chap 2: Basic principals

Question 1

1. A patient’s nutritional intake and laboratory results reflect hypoalbuminemia. This is critical to prescribing because:
2. Distribution of drugs to target tissue may be affected.
3. The solubility of the drug will not match the site of absorption.
4. There will be less free drug available to generate an effect.
5. Drugs bound to albumin are readily excreted by the kidneys.

Answer 1

1. Distribution of drugs to target tissue may be affected.

Question 2

The route of excretion of a volatile drug will likely be the:

1. Kidneys
2. Lungs
3. Bile and feces
4. Skin

Answer 2

2. Lungs

Question 3

Medroxyprogesterone (Depo Provera) is prescribed intramuscularly (IM) to create a storage reservoir of the drug. Storage reservoirs:

1. Assure that the drug will reach its intended target tissue
2. Are the reason for giving loading doses
3. Increase the length of time a drug is available and active
4. Are most common in collagen tissues

Answer 3

3. Increase the length of time a drug is available and active

Question 4

5. The NP chooses to give cephalexin every 8 hours based on knowledge of the drug’s:
6. Propensity to go to the target receptor
7. Biological half-life
8. Pharmacodynamics
9. Safety and side effects

Answer 4

2. Biological half-life

Question 5

Azithromycin dosing requires that the first day’s dosage be twice those of the other 4 days of the prescription. This is considered a loading dose. A loading dose:

1. Rapidly achieves drug levels in the therapeutic range
2. Requires four- to five-half-lives to attain
3. Is influenced by renal function
4. Is directly related to the drug circulating to the target tissues

Answer 5

1. Rapidly achieves drug levels in the therapeutic range

Question 6

The point in time on the drug concentration curve that indicates the first sign of a therapeutic effect is the:

1. Minimum adverse effect level
2. Peak of action
3. Onset of action
4. Therapeutic range

Answer 6

3. Onset of action

Question 7

Phenytoin requires that a trough level be drawn. Peak and trough levels are done:

1. When the drug has a wide therapeutic range
2. When the drug will be administered for a short time only
3. When there is a high correlation between the dose and saturation of receptor sites
4. To determine if a drug is in the therapeutic range

Answer 7

4. To determine if a drug is in the therapeutic range

Question 8

A laboratory result indicates that the peak level for a drug is above the minimum toxic concentration. This means that the:

1. Concentration will produce therapeutic effects
2. Concentration will produce an adverse response
3. Time between doses must be shortened
4. Duration of action of the drug is too long

Answer 8

2. Concentration will produce an adverse response

Question 9

Drugs that are receptor agonists may demonstrate what property?

1. Irreversible binding to the drug receptor site
2. Upregulation with chronic use
3. Desensitization or downregulation with continuous use
4. Inverse relationship between drug concentration and drug action

Answer 9

3. Desensitization or downregulation with continuous use

Question 10

Drugs that are receptor antagonists, such as beta blockers, may cause:

1. Downregulation of the drug receptor
2. An exaggerated response if abruptly discontinued
3. Partial blockade of the effects of agonist drugs
4. An exaggerated response to competitive drug agonists

Answer 10

2. An exaggerated response if abruptly discontinued

Question 11

Factors that affect gastric drug absorption include:

1. Liver enzyme activity
2. Protein-binding properties of the drug molecule
3. Lipid solubility of the drug
4. Ability to swallow

Answer 11

3. Lipid solubility of the drug

Question 12

Drugs administered via IV:

1. Need to be lipid soluble in order to be easily absorbed
2. Begin distribution into the body immediately
3. Are easily absorbed if they are nonionized
4. May use pinocytosis to be absorbed

Answer 12

2. Begin distribution into the body immediately

Question 13

When a medication is added to a regimen for a synergistic effect, the combined effect of the drugs is:

1. The sum of the effects of each drug individually
2. Greater than the sum of the effects of each drug individually
3. Less than the effect of each drug individually
4. Not predictable, as it varies with each individual

Answer 13

2. Greater than the sum of the effects of each drug individually

Question 14

15. Which of the following statements about bioavailability is true?
16. Bioavailability issues are especially important for drugs with narrow therapeutic ranges or sustained-release mechanisms.
17. All brands of a drug have the same bioavailability.
18. Drugs that are administered more than once a day have greater bioavailability than drugs given once daily.
19. Combining an active drug with an inert substance does not affect bioavailability.

Answer 14

1. Bioavailability issues are especially important for drugs with narrow therapeutic ranges or sustained-release mechanisms.

Question 15

Which of the following statements about the major distribution barriers (blood-brain or fetal-placental) is true?

1. Water soluble and ionized drugs cross these barriers rapidly.
2. The blood-brain barrier slows the entry of many drugs into and from brain cells.
3. The fetal-placental barrier protects the fetus from drugs taken by the mother.
4. Lipid-soluble drugs do not pass these barriers and are safe for pregnant women.

Answer 15

2. The blood-brain barrier slows the entry of many drugs into and from brain cells

Question 16

Drugs are metabolized mainly by the liver via phase I or phase II reactions. The purpose of both of these types of reactions is to:

1. Inactivate prodrugs before they can be activated by target tissues
2. Change the drugs so they can cross plasma membranes
3. Change drug molecules to a form that an excretory organ can excrete
4. Make these drugs more ionized and polar to facilitate excretion

Answer 16

3. Change drug molecules to a form that an excretory organ can excrete

Question 17

Once they have been metabolized by the liver, the metabolites may be:

1. More active than the parent drug
2. Less active than the parent drug
3. Totally “deactivated” so they are excreted without any effect
4. All of the above

Answer 17

4. All of the above

Question 18

All drugs continue to act in the body until they are changed or excreted. The ability of the body to excrete drugs via the renal system would be increased by:

1. Reduced circulation and perfusion of the kidney
2. Chronic renal disease
3. Competition for a transport site by another drug
4. Unbinding a nonvolatile drug from plasma proteins

Answer 18

4. Unbinding a nonvolatile drug from plasma proteins

Question 19

Steady state is:

1. The point on the drug concentration curve when absorption exceeds excretion
2. When the amount of drug in the body remains constant
3. When the amount of drug in the body stays below the minimum toxic concentration
4. All of the above

Answer 19

2. When the amount of drug in the body remains constant

Question 20

Two different pain medications are given together for pain relief. The drug—drug interaction is:

1. Synergistic
2. Antagonistic
3. Potentiative
4. Additive

Answer 20

4. Additive

Question 21

Actions taken to reduce drug—drug interaction problems include all of the following EXCEPT:

1. Reducing the dosage of one of the drugs
2. Scheduling their administration at different times
3. Prescribing a third drug to counteract the adverse reaction of the combination
4. Reducing the dosage of both drugs

Answer 21

3. Prescribing a third drug to counteract the adverse reaction of the combination

Question 22

Phase I oxidative-reductive processes of drug metabolism require certain nutritional elements. Which of the following would reduce or inhibit this process?

1. Protein malnutrition
2. Iron-deficiency anemia
3. Both 1 and 2
4. Neither 1 nor 2

Answer 22

4. Neither 1 nor 2

Question 23

The time required for the amount of drug in the body to decrease by 50% is called:

1. Steady state
2. Half-life
3. Phase II metabolism
4. Reduced bioavailability time

Answer 23

2. Half-life

Question 24

An agonist activates a receptor and stimulates a response. When given frequently over time, the body may:

1. Upregulate the total number of receptors
2. Block the receptor with a partial agonist
3. Alter the drug’s metabolism
4. Downregulate the numbers of that specific receptor

Answer 24

4. Downregulate the numbers of that specific receptor

Question 25

Drug antagonism is best defined as an effect of a drug that: 1. Leads to major physiological and psychological dependence 2. Is modified by the concurrent administration of another drug 3. Cannot be metabolized before another dose is administered 4. Leads to a decreased physiological response when combined with another drug

Answer 25

2. Is modified by the concurrent administration of another drug

Question 26

Instructions to a client regarding self-administration of oral enteric-coated tablets should include which of the following statements? 1. “Avoid any other oral medicines while taking this drug.” 2. “If swallowing this tablet is difficult, dissolve it in 3 ounces of orange juice.” 3. “The tablet may be crushed if you have any difficulty taking it.” 4. “To achieve best effect, take the tablet with at least 8 ounces of fluid.”

Answer 26

4. “To achieve best effect, take the tablet with at least 8 ounces of fluid.”

Question 27

The major reason for not crushing a sustained-release capsule is that, if crushed, the coated beads of the drugs could possibly result in: 1. Disintegration 2. Toxicity 3. Malabsorption 4. Deterioration

Answer 27

2. Toxicity

Question 28

Which of the following substances is the most likely to be absorbed in the intestines rather than in the stomach? 1. Sodium bicarbonate 2. Ascorbic acid 3. Salicylic acid 4. Glucose

Answer 28

1. Sodium bicarbonate

Question 29

Which of the following variables is a factor in drug absorption? 1. The smaller the surface area for absorption, the more rapidly the drug is absorbed. 2. A rich blood supply to the area of absorption leads to better absorption. 3. The less soluble the drug, the more easily it is absorbed. 4. Ionized drugs are easily absorbed across the cell membrane.

Answer 29

2. A rich blood supply to the area of absorption leads to better absorption.

Question 30

An advantage of prescribing a sublingual medication is that the medication is: 1. Absorbed rapidly 2. Excreted rapidly 3. Metabolized minimally 4. Distributed equally

Answer 30

1. Absorbed rapidly

Question 31

Drugs that use CYP 3A4 isoenzymes for metabolism may: 1. Induce the metabolism of another drug 2. Inhibit the metabolism of another drug 3. Both 1 and 2 4. Neither 1 nor 2

Answer 31

3. Both 1 and 2

Question 32

Therapeutic drug levels are drawn when a drug reaches steady state. Drugs reach steady state: 1. After the second dose 2. After four to five half-lives 3. When the patient feels the full effect of the drug 4. One hour after IV administration

Answer 32

2. After four to five half-lives

Question 33

Upregulation or hypersensitization may lead to: 1. Increased response to a drug 2. Decreased response to a drug 3. An exaggerated response if the drug is withdrawn 4. Refractoriness or complete lack of response

Answer 33

3. An exaggerated response if the drug is withdrawn