NR565 Advanced Pharmacology
Fundamentals
Pharmacokinetics - ANSWER...-The process by which drugs are absorbed, distributed
within the body, metabolized, and excreted.
Pharmacodynamics - ANSWER...-The study of what the drug does to the body
Factors Affecting Drug Absorption - ANSWER...-Rate of dissolution
Surface area
Blood flow
Lipid solubility
pH partitioning
Factors Affecting Drug Distribution - ANSWER...-Blood flow to tissues
Ability to exit the vascular system
Blood-brain barrier
Protein-binding capacity
Xenobiotics - ANSWER...-substances that are foreign to the body, usually synthetic
chemical compounds; medications are a common example
Cytochrome P450 (CYP450) - ANSWER...-xenobiotic-metabolizing enzymes necessary
for the production of cholesterol and steroids and the detoxification of chemicals and
drug metabolism.
Function of Cytochrome P450 (CYP450) - ANSWER...-responsible for phase 1
metabolism in which drugs are oxidized, reduced, or hydrolyzed
Phase 1 Metabolism of Drugs via P450 - ANSWER...-Oxidation; Reduction; Hydrolysis
Three possible outcomes of phase 1 drug metabolism. - ANSWER...--Drug becomes
completely inactive
-Drug becomes partially inactive but one or more metabolites remain active
-Original drug is not pharmacologically active but one metabolite remains active
,CYP450 Inducers - ANSWER...-Medications that can increase the rate of another drug's
metabolism by elevating CYP450 enzyme activity via increasing enzyme synthesis.
decreasing the concentration of the "parent drug"
CYP450 Inducer Medications - ANSWER...-CRAPGPS
Carbamazepine
Rifampin
Alcohol
Phenytoin
Griseofulvin
Phenobarbital
Sulfonylureas
CYP450 Inhibitors - ANSWER...-Medications that inhibit the metabolic activity of one or
more of the CYP450 enzymes. Higher risk for toxicity; prolongs the pharmacological
effect of the "parent drug".
CYP450 Inhibitor Medications - ANSWER...-VISACKGQ
Valproate
Isoniazid
Sulfonamides
Amiodarone
Chloramphenicol
Ketoconazole
Grapefruit Juice
Quinidine
Beers Criteria - ANSWER...--potentially Inappropriate Medication (PIM) use in older
adults
-potentially Inappropriate Medication (PIM) use in older adults due to medication-
disease or medication-syndrome interactions that may exacerbate the disease or
syndrome
-medications to be used cautiously in older adults
-clinically significant drug interactions that should be avoided in older adults
-medications to be avoided or dosage decreased in the presence of impaired kidney
function in older adults
Pharmacokinetic Interactions - ANSWER...-when one medication systemically alters the
potency of another medication.
Absorption Interaction - ANSWER...-result of a change due to one medication's effect
on another medication's route of entry into the body.
Distribution Interaction - ANSWER...-caused by the amount of unbound/free
medications available at the various target sites.
,Metabolism Interaction - ANSWER...-concentration of the medication after
biotransformation into active and inactive metabolites in higher or lower than expected.
Elimination Interaction - ANSWER...-the body's ability to eliminate medications in pure
form or by altering a metabolite from the body.
Pharmacodynamic Interactions - ANSWER...-does not alter or impact absorption,
distribution, metabolism, or elimination because of the one medication's ability to
manipulate the effect of another medication at its site of action
Practice Authority - ANSWER...-refers to the nurse practitioner's ability to practice
without physician oversight
prescriptive authority - ANSWER...-refers to the nurse practitioner's authority to
prescribe medications.
Full-practice scope - ANSWER...-Nurse practitioners have the autonomy to evaluate
patients, diagnose, order and interpret tests, initiate and manage treatments and
prescribe medications, including controlled substances without physician oversight.
Reduced-practice scope - ANSWER...-Nurse practitioners are limited in at least one
element of practice. The state requires a formal collaborative agreement with an outside
health discipline for the nurse practitioner to provide patient care.
Restricted practice scope - ANSWER...-Nurse practitioners are limited in at least one
element of practice by requiring supervision, delegation, or team management by an
outside health discipline for the nurse practitioner to provide patient care.
Drugs that cannot be ordered via E-Script - ANSWER...-DEA Scheduled Drugs
Drugs that cannot be prescribed or refilled via phone - ANSWER...-Schedule II drugs
Acute Pain - ANSWER...-An occurrence of fewer than three months and is often
precipitated by trauma and acute medical conditions or treatment.
Types of Acute Pain - ANSWER...-Referred Pain
Acute Somatic Pain
Acute visceral pain
Chronic pain - ANSWER...-episode of pain that lasts for 6 months or longer; may be
intermittent or continuous
Referred Pain - ANSWER...-pain that is felt in a location other than where the pain
originates
, Acute Somatic Pain - ANSWER...--Arises from connective tissue, muscle, bone and
skin.
-Sharp and localized or dull and non-localized
-Responds best to: acetaminophen, corticosteroids, NSAIDs, opiates, local anesthetics,
ice, massage
Acute Visceral Pain - ANSWER...-Pain in the internal organs and abdomen
Poorly localized (C-fibers)
Radiates
Most responsive to opiates
May also use corticosteroids, NSAIDs
Opioids - ANSWER...-any drug, natural or synthetic, that has actions similar to those of
morphine
Opioid Receptor Families - ANSWER...-Mu (μ)
Kappa (k)
Delta (δ)
At each type of receptor, a drug can act in one of three ways: - ANSWER...-(1) pure
opioid agonists, (2) agonist-antagonist opioids, (3) pure opioid antagonists.
Mu (u) Receptor - ANSWER...-Opioid receptor most responsible for mediating analgesic
properties
Pure opioid agonists - ANSWER...-activate µ receptors and κ receptors. produce
analgesia, euphoria, sedation, respiratory depression, physical dependence,
constipation, and other effects
Prototype Drug: MORPHINE
Morphine - ANSWER...-Prototype drug of pure opioid agonist; Strong Opioid Agonist
Fentanyl - ANSWER...-A strong opioid analgesic with a high milligram potency (about
100 times that of morphine).
Subcategory of Pure Opioid Agonist - ANSWER...-strong opioid agonists; moderate to
strong opioid agonists
Moderate to Strong Pure Opioid Agonists - ANSWER...-Oxycodone (Roxicodone,
Oxycontin); Hydrocodone (Vicodin)
Agonist-Antagonist Opioids - ANSWER...-The actions of these drugs at µ and κ
receptors When administered alone, produce analgesia. However, if given to a patient
who is taking a pure opioid agonist, can antagonize analgesia
Prototype Drug: Pentazocine
Fundamentals
Pharmacokinetics - ANSWER...-The process by which drugs are absorbed, distributed
within the body, metabolized, and excreted.
Pharmacodynamics - ANSWER...-The study of what the drug does to the body
Factors Affecting Drug Absorption - ANSWER...-Rate of dissolution
Surface area
Blood flow
Lipid solubility
pH partitioning
Factors Affecting Drug Distribution - ANSWER...-Blood flow to tissues
Ability to exit the vascular system
Blood-brain barrier
Protein-binding capacity
Xenobiotics - ANSWER...-substances that are foreign to the body, usually synthetic
chemical compounds; medications are a common example
Cytochrome P450 (CYP450) - ANSWER...-xenobiotic-metabolizing enzymes necessary
for the production of cholesterol and steroids and the detoxification of chemicals and
drug metabolism.
Function of Cytochrome P450 (CYP450) - ANSWER...-responsible for phase 1
metabolism in which drugs are oxidized, reduced, or hydrolyzed
Phase 1 Metabolism of Drugs via P450 - ANSWER...-Oxidation; Reduction; Hydrolysis
Three possible outcomes of phase 1 drug metabolism. - ANSWER...--Drug becomes
completely inactive
-Drug becomes partially inactive but one or more metabolites remain active
-Original drug is not pharmacologically active but one metabolite remains active
,CYP450 Inducers - ANSWER...-Medications that can increase the rate of another drug's
metabolism by elevating CYP450 enzyme activity via increasing enzyme synthesis.
decreasing the concentration of the "parent drug"
CYP450 Inducer Medications - ANSWER...-CRAPGPS
Carbamazepine
Rifampin
Alcohol
Phenytoin
Griseofulvin
Phenobarbital
Sulfonylureas
CYP450 Inhibitors - ANSWER...-Medications that inhibit the metabolic activity of one or
more of the CYP450 enzymes. Higher risk for toxicity; prolongs the pharmacological
effect of the "parent drug".
CYP450 Inhibitor Medications - ANSWER...-VISACKGQ
Valproate
Isoniazid
Sulfonamides
Amiodarone
Chloramphenicol
Ketoconazole
Grapefruit Juice
Quinidine
Beers Criteria - ANSWER...--potentially Inappropriate Medication (PIM) use in older
adults
-potentially Inappropriate Medication (PIM) use in older adults due to medication-
disease or medication-syndrome interactions that may exacerbate the disease or
syndrome
-medications to be used cautiously in older adults
-clinically significant drug interactions that should be avoided in older adults
-medications to be avoided or dosage decreased in the presence of impaired kidney
function in older adults
Pharmacokinetic Interactions - ANSWER...-when one medication systemically alters the
potency of another medication.
Absorption Interaction - ANSWER...-result of a change due to one medication's effect
on another medication's route of entry into the body.
Distribution Interaction - ANSWER...-caused by the amount of unbound/free
medications available at the various target sites.
,Metabolism Interaction - ANSWER...-concentration of the medication after
biotransformation into active and inactive metabolites in higher or lower than expected.
Elimination Interaction - ANSWER...-the body's ability to eliminate medications in pure
form or by altering a metabolite from the body.
Pharmacodynamic Interactions - ANSWER...-does not alter or impact absorption,
distribution, metabolism, or elimination because of the one medication's ability to
manipulate the effect of another medication at its site of action
Practice Authority - ANSWER...-refers to the nurse practitioner's ability to practice
without physician oversight
prescriptive authority - ANSWER...-refers to the nurse practitioner's authority to
prescribe medications.
Full-practice scope - ANSWER...-Nurse practitioners have the autonomy to evaluate
patients, diagnose, order and interpret tests, initiate and manage treatments and
prescribe medications, including controlled substances without physician oversight.
Reduced-practice scope - ANSWER...-Nurse practitioners are limited in at least one
element of practice. The state requires a formal collaborative agreement with an outside
health discipline for the nurse practitioner to provide patient care.
Restricted practice scope - ANSWER...-Nurse practitioners are limited in at least one
element of practice by requiring supervision, delegation, or team management by an
outside health discipline for the nurse practitioner to provide patient care.
Drugs that cannot be ordered via E-Script - ANSWER...-DEA Scheduled Drugs
Drugs that cannot be prescribed or refilled via phone - ANSWER...-Schedule II drugs
Acute Pain - ANSWER...-An occurrence of fewer than three months and is often
precipitated by trauma and acute medical conditions or treatment.
Types of Acute Pain - ANSWER...-Referred Pain
Acute Somatic Pain
Acute visceral pain
Chronic pain - ANSWER...-episode of pain that lasts for 6 months or longer; may be
intermittent or continuous
Referred Pain - ANSWER...-pain that is felt in a location other than where the pain
originates
, Acute Somatic Pain - ANSWER...--Arises from connective tissue, muscle, bone and
skin.
-Sharp and localized or dull and non-localized
-Responds best to: acetaminophen, corticosteroids, NSAIDs, opiates, local anesthetics,
ice, massage
Acute Visceral Pain - ANSWER...-Pain in the internal organs and abdomen
Poorly localized (C-fibers)
Radiates
Most responsive to opiates
May also use corticosteroids, NSAIDs
Opioids - ANSWER...-any drug, natural or synthetic, that has actions similar to those of
morphine
Opioid Receptor Families - ANSWER...-Mu (μ)
Kappa (k)
Delta (δ)
At each type of receptor, a drug can act in one of three ways: - ANSWER...-(1) pure
opioid agonists, (2) agonist-antagonist opioids, (3) pure opioid antagonists.
Mu (u) Receptor - ANSWER...-Opioid receptor most responsible for mediating analgesic
properties
Pure opioid agonists - ANSWER...-activate µ receptors and κ receptors. produce
analgesia, euphoria, sedation, respiratory depression, physical dependence,
constipation, and other effects
Prototype Drug: MORPHINE
Morphine - ANSWER...-Prototype drug of pure opioid agonist; Strong Opioid Agonist
Fentanyl - ANSWER...-A strong opioid analgesic with a high milligram potency (about
100 times that of morphine).
Subcategory of Pure Opioid Agonist - ANSWER...-strong opioid agonists; moderate to
strong opioid agonists
Moderate to Strong Pure Opioid Agonists - ANSWER...-Oxycodone (Roxicodone,
Oxycontin); Hydrocodone (Vicodin)
Agonist-Antagonist Opioids - ANSWER...-The actions of these drugs at µ and κ
receptors When administered alone, produce analgesia. However, if given to a patient
who is taking a pure opioid agonist, can antagonize analgesia
Prototype Drug: Pentazocine
