeutic range - CORRECT ANSWER drug dosing goal?"
"3. Pharmacodynamic Phase - CORRECT ANSWER What the drug does TO the body
- drugs may increase, decrease, replace, inhibit, destroy, protect, irritate to create a response
- drugs exert multiple rather than single effects on the body ( some desired some not)"
"Example of drug exerting multiple rather than single effects on the body (desired or not) -
CORRECT ANSWER metaproterenol (Alupent)
- dilates bronchial passages - the MOA - the therapeutic effect
- it may also produce tracycardia or palpitations as adverse effects"
"pharmacodynamics: Receptor Theory of Drug Action - CORRECT ANSWER - receptors are
proteins located on surfaces of cell membranes
- special chemicals in the body that drugs interact with to produce effects (hormones, neurotransmitter, other molecules)
- when drug molecules bind with receptor molecules --> resulting drug-receptor which --> initiates physiochemical reactions that stimulate/activate OR inhibit normal cellular function -agonistic (stimulates)
- antagonistic ( inhibits)"
"Two types of receptors - CORRECT ANSWER - agonist
"agonist receptor - CORRECT ANSWER a drug that has the ability to initiate a desired
therapeutic effect by binding to a receptor ex: isoproterenol (Isuprel) = beta adrenergic agonist -> it binds to beta receptors and causes vasodilation"
"antagonist receptor - CORRECT ANSWER a drug that produces its action not by stimulating
receptors but by preventing other, natural substances from stimulating receptors ex: ranitidine (Zantac) = H2 antagonist - blocks release of gastric acid
- diphenhydramine (Benadryl) = H1 antagonist - blocks action of histamine to decrease allergic reaction
- propanol (Inderal) = beta adrenergic antagonist - blocks action of epinephrine (slow HR)"
"note - CORRECT ANSWER when a receptor is blocked by a antagonist, the receptor cannot
carry out its normal function"
"drug responses do not always involve receptors - CORRECT ANSWER - some drugs act
through simple physical or chemical interactions with small molecules ex: of receptor less drugs
- Antacids
- magnesium sulfate"
"antacids - CORRECT ANSWER receptor less drug
- neutralize gastric acidity by DIRECT chemical interactions with stomach acid"
"magnesium sulfate - CORRECT ANSWER receptor less drug
- is a powerful laxative that acts by retaining water in the intestinal lumen through an osmotic effect"
"Adverse drug reactions (ADR) aka side effects - CORRECT ANSWER defined by the WHO as
" any noxious, unintended, and undesired effect that occurs at normal drug doses
- range from annoying (drowsiness, nausea, itching, rash) to life threatening (respiratory depression, neutropenia, liver damage, hemorrhage, anaphylaxis)
- most common in elderly and very young
- patients over the age of 50 account for nearly 50% of all reactions
- also high risk in the very ill and pts receiving multiple drugs
- increase # of drugs = increase ADRs"
"high alerts medications: ISMP identified these drugs to most likely cause serious harm and
death: - CORRECT ANSWER - insulin (anti diabetic)
- heparin (anticoagulant)
- opioids (pain mgt.)
- injectable potassium chloride (IV KCL)- dilute always
- neuromuscular blocking agents
- chemotherapy drugs"
"Types of Drug interactions? - CORRECT ANSWER Drug-Drug
- may be intended, unintended, increased risk with polypharmacy (>10 meds) and narrow therapeutic index drugs Drug-Food Drug-Herb Drug- Disease"
"How can the nurse minimize drug interactions? - CORRECT ANSWER - minimize # of drugs
the patient receives
- take a thorough drug history - reconcile meds
- be extra vigilant in monitoring when patient is taking drugs with a narrow therapeutic index"
"Drug-drug interaction: interactions that increase therapeutic effects (Good) - CORRECT
ANSWER Additive effects
Synergism/ potentiation Interference Displacement"
"Additive effects - CORRECT ANSWER interaction that increase therapeutic effects
- two drugs with similar MOA are taken (1+1=2)
- 2 antibiotics to treat a complicated infection"
"Synergism/ potentiation - CORRECT ANSWER interaction that increase therapeutic effects
- two drugs with different MOA; results in combined drug effects that are greater than those that could have been achieved if either drug was given alone (1+1=3)
- Coumadin and ASA"
"interference - CORRECT ANSWER interaction that increase therapeutic effects
- interference by one drug with metabolism/elimination of a second drug can result in increased effects of second drug (CYP 450) and of decrease effects of first drug"
"displacement - CORRECT ANSWER interaction that increase therapeutic effects
- displacement of one drug from plasma protein binding sites by a second drug: increase effects of displaced drug"
"drug-drug interactions: interactions that decrease therapeutic effects - CORRECT ANSWER
-antidote -decreased intestinal absorption of oral drugs -activation of drug metabolizing enzymes in liver called enzyme inducers -increased excretion occurs when urine pH is changes/renal reabsorption is blocked"
"antidote - CORRECT ANSWER interactions that decrease therapeutic effects
- a drug given to antagonize the toxic effects of another drug ex: NARCAN is the antidote for morphine overdose"
"decreased intestinal absorption of oral drugs - CORRECT ANSWER interactions that
decrease therapeutic effects ex: activated charcoal given for drug overdose"
"activation of drug metabolizing enzymes in liver called enzyme inducers - CORRECT
ANSWER interactions that decrease therapeutic effects
- increased metabolism rate of drug (cytochrome P450 system)"
"TRUE. need to be careful when giving drugs to young and old - CORRECT ANSWER
true/false age and gender have a significant impact on a medications pharmacokinetics (ADME)"
"Variable affecting drug action (pharmacokinetics) - CORRECT ANSWER - age
- body weight
- genetic and ethnic characteristics
- gender
- pathologic conditions
- psychologic considerations"
"Drug Therapy in Children - CORRECT ANSWER 1. drug therapy is guided by age, WEIGHT,
level of growth and development, at age 12 handle drugs similar to adults)
- choice of drug is often restricted
- safe therapeutic dosage ranges less well defined
- PO when possible
- IM in infants - thigh muscle
- keep al meds childproof containers out of reach, and not referred to as candy"
