501 QUIZ 1

  1. if the patient has a head ache, the nurse doesn’t want to give some really strong pain medication, like morphine.  We would probably want something with a lower _______  such as aspirin.
  2. if a drug LACKS _______, that can be important.  What can happen is that very large doses may be used to get the effect needed, and this might not be very convenient.
  3. _______ is the largest effect that a drug can produce as 
    indicated by height of ____-_____ ______.
    • max efficacy
    • Dose-Response curve
  4. Match the ______ of the response with the patient’s need
  5. "point of saturation" is another term for ____ _____.
    max efficacy
  6. ___________ is the remainder of an orally administered drug that reaches systemic circulation.
  7. Chemically equivalent drugs can differ in bioavailability because of different ______ __ ______ and ________ __ ______.
    onset of action; intensity of effects
  8. The rate drugs are  ______ is the primary determinant of the concentration of drug in the blood stream.
  9. Renal ______ accounts for most drug excretion, however drugs are also subjected to  _______ in the renal tubule.
    filtration; reabsorption
  10. 3 processes of excretion
    • glomerular filtration
    • passive reabsorption
    • active tubular secretion
  11. water-soluble drugs would be excreted by ______ ______ unless the drug was bound by a _______.
    glomerular filtration; protein
  12. lipid-soluble drugs could  avoid excretion because of ______ ______, which will move drug from tubule into blood stream.
    passive absorption
  13. lipid-soluble drugs could only be excreted in the kidneys by means of _____ ______ _____, which requires active transport.
    active tubular secretion
  14. ______ ______ drives reabsorption of drug from lumen of tubule back into bloodstream.
    Concentration gradient
  15. pharmacokinetic processes determine drug concentrations at ____ __ _____.  However, you can only MEASURE the drug levels in the _____ _____.
    sites of action; blood plasma
  16. therapeutic window vs. therapeutic ratio is parallel to therapeutic ______ vs. therapeutic _____
    range; index
  17. At some point, the amount eliminated in the dosing interval will equal the dose.  This is know as _______.
    plateau/steady state
  18. ______, as the highest plasma level, must be kept below ____ concentration.
    Peaks; toxic
  19. ______, as the lowest plasma level, must be kept above _____.
    Troughs; MEC
  20. Drug A administered 10mg/day.  Peaks exceed toxic concentration and troughs fall below MEC.  However, mean concentration is in therapeutic range.  What are 2 nursing implication?
    • 1) Drug A administered 5mg, twice a day, so that mean concentration the same but peaks lower and troughs higher
  21. How would pharmacological therapy affect half-life in a patient with liver disease who is receiving a drug that undergoes hepatic metabolism?
    • half-life: prolonged 
    • 1)  At normal dosing, the drug could accumulate to toxic levels.
    • 2) The provider would need to decrease the dose and/or extend the timing interval of the doses.
  22. How would pharmacological therapy affect half-life in a patient who is taking Drug A and Drug B, where Drug A is an inducer of metabolizing enzymes for Drug B?  List 2 nursing implications.
    • half-life: shortened
    • 1) The active form of the drug may not reach therapeutic levels in the body.
    • 2) The provider would need to increase the dose and/or shorten the timing interval of doses
  23. an immune response that requires prior sensitization of immune system
    Allergic reaction
  24. Direct chemical example of drug-drug interactions.
    IV precipitate
  25. antacids increase gastric pH and impacts ionization of drugs; laxatives decrease transit time for absorption; narcotics decrease peristalsis and prolong transit time. 

    these are examples of what.  check all that apply.
    • Absorption
    • drug-drug interactions
    • adverse drug reactions
  26. competition for protein binding; alteration in extracellular pH.

    these are examples of what.  check all that apply.
    • Distribution
    • drug-drug interactions
    • adverse drug reactions
  27. induction/inhibition of enzymes (cytochrome P450 enzyme families); common inducers are phenobarbital & carbamazepine (anti-seizure drugs), rifampin (tuberculosis drug), tobacco, & some “herbal supplements,” such as St. John’s wort.

    these are examples of what.  check all that apply.
    • Metabolism
    • drug-drug interactions
    • adverse drug reactions
  28. decreased CO decreases perfusion of glomerulus; alteration in urinary pH affects ionization; competition for transporter binding

    these are examples of what.  check all that apply.
    • Excretion
    • drug-drug interactions
    • adverse drug reactions
  29. P-glycoprotein subject to induction/inhibition by drugs;
    interaction at same or different receptor sites (agonist-antagonist)

    these are examples of what.  check all that apply.
    • Metabolism
    • drug-drug interactions
    • adverse drug reactions
  30. Acetaminophen, a drug metabolized by the liver, is administered to a patient with liver failure.  Which of the following is true?

    A.The half-life may be shortened in this patient.
    B.Drug levels will be decreased in this patient.
    C.The patient will metabolize the drug more quickly.
    D.The patient is more likely to experience a toxic effect of acetaminophen.
    D) The patient is more likely to experience a toxic effect of acetaminophen.
  31. To reach the therapeutic range more quickly, we can give a ________, which is a large dose given at the start of therapy
    loading dose
  32. A more potent drug produces desired effect at lower dosage, as indicated by position of curve along X-axis.
    relative potency
  33. amount of drug that must be given to produce a desired effect
    relative potency
  34. Selectivity
    Specific fit/interaction (shape, charge, etc.)
  35. ________ is reflected in drug’s potency in direct proportion.
  36. ________ is in direct proportion to maximal efficacy.
    intrinsic activity
  37. Intensity of response to drug related to # receptors occupied, but also related to activation of receptors after binding
    Modified Occupancy Theory
  38. Accounts for differences in potency and maximal efficacy
    Modified Occupancy Theory
  39. nursing implications for protein binding.
    • nephrotoxicity
    • ex: albumin
  40. nursing implication for 1st pass
    parenteral instead of PO
  41. active acquired immunity
    • vaccine 
    • ex: MMR
  42. passive acquired immunity
    • series of injections of antibody
    • ex: Hep B immunoglobulin
  43. stages of inflammation
    vascular & cellular
  44. vascular phases of inflammation
    • 1st: vasoconstriction
    • 2nd: vasodilation
  45. vascular phase
    • s/s: injury, swelling, warmth, pain, erythema
    • fxn: blood losss
    • increace WBC
    • increase permeability
    • increase leakage of fluids
  46. cellular phases of inflammation
    • 1st: Migration & Adhesion
    • 2nd: Transmigration
    • 3rd: Chemtaxis
    • 4th: Phagocytosis
  47. migration & adhesion
    • 1st phase of cellular inflammation
    • migration: WBC @ injury site
    • adhesion: WBC @endothelium
  48. transmigration
    • 2nd phase of cellular inflammation
    • WBC permeate
  49. chemotaxis
    • 3rd phase of cellular inflammation
    • chemical gradient
  50. phagocytosis
    • 4th phase of cellular inflammation
    • WBC consume antigen/debris
  51. phagocytic leukocytes
    • NK
    • neutrophil
    • dendritic
    • macrophage
  52. an immune cell that phagocytizes an antigen
    present antigen cell (APC)
  53. cells of inflammation
    • endothelial cells
    • platelets
    • leukocytes
  54. eosinophil
    • anti-parasitic
    • release cytokines during asthma attack @ respiratory tract
  55. basophils
    release histamine @ blood
  56. mast cells
    release histamine @ tissue
  57. *Complement proteins: vasodilation; é capillary permeability; promote leukocyte activation, chemotaxis, and augment phagocytosis
  58. Complement system –cascade of plasma proteins
  59. 2 types of inflammatory mediators
    • 1) cell-derived
    • 2) plasma-derived
  60. 2 types of cell-derived inflammatory mediators
    • 1) histamine
    • 2) arachidonic acid metabolites
  61. 2 types of plasma-derived inflammatory mediators
    • 1) kinin
    • 2) complement protein
  62. vasodilation; capillary permeability; promote leukocyte activation, chemotaxis, and augment phagocytosis
    Complement proteins
  63. an effector of innate and humoral/adaptive immunity
    complement system
  64. peptides, polysaccharides, lipids, nucleic acids; has unique molecular shape recognized by specific receptor on lymphocyte
  65. Recognition of antigen and stimulation by cytokines
    B and T cells
  66. clones that differentiate into effector and memory cell
    B and T cells
  67. B lymphocyte immunity is to _____, as T lymphocyte immunity is to ________.
    humoral; cell -mediated
  68. MHC
    major histocompatability complex
  69. Membrane-bound proteins that display peptides to T cells; recognizes self vs nonself; expressed on APCs
  70. In adaptive immunity, activation requires 2 signals.  what are they?
    • 1st: Antigen 
    • 2nd: Antigen-presenting cells (APCs) found in innate immunity
    • ex: dendritic cells or macrophages
  71. IgG
    • body fluids
    • binding
  72. IgA
    • secretion @ mucous membrane
    • prevents entry
  73. IgM
    • body fluids
    • pulls into clumps
  74. IgD
    • surface of B cells
    • receptor
  75. IgE
    • mast cells
    • 1st responder
    • allergy
  76. master switch; TH cell receptor binds to MHC-II and antigen complex on APC; secretes cytokines; helps activate B cells bound with same antigen
  77. effector; TC cell receptor binds MHC-I and antigen complex; injects preformed cytotoxic proteins into target cell
  78. Discrimination of self and non-self
    Self tolerance
  79. Can initiate, maintain, and down-regulate without help of the nervous system or other systems
  80. Targets very select antigens
  81. Can invoke specific immune response to an indefinite number of different antigens
  82. only Immune system and CNS have these types of cells memory
Card Set
501 QUIZ 1