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The nurse is assigned a 49-year-old female client in the primary care office for a wellness visit. The nurse assesses the client, documents nurses notes, and reviews the medication administration record for potential interactions. The nurse should be most concern with the potential interaction between __and _.
Complete the sentence by choosing one answer from each option in the drop-down list below:
Medication Reconciliation:

St. John's wort 450 mg by mouth twice daily

Gabapentin 400 mg by mouth twice daily

Aspirin 81 mg by mouth daily

Atorvastatin 80 mg by mouth daily

Lisinopril 5 mg by mouth daily

Warfarin 5 mg by mouth daily

Ginger 5mg by mouth daily

Valerian 10mg by mouth daily

Answer and Explanation

Correct Answer : A,F

A. St. John's wort 450 mg by mouth twice daily: St. John's wort is known to be a potent inducer of cytochrome P450 enzymes and can significantly reduce the effectiveness of warfarin by increasing its metabolism. This interaction can lead to subtherapeutic levels of warfarin and an increased risk of thromboembolic events.

B. Gabapentin 400 mg by mouth twice daily: While gabapentin can interact with other medications, its interactions with warfarin or St. John's wort are generally not as significant as those between warfarin and St. John's wort.

C. Aspirin 81 mg by mouth daily: Aspirin has anticoagulant properties and can have interactions with warfarin. However, the interaction with St. John's wort is less pronounced compared to the interaction between warfarin and St. John's wort.

D. Atorvastatin 80 mg by mouth daily: Atorvastatin primarily affects lipid levels and has different metabolic pathways compared to warfarin. It does not have a strong interaction with St. John's wort.

E. Lisinopril 5 mg by mouth daily: Lisinopril is an ACE inhibitor and does not have significant interactions with St. John's wort or warfarin.

F. Warfarin 5 mg by mouth daily. Warfarin is an anticoagulant that requires careful monitoring due to its interactions with various substances that can either increase the risk of bleeding or decrease its effectiveness.

G. Ginger 5 mg by mouth daily: Ginger can affect platelet function but is not as significant in interaction with warfarin as St. John's wort.

H. Valerian 10 mg by mouth daily: Valerian may have mild interactions with central nervous system depressants but does not have significant interactions with warfarin or St. John's wort.

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Correct Answer is ["D","E"]

Explanation

A) Affinity: Affinity refers to the strength of the interaction between a drug and its receptor. It does not describe the body's overall handling of the drug or the drug's effects on the body.

B) Efficacy: Efficacy describes the ability of a drug to produce a desired therapeutic effect. It pertains to the drug’s effectiveness once it interacts with its target but does not encompass the body's handling of the drug.

C) Biotransformation: Biotransformation is the process of drug metabolism, specifically how the body chemically alters a drug. While it is a part of pharmacokinetics, it does not cover the entire concept.

D) Pharmacokinetics: Pharmacokinetics is the term used to describe what the body does with the drug, including absorption, distribution, metabolism, and excretion. It encompasses the processes that determine the drug's concentration in the body over time.

E) Pharmacodynamics: Pharmacodynamics refers to what the drug does to the body, including the relationship between drug concentration and effect. It encompasses the mechanisms of action, including receptor interactions and therapeutic effects.

A. Parenteral medications are avoided due to fragility of veins. B. Older adults are at risk for drug toxicity due to accumulation in the body. C. The elderly population is susceptible to polypharmacy D. Medication metabolism tends to be faster in older adults. E. Older adults have delayed absorption. F. Older adults may require larger doses of medications.

Correct Answer is ["B","C","E"]

Explanation

A) Parenteral medications are avoided due to fragility of veins: While it is true that older adults may have fragile veins, this does not mean that parenteral medications are universally avoided. Parenteral medications are still used based on clinical needs, though careful consideration is given to the condition of the veins.

B) Older adults are at risk for drug toxicity due to accumulation in the body: This is correct. As people age, their liver and kidney functions often decline, leading to decreased metabolism and excretion of drugs. This can result in drug accumulation and an increased risk of toxicity.

C) The elderly population is susceptible to polypharmacy: This is correct. Older adults often take multiple medications for various chronic conditions, increasing the risk of drug interactions, side effects, and complications. Polypharmacy is a common issue in this population.

D) Medication metabolism tends to be faster in older adults: This is incorrect. Medication metabolism generally slows down in older adults due to decreased liver function. Slower metabolism can lead to drug accumulation and increased risk of adverse effects.

E) Older adults have delayed absorption: This is correct. Although the rate of absorption may not be significantly affected, the overall absorption can be altered due to changes in gastrointestinal function and blood flow in older adults.

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Naxlex Comprehensive Predictor Exams

Complete the following sentence using the options in the drop down selection. _____ Is what the body does with the drug versus ____ which is what the drug does to the body.

Correct Answer is ["D","E"]

Explanation

A nurse is caring for an older adult client. The nurse should recognize that which of the following considerations apply to older adults and pharmacology? (Select all that apply).

Correct Answer is ["B","C","E"]

Explanation

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