PHARM- EXAM 1- EAQ ANSWERS ● The Food and Drug Administra on Amendments Act of 2007 approved postmarke ng safety studies of drugs to identify unsafe drugs that were proven safe during premarketing studies. Postmarketing studies involve the reporting of adverse effects of marketed drugs and help identify unsafe drugs. These studies do not help avoid or minimize the abuse of narcotics. Postmarketing studies help remove unsafe drugs from the market; they do not help make the drugs affordable. Postmarketing studies are conducted during phase IV of clinical trials. Clinical orphan drug trials are under the control of the Drug Enforcement Administration and Orphan Drug Act of 1983. ● Schedule IV drugs are medically accepted but have a lower poten al to cause dependence compared with drugs in Schedule III. Schedule I drugs have a high potential for drug abuse and no accepted medical use. Schedule II drugs have a high potential for drug abuse but are medically accepted, although they can lead to strong physical and psychological dependency. Schedule III drugs are medically accepted and have less potential for abuse. ● The primary health care provider writes a note in the prescrip on if the generic medica on can replace the brand-name drug; the nurse should therefore check the note before administering the generic drug rather than the brand-name medication. It is not necessary to notify the primary health care provider because the information can be determined by checking the prescription itself. The nurse can check the composition of the brand-name drug after checking the note in the prescription. The nurse may verify the dose after confirming the presence of the primary health care provider's note. ● Pain can affect absorp on by slowing gastric emptying me. The pH of the stomach affects absorption of drugs dependent on the pH of the drug. Alkaline drugs are absorbed more readily in an alkaline environment, and acidic drugs are absorbed more readily in an acidic environment. The form of the drug also affects absorption, with liquid drugs being absorbed the fastest and enteric-coated tablets the slowest. The presence of food in the stomach usually decreases absorption of drugs but may increase absorption for a few specific medications. Position will not influence absorption. ● Pediatric medica on doses should be calculated based either on weight or body surface area. Laboratory drug levels are used to determine toxicities and alter dosages. Pediatric doses are not based on cutting adult doses in half nor creatinine clearance. ● Older adults have a 10% reduc on in albumin that can result in decreased protein binding of drugs and increased free drug available to exert therapeutic effects, but it also increases the risk for drug toxicity. Therefore a reduced drug dosage may be required. Reduced gastric acid will exert different effects on acidic and alkaline drug preparations. GFR is decreased in the older adult, while ALT and AST may be elevated in the case of liver dysfunction. ● The 66-year-old female taking five different drugs is most at risk for adverse drug events. There is little agreement on the actual number of drugs that constitutes polypharmacy, but researchers use five drugs because this number has been associated with increased incidence of adverse drug reactions, geriatric syndromes, and increased mortality. Additionally, older adults are twice as likely as younger adults to visit the emergency department with adverse drug events and are seven times as likely to be hospitalized. The male taking four drugs and the younger adults (20-year-old and 30-year-old) are at less risk for adverse drug events. ● Superinfec on is a secondary infec on that occurs when the normal flora of the gut are destroyed by the antibiotic use and lead to overgrowth of fungus. Cross-resistance occurs between the antibacterial drugs that have similar actions. Antibiotic resistance occurs when bacteria reduces or eliminates the effectiveness of the antibacterial drug. Nosocomial infection is an infection that has occurred in the hospital. ● Tetracycline is contraindicated in children younger than 8 years because it can cause permanent discoloration of the teeth. Tetracycline is not contraindicated for patients diagnosed with diabetes mellitus or hypertension. Tetracycline is used to treat rickettsiae. ● The most important ac on for the nurse before administering IV amphotericin B is checking for premedication prescriptions because side effects and adverse reactions for amphotericin B include fever, shaking, chills, flushing, loss of appetite, dizziness, nausea, vomiting, headache, shortness of breath, and tachypnea. These symptoms may occur 1 to 3 hours after the infusion has started so pretreatment 30 to 60 minutes before infusion with acetaminophen, diphenhydramine, or hydrocortisone may alleviate these symptoms. There is no specific need to assess for nausea and vomiting before administering the drug. There is no reason to assess for a cardiac dysrhythmia before administering the drug. There is no reason to evaluate the IV site for signs of phlebitis before administering the drug because this is an occurrence during therapy.
