Exam 3 - Pharmacokinetics etc

Pharmacokinetics is

The four basic pharmacokinetic processes are

Pharmacokinetic processes determine the ______ of a drug at its sites of action and determine the time course over which drug responses take place.

To move throughout the body, drugs must cross cell membranes. They do this by:

Which means of crossing the cell membrane is most common?

P-glycoprotein

For most drugs, movement throughout the body depends on the ability to penetrate membranes directly, because:

Polar molecules dissolve in polar solvents (e.g., water) but not in nonpolar solvents (e.g., oil); therefore, polar drugs are:

Acidic drugs ionize in basic (alkaline) media, whereas basic drugs ionize in acidic media. When a pH gradient exists between two sides of a membrane:

What is ion trapping?

Absorption is defined as:

Absorption is influenced by:

The term parenteral

Intravenous administration has several advantages:

Intravenous administration has several disadvantages:

Intramuscular administration has two advantages:

Intramuscular administration has two disadvantages:

Oral administration has the advantages of:

Oral administration has the disadvantages of:

Drug preparations are considered chemically equivalent if they contain

Preparations are considered equal in _______ if the drug they contain is absorbed at the same rate and to the same extent.

Two formulations of the same drug can be chemically equivalent but differ in their:

Enteric-coated oral formulations are designed to

Sustained-release oral formulations are designed to

Distribution is defined as:

In most tissues, drugs can leave the vasculature simply by:

The term blood-brain barrier (BBB) refers to

To leave the blood and reach sites of action within the brain, a drug must be able to pass through cells of the capillary walls. Only drugs that are _____________ can cross the BBB to a significant degree.

Drug movement across the placenta

Many drugs bind reversibly to

Increased levels of free drug (caused by competition for binding sites or albumin deficiency) _______ the intensity of drug responses ______________.

Drug metabolism (biotransformation) is defined as:

Most drug metabolism takes place in the liver and is performed by:

Drug metabolism has six possible consequences of therapeutic significance:

The most important consequence of drug metabolism is:

Drug metabolism can:

Induction of drug-metabolizing enzymes by a drug can have two therapeutic consequences.

The term first-pass effect refers to:

Excretion is:

Most drugs are excreted by _________, but drugs also may be excreted by ____________.

Renal drug excretion has three steps:

In the kidneys, drugs that are lipid soluble undergo ______ from the tubule back into the blood

In the kidneys, drugs that are not lipid soluble (ions and polar compounds):

Drugs taken by breast-feeding women:

Drugs entering the intestine in bile:

For most drugs, a direct correlation exists between:

The minimum effective concentration

The plasma level at which toxic effects begin is called:

The therapeutic range of a drug lies:

Drugs with a wide therapeutic range are ________, whereas drugs with a narrow therapeutic range are _____________.

The half-life of a drug is:

Drugs with a short half-life must be administered:

When drugs are administered repeatedly:

When the amount of drug eliminated between doses equals the dose administered:

When a drug is administered repeatedly in the same dose, a plateau is reached

As long as the dosage remains constant

The highest level is referred to as

The lowest level is referred to as

The acceptable height of the peaks and troughs depends on the drug’s

When a plateau must be achieved quickly, a large initial dose is administered. This is called:

A plateau is maintained by administering

Three techniques can be used to reduce fluctuations in drug levels:

When drug administration is discontinued, most (94%) of the drug in the body is eliminated

Pharmacodynamics is

The dose-response relationship is:

Maximal efficacy is

A drug with a ___________ is not always more desirable than a drug with a ___________;

Potency is defined as

It is important to note that the potency of a drug implies nothing about its

A receptor can be defined as

Binding of a drug to its receptor usually is

The receptors through which drugs act are

Under physiologic conditions, receptor function is regulated by

All that drugs can do at receptors is

Because drug action is limited to mimicking or blocking the body’s own regulatory molecules, drugs cannot

Drugs produce their therapeutic effects by

In theory, it should be possible to synthesize drugs that can

The four primary families of receptors are:

Selective drug action is possible largely because

If a drug interacts with _____ receptor and if that receptor type regulates _______, the drug will have limited effects. Conversely, if a drug interacts with _______ receptor types, it is likely to elicit _____________.

Selectivity does not

The simple occupancy theory of drug-receptor interaction states that

The modified occupancy theory ascribes two qualities to drugs

The term affinity refers to

Drugs with high affinity are

The term intrinsic activity refers to

Drugs with high intrinsic activity have

Affinity and intrinsic activity are

Agonists are molecules that

In terms of the modified occupancy theory, agonists have both

Antagonists produce their effects by

In terms of the modified occupancy theory, antagonists have

Because antagonists act by preventing receptor activation, if no agonist is present, administration of an antagonist has

Antagonists can be subdivided into two major classes:

Noncompetitive antagonists bind

Competitive antagonists bind

Partial agonists have _________ intrinsic activity

When the receptors of a cell are continually exposed to an agonist, the cell

Continuous exposure to antagonists

Although the effects of most drugs result from drug-receptor interactions, some drugs do not act through receptors.

The nurse who appreciates the reality of interpatient variability is better prepared to

The average effective dose is

After a patient’s response to this “standard” dose has been evaluated, subsequent doses can be

At the ED50, some patients will be

Because drug responses are not completely predictable, the nurse must evaluate the patient to determine whether

Because of variability in responses, nurses, patients, and other concerned individuals must evaluate actual responses and be prepared to inform the prescriber about these responses so that

The therapeutic index, defined as the

Drug-drug interactions can occur whenever a patient

Some drug-drug interactions are

When two drugs interact, three outcomes are possible:

When one drug intensifies the effects of another, the interaction often is called

Interactions that result in reduced drug effects are often called

Drugs can interact through four basic mechanisms:

Some drugs, because of their physical or chemical properties, can interact directly with

Because drugs can interact in solution, two or more drugs should never be combined in the same container unless

Drug interactions can affect all four of the basic pharmacokinetic processes; that is, when two drugs are taken together, one may alter the

Drug absorption may be

One drug can alter the distribution of another by two principal mechanisms:

Altered metabolism is

Drugs that increase the metabolism of other drugs do so by

Drugs that decrease the metabolism of other drugs do so by

Drugs that stimulate the synthesis of cytochrome P450 isoenzymes are referred to as

Although inhibition of drug metabolism can be beneficial, as a rule inhibition has

Drugs can alter all three phases of renal excretion:

Most of the drugs that induce or inhibit P450 have the same impact on

Drugs that induce PGP can have the following impacts on other drugs:

The two basic types of pharmacodynamic interactions are

Pharmacodynamic interactions may be

Interactions that occur at the same receptor are almost always

Inhibition occurs when

Drug-drug interactions may increase or decrease the intensity of responses.

Interactions are especially important with drugs that have a

The nurse can help reduce the risk of adverse interactions by

Drug-food interactions are both

Food frequently __________ the rate of drug absorption and occasionally the __________. For some drugs, food may _______.

_______ can inhibit the metabolism of certain drugs, thereby raising their blood levels.

Drug-food interactions sometimes increase

To administer a drug with food means to administer it

To administer a drug on an empty stomach means to administer it

When combined with conventional drugs, dietary supplements may cause

An adverse drug reaction is any:

Patients at increased risk of adverse drug events include

A side effect is formally defined as

Toxicity is defined as

An allergic reaction is

An idiosyncratic effect is

An iatrogenic disease is

Physical dependence is

Because a variety of drugs can cause physical dependence of one type or another and because withdrawal reactions have the potential for harm, patients should be warned against

The term carcinogenic effect refers to

A teratogenic effect is

Many drugs are toxic to specific organs. Two types of organ-specific toxicity deserve special comment:

______ are the leading cause of acute liver failure, a rare condition that can rapidly prove fatal. Combining a hepatotoxic drug with certain other drugs (e.g., alcohol) may increase the risk of liver damage.

The term QT interval drugs, or simply QT drugs, refers to

Because newly released drugs may have as-yet unreported adverse effects, the nurse should be alert for

The responsibility for reducing ADRs lies with

The pharmaceutical industry must strive to produce ________; the prescriber must select the ________ for a particular patient; the nurse must evaluate patients for _____________; and patients and their families must watch for signs that ________.

For drugs with especially serious adverse effects, the FDA now requires one or more of the following:

To help determine if a particular drug is responsible for an adverse effect, the following questions should be considered:

Medication errors are a major cause of

Medication errors can be made by

In the hospital setting, a medication order must be

Because the nurse is the last person who can catch mistakes made by others and because no one is there to catch mistakes the nurse might make, the nurse bears a unique responsibility

The three most common types of fatal medication errors are

The three most common causes of fatal medication errors are

A central theme in the effort to reduce medication errors is changing the institutional culture from one that focuses on “naming, blaming, and shaming” those who make mistakes to one focused on designing institution-wide processes and systems that can prevent errors from happening. Effective measures for reducing medication errors include

The _________ has compiled a list of error-prone abbreviations, symbols, and dose designations, and has recommended against their use. This list includes eight entries that have been banned by ________.

The National Coordinating Council for Medication Error Reporting and Prevention was established to

Nurses can report a medication error via the

Drug use among older adults is

Although older adults constitute only 12% of the U.S. population, they consume

Older patients are _________ to drugs than are younger adults, and they show _________ variation.

Older patients experience ____ adverse drug reactions and drug-drug interactions.

The principal factors underlying complications of adverse drug reactions and drug-drug interactions are

Individualization of therapy for older adults is essential:

Age-related decline in organ function alters the

The rate of drug absorption may be _____ in older adults, although the percentage of absorption usually is unchanged.

Four major factors can alter drug distribution in older adults:

Rates of hepatic drug metabolism tend to decline with age; therefore, the half-lives of certain drugs may be

Beta-adrenergic blocking agents (drugs used primarily for cardiac disorders) are ________ in older adults than in younger adults, even when present in the same concentrations.

Possible explanations for this beta-blockers being less effective in older adults include

Drug accumulation secondary to reduced renal excretion is the most important cause of

Adverse drug reactions (ADRs) are _______ common in older adults than in younger adults, accounting for about 16% of hospital admissions among older individuals and 50% of all medication-related deaths.

Multiple factors predispose older patients to ADRs. The most important are:

Measures that help reduce ADRs in older adults include:

Between 26% and 59% of older patients fail to take their medicines as prescribed. Multiple factors underlie nonadherence to the prescribed regimen. Among these are:

Measures to promote adherence include: