The University of Alabama
Capstone College of Nursing
NUR 521 Advanced Pharmacology
Exam 2 Blueprint and Study Guide
General Tips for Exam Success: A review of anatomy and pathophysiology is included at the
beginning of most modules in the course. You will not see many direct questions about this
information; however, this foundational knowledge is necessary to understand how drugs work
in the body and how the body responds to drugs. You will be much more successful if you have a
strong foundational knowledge and understanding of this information.
You are responsible for knowing the name, MOA, Use (Indication), Common AE, Serious
AE, Dosing, Administration, CI, Interactions, and Patient Education for all prototype
drugs included in each module. Most of the exam questions will focus on the prototype drugs
presented in each module. You also need to know about the drug class across the life span. There
is content in each module that discusses use of each drug class in pediatric, pregnancy,
breastfeeding, and older adult populations. You will not necessarily need to know an exact dose
for prescribing on all of the prototype drugs, but if faculty stresses a certain dose in a lecture, you
will be responsible for this information. When attempting to narrow down the content, consider
what you need to know to be a safe prescriber. Also, listen for tips and what is emphasized in the
lecture. This study guide is intended to help you focus your studies; it does not include an
exhaustive list of every test question. This is only a guide. If any evidenced base guidelines
were presented in the module, be sure to review what information was discussed by faculty in the
lecture.
Complete the following chart. Include only the most pertinent information (what was
emphasized in the lecture and in the readings). Another idea is to only enter information you
do not know well after studying the content. Think through the drug classification and MOA.
Often, it will lead to the AE and what the provider should teach to the patient. Do not seek to
memorize; instead seek to understand what the body does to the drug and what the drug
does to the body.
NUR 521 EXAM 2 STUDY GUIDE
Hemodynamics- the study of movement of blood through the circulatory system along
with the regulatory mechanisms and driving forces that help to control it.
The circulatory system is composed of: the heart and blood vessels
1. Blood vessels include: arteries, arterioles, capillaries, venules, and
veins.
2. Arteries: muscular and do not stretch easy. Large increases in
arterial pressure only result in small increases in arterial diameter.
, 3. Veins: less muscular and stretch 6-10x more than arteries. Small
increases in venous pressure causes large increases in vessel
diameter and increase in venous volume.
Primary Functions of the Circulatory System
- Delivers O2, nutrients, hormones, electrolytes, and other essential
items to cells
- Removes CO2 and waste products from cells
Major Divisions of the Circulatory System
Pulmonary circulation
- Delivers blood to the lungs
Systemic circulation
- Delivers blood to all other organs and tissues
Blood moves within the vessels because the force that drives the blood flow is greater
than the resistance present.
Resistance to flow is determined by diameter/ length of the vessel AND blood viscosity.
From a pharmacological standpoint, the most important
determinant of resistance is the vessel diameter (the larger the
vessel, the smaller the resistance)
- When vessels dilate, the resistance declines
- When vessels constrict, the resistance Increases
- To maintain adequate flow when resistance rises: the blood pressure
must rise as well
Cardiac Output (CO): HR x SV; an increase in HR or SV will increase CO; a
decrease in HR or SV will decrease CO
HR is controlled by: The ANS; HR is increased by B1 adrenergic receptors in the SA node;
HR is decreased by the parasympathetic branches via muscarinic receptors in the SA node.
Parasympathetic impulses reach the heart through the vagus nerve.
3 factors that determine SV:
- (1) Myocardial contractility- the force with which ventricles contract.
- (2) Preload- the tension or stretch applied to the muscle BEFORE contraction.
- (3) Afterload- what the muscle must overcome when it contracts
Starling Law: the force of ventricular contraction is proportional to the muscle fiber
length.
Venous Return: the primary determinant of SV and therefore CO. The systemic filling
pressure (the force that returns blood to the heart) is the most important factor for
pharmacology; blood volume and venous return can be altered by drugs resulting in
increased or decreased venous return
, Regulation of arterial pressure (AP) is what moves blood through the arterial side of the
systemic circulation. AP=PR x CO
Main systems that regulate AP
- ANS
- Renin-Angiotensin-Aldosterone System (RAAS)
- Kidneys
- Natriuretic peptides that come into play when there is volume overload
Main Implications of Diuretics
- Treatment of HTN
- Used to mobilize fluid (e.g. pt. with liver failure, kidney disease, HF)
The basic functional unit of the kidney is: the nephron
4 Functionally Distinct Regions of the Nephron
- Glomerulus
- Proximal convoluted tubule
- Descending/ Ascending loop of Henle
- Distal convoluted tubule (early and late segments)
3 basic Functions of the Kidney
- (1) cleanses extracellular fluid (ECF)/ maintains ECF volume
- (2) helps to maintain acid base
- (3) helps to excrete metabolic waste and foreign substances from the
body.
Basic Processes of the Kidney
- Filtration
- Occurs at the glomerulus
- 1st step in urine formation
- Very small molecules get filtered (electrolytes, amino acids, glucose,
drugs, metabolic waste)
- Larger molecules like lipids and proteins remain in the blood stream
- Reabsorption- Na and Cl get reabsorbed
- Active Secretion- 2 transport proteins help w/ secretion
Furosemide (Lasix)
- Class: Loop diuretic
, - MOA: Acts in the thick segment of the ascending limb of the loop of
Henle. Blocks reabsorption of Na/ Cl, preventing reabsorption of H2O.
Produces profound diuresis
- Use: When rapid or massive mobilization of fluid is needed. Pulmonary
edema associated with CHF, Edema from heart, liver, or kidney that
has not responded well to other drugs, HTN
- Goal: Decrease edema (pulmonary, hepatic, heart, kidney), treat HTN
- Baseline data: Wt., VS, Electrolytes
- Monitoring: BP, Pulse, Wt., AE s/s
- Caution: CV disease, Renal impairment, DM, PMH of gout (can cause
a flare up), Pregnancy, Ototoxic drugs, NSAIDS, antihypertensives
- Dosing/ Admin: 20, 40, 80mg tabs; IV dose available; onset within
60min ; duration 6-8hrs; usual dosage 20-80mg (1-2 times/day); start at
low dose and gradually increase
Especially helpful drug when patients have renal impairment
because diuresis can be produced even if there is a lack of renal
blood flow and even when GFR is decreased
- DI: Digoxin (due to loss of K it can INC Digoxin levels and cause
dysrhythmias), Other Ototoxic Drugs (gentamycin) should be
AVOIDED, K Sparing Diuretics (can negate the wasting some and is
sometimes combined w/ Furosemide), NSAIDS, Antihypertensive
agents, Lithium
- AE: Low Na, K, Cl, Hypotension, Dehydration, Hyperglycemia,
Hyperuricemia (uric acid), INC in LDL/ Triglycerides, DEC in HDL,
Ototoxicity
- Pt Edu: Monitor BP; S/S of ortho hypotn (rise slowly to avoid), K rich
foods, s/s of dehydration
- BBW: All loop diuretics can cause profound diuresis with water and
electrolyte depletion (hypokalemia s/s: constipation, palpitations,
fatigue, muscle weakness, tingling, numbness)
Hydrochlorothiazide (Microzide)
- Class: Thiazide diuretic
- MOA: Acts in the early segment of the distal convoluted tubule.
Promotes urine production by blocking reabsorption of Na and Cl
leading to water retention in the nephron and increased urine flow.
More mild diuresis compared to Furosemide (Lasix)
Must have adequate GFR of at least 20mL/min
Steroid derivative
- Use: HTN, Edema in CHF, Hepatic, or Renal disease
- Goal: Tx HTN or Edema
- Caution: CV disease, Renal impairment, DM, PMH of gout (can cause
a flare); Meds: Digoxin, Lithium, Antihypertensive drugs
- Baseline Data: Wt., VS, Electrolytes
- Monitoring: BP, HR, Wt. s/s of Hypokalemia, s/s of gout
Capstone College of Nursing
NUR 521 Advanced Pharmacology
Exam 2 Blueprint and Study Guide
General Tips for Exam Success: A review of anatomy and pathophysiology is included at the
beginning of most modules in the course. You will not see many direct questions about this
information; however, this foundational knowledge is necessary to understand how drugs work
in the body and how the body responds to drugs. You will be much more successful if you have a
strong foundational knowledge and understanding of this information.
You are responsible for knowing the name, MOA, Use (Indication), Common AE, Serious
AE, Dosing, Administration, CI, Interactions, and Patient Education for all prototype
drugs included in each module. Most of the exam questions will focus on the prototype drugs
presented in each module. You also need to know about the drug class across the life span. There
is content in each module that discusses use of each drug class in pediatric, pregnancy,
breastfeeding, and older adult populations. You will not necessarily need to know an exact dose
for prescribing on all of the prototype drugs, but if faculty stresses a certain dose in a lecture, you
will be responsible for this information. When attempting to narrow down the content, consider
what you need to know to be a safe prescriber. Also, listen for tips and what is emphasized in the
lecture. This study guide is intended to help you focus your studies; it does not include an
exhaustive list of every test question. This is only a guide. If any evidenced base guidelines
were presented in the module, be sure to review what information was discussed by faculty in the
lecture.
Complete the following chart. Include only the most pertinent information (what was
emphasized in the lecture and in the readings). Another idea is to only enter information you
do not know well after studying the content. Think through the drug classification and MOA.
Often, it will lead to the AE and what the provider should teach to the patient. Do not seek to
memorize; instead seek to understand what the body does to the drug and what the drug
does to the body.
NUR 521 EXAM 2 STUDY GUIDE
Hemodynamics- the study of movement of blood through the circulatory system along
with the regulatory mechanisms and driving forces that help to control it.
The circulatory system is composed of: the heart and blood vessels
1. Blood vessels include: arteries, arterioles, capillaries, venules, and
veins.
2. Arteries: muscular and do not stretch easy. Large increases in
arterial pressure only result in small increases in arterial diameter.
, 3. Veins: less muscular and stretch 6-10x more than arteries. Small
increases in venous pressure causes large increases in vessel
diameter and increase in venous volume.
Primary Functions of the Circulatory System
- Delivers O2, nutrients, hormones, electrolytes, and other essential
items to cells
- Removes CO2 and waste products from cells
Major Divisions of the Circulatory System
Pulmonary circulation
- Delivers blood to the lungs
Systemic circulation
- Delivers blood to all other organs and tissues
Blood moves within the vessels because the force that drives the blood flow is greater
than the resistance present.
Resistance to flow is determined by diameter/ length of the vessel AND blood viscosity.
From a pharmacological standpoint, the most important
determinant of resistance is the vessel diameter (the larger the
vessel, the smaller the resistance)
- When vessels dilate, the resistance declines
- When vessels constrict, the resistance Increases
- To maintain adequate flow when resistance rises: the blood pressure
must rise as well
Cardiac Output (CO): HR x SV; an increase in HR or SV will increase CO; a
decrease in HR or SV will decrease CO
HR is controlled by: The ANS; HR is increased by B1 adrenergic receptors in the SA node;
HR is decreased by the parasympathetic branches via muscarinic receptors in the SA node.
Parasympathetic impulses reach the heart through the vagus nerve.
3 factors that determine SV:
- (1) Myocardial contractility- the force with which ventricles contract.
- (2) Preload- the tension or stretch applied to the muscle BEFORE contraction.
- (3) Afterload- what the muscle must overcome when it contracts
Starling Law: the force of ventricular contraction is proportional to the muscle fiber
length.
Venous Return: the primary determinant of SV and therefore CO. The systemic filling
pressure (the force that returns blood to the heart) is the most important factor for
pharmacology; blood volume and venous return can be altered by drugs resulting in
increased or decreased venous return
, Regulation of arterial pressure (AP) is what moves blood through the arterial side of the
systemic circulation. AP=PR x CO
Main systems that regulate AP
- ANS
- Renin-Angiotensin-Aldosterone System (RAAS)
- Kidneys
- Natriuretic peptides that come into play when there is volume overload
Main Implications of Diuretics
- Treatment of HTN
- Used to mobilize fluid (e.g. pt. with liver failure, kidney disease, HF)
The basic functional unit of the kidney is: the nephron
4 Functionally Distinct Regions of the Nephron
- Glomerulus
- Proximal convoluted tubule
- Descending/ Ascending loop of Henle
- Distal convoluted tubule (early and late segments)
3 basic Functions of the Kidney
- (1) cleanses extracellular fluid (ECF)/ maintains ECF volume
- (2) helps to maintain acid base
- (3) helps to excrete metabolic waste and foreign substances from the
body.
Basic Processes of the Kidney
- Filtration
- Occurs at the glomerulus
- 1st step in urine formation
- Very small molecules get filtered (electrolytes, amino acids, glucose,
drugs, metabolic waste)
- Larger molecules like lipids and proteins remain in the blood stream
- Reabsorption- Na and Cl get reabsorbed
- Active Secretion- 2 transport proteins help w/ secretion
Furosemide (Lasix)
- Class: Loop diuretic
, - MOA: Acts in the thick segment of the ascending limb of the loop of
Henle. Blocks reabsorption of Na/ Cl, preventing reabsorption of H2O.
Produces profound diuresis
- Use: When rapid or massive mobilization of fluid is needed. Pulmonary
edema associated with CHF, Edema from heart, liver, or kidney that
has not responded well to other drugs, HTN
- Goal: Decrease edema (pulmonary, hepatic, heart, kidney), treat HTN
- Baseline data: Wt., VS, Electrolytes
- Monitoring: BP, Pulse, Wt., AE s/s
- Caution: CV disease, Renal impairment, DM, PMH of gout (can cause
a flare up), Pregnancy, Ototoxic drugs, NSAIDS, antihypertensives
- Dosing/ Admin: 20, 40, 80mg tabs; IV dose available; onset within
60min ; duration 6-8hrs; usual dosage 20-80mg (1-2 times/day); start at
low dose and gradually increase
Especially helpful drug when patients have renal impairment
because diuresis can be produced even if there is a lack of renal
blood flow and even when GFR is decreased
- DI: Digoxin (due to loss of K it can INC Digoxin levels and cause
dysrhythmias), Other Ototoxic Drugs (gentamycin) should be
AVOIDED, K Sparing Diuretics (can negate the wasting some and is
sometimes combined w/ Furosemide), NSAIDS, Antihypertensive
agents, Lithium
- AE: Low Na, K, Cl, Hypotension, Dehydration, Hyperglycemia,
Hyperuricemia (uric acid), INC in LDL/ Triglycerides, DEC in HDL,
Ototoxicity
- Pt Edu: Monitor BP; S/S of ortho hypotn (rise slowly to avoid), K rich
foods, s/s of dehydration
- BBW: All loop diuretics can cause profound diuresis with water and
electrolyte depletion (hypokalemia s/s: constipation, palpitations,
fatigue, muscle weakness, tingling, numbness)
Hydrochlorothiazide (Microzide)
- Class: Thiazide diuretic
- MOA: Acts in the early segment of the distal convoluted tubule.
Promotes urine production by blocking reabsorption of Na and Cl
leading to water retention in the nephron and increased urine flow.
More mild diuresis compared to Furosemide (Lasix)
Must have adequate GFR of at least 20mL/min
Steroid derivative
- Use: HTN, Edema in CHF, Hepatic, or Renal disease
- Goal: Tx HTN or Edema
- Caution: CV disease, Renal impairment, DM, PMH of gout (can cause
a flare); Meds: Digoxin, Lithium, Antihypertensive drugs
- Baseline Data: Wt., VS, Electrolytes
- Monitoring: BP, HR, Wt. s/s of Hypokalemia, s/s of gout
