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Individual Variation & Pharmacology Across the Lifespan
Terms in this set (39)
List some of the individual variations that could affect drug responses
- Body Weight and Composition
- Placebo Effect
- Genetics and Pharmacogenomics
- Comorbidities and Drug Interactions
- Variability in Absorption
- Gender/Race-related variations
Briefly explain how body weight and composition can affect drug responses
The same dose of the same drug can have potential for toxicity in a smaller person, with the potential for undertreatment in a larger person
Body surface area and percentage of body fat can also affect drug distribution
Why are PTs who are very young (infants) or very old (geriatric)
Because of kidney and liver function; In a newborn, the liver and kidneys aren't properly developed, leading to poor filtration and excretion of drugs. Because of this, newborns cannot handle a large amount of drugs
Geriatric/older PTs have declining kidney and liver function, which would impair drug excretion and filtration
________________ pathology can result in reduced drug excretion, which can lead to increased drug levels in the body
As a health provider, which labs should you monitor to ensure PT's kidney function?
- Comprehensive metabolic panel (CMP); blood test that measures your sugar (glucose) level, electrolyte and fluid balance, kidney function, and liver function
- Arterial Blood Gases(ABGs); imbalances or abnormal levels can indicate kidney failure
- Creatinine Clearance; the level of creatinine in your blood also tells how well your kidneys are working—a high creatinine level may mean your kidneys are not working properly
- Urine Output
As a health provider, which should you monitor to ensure PT's liver function?
- AST and ALT; high levels may indicate liver failure
- Abdominal pain/swelling (RUQ)
What are the three (3) types of drug tolerance?
Which type of drug tolerance is this?
- results from continued administration of a drug, resulting in chronic receptor occupation, increasing the minimum effective concentration (MEC)
Which type of drug tolerance is this?
- results from accelerated drug metabolism, often brought about by the ability of certain drugs to induce synthesis of hepatic drug-metabolizing enzymes
Which type of drug tolerance is this?
- reduction in drug responsiveness from repeated dosing over short time (desensitization that occurs very rapidly)
The component of a drug response that is caused by psychologic factors and not by the biochemical or physiologic properties of the drug is known as what?
The great variability in absorption exists primarily with _____________ administration
Study of how a person's unique genetic makeup (genome) influences his or her response to medications.
The genetic alteration in drug metabolism with Vitamin K antagonist, warfarin (Coumadin) is an example of which variation in drug responses?
Digoxin, a cardiac glycoside that is used to strengthen contractions of the heart, is not often administered to (males/females) because of risk of mortality
Antacids causing altered absorption of medications by increasing the ability of basic drugs to cross membranes, is an example of which variability in drug responses?
Beta blockers are good for the heart, but may narrow the airways, making them contraindicated for asthmatic PTs. This is an example of which type of variability that can affect drug responses
What should be done for a PT who needs to take antacids but also has medication that could be affected by the antacids (altered absorption)?
The PT should space out the antacid consumption after their primary medications (this minimizes drug interaction)
A patient with cancer is receiving morphine for pain control. The patient calls the nurse to report that the morphine is no longer controlling his pain. What is the most appropriate response by the nurse?
A."Increasing the dose of morphine will make you so sleepy that you will not be able to function."
B."This means that you have developed a psychologic addiction to morphine."
C."You have developed a tolerance to morphine and will need a higher dose."
D."It is recommended that we wait to increase the morphine until the pain is more severe."
C; This is an example of pharmacodynamic tolerance
The nurse is preparing to administer warfarin [Coumadin] to a patient. The nurse notes that the patient has altered CYP2C9 genes. It is most important for the nurse to do which of the following?
A.Check for signs of a transient ischemic attack.
B.Monitor for ST-segment elevation or depression.
C.Observe the patient's legs for symptoms of a blood clot.
D.Examine the patient's stools for the presence of blood.
D; Coumadin is a blood thinner, which could result in PT bleeding
A patient was discharged from the hospital with instructions to take an antibiotic for 7 days to treat a bladder infection. Twelve days later, a home care nurse visits the patient and finds that the symptoms have not resolved. What is the most important question for the nurse to ask?
A."Do you think you have another bladder infection?"
B."Have you taken all of the antibiotics as directed?"
C."How much water have you been drinking each day?"
D."What antibiotic do you usually take to treat an infection?"
B; the PT could build up antibiotic resistance if they don't take all of their medication
______________ use can result in newborns with osteoporosis
______________________ , a medication mainly used to treat ulcers, can soften the cervix and start contractions that will empty your uterus, resulting in spontaneous abortion
_______________________ drugs halt the pregnancy or produce a congenital malformation (a birth defect).
True or False;
Category A of the FDA Pregnancy Categories is described as well-controlled studies in humans showing no risk to the fetus
True or False;
Category X of the FDA Pregnancy Categories is described as controlled studies in animals or humans demonstrating fetal abnormalities with risk in pregnant women clearly outweighs any possible benefit
A patient is taking a Category A drug during pregnancy. Which statement by the nurse is accurate?
A."The risk of harm to the fetus is remote."
B."The drug is not safe to take during pregnancy."
C."This drug has caused congenital birth defects."
D."No controlled studies of this drug have been done in humans."
A patient who is breast-feeding her newborn infant is prescribed an antibiotic to take after discharge. Which statement should the nurse include when providing discharge instructions?
A."Drink plenty of fluids to dilute the drug in your breast milk."
B."Take the drug at night with a full glass of water."
C."Pump your breasts, and then discard all of the milk."
D."Take the antibiotic immediately after breast-feeding."
- D; take the antibiotic immediately after breastfeeding so that by the next time it's time to breastfeed, a lot of the medication will be out of the mother's system (minimizes the drug concentration by the next feeding)
Drug responses can often be more intense and prolonged in which developmental group?
Infants and Neonates
Aspirin can produce which negative effect in children and adolescents?
Reye's Syndrome (brain and liver start to fail)
Which drug, when administered over a long period of time to children and adolescents can cause growth suppression?
__________________ , a drug that's used for nausea and vomiting, can cause respiratory depression in young children
A 1-year-old child is prescribed an oral drug that is eliminated by metabolism in the liver. Based on the child's age, the nurse would expect to make which adjustment?
A.The drug may need to be administered more frequently.
B.The dosage of the drug may need to be decreased.
C.The route should be changed from oral to intramuscular.
D.The drug should be administered on an empty stomach.
A; the child will metabolize drugs faster (either reduce dosing interval or give more frequently)
A 15-month-old patient develops chemotherapy-induced nausea and vomiting. Which medication, if ordered by the healthcare provider, should the nurse question?
C (this causes resp. depression in young children)
Coumadin, a blood thinner, is generally unsafe for which developmental age?
- aspirin and others are safer
Anticholinergic drugs often cause what symptoms in older adults, making them contraindicated for geriatric PTs?
Dehydration and Blurry vision (increase risk of falls)
What are some measures to reduce adverse drug reactions (ADR) and drug interactions?
- Routinely reviewing a patient's medication list
- Collaborate with prescribers and pharmacists can help limit ADR and drug interactions in geriatric patients
- Monitor clinical responses and diagnostics to identify ADR earlier on in treatment
- Accommodate for age-related sensory issues
- Encourage patient to dispose of all old drugs
The nurse is assessing an 82-year-old patient before the administration of medications. Which laboratory result would provide the best index of renal this patient's function?
A. Serum creatinine
B. Blood urea nitrogen
D. Creatinine clearance
The nurse instructs an 82-year-old patient about over-the-counter medications that are generally safe for older adults. The nurse should intervene if the patient makes which of the following statements?
A. "I can take chlorpheniramine [Chlor-Trimeton] for allergies."
B. "If I have a headache, I should take acetaminophen [Tylenol]."
C. "Cetirizine [Zyrtec] would be safe to take for my allergies."
D. "I should avoid taking diphenhydramine [Benadryl] for hives."
A ; those are contraindicated for older patients
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