NR656 Midterm Study Guide: Advanced
Pharmacology Fundamentals
Chapter 1: Prescriptive Authority
State Laws Impact on Prescriptive Authority
● Prescriptive authority for nurse practitioners is determined by state law1.
● The specific scope of prescriptive authority, including the ability to prescribe
independently and without limitations, is defined by each state's regulations2222.
● This authority typically falls under the jurisdiction of a health professional board, which
may be the state board of nursing, the state board of medicine, or the state board of
pharmacy, depending on state-specific legislation3333.
Full Practice Authority
● Nurse practitioners with full practice authority have the autonomy to evaluate patients,
diagnose conditions, order and interpret diagnostic tests, initiate and manage treatment
plans, and prescribe medications, including controlled substances, without physician
oversight4.
● This level of practice emphasizes the expanded role and independence of nurse
, practitioners in providing comprehensive patient care.
Chapter 3: Promoting Positive Outcomes of Drug
Therapy
Generic vs. Brand Name: Value of Knowing
● For optimal clarity and to prevent medication errors, both the generic and brand names
of a medication should ideally be included on a prescription5. This helps pharmacists and
patients ensure the correct medication is dispensed and understood.
Duration of Therapy
● Understanding whether medication therapy is intended for a short-term or long-term
duration is crucial for patient education, adherence, and monitoring for potential side
effects associated with prolonged use6.
Blood Flow Impact on Absorption
● Drugs are absorbed more rapidly in areas where blood flow is high7. This is because a
high rate of blood flow quickly carries away the absorbed drug, maintaining a steep
concentration gradient between the administration site and the blood, which drives
faster absorption8. The greater the concentration gradient, the more rapid absorption
will be9.
,Chapter 4: Pharmacokinetics, Pharmacodynamics,
and Drug Interactions
Excretion Process
● Excretion is the process by which drugs and their metabolites are eliminated from the
body10. The kidneys are the primary organs of excretion, but drugs can also be
eliminated via bile, lungs, sweat, saliva, and breast milk.
Metabolism Process
● Metabolism, also known as biotransformation, is the enzymatically mediated alteration of
drug structure11.
● Most drug metabolism occurs in the liver and is performed primarily by the hepatic
microsomal enzyme system, particularly the cytochrome P450 (CYP450) enzyme
family12. This process can convert drugs into more hydrophilic (water-soluble)
compounds, facilitating their excretion, or it can activate prodrugs, inactivate drugs, or
create toxic metabolites.
Distribution Process
● Distribution refers to the reversible movement of drugs from the systemic circulation into
the interstitial fluid and cells of tissues and organs where they exert their effects or are
stored13.
● Factors influencing distribution include blood flow to tissues, the ability of the drug to
exit the vascular system (e.g., through capillary beds), and the ability of the drug to enter
cells. Protein binding also plays a significant role; drugs highly bound to plasma proteins
, (like albumin) are less available for distribution into tissues.
Passage Across Membranes
● Drugs cross cell membranes through several mechanisms: via channels or pores, with
the aid of a transport system, or by direct penetration of the membrane14.
● P-glycoprotein, also known as multidrug transporter protein, is a prominent transport
system that actively pumps a wide variety of drugs out of cells, such as from the
intestinal lumen back into the gut, from the brain back into the blood, or from the kidneys
into the urine15.
● For direct penetration, drugs must be lipid soluble to easily pass through the lipid bilayer
of cell membranes16.
Absorption Process
● Absorption is the movement of a drug from its site of administration into the systemic
circulation17.
● The rate of absorption determines how soon the drug's effects will begin18.
● The amount of drug absorbed helps determine the intensity of the drug's effects19.
Rate of Dissolution
● For a drug administered orally to be absorbed, it must first dissolve in the
gastrointestinal fluids20. Therefore, the rate of dissolution significantly influences the
rate of drug absorption21.
Pharmacology Fundamentals
Chapter 1: Prescriptive Authority
State Laws Impact on Prescriptive Authority
● Prescriptive authority for nurse practitioners is determined by state law1.
● The specific scope of prescriptive authority, including the ability to prescribe
independently and without limitations, is defined by each state's regulations2222.
● This authority typically falls under the jurisdiction of a health professional board, which
may be the state board of nursing, the state board of medicine, or the state board of
pharmacy, depending on state-specific legislation3333.
Full Practice Authority
● Nurse practitioners with full practice authority have the autonomy to evaluate patients,
diagnose conditions, order and interpret diagnostic tests, initiate and manage treatment
plans, and prescribe medications, including controlled substances, without physician
oversight4.
● This level of practice emphasizes the expanded role and independence of nurse
, practitioners in providing comprehensive patient care.
Chapter 3: Promoting Positive Outcomes of Drug
Therapy
Generic vs. Brand Name: Value of Knowing
● For optimal clarity and to prevent medication errors, both the generic and brand names
of a medication should ideally be included on a prescription5. This helps pharmacists and
patients ensure the correct medication is dispensed and understood.
Duration of Therapy
● Understanding whether medication therapy is intended for a short-term or long-term
duration is crucial for patient education, adherence, and monitoring for potential side
effects associated with prolonged use6.
Blood Flow Impact on Absorption
● Drugs are absorbed more rapidly in areas where blood flow is high7. This is because a
high rate of blood flow quickly carries away the absorbed drug, maintaining a steep
concentration gradient between the administration site and the blood, which drives
faster absorption8. The greater the concentration gradient, the more rapid absorption
will be9.
,Chapter 4: Pharmacokinetics, Pharmacodynamics,
and Drug Interactions
Excretion Process
● Excretion is the process by which drugs and their metabolites are eliminated from the
body10. The kidneys are the primary organs of excretion, but drugs can also be
eliminated via bile, lungs, sweat, saliva, and breast milk.
Metabolism Process
● Metabolism, also known as biotransformation, is the enzymatically mediated alteration of
drug structure11.
● Most drug metabolism occurs in the liver and is performed primarily by the hepatic
microsomal enzyme system, particularly the cytochrome P450 (CYP450) enzyme
family12. This process can convert drugs into more hydrophilic (water-soluble)
compounds, facilitating their excretion, or it can activate prodrugs, inactivate drugs, or
create toxic metabolites.
Distribution Process
● Distribution refers to the reversible movement of drugs from the systemic circulation into
the interstitial fluid and cells of tissues and organs where they exert their effects or are
stored13.
● Factors influencing distribution include blood flow to tissues, the ability of the drug to
exit the vascular system (e.g., through capillary beds), and the ability of the drug to enter
cells. Protein binding also plays a significant role; drugs highly bound to plasma proteins
, (like albumin) are less available for distribution into tissues.
Passage Across Membranes
● Drugs cross cell membranes through several mechanisms: via channels or pores, with
the aid of a transport system, or by direct penetration of the membrane14.
● P-glycoprotein, also known as multidrug transporter protein, is a prominent transport
system that actively pumps a wide variety of drugs out of cells, such as from the
intestinal lumen back into the gut, from the brain back into the blood, or from the kidneys
into the urine15.
● For direct penetration, drugs must be lipid soluble to easily pass through the lipid bilayer
of cell membranes16.
Absorption Process
● Absorption is the movement of a drug from its site of administration into the systemic
circulation17.
● The rate of absorption determines how soon the drug's effects will begin18.
● The amount of drug absorbed helps determine the intensity of the drug's effects19.
Rate of Dissolution
● For a drug administered orally to be absorbed, it must first dissolve in the
gastrointestinal fluids20. Therefore, the rate of dissolution significantly influences the
rate of drug absorption21.
