Chapter 01: Drug Regulation, Actions, and Responses Workman & Lacharity: Understanding Pharmacology: Essentials For Medication Safety, 2Nd Edition
Chapter 01: Drug Regulation, Actions, and Responses Workman & Lacharity: Understanding Pharmacology: Essentials For Medication Safety, 2Nd Edition
Chapter 01: Drug Regulation, Actions, and Responses Workman & Lacharity: Understanding Pharmacology: Essentials For Medication Safety, 2Nd Edition
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MULTIPLE CHOICE
BASIC CONCEPTS
1. Which health care professional has the major responsibility for dispensing prescribed drugs
under the direction of a pharmacist?
a. Physician
b. Nurse practitioner
c. Licensed nurse
d. Pharmacy technician
ANS: D
The physician and nurse practitioner have the major responsibility for prescribing drugs, not
dispensing them. The licensed nurse has the primary responsibility for administering drugs,
although under some circumstances a licensed nurse may dispense prescribed drugs but this is
not his or her major responsibility in drug therapy. The pharmacy technician has the major
responsibility of dispensing prescribed drugs under the direction of a licensed pharmacist.
2. Which term describes the effect of a drug that improves body function?
a. Side effect
b. Intended action
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c. Adverse reaction
d. Idiosyncratic response
ANS: B
The purpose of drug therapy is to take a drug to prevent, reduce, or correct a health problem.
This response is any drug’s intended action also known as a therapeutic response.
3. Which type of drug name is “owned” by the company that manufactures it?
a. Generic name
b. Chemical name
c. Category name
d. Trade name
ANS: D
The chemical name is a drug’s exact chemical composition. The generic name is the name
assigned to the drug by the U.S. Adopted Names Council and is not owned by anyone. The
category name refers to the type of drug (what it does or what it is used for) and is not an
actual drug name. The trade name (brand name) is the name provided and owned by a specific
drug’s manufacturer.
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ANS: B
A high alert drug is one in which harm is likely to result if given at the wrong dose, to the
wrong patient, or not given to the correct patient. Drugs classified as high alert drugs include
potassium, narcotics (opioids), insulin, cancer chemotherapy drugs, and heparin (or any drug
that strongly affects blood clotting). Penicillin, NSAIDs, and calcium are not considered high
alert drugs.
5. What is the term for a drug that has the same action as a naturally occurring body hormone or
enzyme?
a. Agonist
b. Blocking agent
c. Chemical
d. Duplicator
ANS: A
A drug agonist is an extrinsic drug that activates the receptor sites of a cell and mimics the
actions of naturally occurring body substances (intrinsic drugs). A blocking agent is a drug
antagonist. A chemical would not necessarily be a drug at all. A duplicator is not a
pharmacologic term. GRADESMORE.COM
DIF: Cognitive Level: Remembering REF: pp. 6-7
7. In the United States, which group is responsible for enforcing established standards for drug
manufacturing?
a. U.S. Pharmacopeia
b. National Institutes of Health
c. Food and Drug Administration
d. Association of Pharmaceutical Manufacturers
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ANS: C
The standards for drug manufacture are established by the U.S. Pharmacopeia. These
standards are enforced by the Food and Drug Administration. Neither the National Institutes
of Health nor the Association of Pharmaceutical Manufacturers has any authority to enforce
drug standards.
ANS: D
Once a transdermal drug moves through the skin, it must enter the bloodstream to reach its
target tissue. If circulation is poor to the area where the transdermal drug is applied, very little,
if any, of the drug will reach its target tissue.
10. A patient asks why his drug to control high blood pressure has only one generic name and two
different trade names. What is your best response?
a. “Most drugs have different trade names that indicate different dosages.”
b. “The two different trade names indicate that one is a more pure and safer drug than
the other.”
c. “The generic name is the actual official drug name and the trade name is a brand
owned by a specific manufacturer.”
d. “If you have insurance, you can get the trade name drug, which is usually more
expensive than the generic named drug.”
ANS: C
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The generic name is the name assigned to the drug by the U.S. Adopted Names Council and is
not owned by anyone. The trade name (brand name) is the name provided and owned by a
specific drug’s manufacturer. More than one manufacturer can make and sell the same drug at
the same time under a different trade name. Regardless of trade name, all drugs that have the
same generic name must be alike in their chemical composition and strength.
11. How are the terms drug and medication different in the health care environment?
a. Medications must be prescribed, whereas drugs are available over-the-counter.
b. Medications are used to treat health problems, whereas drugs can be misused.
c. Drugs are always illegal, whereas medications are legal.
d. There is no difference between these two terms.
ANS: D
Although the lay public may think there is a distinction between these two terms, in health
care they mean the same thing. Both are used to treat health problems and both can be
misused.
12. The prescriber tells a patient with allergies to use oral diphenhydramine (Benadryl)
over-the-counter (OTC) to help manage her symptoms. She tells you that she would rather
have a prescription for the “real” Benadryl because she knows it is stronger and will work
better than the nonprescription form. What is your best response?
a. “If you receive a prescription for this drug your name will be added to a controlled
substances list.”
b. “It is better to use the OTCGBenadryl
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fewer side effects.”
c. “The OTC form of Benadryl is the same strength as the one that was available by
prescription only.”
d. “You are correct. I will ask the health care provider to write a prescription so that
you can get the most effective drug.”
ANS: C
Diphenhydramine (Benadryl) is no longer available by prescription only. The OTC form has
the same strength, action, and side effects that the prescription only drug had.
13. Why is it important to always ask a patient about his or her use of any herbal supplements or
botanicals?
a. Many states do not have regulations about herbal supplements or botanicals.
b. These substances are illegal and their use by patients must be reported.
c. Patients who use botanicals seldom take their prescribed drugs.
d. These substances can interact with a prescribed drug.
ANS: D
Many herbal supplements and botanicals have effects on cell activity. Sometimes these agents
can make drug side effects worse or can reduce the effectiveness of a prescribed drug. Others
can actually cause health problems.
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14. How are the effects of naturally occurring testosterone changed when a patient is taking a
drug that is a testosterone agonist?
a. Effects are increased.
b. Effects are decreased.
c. Effects are eliminated.
d. Effects are unchanged.
ANS: A
An agonist drug has the same effects of the naturally occurring drug. So, taking a testosterone
agonist adds to the effects of the patient’s naturally occurring testosterone.
17. A patient asks why he must take a “loading dose” for the first dose of his prescribed drug and
then take lower doses after that. What is your best response?
a. “The loading dose allows the first dose of this drug to get into your bloodstream
faster and because it stays in the bloodstream a long time, you can take lower
doses after that.”
b. “The first dose of a drug has to be higher to reach the bloodstream because the
liver destroys it before it has a chance to start its action and work for you.”
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c. “By taking the highest dose first and just once, you are reducing the likelihood of
having a bad reaction or other side effects to this drug.”
d. “This schedule helps by ensuring that the drug is having an effect even if you
forget to take the rest of the doses.”
ANS: A
A loading dose is most often used with drugs that have a long half-life. Giving a higher dose
for the first dose allows it to reach the bloodstream rapidly and stay there. Smaller doses
follow it to keep the blood drug level at a steady state without increasing the risk for a drug
over dose.
19. When teaching a patient about adverse drug reactions (ADRs), which precaution is most
important to include? GRADESMORE.COM
a. “Take your medications right before you go to bed so that you can sleep through
an ADR.”
b. “Keep a written record of the date and time an ADR occurs.”
c. “Stop taking the drug and flush it down the toilet.”
d. “Immediately seek medical help.”
ANS: D
An adverse drug reaction can cause tissue damage and death. Any patient experiencing an
ADR needs to seek medical help immediately to reduce the chances of serious problems.
20. A patient tells you that she is allergic to the drug her health care provider just prescribed.
What is your best first response or action?
a. Ask her to describe the allergic response she had previously to this drug.
b. Ask her whether she received the drug she was allergic to by mouth or by
injection.
c. Thank her for the information and ask the health care provider to prescribe
something else.
d. Tell her that the health care provider will also prescribe an antidote that will
prevent an allergic response to the prescribed drug.
ANS: A
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Many patients do not understand the difference between a side effect, an allergy, and an
adverse effect. She may really have had an allergic reaction or perhaps just experienced a side
effect that would not preclude her receiving this drug again. It is important to find out just
what the reaction involved in order to determine whether she should receive this drug.
21. How would a drug dose that is below the minimum effective concentration (MEC) affect a
patient’s response to the drug?
a. Drug entry exceeds drug elimination.
b. The intended response fails to occur.
c. The risk for toxic side effects is increased.
d. The drug’s duration of action is longer than expected.
ANS: B
In order for a drug to produce its intended response, its blood levels must reach the MEC.
Therefore, any drug dose that does not reach the MEC would be ineffective.
22. A patient asks why she becomes sleepy after she takes a specific drug but that her neighbor
who takes the same drug at the same dose does not experience sleepiness. What is your best
response?
a. “Your neighbor may also be taking another drug to reduce the side effects of this
drug.”
b. “Your neighbor is probably addicted to this prescribed drug and you are not.”
c. “Side effects are very dependent on the time of day when the drug is taken.”
GRAeffects
d. “People often experience side DESMofOR E.COM
the same drug differently.”
ANS: D
Although all drugs have at least one side effect, not every patient who takes the drug will have
every side effect.
23. What precaution do you need to take when a patient is prescribed a drug that has a “black box
warning?”
a. Avoiding oral administration of this drug.
b. Avoiding intravenous administration of this drug.
c. Closely observing the patient for specific adverse reactions.
d. Ensuring that the prescriber is present when the drug is given.
ANS: C
A black box warning indicates that a drug may produce specific serious or even
life-threatening effects in some people in addition to the beneficial effects. It is important that
the patient understand the potential problems and that you carefully observe the patient for
any signs that such a reaction is happening. The drug route is not the reason a drug has a black
box designation. It is not usually necessary for the prescriber to be the health care professional
administering the drug.
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24. Morphine and hydromorphone (Dilaudid) are two types of opioid receptor agonists used for
pain management. Hydromorphone is a more potent drug than morphine, and lower doses are
needed to control pain. How do actions at receptor sites explain this difference?
a. Morphine remains bound to opioid receptors longer than hydromorphone does.
b. Hydromorphone remains bound to opioid receptors longer than morphine does.
c. Morphine is metabolized and eliminated at a faster rate than hydromorphone.
d. Hydromorphone is metabolized and eliminated at a faster rate than morphine.
ANS: B
The length of time and intensity of an agonist drug’s response is related to how tightly and
how long it remains bound to its receptors. More potent agonist drugs stay bound longer than
do weaker agonist drugs.
ANS: C
Drugs administered intravenously are immediately available in the bloodstream. If the dosage
is wrong or if it is the wrong drug, there is no simple way to stop the drug’s action.
27. The likelihood that a drug will sequester (be trapped) in fat cells and remain in the body
longer is increased by which drug characteristic?
a. Dissolves easily in water
b. Dissolves easily in lipids
c. Physical small size
d. Physical large size
ANS: B
Drugs that are lipid soluble (dissolve easily in lipids) enter the plasma membranes of all cells
more easily than water-soluble drugs. When a lipid-soluble drug enters a lipid environment
(e.g., inside a fat cell), it is often sequestered there and takes a much longer time to be
eliminated.
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28. A patient has a deficiency of an enzyme that prepares a specific drug for elimination. For
which response or issue should you remain alert?
a. Toxic blood levels of the drug are more likely to occur.
b. Higher drug dosages will be needed for the intended action to occur.
c. The drug will be eliminated more rapidly in the feces rather than in the urine.
d. Delivery of this drug by the parenteral route is more effective than by the enteral
route.
ANS: A
When a patient has a deficiency of the enzyme needed for drug elimination, the drug remains
in the body much longer. The risk for even “normal” dosages to cause serious side effects is
higher, and toxic drug blood levels can occur quickly. If such a drug is prescribed for this
patient, the dosage is lowered and the drug is administered less often.
29. A patient has all of the following health problems. Which problem increases his or her risk for
drug side effects?
a. Asthma
b. Kidney disease
c. GI ulcers
d. Chronic high blood pressure
ANS: B
The liver and kidneys are the organs
GRADE that
SMare
ORmost
E.Cimportant
OM for drug metabolism and
elimination. A problem that decreases the function of either organ increases active blood drug
levels and the length of time a single drug dose remains in the body. Both conditions lead to
an increased risk for drug side effects.
30. When a patient takes 400 mg of an oral drug that has a half-life of 2 hours at noon, at which
time will the patient’s blood drug level first be less than 40 mg?
a. 2:00 p.m.
b. 6:00 p.m.
c. 8:00 p.m.
d. Midnight
ANS: C
With a half-life of 2 hours, the amount of drug remaining in the blood decreases by 50% every
2 hours. So, when 400 mg are given at noon, by 2:00 p.m., 200 mg remain; by 4:00 p.m., 100
mg remain; by 6:00 p.m., 50 mg remain; by 8:00 p.m., 25 mg remain; by 10:00 p.m., 12.5 mg
remain, and by midnight, 6.25 mg remain.
31. When an oral drug that is not absorbed systemically is prescribed to a woman who is
breastfeeding, what is the risk for harm to the infant?
a. Not predicted to increase risk
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32. A patient is prescribed a drug that has an extremely short half-life for chest pain (angina).
Which modification in drug dosage or scheduling should you expect?
a. Once-daily dosing
b. More frequent dosing
c. Larger first dose and smaller repeat doses
d. Parenteral doses greater than enteral doses
ANS: B
Drugs that have a short half-life are given more frequently to maintain drug blood levels
within the minimum effective concentration.
33. Why are antibiotics from the tetracycline drug group seldom prescribed during pregnancy?
a. Although the mother may have an infection, the fetus does not; giving these drugs
to the mother would expose the fetus to unnecessary drugs.
b. The pregnant woman does not metabolize tetracycline to its active form and
excessively high doses areGneeded
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c. These drugs reduce the thickness of the enamel in developing teeth, so the infant
would have darkly stained teeth.
d. The fetal liver is too immature to inactivate these drugs and eliminate them; they
increase the risk for severe birth defects.
ANS: C
Although avoiding drugs during pregnancy is recommended, when an infection is present it
usually must be treated, even though it exposes the fetus to a drug. In the case of tetracycline,
it reduces the density of tooth enamel in the teeth that develop during pregnancy (even though
the teeth have not erupted by birth). This result gives the “baby” teeth a darkened or stained
appearance. Unless the mother has an infection for which no other drug is effective,
tetracyclines are not given during pregnancy.
34. A patient who has a serious chronic disorder (epilepsy) has been taking a drug to control it
that has a moderate likelihood of increasing the risk for birth defects or fetal damage. She tells
you that she would like to have a child. What is your best response?
a. Tell her that taking any drug during pregnancy is not recommended.
b. Suggest that she use a reliable method of contraception and consider adoption.
c. Warn her that her condition will get worse if she stops taking the prescribed drug.
d. Counsel her to discuss her wishes with her health care provider to evaluate her
specific risks and possible pregnancy outcomes.
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ANS: D
The patient must be able to make an informed decision about pregnancy and drug therapy. It
is the responsibility of the health care provider who prescribes the drugs to help her
understand the risks and any alternative therapy choices. It is also helpful to have a pharmacist
involved in such a discussion. It is not the responsibility of the nurse or other health care
professional to provide this information but all have an obligation to help her meet with her
health care provider for this discussion.
35. A patient with severe heart failure asks why the prescriber has lowered the dosages of most of
the patient’s daily medications. What is your best response?
a. “With a weaker heart, the drugs stay in your system longer, so you don’t need as
high a dosage.”
b. “Your heart drugs enhance the action of your other drugs, reducing the need for
higher dosages.”
c. “Your heart is not strong enough to tolerate these drugs, making the risk for a heart
attack higher.”
d. “The drugs are very expensive, and with these heart problems your health is not
expected to improve.”
ANS: A
Good heart function is needed to move drugs in the blood to the liver and kidneys. Poor
circulation as a result of heart failure can lead to slower drug metabolism and elimination.
This can cause toxic buildup of drug blood levels. Commonly, drug dosages are lowered for
patients with severe heart failure.
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DIF: Cognitive Level: Applying or Higher REF: pp. 19-20
36. A 25-year-old patient is prescribed a drug for acne for 6 months that is teratogenic. Which
precaution is most important to teach this patient?
a. “Drugs with this classification reduce the effectiveness of oral contraceptives and
you will need to switch to another form of birth control to prevent pregnancy.”
b. “One side effect of drugs with this classification is nausea, which will make
morning sickness more severe if you become pregnant while taking this drug.”
c. “Use two reliable forms of birth control during the next 6 months because drugs
with this classification cause severe birth defects.”
d. “Your risk for sexually transmitted diseases is increased while taking this drug and
for 3 months after therapy is completed.”
ANS: C
Drugs that are teratogenic (are teratogens) have been tested and are known to greatly increase
the risk for birth defects. These drugs are not to be used during pregnancy unless the health
problem is so serious that the potential benefits outweigh the risk for serious fetal harm. When
prescribed for a sexually active woman of childbearing age, two different types of reliable
birth control methods are recommended.
37. Which precaution is most important to teach parents about giving an over-the-counter (OTC)
drug to a child?
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MULTIPLE RESPONSE
1. Which body tissues or fluids are routes of drug elimination? (select all that apply)
a. Bone marrow
b. Heart
c. Liver
d. Lungs
e. Ovary
f. Saliva
g. Tears
ANS: C, D, F, G
The liver and kidneys are the main sites of drug metabolism and drug elimination. The lungs
are able to eliminate drugs thatGare
RAD easily
ESMturned
ORE.into
COMgases (vaporized). Although only a small
amount of any drug can be expected to be in the saliva or tears, they are an excretion and
elimination route. The bone marrow, heart, and ovaries are not true excretory organs.
COMPLETION
BASIC CONCEPTS
1. What is the weight in pounds for an individual who weighs 70 kg? _____lb
ANS:
154
ADVANCED CONCEPTS
2. An adult patient weighing 180 lb is prescribed a drug dose of 2 mg/kg. What actual dose
should you prepare for this patient?
_____ mg
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ANS:
164
1 kg = 2.2 lb. To obtain the kilogram weight for this patient: 180/2.2 = 81.8 kg (rounded up to
82 kg). The correct dose is 2 mg 82 kg = 164 mg.
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