NUR-641E ADVANCED
PATHOPHYSIOLOGY AND
PHARMACOLOGY FOR THE NURSE
EDUCATOR QUESTIONS AND
ANSWERS
Pharmacokinetics5-
5ansInvolves5ADME5(absorption,5distribution,5metabolism5and5elimination).
Absorption:5absorption5from5the5administration5site5either5directly5or5indirectly5int
o5the5blood/plasma.
Distribution:5reversibly5or5irreversibly5move5from5the5bloodstream5into5the5intersti
tial5and5intracellular5fluid.
Metabolism:5bio-transformed5via5hepatic5metabolism5or5by5other5tissues.
Elimination:5lastly,5the5drug5&5its5metabolites5are5eliminated5from5the5body
The5route5of5administration5with5the5highest5bio-availability5is5-
5ansIntravenous;5putting5entire5dose5into5a5patient's5vein5and5bypassing5absorp
tion.5Intravenous5route5avoids5first-pass5metabolism5in5the5liver.
rectal5administration5disadvantages5-5ansvariable5and5erratic5absorption
Steady5state5(SS)5-5ansis5usually5reached5within54-55half-lives5of5a5drug
The5half-life5of5a5drug5is5defined5as5-
5anshow5long5it5takes5for5half5the5drug5to5be5excreted5from5the5body
Half-life5of5a5drug5-
5ansDetermines5how5frequently5the5drug5must5be5administered
Predicts5how5long5toxic5effects5can5last
Half-life5is5constant5with5first-order5pharmacokinetics5of5a5drug
,Zero-
order5(nonlinear)5pharmacokinetics5means5a5drug5is5metabolized5at5a5constant5
rate5per5unit5time.
CYP3A45substrate5drugs5-
5ansMay5have5enhanced5activity5if5any5CYP3A45inducer5drugs5are5used5along
5with5it.
Drug5development5steps5(according5to5the5FDA)5-
5ansDiscovery:5laboratory5research5to5develop5the5new5drug5
Pre-clinical5research5with5animal5testing5for5safety5(Phase5I)
Clinical5research5on5human5subjects5for5medication5safety5(Phase5II)
Clinical5research5in5humans5comparing5the5new5drug5to5accepted5medications5
or5placebo5depending5on5the5study5(Phase5III)5
FDA5review5of5the5results5to5determine5approval
Post-
marketing5study5to5identify5adverse5effects5not5found5in5earlier5clinical5studies5(
Phase5IV)
Medication5safety5organizations5-
5ansThe5Institute5for5Safe5Medication5Practices5(ISMP)
The5Institute5of5Medicine5(IOM)
The5Joint5Commission
The5National5Coordinating5Council5for5Medication5Error5Reporting5and5Preventio
n5(NCCMERP)
Food5and5Drug5Administration5(FDA)5Safe5Use5Initiative
Adverse5Drug5Reactions5(ADRs)5-
5ansTwo5basic5type5of5ADRs:5pharmacological5and5idiosyncratic.
85%5to590%5of5ADRs5are5pharmacological.
Adverse5drug5reactions5are5usually5preventable,5frequently5occur5in5a5hospital5o
r5nursing5home5setting,5and5include5medication5errors,5adverse5drug5effects,5all
ergic5and5idiosyncratic5type5reactions.5
, ADRs5are5not5commonly5reported;5the5FDA5does5not5mandate5that5ADRs5be5r
eported.
Polypharmacy5involves5using5multiple5healthcare5providers5for5care,5using5multipl
e5medications,5and5using5several5pharmacies5for5prescription5filling.
Cardiovascular-Angiotensin5converting5enzyme5inhibitors5(ACEIs):5-
5ansLisinopril,5captopril,5enalapril,5ramipril,5benazepril,5fosinopril;5
*ACEIs5reduce5blood5pressure5by5suppressing5the5release5of5angiotensin-
converting5enzyme.
*Important5side5effects5of5ACE5inhibitors5include5cough5and5angioedema;5discon
tinue5the5ACEI5if5angioedema5occurs.
Angiotensin5II5receptor5blocking5agents5(ARBs):5-
5ansCandesartan5(Atacand),5eprosartan5(Teveten),5irbesartan5(Avapro),5losartan5(
Cozaar),5telmisartan5(Micardis)5and5valsartan5(Diovan).
ARBs5reduce5blood5pressure5by5blocking5angiotensin5II5receptors.
Cardiovascular-Essential5(primary)5hypertension5-
5ansAccounts5for590%5of5cases;5secondary5hypertension5may5be5caused5by5ch
ronic5renal5failure.
Nitroglycerin5-
5ansnitrate5drug5used5in5the5treatment5of5angina;5a5nitrate5drug5that5can5be5a
dministered5IV,5SL,5a5topical5ointment5and5as5a5transdermal5patch
PDE-55inhibitors5-5ans-Pulmonary5hypertension5therapy
-
Include5sildenafil.5Inhibit5cGMP5PDE55and5prolong5vasodilatory5effect5of5nitric5o
xide.
cGMP5phosphodiesterase5-
5ansan5enzyme5in5cells5that5converts5cGMP5into5GMP
Amiodarone5-
5ansis5the5antiarrhythmic5of5choice5when5there5is5coexisting5heart5failure;5can5
cause5thyroid5and5pulmonary5toxicity.
Alpha-15adrenergic5stimulation5-
5ansresults5in5vasoconstriction5and5increased5blood5pressure.
Alpha-15adrenergic5blockade5-
5ansresults5in5vasodilation5and5reduced5blood5pressure
PATHOPHYSIOLOGY AND
PHARMACOLOGY FOR THE NURSE
EDUCATOR QUESTIONS AND
ANSWERS
Pharmacokinetics5-
5ansInvolves5ADME5(absorption,5distribution,5metabolism5and5elimination).
Absorption:5absorption5from5the5administration5site5either5directly5or5indirectly5int
o5the5blood/plasma.
Distribution:5reversibly5or5irreversibly5move5from5the5bloodstream5into5the5intersti
tial5and5intracellular5fluid.
Metabolism:5bio-transformed5via5hepatic5metabolism5or5by5other5tissues.
Elimination:5lastly,5the5drug5&5its5metabolites5are5eliminated5from5the5body
The5route5of5administration5with5the5highest5bio-availability5is5-
5ansIntravenous;5putting5entire5dose5into5a5patient's5vein5and5bypassing5absorp
tion.5Intravenous5route5avoids5first-pass5metabolism5in5the5liver.
rectal5administration5disadvantages5-5ansvariable5and5erratic5absorption
Steady5state5(SS)5-5ansis5usually5reached5within54-55half-lives5of5a5drug
The5half-life5of5a5drug5is5defined5as5-
5anshow5long5it5takes5for5half5the5drug5to5be5excreted5from5the5body
Half-life5of5a5drug5-
5ansDetermines5how5frequently5the5drug5must5be5administered
Predicts5how5long5toxic5effects5can5last
Half-life5is5constant5with5first-order5pharmacokinetics5of5a5drug
,Zero-
order5(nonlinear)5pharmacokinetics5means5a5drug5is5metabolized5at5a5constant5
rate5per5unit5time.
CYP3A45substrate5drugs5-
5ansMay5have5enhanced5activity5if5any5CYP3A45inducer5drugs5are5used5along
5with5it.
Drug5development5steps5(according5to5the5FDA)5-
5ansDiscovery:5laboratory5research5to5develop5the5new5drug5
Pre-clinical5research5with5animal5testing5for5safety5(Phase5I)
Clinical5research5on5human5subjects5for5medication5safety5(Phase5II)
Clinical5research5in5humans5comparing5the5new5drug5to5accepted5medications5
or5placebo5depending5on5the5study5(Phase5III)5
FDA5review5of5the5results5to5determine5approval
Post-
marketing5study5to5identify5adverse5effects5not5found5in5earlier5clinical5studies5(
Phase5IV)
Medication5safety5organizations5-
5ansThe5Institute5for5Safe5Medication5Practices5(ISMP)
The5Institute5of5Medicine5(IOM)
The5Joint5Commission
The5National5Coordinating5Council5for5Medication5Error5Reporting5and5Preventio
n5(NCCMERP)
Food5and5Drug5Administration5(FDA)5Safe5Use5Initiative
Adverse5Drug5Reactions5(ADRs)5-
5ansTwo5basic5type5of5ADRs:5pharmacological5and5idiosyncratic.
85%5to590%5of5ADRs5are5pharmacological.
Adverse5drug5reactions5are5usually5preventable,5frequently5occur5in5a5hospital5o
r5nursing5home5setting,5and5include5medication5errors,5adverse5drug5effects,5all
ergic5and5idiosyncratic5type5reactions.5
, ADRs5are5not5commonly5reported;5the5FDA5does5not5mandate5that5ADRs5be5r
eported.
Polypharmacy5involves5using5multiple5healthcare5providers5for5care,5using5multipl
e5medications,5and5using5several5pharmacies5for5prescription5filling.
Cardiovascular-Angiotensin5converting5enzyme5inhibitors5(ACEIs):5-
5ansLisinopril,5captopril,5enalapril,5ramipril,5benazepril,5fosinopril;5
*ACEIs5reduce5blood5pressure5by5suppressing5the5release5of5angiotensin-
converting5enzyme.
*Important5side5effects5of5ACE5inhibitors5include5cough5and5angioedema;5discon
tinue5the5ACEI5if5angioedema5occurs.
Angiotensin5II5receptor5blocking5agents5(ARBs):5-
5ansCandesartan5(Atacand),5eprosartan5(Teveten),5irbesartan5(Avapro),5losartan5(
Cozaar),5telmisartan5(Micardis)5and5valsartan5(Diovan).
ARBs5reduce5blood5pressure5by5blocking5angiotensin5II5receptors.
Cardiovascular-Essential5(primary)5hypertension5-
5ansAccounts5for590%5of5cases;5secondary5hypertension5may5be5caused5by5ch
ronic5renal5failure.
Nitroglycerin5-
5ansnitrate5drug5used5in5the5treatment5of5angina;5a5nitrate5drug5that5can5be5a
dministered5IV,5SL,5a5topical5ointment5and5as5a5transdermal5patch
PDE-55inhibitors5-5ans-Pulmonary5hypertension5therapy
-
Include5sildenafil.5Inhibit5cGMP5PDE55and5prolong5vasodilatory5effect5of5nitric5o
xide.
cGMP5phosphodiesterase5-
5ansan5enzyme5in5cells5that5converts5cGMP5into5GMP
Amiodarone5-
5ansis5the5antiarrhythmic5of5choice5when5there5is5coexisting5heart5failure;5can5
cause5thyroid5and5pulmonary5toxicity.
Alpha-15adrenergic5stimulation5-
5ansresults5in5vasoconstriction5and5increased5blood5pressure.
Alpha-15adrenergic5blockade5-
5ansresults5in5vasodilation5and5reduced5blood5pressure
