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statistics for nursing a practical approach
Fundamentals Of Pharmacology : An Applied Approach For Nursing And Health 2nd Edition Shane Hunt - Solutions
Why is suxamethonium used in electroconvulsive therapy (ECT) in preference to other neuromuscular blocking agents?
Why is muscle pain an after effect of suxamethonium use in some patients?
State three conditions that are contraindications for antimuscarinic therapy. State two conditions that are contraindications for muscarinic agonist therapy. For each condition, explain the basis of the contraindication.
State the major adverse effects of muscarinic and antimuscarinic drugs. What are the implications for patient teaching with these classes of drugs?
Identify the three types of muscarinic receptor and their distribution around the body.
Indicate whether the following effects are related to an action at nicotinic or muscarinic receptors and whether the action is that of an agonist or antagonist:(a) skeletal muscle spasm;(b) decreased heart rate;(c) pupil dilation;(d) dry mouth;(e) decreased intraocular pressure.
Explain how the physiological effects of acetylcholine are terminated in terms of your understanding of cholinergic nerve action.
Bill Caries is 28 years of age and is suffering from depression. He is being treated for this with a monoamine oxidase(MAO) inhibitor. What is the role of MAO in adrenergic nerve function? What would you expect this medicine to do to the synaptic levels of the neurotransmitter noradrenaline?
Cecilia Wong is diagnosed with glaucoma. Her drug therapy for this condition comprises the beta-blocker timolol and the α2 agonist apraclonidine. These medicines are administered as eye drops. What are the advantages of this route of administration?
β2 agonists produce bronchodilation as a therapeutic effect and tachycardia and skeletal muscle tremor as adverse effects. Explain these effects with reference to the mechanism of action of this group.
What potential problem is associated with administering short-term beta-blocker treatment to a patient suffering from congestive cardiac failure? Explain your answer with reference to the mechanism of action of beta-blockers.
What are the major adverse effects of sympatholytics? What are the implications for patient teaching?
Dopamine produces sympathetic effects in the periphery. Does it induce these effects by stimulating dopamine or adrenergic receptors? For what conditions could dopamine administration be therapeutically beneficial?
What are the major adverse effects of sympathomimetics? What are the implications for patient teaching?
Mario Molitario, who suffers from asthma, visits the community health centre to have his condition and medication reviewed. He comments to the community nurse that a local general practitioner has put him on propranolol (a non-selective beta-blocker) for high blood pressure. What would the
Outline the processes involved in a second-messenger system.
State three adverse reactions associated with each of the following adrenergic drug groups:(a) α1 agonists;(b) β1 antagonists;(c) β2 agonists;(d) non-selective α and β antagonists.
Indicate whether the following effects are related to an action at α1, α2, β1 or β2 receptors and whether the action is that of an agonist or antagonist:(a) elevated blood pressure;(b) decreased heart rate;(c) pupil dilation;(d) bronchodilation;(e) glycogenolysis.
What are the types of adrenergic receptor present in the human body?
Name the chemical messengers involved in adrenergic stimulation of sympathetic effectors.
Outline the process of adrenergic nerve stimulation and transmitter inactivation.
(a) Define the term ‘neuromodulation’.(b) Give four examples of neuromodulation.
For each of the following effects, determine whether it is due to sympathetic or parasympathetic innervation:(a) increased blood pressure;(b) pupil constriction;(c) sweating;(d) secretion of stomach juices;(e) micturition (urinary bladder emptying).
For each of the following effectors, deduce the effects (if any) of sympathetic and parasympathetic stimulation:(a) myocardium;(b) stomach;(c) sweat glands;(d) iris;(e) salivary glands.
(a) What are the two divisions of the autonomic nervous system?(b) Compare and contrast the anatomical organisation of the divisions.
Terry Sterculia, 28 years old, is a keen amateur boxer. He broke his leg recently in a work-related accident and has not been able to train during this period. A fight is coming up for which he wants to qualify, but he is a few kilograms overweight. In order to lose weight quickly, he is taking his
At 17 years of age, Marie Duphastin shows promise as a sprinter. She tells you that she has been offered anabolic-androgenic steroids by her coach to increase her strength. Her coach has told her that there are no health risks associated with their use. She asks you whether this is true. What
For each of the following substances, indicate whether administration would result in increased androgen production in a male athlete:(a) corticotrophin;(b) dehydroepiandrosterone;(c) growth hormone;(d) luteinising hormone;(e) salbutamol.
Outline the problems associated with the detection of some banned substances through urine testing of sportspeople.
State four examples of substances that are permitted in some sporting competitions, and outline the physiological effects of each that may enhance performance.
State four examples of substances banned from sporting competitions, and indicate the reasons why each is prohibited.
Referring again to question 4, why would small amounts of caffeine in the urine be ignored?
Certain levels of caffeine in the urine of athletes would cause disqualification from the Olympic Games. Why?
Would one consider nicotine chewing gum as an alternative to smoking for patients with severe cardiovascular disease? Give reasons for your answer.
What is meant by the term ‘avoidance therapy’?
What is the difference between a habit and a dependence?
Jack Daniels is a 50-year-old business manager with a past history of rheumatic fever and a mechanical mitral valve replacement. He takes warfarin to prevent clots forming associated with the valve replacement. While showering one day, he notices extensive bruising on his abdomen and thighs.He
John Roberts, an 18-year-old unemployed youth, is brought into the emergency department by a friend after a heroin overdose. A dose of naloxone is administered. He suddenly regains consciousness and begins to tremble and sweat. How would you explain this phenomenon?
Katrina Markowitz, a 22-year-old student, is admitted to the emergency department after an overdose of diazepam and paracetamol. She was lying unconscious in her flat for at least 20 hours before she was found by friends and transferred to hospital. What treatment will be administered? Is it likely
Baby Anna Riali is admitted to the emergency department after the ingestion of iron tablets. What antidote will be administered? What information would you provide to Anna’s mother about this antidote?
Martin Cairns, 27 years old, is receiving treatment for a heart condition. Martin complains of marked dryness of the mouth, a burning sensation and nausea. You note that he has tachycardia, facial flushing, tremor, restlessness and confusion. Is this a case of anticholinesterase or atropine
Phillip Jones, who sustained a deep vein thrombosis 5 days ago, is on a heparin infusion to prevent the development of further clots. As his nurse, you notice haematuria following a urinalysis test, bleeding gums and a bleeding nose. What would you suspect? How would this condition be treated?
Why are the specific antidotes for overdose of heparin and warfarin different, even though both drugs are anticoagulants?
(a) For which examples of overdosage do the antidotes have shorter half-lives than those of the overdosed drug?(b) What is the impact of the relative differences in half-lives on the treatment of overdose?
Name the specific antidote(s) for overdose of the following drugs:(a) morphine;(b) iron;(c) paracetamol;(d) atropine.
Identify the procedures available that form the general approach in drug detoxification. Indicate when each procedure should be used and any problems associated with its use.
Briefly describe the four principles underlying the management of clinical drug overdose.
Mario Malodoro, a 60-year-old farmer, is brought into the emergency department with organophosphate poisoning.How would this form of poisoning be treated?
Your neighbour visits you in an extremely distressed state. Joey, her 3-year-old son, has just swallowed an unknown quantity of paracetamol tablets. What would you advise her to do? Why?
State the three aims of emergency care when someone is bitten or stung by a poisonous animal.
Define the term ‘envenomation’.
Name the agent(s) used in the treatment of poisoning by each of the following substances:(a) cyanide;(b) lead;(c) mercury;(d) pesticides.
What is a chelating agent?
Indicate the circumstances under which each of the following antidotes should not be administered:(a) sodium sulphate;(b) activated charcoal;(c) salts of magnesium;(d) penicillamine.
Aldo Tagliatelli is 71 years old and migrated to this country from Italy with his wife 10 years ago.He is in hospital having treatment for a minor stroke. The stroke has affected his speech and the movement of his right arm and hand (he is right-handed). He is recovering well, and it is expected
Aaron Skeled is 2 years old and is being hospitalised for a respiratory condition. His father is present at the bedside. Aaron requires an intramuscular injection of a drug. Outline the procedure you would take in managing the administration of this medication.
Name five types of drug formulation that are not suitable for crushing before administration.
Summarise the key aspects of clinical management in the elderly patient with respect to each part of the clinical decision-making process.
State one reason for non-adherence with drug treatment for each of the following categories, and indicate how the effect of each reason on compliance could be minimised:(a) social circumstances;(b) biological effects of ageing;(c) health-care team-related problem.
Summarise the key aspects of paediatric clinical management with respect to each part of the clinical decision-making process.
A 20-kg child is to receive a dose of 12.5 mg/kg paracetamol. Your stock solution of paracetamol is 120 mg/5 ml. How many millilitres of paracetamol are required?
Outline all the possible pharmacokinetic effects on the actions of drugs in elderly people.
Outline all the possible pharmacokinetic effects on the actions of drugs in very young patients.
Sinead O’Donald, an 18-year-old student, is brought to your community hospital. Her mother is concerned that she does not eat a balanced diet. Ms O’Donald is on amoxicillin for a respiratory infection. How would Ms O’Donald’s diet affect the metabolism of amoxicillin?
Despina Stamatopoulous is a 65-year-old widow with congestive cardiac failure. She is taking the angiotensinconverting enzyme (ACE) inhibitor enalapril for her cardiac failure and the penicillin ampicillin for a respiratory infection. How would her condition affect the excretion of ampicillin?
Richard Kriochek suffers from severe end-stage liver failure. How would the dosage of his medications be modified?Why?
Your next-door neighbour, who is pregnant, complains to you that in the past week she has been experiencing severe heartburn. How would you explain the reason underlying this condition?
Cecilia Fong is a teenager who has been prescribed tetracycline for her acne. Why would you recommend that she avoid taking dairy products with this medication?
Mary Wolstencort is suffering from acute renal failure following a very severe bleeding episode.How would this condition be expected to alter the effects of any medications she may take during this time? How would drug treatment have to be modified to minimise these effects?
Given the physiological changes that occur during pregnancy, list the expected effects on absorption, distribution, metabolism and excretion. If all of these effects did occur, what would you expect the net change in drug action to be (increased or decreased action)?
Name some conditions that would tend to decrease the rate of drug excretion.
Name some conditions that would tend to decrease the rate of drug metabolism.
Name some conditions that would tend to increase the amount of free drug molecules in the blood.
Name some conditions that would tend to decrease the level of drug absorption.
On examination of your patient’s history, you notice that she is a poor metaboliser of certain medications. How could this affect the patient’s proposed drug therapy?
With respect to metabolism of a particular drug, what does it mean when a patient has a high ratio of active to inactive metabolites present in a urine sample?
Jack Smith has a genetic makeup that involves a deficiency of pseudocholinesterases. How would this affect the metabolism of the neuromuscular blocking agent suxamethonium?
Camilla De Rosa is on the antidepressant phenelzine. It is soon discovered that Ms De Rosa is a slow acetylator of drugs. What change would the doctor make to her prescription?
Halle Zingiber has been granted refugee status in this country. He has had to leave his wife and two children in Ethiopia. He is severely depressed and is receiving treatment with the tricyclic antidepressant nortriptyline. No effects were reported when standard doses of the drug (25 mg t.i.d.)were
For the following drugs, indicate an idiosyncratic reaction that can occur as a result of an unusual genotype:(a) β2 agonists;(b) corticosteroids;(c) mydriatics;(d) sulphonamides.
With respect to drug therapy, suggest ways in which a person’s genetic status could be assessed.
What is the clinical management of someone who metabolises suxamethonium poorly?
What are the consequences of being a non-responder with regard to drug effects?
Define the following terms:(a) pharmacogenetics;(b) polymorphism.
Name the government drug regulatory bodies that oversee the evaluation of new drugs.
Differentiate between acute and chronic toxicity drug tests.
Explain why a double-blind experimental design is appropriate in human clinical drug trials.
Indicate the margin of safety (broad or narrow) for each of the following:(a) penicillin V;(b) aminoglycosides;(c) digoxin.
For each of the following reactions, indicate the type(s) of hypersensitivity to which it belongs:(a) haemolytic anaemia;(b) joint pain and swollen lymph nodes;(c) contact dermatitis;(d) photophobia;(e) rash.
Comment on the factors that will influence the absorption of drug X, a water-soluble drug that is 90 per cent bound to plasma proteins and has a molecular weight of 450 Da.
Determine whether the following drug effects should generally be regarded as predictable or unpredictable effects:(a) rash;(b) bradycardia;(c) dry mouth;(d) anaphylaxis.
The drug fluorouracil is used in the treatment of some forms of cancer. It is very similar to the compound uracil, which is an essential component of RNA. Suggest how this drug exerts its effect.
Iodine is a good oxidising agent and is used topically as a disinfectant. By what mechanism will it kill microorganisms?
Naloxone is used as an antidote for morphine poisoning. Morphine binds to receptors in the brain. Suggest how naloxone exerts its effect.
Simethicone lowers the surface tension of the gastrointestinal fluids. In one word, what is its mechanism of action
Explain the terms ‘potency’ and ‘efficacy’.
Streptokinase is a bacterial enzyme used as a thrombolytic agent. Why would this enzyme be better if it were of human origin? (You need to know some basic immunology to answer this.)
Neostigmine is a competitive inhibitor of cholinesterase. Look up the disease myasthenia gravis and suggest why this drug is used in its treatment.
What is meant by ‘receptor affinity’?
Atropine is used as an antidote for anticholinesterase poisoning. Can you give the reason for this?
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