Nokea
Up to 21% of Asians are ultra-rapid 2D6 metabolizers, requiring:
- A. A need to monitor drugs metabolized by 2D6 for toxicity
- B. Increased dosages needed of drugs metabolized by 2D6, such as the selective serotonin reuptake inhibitors
- C. Decreased conversion of codeine to morphine by CYP 2D6
- D. The need for lowered dosages of drugs, such as beta blockers
Correct Answer: B
Rationale: Ultra-rapid 2D6 metabolizers (e.g., in Asians) need higher SSRI doses due to fast metabolism, unlike toxicity , codeine issues , or lower doses .
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The patient, diagnosed with cancer, is receiving morphine sulfate (a potent narcotic pain reliever) to relieve cancer pain. Approximately every 7 days the medication is no longer effective in controlling the patient's pain and a larger dose is needed to have the same effect. How might the nurse explain why this is happening?
- A. Tolerance
- B. Cumulation
- C. Interactions
- D. Addiction
Correct Answer: A
Rationale: The body may develop a tolerance to some drugs over time. Tolerance may arise because of increased biotransformation of the drug, increased resistance to its effects, or other pharmacokinetic factors. When tolerance occurs, the amount of the drug no longer causes the same reaction. Therefore, increasingly larger doses are needed to achieve a therapeutic effect. Cumulative effect occurs when the drug is not properly eliminated and more of the drug is administered, resulting in toxic levels accumulating. Interactions occur when the drug reacts badly with another substance such as food, another drug, or an alternative or complementary therapy. Addiction is the psychological need for a substance.
Under new U.S. Food and Drug Administration labeling, Pregnancy Categories will be:
- A. Strengthened with a new coding such as C+ or C- to discern when a drug is more or less toxic to the fetus
- B. Changed to incorporate a pregnancy risk summary and clinical considerations on the drug label
- C. Eliminated, and replaced with a link to the National Library of Medicine TOXNET Web site for in-depth information regarding pregnancy concerns
- D. Clarified to include information such as safe dosages in each trimester of pregnancy
Correct Answer: B
Rationale: FDA replaced categories with risk summaries and clinical considerations for clearer, narrative-based guidance, effective 2015.
What is the advantage of sublingual route of administration of drugs
- A. Prevents first pass effect
- B. Easy to administer
- C. Lipid soluble
- D. Can be spitted out with signs of toxicity
Correct Answer: A
Rationale: Sublingual administration bypasses hepatic first-pass metabolism.
Which of the following is a representative of sulfonylurea?
- A. Merformin
- B. Glibenclamide
- C. Acarbose
- D. Liraglutide
Correct Answer: B
Rationale: Glibenclamide is a sulfonylurea that stimulates insulin release from beta cells.
A 73-year-old male patient is being discharged home today. The discharge order reads: Take 10 mL of guaifenesin (Robitussin) PO q4h. This over-the-counter pharmaceutical comes in bottles with plastic measuring caps. How much should the nurse teach the patient to take at home?
- A. 1/2 tsp
- B. 1 tsp
- C. 2 tsp
- D. 1 tbsp
Correct Answer: C
Rationale: 10 mL equals 2 teaspoons (5 mL = 1 tsp), so the patient should take 2 tsp per dose.