Chapter 6

The tendency of a drug to combine with its receptor is called: 1\. potency. 2\. efficacy. 3\. kinetics. 4\. affinity

. The factor that most determines drug distribution is: 1\. vascular perfusion of the tissue or organ. 2\. salt form. 3\. drug interactions. 4\. steady state.

When the amount of drug eliminated in a set amount of time is directly proportional to the amount of drug in the body, the ______________ pharmacokinetic model is being utilized. 1\. zero order 2\. one compartment 3\. first order 4\. two compartment

. Which of the following factors will affect a patient’s response to a drug without an alteration in serum drug concentration? 1\. hepatic or renal dysfunction 2\. tolerance 3\. drug interactions 4\. disease state

The fraction of the administered drug that reaches the systemic circulation is: 1\. prodrug. 2\. absolute bioavailability. 3\. first pass effect. 4\. free drug.

The mechanism of action responsible for interfering with the vital processes of micro-organisms of the \(\beta\)-lactam (for example, Penicillin) antibiotics is: 1\. inhibition of cell wall synthesis. 2\. ribosomal alterations. 3\. decreased cell wall permeability. 4\. inhibition of protein synthesis.

. Drugs are cleared from the body primarily by renal or hepatic routes. Drug clearance is defined as: 1\. the volume of distribution. 2\. the volume of body fluid from which a substance is removed per unit of time. 3\. the half-life. 4\. achieving steady state.

. The half-life of a drug is defined as: 1\. the renal clearance of the drug. 2\. the time required for half of the drug to leave the body. 3\. when the amount of drug administered matches the amount of drug excreted from the body. 4\. the time half way between doses of the medication.

Which phase of drug action includes the absorption, distribution, metabolism, and excretion of a drug? 1\. pharmaceutical phase 2\. pharmacokinetic phase 3\. pharmacodynamic phase 4\. pharmacotherapeutic phase

. The minimum inhibitory concentration (MIC) of an antibiotic is: 1\. persistent suppression of microorganism growth after the antibiotic is discontinued. 2\. lowest concentration of a drug that kills 99.9 percent of initial microorganism density. 3\. the amount of antibiotic that prevents visible growth of microorganisms after 24 hours incubation. 4\. the amount of antibiotic needed to prevent emergence of resistant microorganisms

Which phase of drug action includes the absorption, distribution, metabolism, and excretion of a drug? 1\. pharmaceutical phase 2\. pharmacokinetic phase 3\. pharmacodynamic phase 4\. pharmacolygenic phase

. Your patient has liver disease and is receiving a drug that is highly metabolized by the liver. To achieve the usual pharmacodynamic response to the drug, you would expect the drug’s dose to be: 1\. greater than a standard dose. 2\. smaller than a standard dose. 3\. the same as the standard dose. 4\. the same as the standard dose, but given more frequently.

A patient can receive the mumps, measles, rubella (MMR) vaccine if he/she: 1\. is pregnant. 2\. is immunocompromised. 3\. is allergic to neomycin. 4\. has a cold.

Levothyroxine (Synthroid) is the drug of choice for thyroid replacement therapy in patients with hypothyroidism because: 1\. it is chemically stable, nonallergenic, and can be administered orally once a day. 2\. it is available in a single 25mg tablet making dosing simple. 3\. it is not a prodrug. 4\. it has a short half-life

Metformin (Glucophage) is administered to patients with Type II diabetes mellitus. Metformin is an example of: 1\. an antihyperglycemic agent. 2\. a hypoglycemic agent. 3\. an insulin analogue. 4\. a pancreatic alpha cell stimulant.

Patients with Type I diabetes mellitus require treatment with: 1\. antihyperglycemic oral agents such as metformin (Glucophage). 2\. insulin or an insulin analogue. 3\. hypoglycemic oral agents from the sulfonylurea class. 4\. an alpha-glucosidase inhibitor such as acarbose (Precose).

A patient is hyperglycemic. The physician will order the most rapid-acting insulin available to lower the blood glucose. The physician will choose: 1\. insulin lispro. 2\. insulin injection (regular insulin). 3\. insulin zinc suspension (lente insulin). 4\. isophane insulin suspension (neutral protamine Hagedorn [NPH] insulin

Factors that influence the development of antibiotic-resistant bacteria for patients with otitis media include: 1\. good patient compliance with antibiotic therapy. 2\. appropriate prescribing of antibiotics to treat bacterial infections. 3\. overuse of antibiotics for prophylaxis against recurrent infections. 4\. prescribing antibiotics that are reasonably priced, effective, and palatable.

All of the following medications exhibit sympathomimetic effects except: 1\. dopamine (Intropin). 2\. isoproterenol (Isuprel). 3\. methylprednisolone (Solu-medrol). 4\. albuterol (Proventil, Ventolin).

. Which mechanism appears to be the principle method for transfer of most clinically relevant drugs across the placenta? 1\. active transport 2\. simple diffusion 3\. pinocytosis 4\. facilitated transport

A 30-year-old woman presents to the obstetrical floor with delivery imminent. She reports no prenatal care and a prior history of several sexually transmitted diseases. Before further information can be obtained, a 2,155 gram infant is delivered without respiratory effort. The infant is suctioned, dried, and stimulated and begins to exhibit gasping respiratory effort. Naloxone (Narcan) is: 1\. indicated to facilitate respiratory effort. 2\. not indicated because emergent intubation is needed. 3\. not indicated due to the possibility of maternal infection. 4\. not indicated due to unknown maternal illicit drug status.

Antihistamines have what effect on target cells in the skin and mucosa? 1\. They decrease production of histamine. 2\. Antihistamines prevent the release of histamine from mast cells. 3\. Antihistamines block immunoglobulin E (IgE). 4\. They block the H1 receptor and act as a competitive receptor antagonist.

Your patient has recently had a bone marrow transplant and is currently being treated for disseminated herpes infection with high dose IV acyclovir (Zovirax). He wants to know why he cannot take acyclovir orally and go home. What is your response? 1\. You are too sick to go home. 2\. Oral acyclovir is not well absorbed and cannot adequately treat your infection. 3\. You can. I’ll ask the doctor to switch your medicine to oral tablets. 4\. Oral acyclovir would further irritate your oral lesions.

Empiric antibiotic therapy is: 1\. a cause of microorganism resistance. 2\. reserved for immunocompromised patients. 3\. started immediately after cultures are obtained. 4\. costly with undesirable side effects and seldom utilized.

. Antiretroviral agents in the fusion class, such as infuvirtide (Fuzeon), inhibit HIV viral replication by: 1\. fusing the intracellular contents rendering them harmless. 2\. inhibiting the fusion of HIV positive cells to each other permitting macrophages to move in to phagocytose the positive cell. 3\. fusing the HIV positive cell with a killer T cell. 4\. inhibiting the HIV virus from fusing with a normal cell.

Medications still in the clinical trial process can be utilized in certain patients with life-threatening illness. This action is called: 1\. compassionate usage. 2\. expedited availability. 3\. high alert availability. 4\. phase IV clinical trial provision

A chemical reaction between drugs prior to their administration or absorption is known as: 1\. a drug incompatibility. 2\. a side effect. 3\. an adverse event. 4\. an allergic response.

When medications have an additive, synergistic, or antagonistic effect on a tissue, the nurse knows that a ________ reaction has occurred. 1\. pharmaceutical 2\. pharmacodynamic 3\. pharmacokinetic 4\. drug incompatability

One drug can alter the absorption of another drug. One drug increases intestinal motility. What effect will this have on the second drug? 1\. None; absorption of the second drug is not affected. 2\. The increased gut motility increases the absorption of the second drug. 3\. The absorption of the second drug cannot be predicted. 4\. Less of the second drug will be absorbed.

Enterohepatic cycling of some drugs can be significantly reduced when which of the following classes of drugs is also administered? 1\. antihypertensive agents 2\. antibiotics 3\. antiepileptic drugs 4\. antiarrhythmia medications

Drug interactions are more likely to occur when: 1\. the patient is elderly. 2\. the drugs are taken close together. 3\. the affected drug has a low therapeutic index. 4\. the patient is sedentary

A 56-year-old male is admitted to the coronary care unit with an anterior myocardial infarction. His current drug history includes the use of the beta blocker propranolol (Inderal). The physician orders lidocaine to be “on standby.” The nurse knows that: 1\. concurrent usage of propranolol with lidocaine can precipitate lidocaine toxicity. 2\. beta blockers can precipitate tachycardia. 3\. lidocaine will reverse the effects of propranolol. 4\. propranolol competes with lidocaine receptor sites.

A patient is seen in clinic today and diagnosed with iron deficiency anemia. The physician prescribes iron replacement therapy. When discussing administration of the drug, the nurse must educate the patient that: 1\. if he has trouble swallowing the tablet, he can chew it. 2\. if he forgets his medication for 2 days, he can take the missed doses the next day when he takes that day’s regular dose. 3\. the medication should be taken 2 hours before or after food. 4\. his anemia will be resolved within 7–10 days.

. A patient is seen in the clinic with severe anemia. His religious beliefs prohibit the administration of blood products. His physician prescribes epoetin alfa (Epogen, Procrit) therapy. What other agent will the physician likely prescribe? 1\. myeloablative therapy 2\. a nonsteroidal anti-inflammatory drug 3\. an antimetabolite 4\. ferrous sulfate (Feosol, Feratab)

. A 18-year-old female has had epilepsy since childhood and has been maintained relatively seizure free on antiepileptic drugs (AEDs), including carbamazapine (Tegretol) and phenytoin (Dilantin). Today in clinic she asks you about starting oral contraceptives (OCs) as birth control. You educate her that: 1\. she should not take oral contraceptives because she is too young. 2\. the AEDs she is taking will interact negatively with OCs and could lead to an unplanned pregnancy. 3\. her parents will need to be consulted prior to obtaining the OC prescription. 4\. introducing OCs will likely trigger seizure activity.

An infant with a ventricular septal defect has been maintained on digoxin (Lanoxin) for congestive heart failure. The loop diuretic furosemide (Lasix) was recently added to the pharmacologic regimen to treat symptoms of increasing congestive heart failure. The nurse must be alert for: 1\. hypothyroidism. 2\. hyperaldosteronism. 3\. hypokalemia. 4\. hyperinsulinemia.

Your patient takes levothyroxine (Synthroid) for hypothyroidism and warfarin (Coumadin) for deep vein thrombosis prophylaxis. What is the possible interaction between these drugs? 1\. There is no interaction. 2\. There is an increased risk for bleeding. 3\. There is an increased risk for cardiovascular effects from levothyroxine. 4\. The warfarin dose may need to be increased to anticoagulate the blood.

Which class of medications to treat hyperlipidemia significantly decreases the absorption of numerous other drugs taken simultaneously? 1\. bile acid-binding resins 2\. fibric acid derivatives (the fibrates) 3\. niacin (nicotinic acid) 4\. HMG-CoA reductase inhibitors (the statins)

Your patient is taking the anorexic drug sibutramine (Meridia) to treat obesity. Your patient is also taking the SSRI fluoxetine (Prozac) for depression. You should caution him about which of the following potential drug interactions? 1\. serotonin syndrome 2\. gastroenteritis 3\. seizure 4\. hypertensive crisis

A patient is given an opiate drug for pain relief following general anesthesia. The patient becomes extremely somnolent with respiratory depression. The physician is likely to order the administration of: 1\. Naloxone (Narcan). 2\. Labetalol (Normodyne). 3\. Neostigmine (Prostigmin). 4\. Thiothixene (Navane)

Local anesthetics block the conduction of pain impulses to the spinal cord. Their duration of action: 1\. is always longer than general anesthesia. 2\. is determined by the rate of diffusion and absorption at the site of administration. 3\. is usually short (10 minutes). 4\. varies, depending on the patient’s weight.

A patient asks a nurse working in a dental office what type of drug will the dentist use to provide anesthesia during the extraction of the patient’s wisdom teeth. The nurse knows the dentist will use an anesthetic gas, also known as “laughing gas.” This agent is: 1\. nitrous oxide. 2\. nitrogen. 3\. nitric oxide. 4\. nitrogen dioxide.

. It has been known for centuries that extracts of the opium poppy can relieve pain. An example of an opium poppy extract useful in human pain management is: 1\. the nonsteroidal anti-inflammatory agents such as ibuprofen (Motrin, Advil) and naproxen (Anaprox, Naprelan). 2\. the cyclooxygenase blocker acetyl salicylate. 3\. morphine sulfate (Roxonol, Duramorph). 4\. the analgesic and anti-inflammatory agent indomethacin (Indocin).

Specific receptors for opioids have been detected in the human brain leading scientists to theorize that the human body must produce an endogenous agent that would react with these receptors. These endogenous products are known as: 1\. enkephalins and endorphins. 2\. catecholamines. 3\. cytoplasmic enzymes. 4\. glucuronide.

. A post-operative patient is receiving morphine sulfate via the intravenous route. Analgesia is effective. The physician changes the medication to the oral route at the same dosage. Subsequently, the patient states that he is getting very little pain relief. The nurse realizes that: 1\. the patient is becoming dependent on the drug. 2\. first pass effect is eliminating much of the oral dose. 3\. the patient is exhibiting drug-seeking behavior. 4\. tolerance to the medication has developed.

In patients with severe pain associated with trauma, myocardial infarction, and cancer, the primary analgesic drug(s) of choice for relief is/are: 1\. the nonsteroidal anti-inflammatory agents. 2\. morphine sulfate. 3\. codeine and hydrocodone. 4\. methadone.

. Recently, it has been noted that use of coanalgesic agents, such an antidepressants, are effective in treating chronic pain syndromes. Another class of coanalgesic agents used for chronic pain include: 1\. the tricyclic antidepressants, such as amitriptyline (Elavil). 2\. the nonsteroidal anti-inflammatory agents such as ibuprofen (Advil, Motrin). 3\. the antiepileptic agents such as gabapentin (Neurontin). 4\. the antiarrhythmic agent adenosine (Adenocard).

General anesthesia is administered: 1\. to decrease blood loss by vasoconstriction. 2\. to eliminate pain production. 3\. to block mucous membrane secretion production. 4\. to prevent CNS pain perception.

The mu opiate receptors in the CNS are located in the pain-modulating centers. Continued administration of opiate drugs: 1\. will result in euphoria followed by dysphoria, and physical dependence on the drug. 2\. produces no long-term effects on these receptors. 3\. inhibits nociceptors in the CNS. 4\. causes diaphoresis and increased heart rate and respiratory rate.

Most analgesic meds that are administered orally are absorbed from the: 1\. stomach. 2\. large intestine. 3\. small intestine. 4\. mouth