NURS 5334-PHARM: Advanced Pharmacology Study Guide
Unit 1: Foundational Principles of Pharmacology
1. Define pharmacokinetics and list its four primary processes.
ANSWER ✓ Pharmacokinetics is what the body does to a drug. Its four primary
processes are Absorption, Distribution, Metabolism, and Excretion (ADME).
2. What is the first-pass effect, and how does it affect oral drug bioavailability?
ANSWER ✓ The first-pass effect is the extensive hepatic metabolism of a drug before it
reaches systemic circulation. It significantly reduces the bioavailability of orally
administered drugs, often requiring higher oral doses or alternative routes.
3. Differentiate between a drug's potency and its efficacy.
ANSWER ✓ Potency refers to the amount of drug needed to produce a given effect
(e.g., a lower ED50 means higher potency). Efficacy refers to the maximum therapeutic
response a drug can produce, regardless of dose.
4. Explain the concept of therapeutic index (TI) and its clinical significance.
ANSWER ✓ The Therapeutic Index (TI) is the ratio of a drug's toxic dose (TD50 or LD50)
to its effective dose (ED50). A low TI (e.g., digoxin, warfarin) indicates a narrow margin of
safety, requiring close monitoring. A high TI (e.g., penicillin) is generally safer.
5. What is the role of cytochrome P450 enzymes in drug metabolism, and why are
genetic polymorphisms important?
ANSWER ✓ Cytochrome P450 (CYP) enzymes are the major catalysts for Phase I drug
metabolism. Genetic polymorphisms can create "poor metabolizers" or "ultra-rapid
metabolizers," leading to dangerously high or subtherapeutic drug levels, respectively,
with standard dosing.
Unit 2: Autonomic and Cardiovascular Pharmacology
6. A patient prescribed a non-selective beta-blocker (propranolol) for
hypertension must be cautioned about which acute side effect if they have a
history of asthma?
ANSWER ✓ They must be cautioned about bronchoconstriction. Non-selective beta-
blockers inhibit β2-receptors in the lungs, which can precipitate severe asthma attacks.
7. What is the mechanism of action and primary use of ACE inhibitors (e.g.,
lisinopril)?
ANSWER ✓ ACE inhibitors block the conversion of angiotensin I to angiotensin II,
, reducing vasoconstriction and aldosterone secretion. They are first-line for hypertension,
heart failure, and diabetic nephropathy.
8. Why is monitoring for a persistent dry cough important in patients on ACE
inhibitors?
ANSWER ✓ A dry cough is a common side effect (up to 20% of patients) due to
accumulation of bradykinin. While not dangerous, it often necessitates switching to an
ARB (Angiotensin II Receptor Blocker).
9. Describe the "dihydropyridine" vs. "non-dihydropyridine" classification of
calcium channel blockers and their differing primary uses.
ANSWER ✓ Dihydropyridines (e.g., amlodipine, nifedipine) act primarily on vascular
smooth muscle, causing vasodilation; used for hypertension. Non-dihydropyridines (e.g.,
diltiazem, verapamil) act on the heart and vessels, slowing AV conduction; used for
arrhythmias and angina.
10. What is the mechanism of action of spironolactone, and why must serum
potassium be monitored?
ANSWER ✓ Spironolactone is a potassium-sparing diuretic that acts as an aldosterone
antagonist in the distal tubule. It reduces sodium reabsorption
while inhibiting potassium excretion, posing a significant risk for hyperkalemia.
11. What is the primary life-threatening toxicity of digoxin, and what are its early
symptoms?
ANSWER ✓ The primary toxicity is lethal arrhythmias. Early symptoms include anorexia,
nausea, vomiting, confusion, and visual disturbances (yellow/green halos).
12. When initiating statin therapy (e.g., atorvastatin), what two baseline labs are
essential, and what is the primary patient education point regarding side effects?
ANSWER ✓ Obtain baseline liver function tests (LFTs) and a lipid panel. Educate the
patient to report unexplained muscle pain, tenderness, or weakness immediately, as this
could indicate myopathy/rhabdomyolysis.
Unit 3: Central Nervous System Pharmacology
13. Differentiate between the mechanism of action of SSRIs (e.g., sertraline) and
SNRIs (e.g., venlafaxine).
ANSWER ✓ SSRIs selectively inhibit the reuptake of serotonin. SNRIs inhibit the
reuptake of both serotonin and norepinephrine, which may provide broader efficacy for
some patients.
14. What is "black box warning" associated with all antidepressants in children,
adolescents, and young adults?
Unit 1: Foundational Principles of Pharmacology
1. Define pharmacokinetics and list its four primary processes.
ANSWER ✓ Pharmacokinetics is what the body does to a drug. Its four primary
processes are Absorption, Distribution, Metabolism, and Excretion (ADME).
2. What is the first-pass effect, and how does it affect oral drug bioavailability?
ANSWER ✓ The first-pass effect is the extensive hepatic metabolism of a drug before it
reaches systemic circulation. It significantly reduces the bioavailability of orally
administered drugs, often requiring higher oral doses or alternative routes.
3. Differentiate between a drug's potency and its efficacy.
ANSWER ✓ Potency refers to the amount of drug needed to produce a given effect
(e.g., a lower ED50 means higher potency). Efficacy refers to the maximum therapeutic
response a drug can produce, regardless of dose.
4. Explain the concept of therapeutic index (TI) and its clinical significance.
ANSWER ✓ The Therapeutic Index (TI) is the ratio of a drug's toxic dose (TD50 or LD50)
to its effective dose (ED50). A low TI (e.g., digoxin, warfarin) indicates a narrow margin of
safety, requiring close monitoring. A high TI (e.g., penicillin) is generally safer.
5. What is the role of cytochrome P450 enzymes in drug metabolism, and why are
genetic polymorphisms important?
ANSWER ✓ Cytochrome P450 (CYP) enzymes are the major catalysts for Phase I drug
metabolism. Genetic polymorphisms can create "poor metabolizers" or "ultra-rapid
metabolizers," leading to dangerously high or subtherapeutic drug levels, respectively,
with standard dosing.
Unit 2: Autonomic and Cardiovascular Pharmacology
6. A patient prescribed a non-selective beta-blocker (propranolol) for
hypertension must be cautioned about which acute side effect if they have a
history of asthma?
ANSWER ✓ They must be cautioned about bronchoconstriction. Non-selective beta-
blockers inhibit β2-receptors in the lungs, which can precipitate severe asthma attacks.
7. What is the mechanism of action and primary use of ACE inhibitors (e.g.,
lisinopril)?
ANSWER ✓ ACE inhibitors block the conversion of angiotensin I to angiotensin II,
, reducing vasoconstriction and aldosterone secretion. They are first-line for hypertension,
heart failure, and diabetic nephropathy.
8. Why is monitoring for a persistent dry cough important in patients on ACE
inhibitors?
ANSWER ✓ A dry cough is a common side effect (up to 20% of patients) due to
accumulation of bradykinin. While not dangerous, it often necessitates switching to an
ARB (Angiotensin II Receptor Blocker).
9. Describe the "dihydropyridine" vs. "non-dihydropyridine" classification of
calcium channel blockers and their differing primary uses.
ANSWER ✓ Dihydropyridines (e.g., amlodipine, nifedipine) act primarily on vascular
smooth muscle, causing vasodilation; used for hypertension. Non-dihydropyridines (e.g.,
diltiazem, verapamil) act on the heart and vessels, slowing AV conduction; used for
arrhythmias and angina.
10. What is the mechanism of action of spironolactone, and why must serum
potassium be monitored?
ANSWER ✓ Spironolactone is a potassium-sparing diuretic that acts as an aldosterone
antagonist in the distal tubule. It reduces sodium reabsorption
while inhibiting potassium excretion, posing a significant risk for hyperkalemia.
11. What is the primary life-threatening toxicity of digoxin, and what are its early
symptoms?
ANSWER ✓ The primary toxicity is lethal arrhythmias. Early symptoms include anorexia,
nausea, vomiting, confusion, and visual disturbances (yellow/green halos).
12. When initiating statin therapy (e.g., atorvastatin), what two baseline labs are
essential, and what is the primary patient education point regarding side effects?
ANSWER ✓ Obtain baseline liver function tests (LFTs) and a lipid panel. Educate the
patient to report unexplained muscle pain, tenderness, or weakness immediately, as this
could indicate myopathy/rhabdomyolysis.
Unit 3: Central Nervous System Pharmacology
13. Differentiate between the mechanism of action of SSRIs (e.g., sertraline) and
SNRIs (e.g., venlafaxine).
ANSWER ✓ SSRIs selectively inhibit the reuptake of serotonin. SNRIs inhibit the
reuptake of both serotonin and norepinephrine, which may provide broader efficacy for
some patients.
14. What is "black box warning" associated with all antidepressants in children,
adolescents, and young adults?
