Test Bank for Pharmacology an Introduction 7th Edition by Henry Hitner, Barbara Nagle by Academic Minute

Test Bank for Pharmacology an Introduction 7th Edition by Henry Hitner, Barbara Nagle

Chapter 01 - Introduction to Pharmacology

Chapter 01 Introduction to Pharmacology Multiple Choice Questions 1. Pharmacokinetics is the area of pharmacology that deals with the study of: A. the processes of drug absorption, distribution, metabolism, and excretion. B. the action of drugs on living tissue. C. the use of drugs in treating disease. D. the harmful effects of drugs on living tissue. Pharmacokinetics is the area of pharmacology that deals with the study of the processes of drug absorption, distribution, metabolism, and excretion.

ABHES: 6.a. Identify drug classification, usual dose, side effects, and contraindications of the top most commonly used medications Blooms: Remember CAAHEP: I.C.11.a. Identify the classifications of medications including indications for use Difficulty: 1 Easy Learning Outcome: 01.01

2. Which of the following is an example of a drug derived from a plant? A. Insulin B. Digitalis C. Cephalosporin D. Estradiol Examples of drugs derived from plants that are still widely used today include the analgesics morphine and codeine, which were obtained from the poppy plant (Papver somniferum); the heart drug digitalis, which was obtained from the purple foxglove (Digitalis purpurea); and the antimalarial drug quinine, which was obtained from the bark of the cinchona tree.

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Chapter 01 - Introduction to Pharmacology

3. Today, new drugs are mainly derived from: A. chemical synthesis. B. animals. C. plants. D. enzymatic synthesis. Despite the many examples of drugs obtained from plants and living organisms, the main source of new drugs today is from chemical synthesis.

4. Which of the following statements is true of toxicity? A. Toxic effects refer to those effects triggered by drugs that are undesirable but not harmful. B. The toxic effects of a drug can be life-threatening. C. The toxic effects of a drug can be controlled by increasing the dosage of the drug. D. Patients are often advised to t ol eraNt Ue RthSeINtoGxTiBc.iCtyOoMf a drug in order to benefit from the drug's therapeutic actions. Toxic effects, or toxicity, implies drug poisoning, the consequences of which can be extremely harmful and may be life-threatening.

ABHES: 6.d. Properly utilize Physician’s Desk Reference (PDR), drug handbook and other drug references to identify a drug’s classification, usual dosage, usual side effects, and contraindications. Blooms: Understand CAAHEP: I.C.11.a. Identify the classifications of medications including indications for use Difficulty: 2 Medium Learning Outcome: 01.02

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Chapter 01 - Introduction to Pharmacology

5. Which of the following statements is true of a drug? A. The effects produced by a drug are always desirable. B. The properties of a drug do not influence the effects it produces. C. A drug does not produce more than one effect. D. A pure drug is a chemical compound with a specific chemical structure. Every pure drug is a chemical compound with a specific chemical structure.

ABHES: 6.a. Identify drug classification, usual dose, side effects, and contraindications of the top most commonly used medications Blooms: Understand CAAHEP: I.C.11.a. Identify the classifications of medications including indications for use Difficulty: 2 Medium Learning Outcome: 01.02

6. Maria visits Dr. John's clinic for a medical consultation. After learning that Maria has been experiencing a severe case of cold and cough, Dr. John conducts a thorough physical examination and prescribes a cough syrup and cetirizine tablets for her symptoms. A few days later, Maria calls Dr. John and informs him that the medication has been making her feel drowsy. How is Dr. John most likely to respond? A. He will ask Maria to start taking aNdUiR ffSeIrNeG ntTdBo.CsO agMe of cetirizine. B. He will advise Maria to bear with the effects of the medication in order to benefit from its therapeutic actions. C. He will advise Maria to stop taking the tablets immediately and to visit his clinic for another examination. D. He will ask Maria to stop taking the drug and immediately rush to her house to administer an antidote. In this case, Maria is most likely experiencing the side effects of the drug. Many side effects are more of a nuisance than they are harmful. Dr. John will advise Maria to bear with the side effects of the medication in order to benefit from its therapeutic actions.

ABHES: 6.a. Identify drug classification, usual dose, side effects, and contraindications of the top most commonly used medications Blooms: Analyze CAAHEP: I.C.11.c. Identify the classifications of medications including side effects Difficulty: 3 Hard Learning Outcome: 01.02

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Chapter 01 - Introduction to Pharmacology

7. Examples of common adverse effects include all of the following except: A. persistent diarrhea. B. vomiting. C. confusion. D. anaphylaxis. Adverse effects are also undesired effects, but these are effects that may be harmful (persistent diarrhea, vomiting, or central nervous system disturbances such as confusion) or that with prolonged treatment may cause conditions that affect the function of vital organs such as the liver or kidney.

8. Drugs that bind to specific receptors and produce a drug action are called A. repressors B. antagonists C. agonists D. modulators

Drugs that bind to specific receptors and produce a drug action are called agonists.

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Chapter 01 - Introduction to Pharmacology

9. A group of interns at Wingsdale Hospital are watching Dr. Gerald and his team perform a surgery. During the surgery, Dr. Gerald resuscitates his patient from cardiac arrest by giving her an intravenous injection of epinephrine. As soon as the patient's condition improves, Dr. Gerald explains to his interns that when epinephrine binds to the beta receptors of the heart, it triggers an increase in heart rate and blood pressure. Based on the information provided in this scenario, we can conclude that epinephrine is acting as a(n): A. antagonist. B. modulator. C. agonist. D. partial antagonist. Based on the information provided in this scenario, we can conclude that epinephrine is acting as an agonist. Drugs that bind to specific receptors and produce a drug action are called agonists.

10. Identify a difference between agonists and antagonists. A. Agonists bind to specific receptors to trigger a drug action, while antagonists bind to specific receptors to block a drug action. B. Agonists bind to receptors and prevent them from being activated, while antagonists bind to receptors to activate them. C. Agonists bind to a specific receptor site in the body, while antagonists can bind to any receptor site in the body. D. A typical example of an agonist is naloxone, while a typical example of an antagonist is morphine. Drugs that bind to specific receptors and produce a drug action are called agonists. Drugs that bind to specific receptors and block agonist drug action or cellular functions are called antagonists.

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Chapter 01 - Introduction to Pharmacology

11. During a pharmaceutical class, Dr. Patrick explains how a certain class of antipsychotic drugs prevents dopamine from producing its effects by blocking specific membrane receptors for dopamine. As a result, dopamine cannot stimulate its receptors to trigger certain cellular functions, and its effects are no longer experienced. After the discussion, Dr. Patrick asks his students to describe the action of the antipsychotic drugs. Which of the following responses from his students is the most accurate? A. The antipsychotic drugs act as agonists. B. The antipsychotic drugs act as antagonists. C. The antipsychotic drugs act as modulators. D. The antipsychotic drugs act as inducers. In this case, the antipsychotic drugs are behaving like antagonists. Drugs that bind to specific receptors and block agonist drug action or cellular functions are called antagonists.

12. Competitive antagonism occurs when: A. two agonists compete for the same receptor. B. an agonist and an antagonist compete for the same receptor. C. an antagonist directly inactivates an agonist. D. an antagonist cancels out the effect of an agonist by binding to a unique receptor. When both agonist and antagonist drugs bind to the same receptor and are administered together, they compete with each other for the same receptor site. This effect is known as competitive antagonism.

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Chapter 01 - Introduction to Pharmacology

13. James, a health care professional, states that the drug morphine is an agonist. Which of the following supports his statement? A. Morphine binds to specific receptor sites in the body and triggers a series of cellular changes. B. Morphine is immediately absorbed by the cells of the body and metabolized. C. Morphine binds to specific receptor sites in the body and inhibits certain cellular functions. D. Morphine binds to specific sites in the body and signals surrounding drug molecules to the area. Morphine is an example of an agonist. Drugs that bind to specific receptors and produce a drug action are called agonists.

ABHES: 6.a. Identify drug classification, usual dose, side effects, and contraindications of the top most commonly used medications Blooms: Analyze CAAHEP: I.C.11.a. Identify the classifications of medications including indications for use Difficulty: 3 Hard Learning Outcome: 01.03

14. Mrs. Breaux, a patient at St. An thNoUnRyS' sI NHGoTs Bp .iCt aOl ,Mal m o st became comatose after receiving an overdose of morphine. In order to reverse this effect, the doctor ordered the administration of naloxone, which served as a(n): A. partial agonist. B. agonist. C. modulator. D. antagonist. Naloxone, a morphine antagonist, is administered to prevent, or antagonize, the effects of morphine in cases of morphine overdose. Usually, antagonists bind to a specific receptor to displace or prevent an agonist drug or body substance from activating that receptor.

ABHES: 6.a. Identify drug classification, usual dose, side effects, and contraindications of the top most commonly used medications Blooms: Apply CAAHEP: I.C.11.a. Identify the classifications of medications including indications for use Difficulty: 2 Medium Learning Outcome: 01.03

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Chapter 01 - Introduction to Pharmacology

15. Identify an accurate statement about the dose-response relationship. A. A drug response is inversely proportional to the dose. B. The magnitude of a drug response decreases with an increase in its dose. C. Drugs that continue to show an increase in drug response with an increase in dosage have a ceiling effect. D. Above a certain dosage no further increase in effect is observed. Above a certain dosage no further increase in effect is observed. Doses above those needed to produce the ceiling effect usually cause other undesired, often toxic, drug effects.

16. is a measure of the strength, or concentration, of a drug required to produce a specific effect. A. Toxicity B. Affinity C. Potency D. Bioavailability Potency is a measure of the strength, or concentration, of a drug required to produce a specific effect.

ABHES: 3.a. Define and use entire basic structure of medical words and be able to accurately identify in the correct context, i.e. root, prefix, suffix, combinations, spelling, and definitions Blooms: Remember CAAHEP: I.C.11.a. Identify the classifications of medications including indications for use Difficulty: 1 Easy Learning Outcome: 01.04

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Chapter 01 - Introduction to Pharmacology

17. The phenomenon that occurs upon taking additional doses of acetaminophen for pain when a 100 percent response has been attained is called the . A. ceiling effect B. placebo effect C. first-pass effect D. Purkinje effect The ceiling effect reflects the limit of some drug classes to produce a particular effect. Above a certain dosage no further increase in effect is observed.

18. Which of the following values can be derived from a drug-response curve and used to compare the potency of drugs that produce the same response? A. Infusion rate B. Half-life C. Effective dose 50 D. Drug clearance The effective dose 50 (ED50) can be derived from a drug-response curve and used to compare the potency of drugs that produce the same response.

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Chapter 01 - Introduction to Pharmacology

19. Consider a graded dose-response curve plotted for a drug. Toward which direction would the dose-response curve shift if the curve were plotted for a more potent drug? A. Up B. Down C. Left D. Right Consider the ED50 of drug A as 10 mg and of drug B as 20 mg. Therefore, drug A is twice as potent as drug B. When a graded dose-response curve is plotted, the curve shifts to the left for the more potent medication.

ABHES: 6.b. Demonstrate accurate occupational math and metric conversions for proper medication administration Blooms: Analyze CAAHEP: I.C.11.a. Identify the classifications of medications including indications for use CAAHEP: II.C.6.a. Analyze healthcare results as reported in graphs Difficulty: 2 Medium Learning Outcome: 01.04

20. What type of curve should be used for representing data when a proper dosing frequency is being determined? A. A time-response curve B. A scatter plot C. A graded dose-response curve D. A quantal dose-response curve The relationship of time and the plasma drug concentration is known as the time-plasma drug concentration curve or time-response curve since it reflects the duration of action. Timeplasma drug concentration curves are used for predicting the frequency with which a drug must be administered in order to maintain an effective drug response.

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Chapter 01 - Introduction to Pharmacology

21. David is analyzing the drug-response relationships of two different drugs, drug A and drug B. Drug A and drug B belong to the same class of drugs. During his study, David discovers that drug A produces the ceiling effect at a much lower dosage than drug B. What does this imply? A. Drug B is more potent than drug A. B. Drug A is more potent than drug B. C. The effective dose 50 (ED50) of drug B is lower than the ED50 of drug A. D. Drug dosage and drug response are independent of each other. In this case, drug A is more potent than drug B. Drugs within a drug class that are more potent than other drugs in the same class will produce the ceiling effect at a lower dosage, but they will not “raise the ceiling.”

22. What will be the effect of taking two aspirin tablets instead of one? A. The analgesic effect of the drug will decrease. B. The analgesic effect of the drug will increase. C. There will be no change in the analgesic effect of the drug. D. The drug will result in adverse toxic effects. In this case, the analgesic effect of the drug will increase. The main feature of the doseresponse relationship is that a drug response is proportional to the dose. As the dose increases, so does the magnitude of the response.

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Chapter 01 - Introduction to Pharmacology

23. Which of the following would not be considered an adverse effect of taking an oral antibiotic? A. Extravasation B. Diarrhea C. Nausea D. Vomiting Oral drugs often cause nausea, vomiting, and diarrhea because of gastrointestinal (GI) irritation.

24. The lethal dose 50 of a drug is 2500 mg, and the effective dose 50 of the drug is 250 mg. The therapeutic index of the drug will be . A. 10 B. 0.1 C. 25 D. 2.5 In this case, the therapeutic index of the drug will be 10. The therapeutic index (TI) is a ratio of the lethal dose 50 (LD50) to the effective dose 50 (ED50) of a drug. This index indicates that ten times as much drug is needed to produce a lethal effect in 50 percent of the animals as is needed to produce the therapeutic effect in 50 percent of the animals.

ABHES: 6.b. Demonstrate accurate occupational math and metric conversions for proper medication administration Blooms: Apply CAAHEP: I.P.4.c. Verify the rules of medication administration right dose CAAHEP: II.C.2. Apply mathematical computations to solve equations Difficulty: 2 Medium Learning Outcome: 01.05

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Chapter 01 - Introduction to Pharmacology

25. The therapeutic index of drug A is 10, and its effective dose 50 (ED50) is 200 mg. What is the lethal dose 50 (LD50) of drug A? A. 20 mg B. 2000 mg C. 100 mg D. 400 mg The LD50 of drug A is 2000 mg. The therapeutic index (TI) is a ratio of the LD50 to the ED50 of a drug. The equation is expressed as TI = LD50/ED50. Therefore, LD50 is equal to the product of the therapeutic index and ED50.

ABHES: 6.d. Properly utilize Physician’s Desk Reference (PDR), drug handbook and other drug references to identify a drug’s classification, usual dosage, usual side effects, and contraindications. Blooms: Analyze CAAHEP: I.P.4.c. Verify the rules of medication administration right dose CAAHEP: II.C.2. Apply mathematical computations to solve equations Difficulty: 3 Hard Learning Outcome: 01.05

26. Three medications have the following therapeutic index values: 2, 4, and 0.5. Which medication is the safest? A. The medication with the therapeutic index value of 0.5 B. The medication with the therapeutic index value of 2 C. The medication with the therapeutic index value of 4 D. None of these medications The therapeutic index (TI) is a ratio of the lethal dose 50 (LD50) to the effective dose 50 (ED50) of a drug. A therapeutic index value of four indicates that four times as much drug is needed to produce a lethal effect in 50 percent of the animals as is needed to produce the therapeutic effect in 50 percent of the animals.

ABHES: 6.d. Properly utilize Physician’s Desk Reference (PDR), drug handbook and other drug references to identify a drug’s classification, usual dosage, usual side effects, and contraindications. Blooms: Analyze CAAHEP: I.C.11.a. Identify the classifications of medications including indications for use CAAHEP: I.P.4.b. Verify the rules of medication administration right medication CAAHEP: I.P.4.c. Verify the rules of medication administration right dose Difficulty: 3 Hard Learning Outcome: 01.05

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Chapter 01 - Introduction to Pharmacology

27. Which of the following would not be considered a dose-dependent adverse effect of a drug? A. Nausea B. Liver damage C. Kidney damage D. Idiosyncrasy A few adverse drug effects are not dose-dependent. These effects, such as drug idiosyncrasy and drug allergy, are determined by individual variation.

28. Drugs, such as thalidomide, that produce birth defects are known as A. mutagens B. carcinogens C. teratogens D. allergens

Drugs, such as thalidomide, that produce birth defects are known as teratogens.

ABHES: 6.d. Properly utilize Physician’s Desk Reference (PDR), drug handbook and other drug references to identify a drug’s classification, usual dosage, usual side effects, and contraindications. Blooms: Remember CAAHEP: I.C.11.a. Identify the classifications of medications including indications for use CAAHEP: I.C.11.d. Identify the classifications of medications including adverse reactions Difficulty: 1 Easy Learning Outcome: 01.05

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Chapter 01 - Introduction to Pharmacology

29. Which of the following statements is true of drug nomenclature? A. The nonproprietary name of a drug is usually a contraction of its chemical name. B. The proprietary name of a drug is more commonly referred to as the generic name. C. A drug can have several different generic names. D. The name under which a drug is marketed is known as its nonproprietary name. All drugs are chemicals, and many have long chemical-names. As a result, all drugs are given a shorter name, known as the nonproprietary name, which is usually a contraction of the chemical name.

30. The nonproprietary name of a medication is more commonly known as its A. trade name B. generic name C. chemical name D. brand name

The nonproprietary name is more commonly referred to as the generic name.

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Chapter 01 - Introduction to Pharmacology

31. Orion laboratories, a pharmaceutical manufacturing company, manufactures the drug cetirizine and markets the tablets under the name "Alzer." In this case, cetirizine is the name of the drug. A. proprietary B. generic C. trade D. brand In the case, cetirizine is the generic name of the drug. All drugs are given a shorter name, known as the nonproprietary name, which is usually a contraction of the chemical name. The nonproprietary name is more commonly referred to as the generic name.

32. Which of the following is a drug information service that is updated on a monthly basis with the most current drug informatioNnU? RSINGTB.COM A. The Physicians' Desk Reference B. Drug Facts and Comparisons C. The United States Pharmacopeia/National Formulary D. Drug Information—American Hospital Formulary Service Drug Facts and Comparisons (F&C) is a loose-leaf index that provides the most current drug information on a regular basis. Drug information and new drug additions are updated monthly.

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Chapter 01 - Introduction to Pharmacology

33. Which of the following statements is true of the United States Pharmacopeia/National Formulary (USP/NF)? A. It is updated once in every six months. B. It is primarily used by physicians and nurses for information relating to the use of drugs in the practice of medicine. C. It is primarily used by drug manufacturers to ensure that drug production adheres to official government standards. D. It provides the most current drug information on a regular basis. The United States Pharmacopeia/National Formulary (USP/NF) is primarily used by drug manufacturers to ensure that drug production adheres to official government standards.

ABHES: 6.e. Comply with federal, state, and local health laws and regulations Blooms: Understand CAAHEP: I.C.11.a. Identify the classifications of medications including indications for use CAAHEP: I.C.12. Identify quality assurance practices in healthcare Difficulty: 2 Medium Learning Outcome: 01.07

34. The of 1970 was designedNtU o RreSgINuGlaTteB.tChOe Mdispensing of drugs that have the potential to be misused. A. Federal Food Drug and Cosmetic Act B. Federal Pure Food and Drug Act C. Federal Comprehensive Drug Abuse Prevention and Control Act D. Regulated Health Professions Act

The Federal Comprehensive Drug Abuse Prevention and Control Act of 1970 was designed to regulate the dispensing of drugs, called controlled substances, that have the potential for abuse.

ABHES: 6.c.3 Comply with legal aspects of creating prescriptions, including federal and state laws ABHES: 6.e. Comply with federal, state, and local health laws and regulations Blooms: Remember CAAHEP: I.C.12. Identify quality assurance practices in healthcare Difficulty: 1 Easy Learning Outcome: 01.07

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Chapter 01 - Introduction to Pharmacology

35. In the context of the drug schedules defined in the Federal Comprehensive Drug Abuse Prevention and Control Act, identify an accurate statement about schedule I drugs. A. These drugs are prescribed by physicians for a narrow range of medical conditions. B. These drugs have a high potential for abuse and no accepted medical use. C. This category of drugs includes narcotics such as morphine and pure codeine. D. These drugs have a very low potential for abuse and are widely used in medical treatment. Schedule I drugs have a high potential for abuse and no accepted medical use.

ABHES: 6.c.3 Comply with legal aspects of creating prescriptions, including federal and state laws ABHES: 6.d. Properly utilize Physician’s Desk Reference (PDR), drug handbook and other drug references to identify a drug’s classification, usual dosage, usual side effects, and contraindications. Blooms: Understand CAAHEP: I.C.12. Identify quality assurance practices in healthcare Difficulty: 2 Medium Learning Outcome: 01.07

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Chapter 02 - Pharmacokinetics and Factors of Individual Variation

Chapter 02 Pharmacokinetics and Factors of Individual Variation Multiple Choice Questions 1. Identify the term used for the process by which a drug enters the bloodstream from its site of administration. A. Drug absorption B. Drug excretion C. Drug distribution D. Drug metabolism Drug absorption refers to the entrance of a drug into the bloodstream from its site of administration.

2. Identify the drug that is available as a transdermal patch system. A. Nitroglycerin B. Clonidine C. Estrogen D. All of the above Transdermal products are administered through a bandage or patch system. Nitroglycerin, estrogen, and clonidine are drugs available in this form.

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Chapter 02 - Pharmacokinetics and Factors of Individual Variation

3. Identify the drug form that contains dried and finely ground drugs or drug extracts. A. Powders B. Tablets C. Troches D. Capsules Powders are drugs or drug extracts that are dried and ground into fine particles.

4. Identify the medical condition that the drug form known as a "troche" is commonly used to treat. A. Asthma B. Bradycardia C. Sore throat D. Toothache Troches are flattened tablets that are allowed to dissolve in the mouth. They are commonly used for colds and sore throats.

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Chapter 02 - Pharmacokinetics and Factors of Individual Variation

5. Among the factors that affect drug distribution, the factor that plays the biggest role in determining the concentration of a drug that penetrates the brain by overcoming the blood– brain barrier is: A. lipid solubility. B. blood circulation. C. plasma protein binding. D. GI absorption rate. An additional lipid barrier, the blood–brain barrier, protects the brain by restricting the passage of electrolytes and other water-soluble substances. Since the brain is composed of a large amount of lipid (nerve membranes and myelin), lipid-soluble drugs pass readily into the brain. As a general rule, then, a drug must have a certain degree of lipid solubility if it is to penetrate this barrier and gain access to the brain.

ABHES: 2.a. List all body systems, their structure and functions Blooms: Understand CAAHEP: I.C.7. Describe the normal function of each body system Difficulty: 1 Easy Learning Outcome: 02.02

6. Identify the drug preparation that is described as a solution containing water, sugar, and a drug. A. Elixir B. Tincture C. Syrup D. Fluid extract Syrups are commonly used aqueous preparations. A syrup is a solution of water and sugar to which a drug is added.

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Chapter 02 - Pharmacokinetics and Factors of Individual Variation

7. The processes of drug absorption, drug distribution, drug metabolism, and drug excretion are components of the study known as . A. synergism B. pharmacokinetics C. bioavailability D. enzyme induction Pharmacokinetics is a study of the factors that determine drug absorption, drug distribution, drug metabolism, and drug excretion.

ABHES: 3.a. Define and use entire basic structure of medical words and be able to accurately identify in the correct context, i.e. root, prefix, suffix, combinations, spelling, and definitions Blooms: Understand CAAHEP: I.C.11.a. Identify the classifications of medications including indications for use Difficulty: 1 Easy Learning Outcome: 02.02

8. Identify the usual range of alcohol concentration used in alcoholic preparations of drugs such as elixirs, spirits, tinctures, and fluid extracts. A. 35 to 45 percent B. 25 to 35 percent C. 20 to 25 percent D. 5 to 20 percent Elixirs, spirits, tinctures, and fluid extracts are drugs dissolved in various concentrations of alcohol, usually in the range of 5 to 20 percent.

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Chapter 02 - Pharmacokinetics and Factors of Individual Variation

9. The fact that adipose tissue receives a relatively poor blood supply indicates that adipose tissue: A. accumulates large amounts of drug. B. does not accumulate large amounts of drug. C. does not accumulate lipid-soluble drugs. D. metabolizes large amounts of drug. Some tissues, such as adipose tissue, receive a relatively poor blood supply and, as a result, do not accumulate large amounts of drug.

ABHES: 2.a. List all body systems, their structure and functions Blooms: Understand CAAHEP: I.C.7. Describe the normal function of each body system Difficulty: 1 Easy Learning Outcome: 02.02

10. A patient's dose of an analgesic agent that he uses to manage chronic pain is increased twice over a span of six months. In the context of the terms drug tolerance, drug dependence, and drug addiction, identify the reason for the increase in the dosage. sU t hReSeINf fGecTtBo.Cf OaMdrug. A. Repeated administration decrease N B. Reliance on the administration of a drug leads to a psychological dependence on the drug. C. Compulsive dependence on a drug dominates all other activities in the patient's life. D. None of the above statements are correct. Drug tolerance is defined as a decreased drug effect that occurs after repeated administration. In order to attain the previous drug effect, the dosage must be increased.

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Chapter 02 - Pharmacokinetics and Factors of Individual Variation

11. Use a half-life of 8 hours to determine the amount of a drug left in the body at 4 p.m. if a 500-mg dose of the drug was taken at 8 a.m. A. 250 mg B. 125 mg C. 375 mg D. None of the above The half-life of a drug is the time required for the blood or plasma concentration of the drug to fall to half of its original level. The number of hours that have lapsed between 8 a.m. and 4 p.m. is 8 hours. The half-life of the drug is 8 hours; this implies that one half-life has elapsed since the administration of the drug. The amount of the drug remaining at 4 p.m. is 50 percent of its initial dose (50%  500 mg = 250 mg).

ABHES: 6.b. Demonstrate accurate occupational math and metric conversions for proper medication administration Blooms: Apply CAAHEP: II.C.2. Apply mathematical computations to solve equations Difficulty: 2 Medium Learning Outcome: 02.03

12. Use a half-life of 4 hours to d e t e rNmUi nR eS I tNh Ge TaBm. Co Ou nMt of a drug left in the body at 2 p.m. if a dose of 200 mg was administered intravenously at 6 a.m. A. 25 mg B. 12.5 mg C. 50 mg D. None of the above The half-life of a drug is the time required for the blood or plasma concentration of the drug to fall to half of its original level. The number of hours that have elapsed between 6 a.m. and 2 p.m. is 8 hours. The half-life of the drug is 4 hours; this implies that two half-lives have elapsed since the administration of the drug. The amount of the drug remaining at 2 p.m. is 25 percent of its initial dose (25%  200 mg = 50 mg).

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Chapter 02 - Pharmacokinetics and Factors of Individual Variation

13. A patient education program should include educating patients on the effective administration of drugs. How should patients be instructed to take enteric-coated products? A. On an empty stomach with water B. One hour before meals C. Two hours after meals D. All of these are correct. Enteric-coated products should be taken on an empty stomach with water, either 1 hour before or 2 hours after meals.

14. In terms of patient safety and ease of drug administration, identify the most convenient route of drug administration for a patient with a busy lifestyle and a hectic schedule. A. Intramuscular administration B. Oral administration C. Topical administration D. Intravenous administration Whenever possible, the oral administration route is the safest and the most convenient method.

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Chapter 02 - Pharmacokinetics and Factors of Individual Variation

15. Which of the following routes of drug administration has the slowest onset of action? A. Inhalation B. Transdermal C. Intramuscular D. Sublingual The transdermal route of administration has an onset of action at approximately 30 to 60 minutes.

16. Which of the following routes of drug administration has the fastest onset of action? A. Inhalation B. Transdermal C. Intramuscular D. Sublingual The inhalation route of administration has an onset of action of less than a minute from the time of administration.

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Chapter 02 - Pharmacokinetics and Factors of Individual Variation

17. In the context of the factors of individual variation that alter the effect of a drug, select the statement that best describes the placebo effect. A. Excitement can lead to perceived symptom improvement. B. Positive attitude can lead to perceived symptom improvement. C. Less body fat can lead to perceived symptom improvement. D. None of the above statements are correct. It has been observed that if patients have a positive attitude and think that the drug or treatment will help, chances are the patients claim an improvement whether there actually is one or not.

18. Differentiate between the routes of drug administration in order to select the route that is restricted to use in a hospital setting dNuUeRtoSIiNmGm ed.CiaOtM e onset of action and high percentage of TB drug bioavailability. A. Intramuscular injection method B. Intravenous injection method C. Topical application method D. Suppository insertion method Intravenous (IV) injection is usually restricted to use in the hospital. IV injection offers the fastest means of drug absorption because the drug is delivered directly into the circulation; therefore, the onset of drug action is almost immediate.

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Chapter 02 - Pharmacokinetics and Factors of Individual Variation

19. Which transport mechanism is used by cells to allow drugs to pass through the cell membrane? A. Filtration B. Passive transport C. Active transport D. All of the above Cells have special transport mechanisms that allow various substances (including drugs) to pass through the cell membrane. These mechanisms include filtration, passive transport, and active transport.

ABHES: 2.a. List all body systems, their structure and functions Blooms: Analyze CAAHEP: I.C.7. Describe the normal function of each body system Difficulty: 3 Hard Learning Outcome: 02.02

20. Select the basic principle in passive transport by which most drug molecules diffuse through cell membranes. raTtBio.CnOtoMan area of low concentration. A. Drug passes from an area of high NcoUnRcSeInNtG B. Drug passes from an area of low concentration to an area of high concentration. C. Drug passes from an area of high concentration to an area of high concentration. D. Drug passes from an area of low concentration to an area of low concentration. Most drugs pass through membranes by passive transport. An important principle in passive transport is that the concentration of drug on each side of the membrane differs. In passive transport, drug molecules diffuse from an area of high concentration to an area of low concentration (law of diffusion).

ABHES: 2.a. List all body systems, their structure and functions Blooms: Analyze CAAHEP: I.C.7. Describe the normal function of each body system Difficulty: 3 Hard Learning Outcome: 02.02

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Chapter 02 - Pharmacokinetics and Factors of Individual Variation

21. Differentiate between tolerance, antagonism, and synergism in order to select the drug interaction that occurs during antagonism. A. The combined effect of two drugs, by the same mechanism of action, is equal to the sum of their individual effects. B. The combined effect of two drugs, by different mechanisms of action, is equal to the sum of their individual effects. C. The combined effect of two drugs is less than the sum of their individual effects. D. The combined effect of two drugs is greater than the sum of their individual effects. Antagonism occurs when the combined effect of two drugs is less than the sum of their individual effects.

22. In the context of the FDA P re gn aNn Uc yR SCI NatGe gT oB r. Ci eOs Mf or drugs, identify the proper category for a drug for which studies on animals have not demonstrated fetal risk and no studies have been performed in pregnant women. A. Pregnancy Category A B. Pregnancy Category B C. Pregnancy Category D D. None of the above Pregnancy Category B: Drug studies have not been performed in pregnant women and animal studies have not demonstrated fetal risk.

ABHES: 6.e. Comply with federal, state, and local health laws and regulations Blooms: Analyze CAAHEP: I.C.11.a. Identify the classifications of medications including indications for use Difficulty: 3 Hard Learning Outcome: 02.05

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Chapter 02 - Pharmacokinetics and Factors of Individual Variation

23. When differentiating between enzyme induction and enzyme inhibition, enzyme induction can be interpreted as resulting in: A. an increase in the rate of drug metabolism in the liver, leading to a decreased duration of action. B. a decrease in the rate of drug metabolism in the liver, leading to a decreased duration of action. C. a decrease in the bioavailability of the drug, leading to an increased duration of action. D. none of the above. By stimulating the drug microsomal metabolizing system, the drugs actually increase the amount of enzymes (cytochrome P450s) in the system; this process is referred to as enzyme induction. With an increase in the amount of enzymes, there is a faster rate of drug metabolism. Consequently, the duration of drug action is decreased for all drugs metabolized.

ABHES: 2.a. List all body systems, their structure and functions Blooms: Analyze CAAHEP: I.C.7. Describe the normal function of each body system Difficulty: 3 Hard Learning Outcome: 02.02

24. Identify a difference between free drug molecules and drug molecules that are bound to plasma proteins. A. Only unbound or free drug molecules can exert a pharmacological effect. B. Only the drug molecules that are bound to plasma can exert a pharmacological effect. C. Free drug molecules exert a lower level of pharmacological effect than drug molecules that are bound to plasma. D. None of the above statements are correct. Only unbound or free drug molecules can exert a pharmacological effect.

ABHES: 2.a. List all body systems, their structure and functions Blooms: Analyze CAAHEP: I.C.11.b. Identify the classifications of medications including desired effects Difficulty: 3 Hard Learning Outcome: 02.02

2-12

Chapter 02 - Pharmacokinetics and Factors of Individual Variation

25. You have been asked to explain to a patient the possibility that he will experience drug interactions while taking his newly prescribed medications. Select the appropriate statement you will use when explaining synergism to the patient. A. Drugs may increase each other's effect to the equivalent of the sum of their individual effects. B. Drugs may increase each other's effect to an amount that is greater than the sum of their individual effects. C. Drugs may cancel each other's effect or lead to a response that is less than the sum of their individual effects. D. None of the above statements are correct. Synergism occurs when the combined effect of two drugs is greater than the sum of their individual effects.

26. Select the drug administration method by which the bioavailability of the drug in the circulatory system will be 100 percent immediately after the administration. A. Subcutaneous injection method B. Inhalation method C. Transdermal patch method D. Intravenous injection method Bioavailability is the percentage of the dose of a drug that is actually absorbed into the bloodstream. Differences in drug formulation, route of administration, and factors that affect gastrointestinal (GI) absorption can influence bioavailability. In intravenous (IV) administration of a drug, the drug is delivered directly into the circulation.

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Chapter 02 - Pharmacokinetics and Factors of Individual Variation

27. Select the most appropriate reason why a patient with cirrhosis of the liver may not get the therapeutic response expected from the medication that she is taking. A. The patient's ability to absorb drugs is impaired. B. The patient's ability to distribute drugs throughout the body is impaired. C. The patient's ability to metabolize drugs is impaired. D. The patient's ability to maintain bioavailability of drugs is impaired. Drug metabolism, also referred to as biotransformation, is the chemical alteration of drugs and foreign compounds in the body. The liver is the main organ involved in drug metabolism.

ABHES: 2.b. Describe common diseases, symptoms and etiologies as they apply to each system Blooms: Analyze CAAHEP: I.C.11.a. Identify the classifications of medications including indications for use Difficulty: 3 Hard Learning Outcome: 02.02

28. A patient is instructed to take two tablets orally on the first day and then take one tablet orally daily for the next four days. Select the term that refers to the instruction to take two tablets by mouth on the first day. A. Maintenance dose B. Therapeutic dose C. Loading dose D. None of the above A loading dose is usually an initial higher dose of drug, often administered IV, to rapidly attain the therapeutic drug level and drug effects. Loading doses are usually followed by maintenance doses that are smaller and calculated to maintain the drug level within the therapeutic range.

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Chapter 02 - Pharmacokinetics and Factors of Individual Variation

29. Select the most likely reason why a patient who has been diagnosed with end-stage renal disease must have routine blood work drawn to check his plasma levels of a prescribed drug. A. Due to the renal disease, the patient will be unable to effectively eliminate the drug, causing accumulation of the drug in the plasma. B. Due to the renal disease, the patient will be unable to effectively metabolize the drug, causing low levels of the drug in the plasma. C. Due to the renal disease, the patient will be unable to effectively absorb the drug, causing low levels of the drug in the plasma. D. None of the above statements are correct. Patients with hepatic or renal disease suffer a greater incidence of adverse drug effects because they are unable to eliminate the drug and its metabolites effectively. Consequently, plasma drug levels are much higher in these patients due to accumulation of the drug in the plasma.

ABHES: 2.b. Describe common diseases, symptoms and etiologies as they apply to each system Blooms: Analyze CAAHEP: I.C.11.d. Identify the classifications of medications including adverse reactions Difficulty: 3 Hard Learning Outcome: 02.04

30. A surgical team decides to use a spinal anesthetic to aid the surgery on a patient’s spinal cord. The preferred route of administration for such anesthetic is . A. intrathecal B. intraarterial C. inhalation D. transdermal The preferred route of administration to achieve local effects within the spinal cord is intrathecal. Drugs administered through this route take several minutes for onset of action.

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Chapter 02 - Pharmacokinetics and Factors of Individual Variation

31. Suzan returns from a day at the beach and realizes that she has sunburns on her arms and legs. Although not severe, the burns cause Suzan some discomfort. Suzan applies a moisturizing cream that contains aloe vera extracts. In this scenario, the route of administration is . A. intravenous B. topical C. oral D. sublingual The route of administration in this scenario is topical. A topical route of administration is used for local effects on the skin, eye, or ear. Medications that use the topical route include creams and ointments.

32. A patient presents with symptoms of malaria and the physician prescribes a basic drug to treat the patient. The patient skips a dose of the drug and tries to compensate the next time by consuming more than the recommended dosage. This leads to drug overdose. How should this drug toxicity be treated? A. The patient’s urine must be alkalinized. B. The patient’s urine must be acidified. C. An alternative drug must be prescribed to treat malaria. D. An alternative drug, preferably an acidic drug, must be prescribed to treat malaria. The acidic and basic natures of drugs are useful in treating drug toxicity (overdose). Drugs are generally excreted by the kidneys in an ionized form. To increase drug excretion, the pH of the urine can be altered. Basic drugs are more rapidly excreted by acidifying the urine.

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Chapter 02 - Pharmacokinetics and Factors of Individual Variation

33. A patient is prescribed a drug preparation that contains barbiturates to treat a medical condition. The patient is also being treated with medications for other medical conditions. After a few days of consuming the barbiturate-containing medication, the patient realizes that his other medical conditions have worsened. What is the most likely reason for this occurrence? A. The barbiturate medication is causing drug overdose. B. The previous medications are causing enzyme inhibition and blocking the effects of the barbiturate medication. C. The barbiturate medication is causing enzyme induction. D. The patient has developed tolerance to both the barbiturate medication and his previous medications. The most likely reason for this occurrence is that the barbiturate medication is causing enzyme induction. When barbiturates and other sedative hypnotic drugs are taken repeatedly, they stimulate the drug microsomal metabolizing system. By stimulating this system, the drugs actually increase the amount of enzymes (cytochrome P450s) in the system; this process is referred to as enzyme induction.

34. Veronica is being treated with amphetamines for narcolepsy. After a month of treatment, the medication begins to have a reduced effect on Veronica’s medical condition. This scenario exemplifies . A. first-pass metabolism B. enzyme inhibition C. enzyme induction D. drug tolerance Drug tolerance is defined as a decreased drug effect that occurs after repeated administration. This scenario exemplifies drug tolerance.

ABHES: 2.c. Identify diagnostic and treatment modalities as they relate to each body system Blooms: Apply CAAHEP: I.C.11.a. Identify the classifications of medications including indications for use Difficulty: 3 Hard Learning Outcome: 02.07

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Chapter 02 - Pharmacokinetics and Factors of Individual Variation

35. William is narcoleptic and his physician prescribes amphetamines to treat his medical condition. After a few months of treatment, William’s medical condition improves and the physician reduces the required dosage of amphetamines. However, the reduced dosage produces unpleasant feelings associated with withdrawal symptoms. William doubles the dosage to counter what he perceives as drug tolerance without consulting his physician and begins consuming more than the recommended dosage regularly. This scenario exemplifies . A. enzyme inhibition B. drug intolerance C. drug addiction D. enzyme induction This scenario exemplifies drug addiction. When drug dependence is particularly severe and compulsive drug behavior dominates all other activities, the term drug addiction is used.

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Chapter 03 - Geriatric Pharmacology

Chapter 03 Geriatric Pharmacology

Multiple Choice Questions 1. In comparison to the members of other age groups, members of the geriatric population are: A. less likely to consume drugs. B. more likely to experience the adverse effects of a drug. C. less likely to suffer from toxicity. D. more likely to benefit from the therapeutic effects of the drug. Drug use increases with increasing age, and the number of drugs consumed in the geriatric population averages between three and four drugs per individual. Both the nature and frequency of adverse drug reactions increase with age.

ABHES: 2.a. List all body systems, their structure and functions Blooms: Understand CAAHEP: I.C.7. Describe the normal function of each body system CAAHEP: I.C12. Identify quality assurance practices in healthcare Difficulty: 2 Medium Learning Outcome: 03.01

Chapter 03 - Geriatric Pharmacology

2. Identify an accurate statement about the use of drugs in the elderly. A. Elderly people tend to use less drugs than people in other age groups. B. Elderly people are less likely than people from other age groups to experience adverse drug reactions. C. Compared to people from other age groups, elderly people account for the highest percentage of drug prescriptions per year. D. Compared to people from other age groups, elderly people are more able to eliminate drugs from their bodies. Compared to other age groups, the geriatric population accounts for the highest percentage of drug prescriptions per year.

ABHES: 2.a. List all body systems, their structure and functions Blooms: Understand CAAHEP: I.C.9.b. Analyze pathology for each body system including treatment modalities Difficulty: 2 Medium Learning Outcome: 03.01

3. Which of the following changes takes place as a person ages? t pT eBr. CmOiMn u t e increases. A. The amount of blood pumped by tNhUeRhSeIaNrG B. The size of several body organs decreases. C. The frequency and nature of adverse reactions to drugs decreases. D. The efficiency with which the liver metabolizes drugs increases. The size of most body organs decreases with age and, therefore, there are fewer cells to carry out organ functions.

ABHES: 2.a. List all body systems, their structure and functions Blooms: Understand CAAHEP: I.C.7. Describe the normal function of each body system Difficulty: 2 Medium Learning Outcome: 03.01

Chapter 03 - Geriatric Pharmacology

4. Which of the following changes in aging people tends to slow down the rate of drug absorption and the onset of drug action? A. A decrease in the amount of gastric acid secreted B. An increase in intestinal motility C. An increase in blood flow to the intestinal tract D. A decrease in the percentage of adipose tissue in the body With age there is a decrease in blood flow to the intestinal tract, reduced intestinal absorptive surface area, a decrease in gastric acid secretion, and a decrease in intestinal motility. These changes tend to slow the rate of drug absorption and the onset of drug action.

ABHES: 2.a. List all body systems, their structure and functions Blooms: Understand CAAHEP: I.C.7. Describe the normal function of each body system Difficulty: 2 Medium Learning Outcome: 03.02

5. Dr. Hampton administers the same dose of a certain water-soluble drug to two of his patients, Nathaniel, who is 65 years of age, and Mark, who is 25 years of age. Which of the following is most likely going to happNeUnR? SINGT B. CO M A. Most of the drug in Nathaniel's body will get deposited in the body organs that have a high fat content, away from the liver and kidneys. B. The drug will be more widely distributed in Nathaniel's body than it will be in Mark's body. C. Nathaniel will experience a more intense pharmacological drug effect than Mark will experience. D. The concentration of the drug in Mark's blood plasma will be higher than the concentration of the drug in Nathaniel's blood plasma. In the bodies of older people, water-soluble drugs will have less body fluid in which to dissolve and are less widely distributed out to the organs with high fat content. This produces higher plasma drug levels and greater pharmacological effects when compared to the same dosage of drug administered to a younger adult.

ABHES: 6.d. Properly utilize Physician’s Desk Reference (PDR), drug handbook and other drug references to identify a drug’s classification, usual dosage, usual side effects, and contraindications Blooms: Apply CAAHEP: I.C.10. Identify CLIA waived tests associated with common diseases CAAHEP: I.C.9.b. Analyze pathology for each body system including treatment modalities Difficulty: 3 Hard Learning Outcome: 03.02

Chapter 03 - Geriatric Pharmacology

6. Equal doses of a certain fat-soluble drug are administered to two individuals, John, who is 20 years old and Eric, who is 70 years old. Which of the following is most likely to happen based on the information provided in this scenario? A. A greater percentage of the drug in John's body will get diverted away from the liver and kidneys than the percentage of the drug in Eric's body. B. Eric's body will be able to eliminate the drug much faster than John's body will be able to eliminate it. C. The drug will get more widely distributed to various organs in John's body than it will get distributed to the organs in Eric's body. D. The drug will have a longer half-life in Eric's body than it will have in John's body. The drug will have a longer half-life in Eric's body than it will have in John's body. The percentage of body fat increases with age. This causes lipid-soluble drugs to be more widely distributed to the body organs that have a high fat content, such as adipose tissue and muscle, and away from the liver and kidneys. Since the liver and kidneys are responsible for drug metabolism and excretion, any diversion from them will slow elimination of the drug from the body. The drug will then have a longer half-life and duration of action.

ABHES: 2.a. List all body systems, their structure and functions Blooms: Analyze CAAHEP: I.C.9.b. Analyze pathology for each body system including treatment modalities Difficulty: 3 Hard Learning Outcome: 03.02

7. Why do fat-soluble drugs have a longer half-life and duration of action in the elderly? A. Because they get diverted away from the liver and kidneys B. Because they dissolve faster in the fluids of the body C. Because they are less widely distributed to the other organs in the body D. Because they are instantly metabolized as soon as they are ingested The percentage of body fat increases with age. This causes lipid-soluble drugs to be more widely distributed to the body organs that have a high fat content, such as adipose tissue and muscle, and away from the liver and kidneys. Since the liver and kidneys are responsible for drug metabolism and excretion, any diversion from them will slow elimination of the drug from the body. The drug will then have a longer half-life and duration of action.

ABHES: 2.a. List all body systems, their structure and functions Blooms: Understand CAAHEP: I.C.7. Describe the normal function of each body system Difficulty: 2 Medium Learning Outcome: 03.02

Chapter 03 - Geriatric Pharmacology

8. Ken, a 60-year-old, has been taking daily doses of certain fat-soluble drugs. Identify an accurate statement about how these drugs will get distributed in Ken's body. A. Most of the drugs will dissolve into the body fluids. B. The drugs will be distributed to the body organs that have a high content of adipose tissue. C. The drugs will be directly diverted to the liver and kidneys. D. Most of the drugs will dissolve into the blood plasma. The percentage of body fat (adipose tissue) increases with age. This causes lipid-soluble drugs to be more widely distributed to the body organs that have a high fat content, such as adipose tissue and muscle (modest fat content, but large mass), and away from the liver and kidneys. Since the liver and kidneys are responsible for drug metabolism and excretion, any diversion from them will slow elimination of the drug from the body.

ABHES: 2.a. List all body systems, their structure and functions Blooms: Apply CAAHEP: I.C.7. Describe the normal function of each body system Difficulty: 3 Hard Learning Outcome: 03.02

9. Which of the following may contriNbUuRteSIt N o GdTruBg. CtOo M x icity in the geriatric population? A. Increased activity of liver enzymes B. Stable creatinine levels C. Reduced production of plasma proteins D. Leukopenia The concentration of plasma proteins, mainly albumin, decreases with age. Since most drugs are bound to some extent to plasma proteins and it is only the concentration of "free drug" that produces the pharmacological effect, any decrease in plasma proteins and plasma protein drug binding will increase the amount of free or unbound drug and, therefore, the intensity of the drug effect.

Chapter 03 - Geriatric Pharmacology

10. An elderly man has been taking an adult-strength dose of the topical steroid hydrocortisone for the past four weeks. He has developed thin skin and stria along his back, which are physical indications of toxicity. Which of the following might have led to the toxic effects of the steroid? A. A reduction in the amount of the drug absorbed by the intestine B. A buildup of the drug in the adipose tissues C. An increase in the metabolic activity of the liver D. An increase in the rate at which the drug is excreted by the kidneys The percentage of body fat (adipose tissue) increases with age. This causes lipid-soluble drugs to be more widely distributed to the body organs that have a high fat content, such as adipose tissue and muscle (modest fat content, but large mass), and away from the liver and kidneys.

Chapter 03 - Geriatric Pharmacology

11. Arthur, a 70-year-old, and Kevin, a 24-year-old, are given the same dose of a certain water-soluble drug X. When Dr. Robinson examines samples of their blood plasma, he finds that the concentration of X in Arthur’s system is much higher than the concentration of X in Kevin’s system. Why is Arthur’s blood plasma more concentrated with drug X than Kevin’s blood plasma? A. Because elderly people have a lower percentage of total body water than younger people do B. Because elderly people have more lean body mass than younger people do C. Because elderly people have less adipose tissue than younger people do D. Because elderly people have less intestinal absorptive surface area than younger people do The percentage of lean body mass (muscle) and the percentage of total body water decrease with age. If one thinks of the body as a big beaker filled with 35 liters of fluid and a drug dose dumped into the beaker, there will be a certain concentration of drug per liter. As the percentage of water decreases, the same dose will produce a higher concentration of drug in the beaker. The same thing occurs in the body. As one becomes older, the same dosage of drug given to a younger adult will produce a higher drug concentration in the elderly.

ABHES: 2.a. List all body systems, their structure and functions Blooms: Analyze CAAHEP: I.C.11.a. Identify the classifications of medications including indications for use CAAHEP: I.C.7. Describe the normal function of each body system Difficulty: 3 Hard Learning Outcome: 03.02

12. The enzymes that are most affected by the process of aging are those that play a role in drugs. A. oxidizing B. reducing C. chelating D. alkylating The age-related decreases in liver blood flow and production of some drug microsomal metabolizing enzymes (DMMS) reduce the rate of drug metabolism. The enzymes that are most affected appear to be the enzymes that oxidize drugs, referred to as the mixed-function oxidase system.

ABHES: 2.a. List all body systems, their structure and functions Blooms: Apply CAAHEP: I.C.7. Describe the normal function of each body system Difficulty: 2 Medium Learning Outcome: 03.03

Chapter 03 - Geriatric Pharmacology

13. Which of the following age-related changes is responsible for the decrease in the rate of drug metabolism in elderly patients? A. The increase in the production of drug microsomal metabolizing enzymes B. The reduction in renal blood flow C. The decrease in liver blood flow D. The increase in the concentration of plasma proteins The age-related decreases in liver blood flow and production of some drug microsomal metabolizing enzymes (DMMS) reduce the rate of drug metabolism.

ABHES: 2.a. List all body systems, their structure and functions Blooms: Understand CAAHEP: I.C.7. Describe the normal function of each body system Difficulty: 2 Medium Learning Outcome: 03.03

14. The drug morphine has a high first-pass metabolism. What change in the dosage of morphine would have to be made if the drug were to be administered to an elderly patient? A. A higher dose of morphine should be administered. B. The same dose of morphine that wNoUuRl dS IbNeGaTdBm. Ci On iMs t e r e d to a younger patient should be administered. C. The drug morphine should not be administered to a patient above the age of 60. D. A lower dose of morphine should be administered. Drugs that normally undergo first-pass metabolism are not as extensively metabolized during the first pass through the liver. This allows a greater amount of drug to be absorbed, an example of increased bioavailability.

Chapter 03 - Geriatric Pharmacology

15. Which of the following pharmacokinetic processes is most affected by the reduction of renal blood flow with age? A. Drug absorption B. Drug metabolism C. Drug distribution D. Drug excretion The reduction of renal blood flow with age has a significant effect on the renal elimination of drugs. Renal excretion is probably the most important pharmacokinetic process that is affected by age.

ABHES: 2.a. List all body systems, their structure and functions Blooms: Understand CAAHEP: I.C.7. Describe the normal function of each body system Difficulty: 1 Easy Learning Outcome: 03.03

16. How would John, an elderly patient who smokes and consumes alcohol, tolerate an adultstrength dose of actively oxidized medication in comparison to Rick, an elderly patient who neither smokes nor drinks? A. John would not be able to metabolize the drug, whereas Rick would be able to metabolize it. B. Rick would be able to metabolize the drug in the same amount of time as John would be able to metabolize it. C. John would be able to metabolize the drug at a faster rate than Rick would be able to metabolize it. D. Rick's body would absorb a lesser amount of the drug than John's body would absorb. John would be able to metabolize the drug at a faster rate than Rick would be able to metabolize it. Factors such as smoking, alcohol consumption, and the administration of certain drugs may cause microsomal enzyme induction, which will increase the rate of drug metabolism.

ABHES: 6.d. Properly utilize Physician’s Desk Reference (PDR), drug handbook and other drug references to identify a drug’s classification, usual dosage, usual side effects, and contraindications Blooms: Analyze CAAHEP: I.C.11.a. Identify the classifications of medications including indications for use CAAHEP: I.C.9.b. Analyze pathology for each body system including treatment modalities Difficulty: 3 Hard Learning Outcome: 03.03

Chapter 03 - Geriatric Pharmacology

17. Harry, a 70-year-old, and Ben, a 28-year-old, are taking the same dose of a certain drug that needs to undergo oxidation in their bodies. How will the drug metabolism in Harry's body differ from that in Ben's body? A. The rate at which the drug will be metabolized in Harry's body will be much faster than the rate at which it will be metabolized in Ben's body. B. A greater amount of the drug will be absorbed by Ben's body than it will be absorbed by Harry's body. C. The duration of drug action in Ben's body will be longer than the duration of drug action in Harry's body. D. The pharmacological effects of the drug will be experienced for a longer duration of time in Harry's body than they will be experienced in Ben's body. In general, the rate of drug metabolism decreases with age, although there is much variability. The pharmacological effects of drugs requiring oxidation, the benzodiazepines (diazepam, Valium) for example, are usually prolonged with age.

ABHES: 2.a. List all body systems, their structure and functions ABHES: 6.d. Properly utilize Physician’s Desk Reference (PDR), drug handbook and other drug references to identify a drug’s classification, usual dosage, usual side effects, and contraindications Blooms: Analyze CAAHEP: I.C.9.b. Analyze pathology for each body system including treatment modalities Difficulty: 3 Hard Learning Outcome: 03.03

18. Who among the following is most likely to have the lowest rate of drug metabolism? A. 62-year-old Edward, whose liver is showing symptoms of poor blood circulation B. 30-year-old Estella, who is following a protein-rich diet C. 21-year-old Fabiola, who often consumes alcohol when she goes out D. 60-year-old John, who smokes occasionally The age-related decreases in liver blood flow and production of some drug microsomal metabolizing enzymes (DMMS) reduce the rate of drug metabolism. Other factors such as smoking, alcohol consumption, and the administration of certain drugs, all of which may cause microsomal enzyme induction, will increase the rate of drug metabolism.

ABHES: 2.a. List all body systems, their structure and functions Blooms: Analyze CAAHEP: I.C.7. Describe the normal function of each body system Difficulty: 3 Hard Learning Outcome: 03.03

Chapter 03 - Geriatric Pharmacology

19. Drugs are mainly eliminated from the body by A. sweating B. renal excretion C. enterohepatic recycling D. regurgitation

Drugs are eliminated from the body mainly by renal excretion and gastrointestinal elimination.

ABHES: 2.a. List all body systems, their structure and functions Blooms: Remember CAAHEP: I.C.7. Describe the normal function of each body system Difficulty: 1 Easy Learning Outcome: 03.03

20. A decrease in renal function is associated with: A. an increase in the rate of drug excretion. B. an increase in the duration of the drug action. C. a decrease in the intensity of the drug action. D. a decrease in the rate of drug metaNbUoRliSsIm N.G TB.COM Age-related decreases in renal function and blood flow slow the rate of drug excretion and increase the duration and intensity of drug action.

ABHES: 2.a. List all body systems, their structure and functions Blooms: Understand CAAHEP: I.C.7. Describe the normal function of each body system Difficulty: 2 Medium Learning Outcome: 03.03

Chapter 03 - Geriatric Pharmacology

21. Which of the following physiological changes in an elderly patient lowers the rate of drug metabolism? A. An increase in the flow of blood to the liver B. A decrease in the production of enzymes that oxidize drugs C. An increase in renal blood flow D. A decrease in the percentage of adipose tissue in the body The age-related decreases in liver blood flow and production of some drug microsomal metabolizing enzymes (DMMS) reduce the rate of drug metabolism. The enzymes that are most affected appear to be the enzymes that oxidize drugs, referred to as the mixed-function oxidase system.

ABHES: 2.a. List all body systems, their structure and functions Blooms: Understand CAAHEP: I.C.7. Describe the normal function of each body system Difficulty: 2 Medium Learning Outcome: 03.03

22. A decrease in the size of the liver is directly associated with a(n): A. increase in the rate of drug absorpNtiUoRn .SINGTB.COM B. decrease in the rate of drug excretion. C. increase in the rate at which the drug is distributed through the body. D. decrease in the rate of drug metabolism. Decreased liver blood flow, liver organ size, and enzyme concentrations decrease the rate of drug metabolism and increase the duration and intensity of drug action.

ABHES: 2.a. List all body systems, their structure and functions Blooms: Understand CAAHEP: I.C.7. Describe the normal function of each body system Difficulty: 2 Medium Learning Outcome: 03.03

Chapter 03 - Geriatric Pharmacology

23. How would one expect the plasma creatinine levels in a person's body to change with age? A. Slightly decrease with age B. Remain unchanged C. Dramatically decrease with age D. Increase with age The plasma concentration of creatinine increases with age and renal disease and reflects the effects of age and disease to decreased renal function.

ABHES: 2.a. List all body systems, their structure and functions Blooms: Apply CAAHEP: I.C.7. Describe the normal function of each body system Difficulty: 2 Medium Learning Outcome: 03.03

24. A patient having multiple chronic diseases can expect: A. an increase in the consequences of a drug's action. B. a decrease in the consequences of a drug's action. C. no change in the consequences of NaUdRruSgI N'sGaTcBti.oCnO.M D. all of these. Reduction of organ function decreases the ability of organs to metabolize and eliminate drugs. Consequently, the actions and adverse effects of most drugs are increased. The consequences of disease on drug action increase as the number of diseases in any one individual increase.

Chapter 03 - Geriatric Pharmacology

25. Which of the following factors can affect drug metabolism by reducing the efficiency with which organs function? A. Genetics B. Nutritional deficiency C. Disease D. All of these An adequate diet is important in relation to liver function and the ability to metabolize drugs. The major chronic diseases of aging—hypertension, coronary artery disease, diabetes, cancer, and many others—all have effects that reduce vital organ function, especially of the heart, liver, and kidneys. Reduction of organ function decreases the ability of these organs to metabolize and eliminate drugs.

ABHES: 2.a. List all body systems, their structure and functions Blooms: Apply CAAHEP: IV.P.1. Instruct a patient according to patient’s special dietary needs Difficulty: 2 Medium Learning Outcome: 03.04

26. Adequate nutrition in elderly p a t iNe Un tRs Si IsNiGmTpBo. Cr t Oa nMt for synthesizing drug-metabolizing enzymes. The body produces these enzymes from foods that are high in: A. fat. B. protein. C. carbohydrate. D. sugar. Protein intake is important for the synthesis of drug-metabolizing enzymes.

ABHES: 2.d.ii. Educate patients regarding proper diet and nutrition guidelines Blooms: Analyze CAAHEP: IV.P.1. Instruct a patient according to patient’s special dietary needs Difficulty: 3 Hard Learning Outcome: 03.04

Chapter 03 - Geriatric Pharmacology

27. Who among the following is most likely to experience an impaired drug response caused by the lack of adequate nutrition? A. A comatose patient on TPN B. A patient living with his or her family members C. A nursing home patient D. A physically active senior citizen Many of the elderly live alone or in unfamiliar surroundings such as nursing homes. The desire, ability, and affordability to prepare well-balanced meals are often lacking. An adequate diet is important in relation to liver function and the ability to metabolize drugs.

ABHES: 2.d.ii. Educate patients regarding proper diet and nutrition guidelines Blooms: Apply CAAHEP: IV.P.1. Instruct a patient according to patient’s special dietary needs Difficulty: 2 Medium Learning Outcome: 03.04

28. In relation to their medications, why is it important for elderly patients to increase their dietary protein intake? A. To maintain appropriate albumin N l eUvRelSsINGTB.COM B. To increase serum potassium levels C. To lower serum triglyceride levels D. To maintain serum calcium levels Lack of adequate protein intake lowers the concentration of plasma proteins, especially albumin, which is necessary for plasma protein drug binding.

ABHES: 2.d.ii. Educate patients regarding proper diet and nutrition guidelines Blooms: Analyze CAAHEP: IV.C.1.c. Describe dietary nutrients including protein Difficulty: 3 Hard Learning Outcome: 03.04

Chapter 03 - Geriatric Pharmacology

29. Lack of adequate protein intake in elderly people: A. leads to a lower concentration of plasma proteins. B. leads to an increase in the synthesis of drug metabolizing enzymes. C. leads to an increase in the rate of drug metabolism. D. leads to a decrease in the intensity of drug action. Lack of adequate protein intake lowers the concentration of plasma proteins, especially albumin, necessary for plasma protein drug binding.

ABHES: 2.a. List all body systems, their structure and functions Blooms: Understand CAAHEP: IV.C.1.c. Describe dietary nutrients including protein Difficulty: 2 Medium Learning Outcome: 03.04

30. Which of the following proteins plays an important role in plasma protein drug binding? A. Albumin B. Myoglobin C. Hemoglobin D. Myosin Lack of adequate protein intake lowers the concentration of plasma proteins, especially albumin, necessary for plasma protein drug binding.

ABHES: 2.a. List all body systems, their structure and functions Blooms: Remember CAAHEP: IV.C.1.c. Describe dietary nutrients including protein Difficulty: 1 Easy Learning Outcome: 03.04

Chapter 03 - Geriatric Pharmacology

31. The term used to describe the situation that involves multiple drug prescriptions is A. pharmacotherapy B. polypharmacy C. therapeutic duplication D. monotherapy The term polypharmacy is used to describe the situation that involves multiple drug prescriptions.

ABHES: 2.c. Identify diagnostic and treatment modalities as they relate to each body system Blooms: Remember CAAHEP: I.C.9.b. Analyze pathology for each body system including treatment modalities Difficulty: 1 Easy Learning Outcome: 03.05

32. One way to improve compliance for a patient with arthritis would be to: A. encourage the patient to take medication on an empty stomach. B. suggest not using child safety caps on medication bottles. tion literature. C. encourage the patient to read med NicUatRi So InNiGnTfoBr. m C OaM D. allow the patient to identify the drugs he requires on his own. Many elderly patients have difficulty swallowing large capsules. In addition, they often cannot get the lid off the drug container. There are easy-to-open lids for the elderly, available upon request.

ABHES: 9.j. Make adaptations with patients with special needs Blooms: Understand CAAHEP: V.C.6.c. Define coaching a patient as it relates to compliance with treatment plan Difficulty: 1 Easy Learning Outcome: 03.05

Chapter 03 - Geriatric Pharmacology

33. An elderly patient was on medication for diabetes and hypertension before suffering a heart attack. Her cardiologist gave her thorough directions on taking her new heart medications. What would be a probable outcome of this situation? A. No change in patient compliance B. A slight improvement in patient compliance C. A substantial increase in patient compliance D. A decrease in patient compliance Elderly patients often have difficulty understanding and remembering what the drug is and exactly why it was prescribed. The confusion is increased in those who already have problems with memory, who live alone, and who are not provided with sufficient time for instruction and training on the proper procedures for drug administration.

ABHES: 9.j. Make adaptations with patients with special needs Blooms: Apply CAAHEP: V.C.6.c. Define coaching a patient as it relates to compliance with treatment plan Difficulty: 2 Medium Learning Outcome: 03.05

34. Which of the following would m oNsUt Rl iSkI eNl Gy TbBe. Ca OcMh i e f complaint from elderly patients taking omeprazole capsules? A. Dosing frequency B. Dietary restrictions C. Difficulty swallowing D. Small size Many elderly patients have difficulty swallowing large capsules.

ABHES: 9.j. Make adaptations with patients with special needs Blooms: Analyze CAAHEP: V.C.6.c. Define coaching a patient as it relates to compliance with treatment plan Difficulty: 3 Hard Learning Outcome: 03.05

Chapter 03 - Geriatric Pharmacology

35. One approach that can be used to facilitate decisions and enhance compliance when explaining medications to an elderly patient is to: A. provide current pharmaceutical literature. B. speak loudly. C. use proper medical terminology. D. display appropriate demeanor. The attitude and demeanor of the person providing drug prescribing instructions are sometimes the key ingredients to successful drug compliance.

Chapter 04 - Math Review and Dosage Calculations

Chapter 04 Math Review and Dosage Calculations

Multiple Choice Questions 1. Which of the following units in the metric system is used to measure liquid volume? A. Meter B. Liter C. Gram D. Grain The units of measure for the metric system are meter (length), gram (weight), and liter (volume).

ABHES: 6.b. Demonstrate accurate occupational math and metric conversions for proper medication administration Blooms: Remember CAAHEP: I.C.11.a. Identify the classifications of medications including indications for use Difficulty: 1 Easy Learning Outcome: 04.03

2. Identify the term that refers to the liquid portion of a solution that is capable of dissolving another substance. A. Solute B. Plasma C. Solvent D. None of these A solution is a homogeneous mixture of two or more substances. The liquid portion of the solution is known as the solvent, and the substance dissolved within the solvent is the solute.

Chapter 04 - Math Review and Dosage Calculations

3. Recall the definition of an improper fraction, and identify from the following a correct numerical equivalent. A. 3/5 B. 2/4 C. 1/3 D. 5/5 Fractions whose values are equal to or greater than 1 (the numerator is equal to or greater than the denominator) are called improper fractions.

ABHES: 6.b. Demonstrate accurate occupational math and metric conversions for proper medication administration Blooms: Remember CAAHEP: II.C.1. Demonstrate knowledge of basic math computations Difficulty: 1 Easy Learning Outcome: 04.01

4. Match the set of examples to the definition of a ratio. A. 2.1, 3.5, 2.9 B. 1:5, 4:10, 10:100 C. The 3 in 3/4 or the 9 in 9/11 D. All of these Ratio is the relationship of one number to another expressed by whole numbers (1:5) or as a fraction (1/5).

ABHES: 6.b. Demonstrate accurate occupational math and metric conversions for proper medication administration Blooms: Understand CAAHEP: II.C.1. Demonstrate knowledge of basic math computations Difficulty: 1 Easy Learning Outcome: 04.02

Chapter 04 - Math Review and Dosage Calculations

5. Match the set of examples to the definition of a numerator. A. The 13 in 13.14, 33 in 33.58, and 21 in 21.92 B. The 5 in 2:5, 4 in 1:4, and 8 in 5:8 C. The 1 in 1/4, 4 in 4/11, and 5 in 5/25 D. All of these A fraction is composed of two numbers, a numerator and a denominator. The numerator is the top number of a fraction. It indicates how many parts are being referred to.

6. While summarizing the factors that affect IV solutions, it can be concluded that: A. IV drug solutions must be free of contamination. B. IV drug solutions must constitute drugs and solutions that are chemically compatible. C. IV drug solutions must be adjusted to a targeted pH range. D. all of these are correct. The IV drug infusion solutions must be prepared under aseptic conditions, the drugs and solutions mixed must be chemically compatible, and often the infusion solution must be adjusted to a specific pH value.

ABHES: 6.d. Properly utilize Physician’s Desk Reference (PDR), drug handbook and other drug references to identify a drug’s classification, usual dosage, usual side effects, and contraindications ABHES: 9.a. Practice standard precautions and perform disinfection/sterilization techniques Blooms: Understand CAAHEP: I.C.11.a. Identify the classifications of medications including indications for use Difficulty: 1 Easy Learning Outcome: 04.06

Chapter 04 - Math Review and Dosage Calculations

7. You are reviewing dosage calculations with a new employee. You summarize the dosage calculations based on weight as: A. the amount of drug in mg ordered per unit of weight in kg. B. the amount of drug in mg ordered per unit of weight in lb. C. the amount of drug in ml ordered per unit of weight in kg. D. none of these. Drug dosages are sometimes administered on a body weight basis, for example, in mg/kg. This may require conversion of pounds to kilograms (1 kg = 2.2 lb).

ABHES: 6.b. Demonstrate accurate occupational math and metric conversions for proper medication administration Blooms: Understand CAAHEP: II.C.4. Convert among measurement systems Difficulty: 1 Easy Learning Outcome: 04.05

8. Identify from the following the correct metric conversion value with its corresponding household measure. A. 10 ml = 1 tablespoonful B. 5 ml = 1 teaspoonful C. 1 grain = 60 mg D. 1500 ml = 1.5 l Approximate household measures: 60 drops (gtt) = 1 teaspoon (tsp); 1 teaspoonful (tsp) = approximately 5.0 ml; 1 tablespoonful (tbsp) = approximately 15.0 ml; 2 tablespoons (tbsp) = approximately 1 fluid ounce (oz); 1 measuring cup = approximately 8 fluid ounces (oz).

Chapter 04 - Math Review and Dosage Calculations

9. A sample of a weight in volume (W/V) solution would contain: A. a given weight of drug in a definite weight of solvent so that the final solution is 100 parts by weight. B. a definite volume of solute added to enough water so that the final solution is 100 parts by volume. C. a given weight of solute in enough solvent so that the final solution contains 100 parts by volume. D. none of these. Weight in volume solutions contain a given weight of solute (drugs, salts) in enough solvent so that the final solution contains 100 parts by volume.

10. Determine the correct dose of a drug 15 mg/kg to be administered for a patient who weighs 55 pounds and is 8 years old. A. 125 mg B. 250 mg C. 375 mg D. 425 mg The first step is to convert the weight in pounds to kilograms. 1 kg:2.2 lb = X:55 lb. Solving for X, X = 25 kg. The next step is to determine how many milligrams of drug are required. The amount of drug required = 15 mg/kg  25 kg = 375 mg.

Chapter 04 - Math Review and Dosage Calculations

11. A child is 5 years old and weighs 40 pounds. Use Clark's rule to determine the necessary dose of a drug routinely ordered for adults as 300 mg. A. 50 mg B. 60 mg C. 70 mg D. 80 mg Clark's rule: weight of child /150 lb  adult dose = child's dose. 40 lb/150 lb  300 mg = 80 mg.

12. child is 3.5 years old and weighs 36 pounds. Using Fried's rule, determine the necessary dose of drug Y that is routinely ordered for adults as 2 teaspoons every 4 hours. A. 2.8 ml B. 2.6 ml C. 2.4 ml D. 2.2 ml Fried's rule: age in months/150  average adult dose = child's dose. 42/150  10 ml = 2.8 ml.

Chapter 04 - Math Review and Dosage Calculations

13. Use a recommended dose of 10 mcg/kg to calculate the loading dose of digoxin for a patient weighing 143 pounds. A. 600 mcg B. 625 mcg C. 650 mcg D. 675 mcg Step 1: Convert pounds to kilograms. 143 lb/2.2 lb/kg = 65 kg. Step 2: Determine how many micrograms are required. 10 mcg/kg  65 kg = 650 mcg.

14. Carry out the necessary calculations to determine the number of teaspoons that should be administered for a dosage of 50 mg if the drug is available in a concentration of 10 mg/ml. A. 0.5 teaspoons B. 1 teaspoon C. 1.5 teaspoons D. None of these are correct. Step 1: Determine the dosage. 10 mg/ml = 50 mg/X; 10X = 50 mg; X = 50 mg/10 mg per ml; X= 5 ml. Step 2: Determine the number of teaspoons that should be administered to deliver a dosage of 5 ml. 1 teaspoonful = 5 ml.

Chapter 04 - Math Review and Dosage Calculations

15. Carry out the necessary metric, apothecary, or household conversions to determine how many milliliters of cough syrup a nurse will give to a patient each day if the nurse is instructed to give the patient 2 teaspoons of cough syrup four times a day. A. 20 ml B. 30 ml C. 40 ml D. 50 ml Step 1: Calculate the total number of teaspoons administered in one day. 2 tsp  4 = 8 tsp daily. Step 2: Multiply the number of teaspoons per day by number of milliliters per teaspoon. 8 tsp  5 ml/tsp = 40 ml.

ABHES: 6.b. Demonstrate accurate occupational math and metric conversions for proper medication administration Blooms: Apply CAAHEP: II.C.4. Convert among measurement systems Difficulty: 2 Medium Learning Outcome: 04.03

16. Use metric system equivalents to select the quantity equal to 3 g. A. 3000 mg B. 50 grains C. 0.003 kg D. All of these Weight conversion measures: 1 kilogram (kg) = 1000 grams (g); 1 gram (g) = 1000 milligrams (mg); 1 milligram (mg) = 1000 micrograms (mcg); 1 grain (gr, apothecary system) = 60.0 mg.

ABHES: 6.b. Demonstrate accurate occupational math and metric conversions for proper medication administration Blooms: Apply CAAHEP: II.C.1. Demonstrate knowledge of basic math computations Difficulty: 2 Medium Learning Outcome: 04.03

Chapter 04 - Math Review and Dosage Calculations

17. Carry out the necessary calculations in order to administer the required number of tablets to a patient with an order for 60 mg of a drug that is available in 30-mg tablets. How many tablets should you administer? A. 2 tablets B. 1.5 tablets C. 1 tablet D. 0.5 tablet Step 1: Determine the number of tablets needed by setting up a fraction based on desired dosage/available dosage. 60 mg/30 mg (1 tablet) = 2 tablets.

18. Carry out the necessary calculations in order to administer the required number of tablets to a patient with an order for 0.25 mg of digoxin, which is available in 250-mcg tablets. How many tablets will you administer? A. 2 tablets B. 1.5 tablets C. 1 tablet D. 0.5 tablet Step 1: Convert 0.25 mg to mcg using metric conversion. 0.25 mg  1000 = 250 mcg. Step 2: Determine the number of tablets needed by setting up a fraction based on desired dosage/available dosage. 250 mcg/250 mcg (1 tablet) = 1 tablet.