Advanced Pharmacology Exam 1
CORRECT SOLUTION GRADE A+
ACCREDITED
Once you graduate from an NP program, in order to prescribe you'll
need:
-Advanced nurse prescriber license
-DEA #
What is the purpose of a DEA #?
Needed to prescribed scheduled drugs
Rules for prescribing Schedule II drugs:
-Written script needed
-1 month supply only
-No refills
What is the PDMP?
Prescription Drug Monitoring Program
Used to effectively track patient's controlled substance uses across
different health facilities (in the same state)
What are clinical practice guidelines?
Recommendations that are intended to optimize patient care that are
informed by a systematic review of the evidence and an assessment of
the benefits/harms of alternative care practices
Ex: sepsis, CAP
Common causes of medication errors:
-Illegible writing
-Drug names that sound alike
-Medications that look alike
-Administering a drug with the wrong route
What is pharmacokinetics? What are its 4 categories?
What the body does to the drug
1. Absorption
2. Metabolism
3. Distribution
4. Excretion
Quickest route of absorption? Slowest?
,IV = quickest
IM = slowest
What is the most common way drugs pass through cell membranes?
Passive diffusion
What characteristics of a drug allow it to pass most quickly through
cell membranes (usually through passive diffusion)?
Small, uncharged (unionized), lipid soluble--pass through membrane
without any energy
What does it mean when a drug is ionized?
It means that the drug is stuck in the compartment it was ionized in
and has to be moved to the next compartment (cannot be absorbed into
the bloodstream)
Where do weak acids absorb?
Stomach
Where do weak bases absorb?
Small intestine
pH of stomach:
2-4
pH of small intestine:
6-7
pH of large intestine:
6-7
pH of bloodstream:
7.35-7.45
pH of bladder:
5-8
pH of breastmilk:
7.1
Where will a drug absorb if it is a weak base that ionizes at a pH of
4 and lower?
In the small intestine (since the stomach has a pH of 2-4, so the
drug will become ionized and move to the small intestine where it
will be able to absorb into the bloodstream)
How can we manipulate the urine pH in cases of overdose?
Drugs that are weak acids (aspirin) can be trapped and excreted
through the urine.
We raise pH of the urine (with sodium bicarb) to force the drug to
ionize and allow it to be excreted, not reabsorbed through the
bloodstream.
What is distribution?
How a drug will be transported to the tissues it needs to go to in
order for it to exert its effects
Drug factors related to distribution:
, -Lipid solubility
-Molecular size
-Degree of ionization
-Duration of action
-Cellular binding
-Therapeutic effects
-Toxic effects
(lipid soluble, small, and non-ionized drugs will distribute more
quickly)
Body factors related to distribution:
-Vascularity (poor perfusion, disruption of blood flow due to trauma-
-difficulty distributing)
-Blood barriers (blood-brain-barrier can be problematic if we need to
get drugs to the brain--will need very high dosing since only a small
amount of the drug will get through)
-Transport mechanisms
-Plasma binding proteins
-Disease states
-Volume of distribution
-Drug interactions
What is the key plasma protein involved with protein binding for
medications?
Albumin
Why do we monitor albumin?
Indicative of nutritional status and how well protein-bound drugs
will be transported to their target locations
What happens to the therapeutic effect of a drug when the patient is
elderly and has very low levels of albumin?
The drug does not bind to the protein (albumin) as much as expected,
so there is a lot of free drug floating in the plasma; high risk for
drug toxicity
Protein bound means:
Inactive form of the drug; does not have any therapeutic effect when
bound to a protein
Free drug means:
Active form of the drug (available for therapeutic effect)
What happens when a patient is on two drugs that are competing for
the same protein binding site on the albumin?
Some drug interactions can occur. Drugs fight for binding position,
but both drugs do not get enough as the usually would. Leads to
higher free drug levels, decreased overall albumin binding, and
potential toxicity for both drugs.
CORRECT SOLUTION GRADE A+
ACCREDITED
Once you graduate from an NP program, in order to prescribe you'll
need:
-Advanced nurse prescriber license
-DEA #
What is the purpose of a DEA #?
Needed to prescribed scheduled drugs
Rules for prescribing Schedule II drugs:
-Written script needed
-1 month supply only
-No refills
What is the PDMP?
Prescription Drug Monitoring Program
Used to effectively track patient's controlled substance uses across
different health facilities (in the same state)
What are clinical practice guidelines?
Recommendations that are intended to optimize patient care that are
informed by a systematic review of the evidence and an assessment of
the benefits/harms of alternative care practices
Ex: sepsis, CAP
Common causes of medication errors:
-Illegible writing
-Drug names that sound alike
-Medications that look alike
-Administering a drug with the wrong route
What is pharmacokinetics? What are its 4 categories?
What the body does to the drug
1. Absorption
2. Metabolism
3. Distribution
4. Excretion
Quickest route of absorption? Slowest?
,IV = quickest
IM = slowest
What is the most common way drugs pass through cell membranes?
Passive diffusion
What characteristics of a drug allow it to pass most quickly through
cell membranes (usually through passive diffusion)?
Small, uncharged (unionized), lipid soluble--pass through membrane
without any energy
What does it mean when a drug is ionized?
It means that the drug is stuck in the compartment it was ionized in
and has to be moved to the next compartment (cannot be absorbed into
the bloodstream)
Where do weak acids absorb?
Stomach
Where do weak bases absorb?
Small intestine
pH of stomach:
2-4
pH of small intestine:
6-7
pH of large intestine:
6-7
pH of bloodstream:
7.35-7.45
pH of bladder:
5-8
pH of breastmilk:
7.1
Where will a drug absorb if it is a weak base that ionizes at a pH of
4 and lower?
In the small intestine (since the stomach has a pH of 2-4, so the
drug will become ionized and move to the small intestine where it
will be able to absorb into the bloodstream)
How can we manipulate the urine pH in cases of overdose?
Drugs that are weak acids (aspirin) can be trapped and excreted
through the urine.
We raise pH of the urine (with sodium bicarb) to force the drug to
ionize and allow it to be excreted, not reabsorbed through the
bloodstream.
What is distribution?
How a drug will be transported to the tissues it needs to go to in
order for it to exert its effects
Drug factors related to distribution:
, -Lipid solubility
-Molecular size
-Degree of ionization
-Duration of action
-Cellular binding
-Therapeutic effects
-Toxic effects
(lipid soluble, small, and non-ionized drugs will distribute more
quickly)
Body factors related to distribution:
-Vascularity (poor perfusion, disruption of blood flow due to trauma-
-difficulty distributing)
-Blood barriers (blood-brain-barrier can be problematic if we need to
get drugs to the brain--will need very high dosing since only a small
amount of the drug will get through)
-Transport mechanisms
-Plasma binding proteins
-Disease states
-Volume of distribution
-Drug interactions
What is the key plasma protein involved with protein binding for
medications?
Albumin
Why do we monitor albumin?
Indicative of nutritional status and how well protein-bound drugs
will be transported to their target locations
What happens to the therapeutic effect of a drug when the patient is
elderly and has very low levels of albumin?
The drug does not bind to the protein (albumin) as much as expected,
so there is a lot of free drug floating in the plasma; high risk for
drug toxicity
Protein bound means:
Inactive form of the drug; does not have any therapeutic effect when
bound to a protein
Free drug means:
Active form of the drug (available for therapeutic effect)
What happens when a patient is on two drugs that are competing for
the same protein binding site on the albumin?
Some drug interactions can occur. Drugs fight for binding position,
but both drugs do not get enough as the usually would. Leads to
higher free drug levels, decreased overall albumin binding, and
potential toxicity for both drugs.
