NURS 5334/ NURS5334 Test 1 – Advanced Pharmacology
Review | UTA (Latest 2026/ 2027 Update) 500+ Verified
Questions & Answers | Grade A
2026/2027 | GR
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Question:
Pregnancy: Changes in drug metabolism
Answer -Hepatic metabolism and GFR increase during pregnancy, dosages of some drugs may need to be increased -For some drugs, hepatic metabolism increases during pregnancy--> some drugs may need to be increased -Tone and motility of the bowel decrease in pregnancy, causing intestinal transit time to increase -->more time for drugs to be absorbed--> might need to reduce dosage -Prolongation of drug effects total 1-2 life increases
Question:
Fetal development in pregnancy (stages)
Answer -preimplantation/presomite: conception-2 weeks: all or nothing -embryonic period: weeks 3-8: gross malformations -Fetal period: week 9- term: exposure disrupts function not gross anatomy
Question:
Pregnancy Labeling
Answer -As of 2015, the Food and Drug Administration had a Pregnancy and Lactation Labeling Rule change. -No more lettering of the categories of drugs for pregnancy. According to the lettering system, drugs can be put into
one of five risk categories: be A, B, C, D, and X. -By 2020, all prescriptions must remove lettering labels altogether. -The PLLR requires three sections for labeling:
o (1) pregnancy, (2) lactation, and (3) females and males of reproductive potential.
Question:
How do you decrease risk in the infant during breastfeeding?
Answer
o Take the drugs immediately after breastfeeding
o Avoid drugs that have long half-lives
o Choose drugs that tend to be excluded from milk, and that are least likely to affect the infant
o Avoid the drugs that are known to be hazardous
o Use the lowest effective dosage for the shortest possible time
o Abandon plans to breastfeed if a necessary drug is known to be harmful to the child.
Question:
How do pediatric patients differ in their response to medication? Absorption?
Answer
o Oral administration -Gastric emptying time is prolonged & irregular in early infancy
· Adult function at 5-8 months
· For drugs that are absorbed primarily from the stomach, delayed gastric emptying enhances absorption
· For drugs that are absorbed primarily from the intestine, absorption is delayed
· Because gastric emptying time is irregular, the precise effect on absorption is not predictable - Gastric Acidity
· Very low 24 hours after birth
· Does not reach adult values for 2 years
· Low acidity absorption of acid-labile drugs is increased
o Intramuscular -Slow, erratic in neonates - Delayed absorption as a result of low blood flow during the first few days of life - By early infancy, absorption of IM drugs is more rapid than in neonates and adults
o Skin - More rapid and complete in infants than in older children and adults - The stratum corneum of the infant's skin is very thin, and blood flow to the skin is greater in infants than in older
patients. Because of this enhanced absorption, infants are at increased risk for toxicity from topical drugs.
Question:
How do pediatric patients differ in their response to medication? Distribution r/t protein binding?
Answer -Binding of drugs to albumin and other plasma proteins is limited in the infant - Amount of serum albumin is relatively low - Endogenous compounds (fatty acids, bilirubin) compete with drugs for available binding sites - Limited drug/protein binding in infants --> concentration of free levels of drugs that usually undergo extensive
protein binding in adults is relatively high in the infant --> intensified effects - Reduced dosage needed - Adult protein binding capacity by 10-12 months of age
Question:
How do pediatric patients differ in their response to medication? Distribution r/t BBB?
Answer - Not fully developed at birth - Drugs and other chemicals have relatively easy access to the CNS - Infants are especially sensitive to drugs that affect CNS function - all medicines employed for their CNS effects (e.g., morphine, phenobarbital) should be given in reduced dosage - Dosage should also be reduced for drugs used for actions outside the CNS if those drugs are capable of producing
CNS toxicity as a side effect
Question:
How do pediatric patients differ in their response to medication? Metabolism r/t Hepatic function?
Answer
o The drug-metabolizing capacity of newborns is low
o Neonates are especially sensitive to drugs that are eliminated primarily by hepatic metabolism
o The liver's capacity to metabolize many drugs increased rapidly about 1 month after birth
o The ability to metabolize drugs at the adult level is reached a few months later
o Complete liver maturation occurs by 1 year of age
o Dosages must be reduced
Question:
How do pediatric patients differ in their response to medication? Renal excretion?
Answer
o Significantly reduced at birth
o Low renal blood flow, glomerular filtration, and active tubular secretion
o Drugs eliminated primarily by renal excretion must be given in reduced dosage and/or longer dosing intervals
o Adult levels of renal function achieved by 1 year
Question:
Definition of polypharmacy
Answer
Treatment with multiple drugs
Question:
Beers List
Answer
a list of drugs for which monitoring is especially important and possible inappropriate to administer in elderly patients -should avoid these drugs
Question:
Geriatric patient changes in absorption
Answer
o Altered GI absorption is not a major factor in drug sensitivity -Oral dose does not usually change with age
o Rate of absorption may slow with age
- D/t Delayed gastric emptying and reduced splanchnic blood flow also occur - Drug responses may be delayed
o Gastric acidity is reduced --> may alter the absorption of certain drugs -some drug formulations require high acidity to dissolve, and hence their absorption may be reduced.
Question:
Geriatric patient changes in distribution
Answer
(1) increased percentage of body fat
· Increased storage depot for lipid-soluble drugs (e.g., propranolol)
· Results in decreased plasma level --> reduction in response
(2) decreased percentage of lean body mass
(3) decreased total body water
· Because of the decline in lean body mass and total body water, water-soluble drugs (e.g., ethanol) become distributed
in a smaller volume than in younger adults --> the concentration of these drugs is increased, causing effects to be more
intense.
(4) reduced concentration of serum albumin
· Although albumin levels are only slightly reduced in healthy older adults, these levels can be significantly reduced in
older adults who are malnourished --> reduced albumin levels --> sites for protein binding of drugs decrease--> levels
of free drug rise
Question:
Geriatric changes in metabolism
Answer
o Hepatic metabolism declines with age
o Reduced hepatic blood flow, reduced liver mass, and decreased activity of some hepatic enzymes occur
o The half-lives of some drugs may increase, and responses are prolonged
o Response to oral drugs (e.g., those that undergo extensive first-pass effect) may be enhanced because fewer drugs are
inactivated before entering the systemic circulation.
o Important to note: the degree of decline in drug metabolism varies greatly among individuals. As a result, we cannot
predict whether drug responses will be significantly reduced in any particular patient.
Question:
Geriatric changes in renal excretion
Answer
o Renal function undergoes progressive decline beginning in early adulthood. - Reduction in renal blood flow, GFR, active tubular secretion, and # of nephrons
o Drug accumulation secondary to reduced renal excretion is the most important cause of ADRs in older adults.
o when patients are taking drugs that are eliminated primarily by the kidneys, renal function should be assessed. - In older adults, the proper index of renal function is creatinine clearance, not serum creatinine levels (because lean
muscle mass which is the source of creatinine declines parallel to kidney function creatinine levels may be normal even
though kidney function is greatly reduced) -Although most medication adjustments for renal problems use creatinine clearance, for a few medications the
estimated glomerular filtration rate (eGFR) is used.
Question:
Gram positive bacteria
Answer
Staph, strep, enterococcus, some other atypicals (everything else is gram negative)
Bacteriostatic (drugs that slow bacterial growth but do not cause cell death)
Answer
ECSTaTiC -Erythromycin -Clindamycin -Sulfamethoxazole -Trimethoprim -Tetracycline -Chloramphenicol
Bactericidal (Drugs that are directly lethal to bacterial)
Answer
Very Finely Proficient At Cell Murder -Vancomycin -Fluoroquinolones -Penicillin -Aminoglycosides -Cephalosporins -Metronidazole
What is empiric antibiotic use?
Answer -Empiric-based on clinical presentation -Covering most likely organisms -Cultures should be obtained prior to initiation -Re-evaluated upon results
Which antibiotics work by weakening the cell wall?
Penicillin's, cephalosporins, carbapenems, vancomycin, telavancin, monobactam, Fosfomycin (monu
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