NUR 243: Exam 1 Study Guide UPDATED ACTUAL Questions
and CORRECT Answers
Drug Development 1. Preclinical Testing (in Animals)
2. Clinical Testing (in Humans): Phase 1 (Healthy Volunteers -> Metabolism,
pharmacokinetics, biological effects), Phase 2 (Patients -> Therapeutic utility and
dosage range), Phase 3 (Patients -> Safety and effectiveness), Phase 4
(Postmarketing Surveillance)
Limitations of drug testing Limited information about certain populations (women & children); Failure to
detect all adverse effects
Pharmacokinetics Determining how much of the administered dose gets to its site of action; how
does the BODY metabolize the drug
Pharmacodynamics Impact of the DRUGS on the body; binding of the drug to its receptor
P-glycoprotein Trasports drugs back into the blood; Transmembrane protein that transports a
wide variety of drugs out of cells; Liver -> transports drugs into the bile for
elimination; Kidney -> pumps drugs into the urine for excretion; Placenta ->
transports drugs back into the maternal blood; Brain -> Pumps drugs into the
blood to limit drugs' access to the brain
CYP450 System Enzymes in the liver that change the structure of a drug; renders them therapeutic
in order for them to perform efficiently; factor in altered metabolism -> increases
rate two- to threefold over 7-10 days, resolve over 7-10 days after withdrawal;
inhibits CYP isoenzymes (usually undesired)
Therapeutic Index Measure of a drug's safety; Ratio of the drug's LD50 (average lethal dose to 50%
of the animals treated) to its ED50; the larger/higher, the safer; the smaller/lower,
the less safe
Receptors Functional macromolecules on a cell that most drugs interact with to produce
effects; their binding is usually reversible; include enzymes, ribosomes, and
tubulin; once bound, they will MIMIC or BLOCK the action of the endogenous
regulatory molecules and increase or decrease the rate of physiologic activity
normally controlled by it
Protein binding Drugs can form reversible bonds with various proteins; Plasma albumin is the
most abundant & important protein -> always remains in the bloodstream, affects
drug distribution, aids in transport
Toxicity Adverse drug reaction caused by excessive dosing; may occur even with normal
dosing (depends on Pt metabolism)
, First-pass effect The metabolism of an orally administered drug by the liver (and sometimes
intestinal wall) before it reaches systemic circulation; reduces the amount of
active drug available (bioavailability) and may require higher oral doses or
alternative routes of administration (e.g., IV, sublingual); body is naturally going
to eliminate most of the medication; higher = higher dose needed or alternative
route of administration
Kidney function Pumps drugs into the urine for excretion; renal function should be assessed with
drugs that are primarily eliminated there; creatinine clearance/levels are the best
index of function; slow down with age
Liver function Transports drugs into the bile for elimination; where metabolism often takes place
(hepatic drug-metabolizing enzymes - P450 system); toxicity; signs of jaundice
Rights of medication administration Right drug, patient, dose, route, time, documentation
Nursing Process & Role in Med Admin Correct administration, without additional interventions, cannot ensure that
treatment will result in the therapeutic objective --> Proper delivery is only the
beginning of a nurse's responsibility; ADVOCATE
Patient education Medication (generic/brand names & therapeutic category), Dose, Time, Route,
Duration of treatment, Method of drug storage; Response (expected therapeutic
response & when it should develop); Promoting therapeutic effects, minimizing
adverse effects
Promoting adherence Simplified drug regimens; Ensuring meds are accessible & affordable; Clear &
concise verbal & written instructions; Appropriate dosage form; Clearly labeled &
easy-to-open containers; Daily reminders; Support system; Frequent monitoring
Adverse Drug Reactions (ADRs) Seven times more likely in the elderly; Account for 16% of hospital admissions;
Account for 50% of all medication-related deaths; Majority are dose related rather
than idiosyncratic; Symptoms in older adults often nonspecific (dizziness,
cognitive impairment)
ADRs risk factors Drug accumulation secondary to reduced renal function; Polypharmacy (taking
too many drugs); Greater severity of illness; Presence of comorbidities; Greater
use of drugs with a low therapeutic index (ex. digoxin); Increased individual
variations secondary to altered pharmacokinetics; Inadequate supervision of
long-term therapy; Poor patient adherence
PO Oral; slow & variable; easy, convenient, inexpensive, ideal for self-medication,
potentially reversible, safer than parenteral routes
SL Sublingual; A route of medication administration in which the drug is placed under
the tongue to dissolve and be absorbed directly into the bloodstream through
oral mucosa; bypasses the first-pass effect and produces rapid onset of action.
and CORRECT Answers
Drug Development 1. Preclinical Testing (in Animals)
2. Clinical Testing (in Humans): Phase 1 (Healthy Volunteers -> Metabolism,
pharmacokinetics, biological effects), Phase 2 (Patients -> Therapeutic utility and
dosage range), Phase 3 (Patients -> Safety and effectiveness), Phase 4
(Postmarketing Surveillance)
Limitations of drug testing Limited information about certain populations (women & children); Failure to
detect all adverse effects
Pharmacokinetics Determining how much of the administered dose gets to its site of action; how
does the BODY metabolize the drug
Pharmacodynamics Impact of the DRUGS on the body; binding of the drug to its receptor
P-glycoprotein Trasports drugs back into the blood; Transmembrane protein that transports a
wide variety of drugs out of cells; Liver -> transports drugs into the bile for
elimination; Kidney -> pumps drugs into the urine for excretion; Placenta ->
transports drugs back into the maternal blood; Brain -> Pumps drugs into the
blood to limit drugs' access to the brain
CYP450 System Enzymes in the liver that change the structure of a drug; renders them therapeutic
in order for them to perform efficiently; factor in altered metabolism -> increases
rate two- to threefold over 7-10 days, resolve over 7-10 days after withdrawal;
inhibits CYP isoenzymes (usually undesired)
Therapeutic Index Measure of a drug's safety; Ratio of the drug's LD50 (average lethal dose to 50%
of the animals treated) to its ED50; the larger/higher, the safer; the smaller/lower,
the less safe
Receptors Functional macromolecules on a cell that most drugs interact with to produce
effects; their binding is usually reversible; include enzymes, ribosomes, and
tubulin; once bound, they will MIMIC or BLOCK the action of the endogenous
regulatory molecules and increase or decrease the rate of physiologic activity
normally controlled by it
Protein binding Drugs can form reversible bonds with various proteins; Plasma albumin is the
most abundant & important protein -> always remains in the bloodstream, affects
drug distribution, aids in transport
Toxicity Adverse drug reaction caused by excessive dosing; may occur even with normal
dosing (depends on Pt metabolism)
, First-pass effect The metabolism of an orally administered drug by the liver (and sometimes
intestinal wall) before it reaches systemic circulation; reduces the amount of
active drug available (bioavailability) and may require higher oral doses or
alternative routes of administration (e.g., IV, sublingual); body is naturally going
to eliminate most of the medication; higher = higher dose needed or alternative
route of administration
Kidney function Pumps drugs into the urine for excretion; renal function should be assessed with
drugs that are primarily eliminated there; creatinine clearance/levels are the best
index of function; slow down with age
Liver function Transports drugs into the bile for elimination; where metabolism often takes place
(hepatic drug-metabolizing enzymes - P450 system); toxicity; signs of jaundice
Rights of medication administration Right drug, patient, dose, route, time, documentation
Nursing Process & Role in Med Admin Correct administration, without additional interventions, cannot ensure that
treatment will result in the therapeutic objective --> Proper delivery is only the
beginning of a nurse's responsibility; ADVOCATE
Patient education Medication (generic/brand names & therapeutic category), Dose, Time, Route,
Duration of treatment, Method of drug storage; Response (expected therapeutic
response & when it should develop); Promoting therapeutic effects, minimizing
adverse effects
Promoting adherence Simplified drug regimens; Ensuring meds are accessible & affordable; Clear &
concise verbal & written instructions; Appropriate dosage form; Clearly labeled &
easy-to-open containers; Daily reminders; Support system; Frequent monitoring
Adverse Drug Reactions (ADRs) Seven times more likely in the elderly; Account for 16% of hospital admissions;
Account for 50% of all medication-related deaths; Majority are dose related rather
than idiosyncratic; Symptoms in older adults often nonspecific (dizziness,
cognitive impairment)
ADRs risk factors Drug accumulation secondary to reduced renal function; Polypharmacy (taking
too many drugs); Greater severity of illness; Presence of comorbidities; Greater
use of drugs with a low therapeutic index (ex. digoxin); Increased individual
variations secondary to altered pharmacokinetics; Inadequate supervision of
long-term therapy; Poor patient adherence
PO Oral; slow & variable; easy, convenient, inexpensive, ideal for self-medication,
potentially reversible, safer than parenteral routes
SL Sublingual; A route of medication administration in which the drug is placed under
the tongue to dissolve and be absorbed directly into the bloodstream through
oral mucosa; bypasses the first-pass effect and produces rapid onset of action.
