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NSG 6005 Advanced Pharmacology Midterm—Study Guide
There will be 75 questions on the Midterm. Most will be multiple choice. There are a
couple True/False and 5 matching questions. I suggest you review your PowerPoints and
Textbook Assignments. I hope this study guide is helpful
Make sure you know the following topics very well.
• When a medication is listed below, make sure you know all about it and how
to apply it to different patient situations: What disease process it is used
for?, how does it work?, when should it not be used?, adverse effects,
pros/cons, interactions, patient education factors (should it be taken w/ food?
At bedtime?), tapering, preliminary and post treatment labs, black box
warnings/CI, etc.
• If a disease process is mentioned below—know how to diagnose and
recommended treatment guidelines.
1) General principles of pharmacokinetics and dynamics?
PHARMACOKINETICS- What the body does to the drug”
Absorption –Entry of drug to the blood stream. Usually depends on passive diffusion of drug
through cell membranes.
• Absorption depends on: blood flow at site, drugs lipid soluability (>lipic,
>soluabililty that directly penetrate the memebrane), local PH and drug ionization
(non-ionized absorb better), pharmaceutical processing (coatings and additives.
• Blood brain barrier: allow lipid soluable only. May pump out any drug that it sees
as foreign, hard to treat CNS infections.
• Placenta: allows lipid drugs so does not protect from lipid soluable drugs, which
is why pregnant women are limited to drugs. Know gestation age.
•
, 2
Distribution
: fat ratio changes may alter distribution, especially a people age.
• Fat soluable drugs may be accumulated: weight loss will release these drugs.
• Water soluable drugs are affected by dehydration
Biotransformation (Metabolism) : Drugs become more hydrophilic (water soluable) for
excretion.
• Also referred to as the P450 system or cytochrome P450 system. (a group
of enzymes in the liver identified for their ability to breakdown drugs.)
• Hepatic“First Pass Effect” (parenteral (IV or IM) meds bypass this
enzymatic effect)
• breaks PO meds down to some degree, some are protected with coating
but they don’t always work
• Metabolites
Usually less active, less toxic, easier
• to excrete
• Prodrugs - inactive in form given but metabolized to active drug (ex:
enalapril)
• Liver function determined by liver enzymes
• Failing liver produces fewer enzymes, drugs available longer: caution
•
, 3
• Excretion:Process by which medications are eliminated from the body unchanged or as
metabolites
• Kidneys are main organ of excretion
• If poor renal function, drug may accumulate, may
wish to prescribe less of drug
• Also eliminated via respiration, breast milk, defecation. Tears, sweat, saliva not as
significant.
• START LOW AND GO SLOW!!!!
PHARMOCODYNAMICS- “effect of drug on the body”
Receptors: Drugs must bind to for effect o Help a process happen: agonist
oBlock a process from happening: antagonist o Know that:
• All drugs have an effect
• A drug’s ability to cause a response is called its efficacy
• If you give a bigger dose you will get a bigger effect up to a point, most drugs have a ceiling.
, 4
2) CRITERIA FOR CHOOSING AND EFFECTIVE DRUG?
• A.) Effectiveness: elicits responses for which it is given - most important
• Safety: Cannot produce harmful effects even at very high dosages and for long time
oNo such thing as completely safe drug
• Selectivity: Only elicits response for which it is given, no side effects
• No such thing as a selective drug, all have ADRs
• Reversible action: most drugs should be reversible
• Predictability: Know with certainty exactly how individual patient will respond – impossible,
must individualize
• Ease of administration: simple, convenient route - enhances compliance and decreases errors
• Freedom from drug interactions: few drugs are without drug interaction
• Low cost: easy to afford; significant factor in adherence, esp. with elderly
• Chemical stability: drugs ability to be stored for long time without loss of effectiveness –
variable between drugs
NSG 6005 Advanced Pharmacology Midterm—Study Guide
There will be 75 questions on the Midterm. Most will be multiple choice. There are a
couple True/False and 5 matching questions. I suggest you review your PowerPoints and
Textbook Assignments. I hope this study guide is helpful
Make sure you know the following topics very well.
• When a medication is listed below, make sure you know all about it and how
to apply it to different patient situations: What disease process it is used
for?, how does it work?, when should it not be used?, adverse effects,
pros/cons, interactions, patient education factors (should it be taken w/ food?
At bedtime?), tapering, preliminary and post treatment labs, black box
warnings/CI, etc.
• If a disease process is mentioned below—know how to diagnose and
recommended treatment guidelines.
1) General principles of pharmacokinetics and dynamics?
PHARMACOKINETICS- What the body does to the drug”
Absorption –Entry of drug to the blood stream. Usually depends on passive diffusion of drug
through cell membranes.
• Absorption depends on: blood flow at site, drugs lipid soluability (>lipic,
>soluabililty that directly penetrate the memebrane), local PH and drug ionization
(non-ionized absorb better), pharmaceutical processing (coatings and additives.
• Blood brain barrier: allow lipid soluable only. May pump out any drug that it sees
as foreign, hard to treat CNS infections.
• Placenta: allows lipid drugs so does not protect from lipid soluable drugs, which
is why pregnant women are limited to drugs. Know gestation age.
•
, 2
Distribution
: fat ratio changes may alter distribution, especially a people age.
• Fat soluable drugs may be accumulated: weight loss will release these drugs.
• Water soluable drugs are affected by dehydration
Biotransformation (Metabolism) : Drugs become more hydrophilic (water soluable) for
excretion.
• Also referred to as the P450 system or cytochrome P450 system. (a group
of enzymes in the liver identified for their ability to breakdown drugs.)
• Hepatic“First Pass Effect” (parenteral (IV or IM) meds bypass this
enzymatic effect)
• breaks PO meds down to some degree, some are protected with coating
but they don’t always work
• Metabolites
Usually less active, less toxic, easier
• to excrete
• Prodrugs - inactive in form given but metabolized to active drug (ex:
enalapril)
• Liver function determined by liver enzymes
• Failing liver produces fewer enzymes, drugs available longer: caution
•
, 3
• Excretion:Process by which medications are eliminated from the body unchanged or as
metabolites
• Kidneys are main organ of excretion
• If poor renal function, drug may accumulate, may
wish to prescribe less of drug
• Also eliminated via respiration, breast milk, defecation. Tears, sweat, saliva not as
significant.
• START LOW AND GO SLOW!!!!
PHARMOCODYNAMICS- “effect of drug on the body”
Receptors: Drugs must bind to for effect o Help a process happen: agonist
oBlock a process from happening: antagonist o Know that:
• All drugs have an effect
• A drug’s ability to cause a response is called its efficacy
• If you give a bigger dose you will get a bigger effect up to a point, most drugs have a ceiling.
, 4
2) CRITERIA FOR CHOOSING AND EFFECTIVE DRUG?
• A.) Effectiveness: elicits responses for which it is given - most important
• Safety: Cannot produce harmful effects even at very high dosages and for long time
oNo such thing as completely safe drug
• Selectivity: Only elicits response for which it is given, no side effects
• No such thing as a selective drug, all have ADRs
• Reversible action: most drugs should be reversible
• Predictability: Know with certainty exactly how individual patient will respond – impossible,
must individualize
• Ease of administration: simple, convenient route - enhances compliance and decreases errors
• Freedom from drug interactions: few drugs are without drug interaction
• Low cost: easy to afford; significant factor in adherence, esp. with elderly
• Chemical stability: drugs ability to be stored for long time without loss of effectiveness –
variable between drugs
