NUR 635 ADVANCED PHARMACOLOGY
MIDTERM COMPREHENSIVE STUDY GUIDE 2026
DRUG THERAPY PRINCIPLES AND ADVANCED
PHARMACOLOGY CONCEPTS
◉ Pharmacokinetics includes the following:
Answer: ADME (absorption, distribution, metabolism and
elimination).
◉ Pharmacokinetics is...
Answer: How the body effects the drug
◉ Absorption
Answer: absorption from the administration site either directly or
indirectly into the blood/plasma.
◉ Distribution
Answer: reversibly/irreversibly movement of drug from the
bloodstream into the interstitial and intracellular fluid.
◉ Metabolism
,Answer: drug biotransformation via metabolic pathways, primarily
the liver, or by other tissues.
◉ Elimination
Answer: how parent drug & its metabolites are eliminated from the
body
◉ Absorption factors
Answer: · Gastrointestinal pH changes
· Gastric emptying
· Gastric/intestinal enzymes
· Bile acids & biliary function
· Gastrointestinal flora (type and quantity of bacteria)
· Food & nutrient interactions (most common interaction influencing
GI drug absorption)
· Lipid solubility of the drug
◉ Distribution factors
Answer: · Membrane permeability: Cross membranes to site of
action
· Blood brain barrier reduces the speed of drug passage into and out
of brain tissue
,· Plasma protein binding: drugs bound to plasma proteins do not
cross membranes (Note: Malnutrition = aalbumin = a free drug =
greater pharmacologic response)
· Aging cause a reduction in production of plasma proteins
· Lipophilicity of drug: lipophilic drugs concentrate in adipose tissue;
remain in the body for a longer period of time
◉ Volume of distribution
Answer: · Body Composition
- Increased Total body water and extracellular fluid
-Decreased Adipose tissue and skeletal muscle
· Protein Binding (changes with aging)
-Albumin, bilirubin, a1-acid glycoprotein
-Albumin affected by nutrition
-Low albumin (hypoalbuminemia) can cause less protein-bound
drug reaching the tissue site of action.
· Tissue Binding
- Compositional changes
◉ Metabolism factors
Answer: o Drugs can undergo metabolism in the lungs, blood, liver,
intestines and kidney
o Volatile drugs are primarily excreted by the lungs
, · The body changes drugs to more or less active forms (metabolites),
increases water solubility to increase elimination.
◉ Phase 1 Metabolism
Answer: · Cytochrome P450 system
· Located within the endoplasmic reticulum of hepatocytes.
· Through electron transport chain, a drug bound to the CYP450
system undergoes oxidation or reduction.
· Drug metabolism in the liver is also affected by:
-Enzyme induction
- Drug interactions
◉ CYP450
Answer: · CYP: a set of isozymes primarily found in the liver and GI
tract
· Convert lipophilic drugs into more polar (and soluble) molecules
· Considerable genetic variability exists across race and gender
· Results in CYP450 polymorphisms which have a direct effect on
drug metabolism.
◉ Four isozymes are responsible for the majority of Phase I
Metabolism reactions
Answer: 1. CYP3A4/5
MIDTERM COMPREHENSIVE STUDY GUIDE 2026
DRUG THERAPY PRINCIPLES AND ADVANCED
PHARMACOLOGY CONCEPTS
◉ Pharmacokinetics includes the following:
Answer: ADME (absorption, distribution, metabolism and
elimination).
◉ Pharmacokinetics is...
Answer: How the body effects the drug
◉ Absorption
Answer: absorption from the administration site either directly or
indirectly into the blood/plasma.
◉ Distribution
Answer: reversibly/irreversibly movement of drug from the
bloodstream into the interstitial and intracellular fluid.
◉ Metabolism
,Answer: drug biotransformation via metabolic pathways, primarily
the liver, or by other tissues.
◉ Elimination
Answer: how parent drug & its metabolites are eliminated from the
body
◉ Absorption factors
Answer: · Gastrointestinal pH changes
· Gastric emptying
· Gastric/intestinal enzymes
· Bile acids & biliary function
· Gastrointestinal flora (type and quantity of bacteria)
· Food & nutrient interactions (most common interaction influencing
GI drug absorption)
· Lipid solubility of the drug
◉ Distribution factors
Answer: · Membrane permeability: Cross membranes to site of
action
· Blood brain barrier reduces the speed of drug passage into and out
of brain tissue
,· Plasma protein binding: drugs bound to plasma proteins do not
cross membranes (Note: Malnutrition = aalbumin = a free drug =
greater pharmacologic response)
· Aging cause a reduction in production of plasma proteins
· Lipophilicity of drug: lipophilic drugs concentrate in adipose tissue;
remain in the body for a longer period of time
◉ Volume of distribution
Answer: · Body Composition
- Increased Total body water and extracellular fluid
-Decreased Adipose tissue and skeletal muscle
· Protein Binding (changes with aging)
-Albumin, bilirubin, a1-acid glycoprotein
-Albumin affected by nutrition
-Low albumin (hypoalbuminemia) can cause less protein-bound
drug reaching the tissue site of action.
· Tissue Binding
- Compositional changes
◉ Metabolism factors
Answer: o Drugs can undergo metabolism in the lungs, blood, liver,
intestines and kidney
o Volatile drugs are primarily excreted by the lungs
, · The body changes drugs to more or less active forms (metabolites),
increases water solubility to increase elimination.
◉ Phase 1 Metabolism
Answer: · Cytochrome P450 system
· Located within the endoplasmic reticulum of hepatocytes.
· Through electron transport chain, a drug bound to the CYP450
system undergoes oxidation or reduction.
· Drug metabolism in the liver is also affected by:
-Enzyme induction
- Drug interactions
◉ CYP450
Answer: · CYP: a set of isozymes primarily found in the liver and GI
tract
· Convert lipophilic drugs into more polar (and soluble) molecules
· Considerable genetic variability exists across race and gender
· Results in CYP450 polymorphisms which have a direct effect on
drug metabolism.
◉ Four isozymes are responsible for the majority of Phase I
Metabolism reactions
Answer: 1. CYP3A4/5
