NRNP 6566 WK1-5 Midterm Questions and Correct Answers Updated Version 2023 Abnormal labs with hyperthyroidism - Correct Answerelevated T3, T4, thyroid resin uptake, and free thyroxine index. Sometimes T4 is normal but T3 is always high Elevated sed rate Elevated antinuclear antibody, without evidence of lupus or autoimmune disorder Hypercalcemia and low h/h
Atrial fibrillation - Correct AnswerStable- rate control versus rhythm control strategy
(example: AV nodal blockers, antiarrhythmics, anticoagulation). Ablation may be
needed if no response to medications Unstable- DCC/ cardioversion
Atrial Flutter - Correct AnswerCardioversion Rate control not as responsive as Afib
Be able to calculate creatinine clearance using Cockgraft Gault equation: - Correct AnswerMale = 140-age times weight in kilograms divided by serum creatinine times 72.Women = CRCL (male) times 0.85
Be familiar with the beers criteria and how to use it - Correct AnswerPotentially Inappropriate Medication Use in Older Adults to call attention to medications that are most commonly problematic and thus should be avoided in older adults
CHADS 2 score - Correct Answeranything greater than 3 is high risk and start anticoagulant
- point for each with history of heart failure, hypertension, and diabetes mellitus
Stroke is 2 points and greater than 75 years old is one point
Define narrow therapeutic index. How would you monitor a patient with a narrow therapeutic index? - Correct AnswerTherapeutic index is the dose range of effiency of med is optimized while side effects are minimized Narrow therapeutic index drugs are defined as those drugs where small differences in dose or blood concentration may lead to dose and blood concentration dependant, serious therapeutic failures or adverse drug reactions.You will need to monitor blood tests to monitor blood concentrations and dose adjustments accordingly.
Describe cytochrome p450 system - Correct AnswerCytochrome p450 system is a series of enzymes used to metabolize medications
Describe effect on low and high albumin levels on active drug levels especially for drugs that are highly protein bound - Correct AnswerAlbumin is the plasma protein with 1 / 2
the greatest capacity for binding drugs. Binding plasma proteins affect drug distribution into tissues, because only drug that is not bound is available to penetrate tissues, bind to receptors, and exert activity. As free drug leaves the blood stream, more bound drug is released from binding sites.
Describe factors that affect absorption - Correct Answerlow blood state (shock or arrest), contact time with GI tract too fast (diarrhea = cant absorb), delayed stomach emptying (large meal = delayed absorption)Drug- to drug or drug to food interactions
Describe factors that affect excretion - Correct Answeraffected by abnormal kidney or liver function, age, drug interactions
Describe how aging can affect absorption, distribution, metabolism and excretion - Correct Answerdecreased organ function, poorly tolerate drugs that require metabolism, lower rates of excretion decrease in small-bowel surface area, slowed gastric emptying, increase in gastric PH, changes in drug absorption With age, body fat generally increases and total body water decreases. Increased fat increases the volume of distribution for highly lipophilic drugs (for example, diazepam and chlordiazepoxide), which may increase their elimination half-lives.Serum albumin decreases and alpha 1 acid glycoprotein increases -- Phenytoin and warfarin are examples of medications with a higher risk of toxic effects when serum albumin increases hepatic metabolism of many drugs through cytochrome P enzyme system decreases with age; decreasing 30-40% decreased renal elimination
Describe the factors that affect distribution - Correct Answerlow albumin levels, body composition, cardiac decompensation (heart failure), age
Describe the factors that affect metabolism - Correct Answergenetics, age, organ function
Describe the ways the hepatic first pass effect- which is metabolism during first pass
through the liver - Correct AnswerAlternative routes include:
suppository intravenous intramuscular inhalational aerosol transdermal sublingual
These allow drugs to bypass the first-pass effect and be absorbed directly into systemic circulation
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