lOMoARcPSD| 62788957
lOMoAR cPSD| 62788957
NR565 – Advanced Pharmacology Fundamentals
Exam Study Guide – Midterm Exam
Week 1: Chapters 1–10 – Foundations in Pharmacology
• Prescriptive authority
Definition: Prescriptive authority refers to the legal ability of licensed healthcare providers (physicians,
nurse practitioners, physician assistants) to prescribe medications.
Key Considerations: Prescriptive authority is governed by state and federal laws, and the scope may
vary by provider type and jurisdiction. Prescribers must follow drug approval guidelines, consider
patient conditions, and prescribe within their area of expertise.
• Prescription writing
Patient information (name, date, age)
Medication name (generic and/or brand)
Dosage form (tablet, injection, cream)
Dosage strength
Dosage instructions (how, when, and for how long to take the drug
Quantity to dispense
Refills (if applicable)
Prescriber’s signature and license number
Legal Considerations: Prescriptions should be clear, legible, and in accordance with regulatory
standards (e.g., controlled substances require specific documentation).
• Prescribing considerations
Patient Factors: Age, weight, gender, health status, kidney/liver function, allergies, and other drugs
being taken.
Therapeutic Effect: Consider the drug’s therapeutic benefits and the potential risks.
Cost: Affordable options should be considered to improve patient adherence.
, lOMoARcPSD| 62788957
Drug Formulation: Availability of the drug in suitable formulations (oral, topical, injectable) for the
patient’s condition
• Medication education
Patient Education: Include information on how to take the medication correctly, potential side effects,
what to do in case of missed doses, and the importance of follow-up visits.
Safety Information: Educate patients on potential drug interactions, warnings, and signs of adverse
reactions.
• Drug absorption
The process by which a drug moves from its site of administration (oral, intravenous, topical) into the
bloodstream.
Route: Oral vs. IM vs. SubQ
Blood flow
GI motility and pH
Drug formulation (extended-release vs. immediate-release) Process by which a
drug enters the bloodstream.
Affected by: route (oral, IV, IM, transdermal), gastric pH, motility, blood flow, and first-pass
metabolism.
Pediatric patients: gastric acidity low, delayed gastric emptying, affecting absorption.
Older adults: slowed absorption due to delayed gastric emptying and reduced splanchnic blood flow.
• Drug distribution
The process by which the drug moves from the bloodstream into various tissues and organs.
Influenced by: plasma protein binding (albumin), tissue perfusion, body composition, and blood-
brain barrier permeability.
Pediatrics: low albumin → higher free drug levels → increased sensitivity.
Geriatrics: increased body fat → prolonged half-life for lipophilic drugs; decreased water → higher
concentrations for hydrophilic drugs
• Drug metabolism
Mostly occurs in the liver via cytochrome P450 enzymes.
Converts drugs to more water-soluble metabolites for renal excretion.
Pediatrics: immature hepatic enzymes → slower metabolism in neonates, faster than adults in
toddlers.
Geriatrics: decreased hepatic blood flow, mass, and enzyme activity → prolonged half-life.
, lOMoARcPSD| 62788957
Genetic variation in metabolizing enzymes. Age, liver
function, other drugs, and diet.
• Renal drug excretion
The removal of drugs and metabolites from the body via the kidneys (urine).
Processes Involved:
Glomerular filtration
Tubular secretion (active transport of drugs into the urine)
Reabsorption (drugs may be reabsorbed into the bloodstream, affecting drug elimination).
Factors Affecting Renal Excretion:
Renal function (creatinine clearance, glomerular filtration rate)
Urine pH
Kidney disease (can reduce drug elimination).
Pediatrics: immature renal function → reduced excretion → increased risk of toxicity.
Older adults: decreased renal blood flow, GFR, tubular function → monitor creatinine clearance, not
serum creatinine alone.
• Agonists and antagonists
Agonists: Drugs that bind to a receptor and activate it to produce a physiological response.
Example: morphine is an agonist at opioid receptors.
Antagonists: Drugs that bind to a receptor but do not activate it, blocking the effect of agonists.
Example: naloxone (Narcan) is an antagonist at opioid receptors and can reverse opioid toxicity
Clinical relevance: understanding receptor interactions helps predict drug efficacy and potential side
effects.
• Drug interactions
Can alter absorption, distribution, metabolism, or excretion.
Can lead to enhanced or reduced drug effects, or adverse reactions.
Polypharmacy in pediatrics and geriatrics increases risk.
Examples: CYP450 inhibitors/inducers, protein binding displacement, additive CNS depression.
, lOMoARcPSD| 62788957
• Hepatic drug metabolism
Cytochrome P450 Enzymes: The liver is a primary site for drug metabolism, particularly via the CYP450
system. Inducers or inhibitors of these enzymes can significantly alter drug levels.
Liver Disease: In conditions like cirrhosis, liver function may be compromised, which can impair drug
metabolism.
• Half-life
The time it takes for the concentration of the drug in the plasma to decrease by half.
A drug with a long half-life stays in the body longer, while one with a short half-life is eliminated more
quickly. The half-life helps determine dosing schedules.
• Ways to minimize adverse drug reactions
Individualized Dosing: Tailor the dose based on patient characteristics (age, weight, kidney/liver
function).
Drug Monitoring: Regular monitoring of drug levels, especially for narrow therapeutic index drugs (e.g.,
digoxin, warfarin).
Patient Education: Inform patients about potential side effects, how to recognize them, and when to
seek medical help.
Drug Interactions: Be mindful of potential interactions with other drugs or foods.
• Boxed warnings
The FDA’s most serious safety warning included in the drug’s labeling, indicating significant risk of
adverse effects (e.g., black box warning).
• Special considerations in drug metabolism
Genetic Polymorphisms: Differences in drug metabolism due to genetic factors can affect drug
response.
Age: Infants and elderly patients may have altered metabolic capacities. CYP450 enzyme activity is
immature in infants and can decline in elderly.
Liver Function: Patients with liver disease may need lower doses of drugs metabolized by the liver.
Pharmacogenomic variations can affect drug response.
• Drug therapy during pregnancy
Consider maternal-fetal risk, trimester-specific effects, and placental transfer.
Drugs must be chosen to minimize fetal harm.
lOMoAR cPSD| 62788957
NR565 – Advanced Pharmacology Fundamentals
Exam Study Guide – Midterm Exam
Week 1: Chapters 1–10 – Foundations in Pharmacology
• Prescriptive authority
Definition: Prescriptive authority refers to the legal ability of licensed healthcare providers (physicians,
nurse practitioners, physician assistants) to prescribe medications.
Key Considerations: Prescriptive authority is governed by state and federal laws, and the scope may
vary by provider type and jurisdiction. Prescribers must follow drug approval guidelines, consider
patient conditions, and prescribe within their area of expertise.
• Prescription writing
Patient information (name, date, age)
Medication name (generic and/or brand)
Dosage form (tablet, injection, cream)
Dosage strength
Dosage instructions (how, when, and for how long to take the drug
Quantity to dispense
Refills (if applicable)
Prescriber’s signature and license number
Legal Considerations: Prescriptions should be clear, legible, and in accordance with regulatory
standards (e.g., controlled substances require specific documentation).
• Prescribing considerations
Patient Factors: Age, weight, gender, health status, kidney/liver function, allergies, and other drugs
being taken.
Therapeutic Effect: Consider the drug’s therapeutic benefits and the potential risks.
Cost: Affordable options should be considered to improve patient adherence.
, lOMoARcPSD| 62788957
Drug Formulation: Availability of the drug in suitable formulations (oral, topical, injectable) for the
patient’s condition
• Medication education
Patient Education: Include information on how to take the medication correctly, potential side effects,
what to do in case of missed doses, and the importance of follow-up visits.
Safety Information: Educate patients on potential drug interactions, warnings, and signs of adverse
reactions.
• Drug absorption
The process by which a drug moves from its site of administration (oral, intravenous, topical) into the
bloodstream.
Route: Oral vs. IM vs. SubQ
Blood flow
GI motility and pH
Drug formulation (extended-release vs. immediate-release) Process by which a
drug enters the bloodstream.
Affected by: route (oral, IV, IM, transdermal), gastric pH, motility, blood flow, and first-pass
metabolism.
Pediatric patients: gastric acidity low, delayed gastric emptying, affecting absorption.
Older adults: slowed absorption due to delayed gastric emptying and reduced splanchnic blood flow.
• Drug distribution
The process by which the drug moves from the bloodstream into various tissues and organs.
Influenced by: plasma protein binding (albumin), tissue perfusion, body composition, and blood-
brain barrier permeability.
Pediatrics: low albumin → higher free drug levels → increased sensitivity.
Geriatrics: increased body fat → prolonged half-life for lipophilic drugs; decreased water → higher
concentrations for hydrophilic drugs
• Drug metabolism
Mostly occurs in the liver via cytochrome P450 enzymes.
Converts drugs to more water-soluble metabolites for renal excretion.
Pediatrics: immature hepatic enzymes → slower metabolism in neonates, faster than adults in
toddlers.
Geriatrics: decreased hepatic blood flow, mass, and enzyme activity → prolonged half-life.
, lOMoARcPSD| 62788957
Genetic variation in metabolizing enzymes. Age, liver
function, other drugs, and diet.
• Renal drug excretion
The removal of drugs and metabolites from the body via the kidneys (urine).
Processes Involved:
Glomerular filtration
Tubular secretion (active transport of drugs into the urine)
Reabsorption (drugs may be reabsorbed into the bloodstream, affecting drug elimination).
Factors Affecting Renal Excretion:
Renal function (creatinine clearance, glomerular filtration rate)
Urine pH
Kidney disease (can reduce drug elimination).
Pediatrics: immature renal function → reduced excretion → increased risk of toxicity.
Older adults: decreased renal blood flow, GFR, tubular function → monitor creatinine clearance, not
serum creatinine alone.
• Agonists and antagonists
Agonists: Drugs that bind to a receptor and activate it to produce a physiological response.
Example: morphine is an agonist at opioid receptors.
Antagonists: Drugs that bind to a receptor but do not activate it, blocking the effect of agonists.
Example: naloxone (Narcan) is an antagonist at opioid receptors and can reverse opioid toxicity
Clinical relevance: understanding receptor interactions helps predict drug efficacy and potential side
effects.
• Drug interactions
Can alter absorption, distribution, metabolism, or excretion.
Can lead to enhanced or reduced drug effects, or adverse reactions.
Polypharmacy in pediatrics and geriatrics increases risk.
Examples: CYP450 inhibitors/inducers, protein binding displacement, additive CNS depression.
, lOMoARcPSD| 62788957
• Hepatic drug metabolism
Cytochrome P450 Enzymes: The liver is a primary site for drug metabolism, particularly via the CYP450
system. Inducers or inhibitors of these enzymes can significantly alter drug levels.
Liver Disease: In conditions like cirrhosis, liver function may be compromised, which can impair drug
metabolism.
• Half-life
The time it takes for the concentration of the drug in the plasma to decrease by half.
A drug with a long half-life stays in the body longer, while one with a short half-life is eliminated more
quickly. The half-life helps determine dosing schedules.
• Ways to minimize adverse drug reactions
Individualized Dosing: Tailor the dose based on patient characteristics (age, weight, kidney/liver
function).
Drug Monitoring: Regular monitoring of drug levels, especially for narrow therapeutic index drugs (e.g.,
digoxin, warfarin).
Patient Education: Inform patients about potential side effects, how to recognize them, and when to
seek medical help.
Drug Interactions: Be mindful of potential interactions with other drugs or foods.
• Boxed warnings
The FDA’s most serious safety warning included in the drug’s labeling, indicating significant risk of
adverse effects (e.g., black box warning).
• Special considerations in drug metabolism
Genetic Polymorphisms: Differences in drug metabolism due to genetic factors can affect drug
response.
Age: Infants and elderly patients may have altered metabolic capacities. CYP450 enzyme activity is
immature in infants and can decline in elderly.
Liver Function: Patients with liver disease may need lower doses of drugs metabolized by the liver.
Pharmacogenomic variations can affect drug response.
• Drug therapy during pregnancy
Consider maternal-fetal risk, trimester-specific effects, and placental transfer.
Drugs must be chosen to minimize fetal harm.
