NUR-641E ADVANCED PATHOPHYSIOLOGY AND PHARMACOLOGY FOR THE
NURSE EDUCATOR 2026/2027 | STUDY GUIDE, PRACTICE QUESTIONS & EXAM
REVIEW
Involves ADME (absorption, distribution, metabolism and elimination).
Absorption: absorption from the administration site either directly or indirectly into the blood/plasma.
Distribution: reversibly or irreversibly move from the bloodstream into the interstitial and intracellular
fluid.
Metabolism: bio-transformed via hepatic metabolism or by other tissues.
Elimination: lastly, the drug & its metabolites are eliminated from the body - ANS ✔✔Pharmacokinetics
Intravenous; putting entire dose into a patient's vein and bypassing absorption. Intravenous route avoids
first-pass metabolism in the liver. - ANS ✔✔The route of administration with the highest bio-availability
is
variable and erratic absorption - ANS ✔✔rectal administration disadvantages
is usually reached within 4-5 half-lives of a drug - ANS ✔✔Steady state (SS)
how long it takes for half the drug to be excreted from the body - ANS ✔✔The half-life of a drug is
defined as
Determines how frequently the drug must be administered
Predicts how long toxic effects can last
Half-life is constant with first-order pharmacokinetics of a drug
Zero-order (nonlinear) pharmacokinetics means a drug is metabolized at a constant rate per unit time. -
ANS ✔✔Half-life of a drug
May have enhanced activity if any CYP3A4 inducer drugs are used along with it. - ANS ✔✔CYP3A4
substrate drugs
Discovery: laboratory research to develop the new drug
Pre-clinical research with animal testing for safety (Phase I)
Clinical research on human subjects for medication safety (Phase II)
Clinical research in humans comparing the new drug to accepted medications or placebo depending on
the study (Phase III)
, FDA review of the results to determine approval
Post-marketing study to identify adverse effects not found in earlier clinical studies (Phase IV) - ANS
✔✔Drug development steps (according to the FDA)
The Institute for Safe Medication Practices (ISMP)
The Institute of Medicine (IOM)
The Joint Commission
The National Coordinating Council for Medication Error Reporting and Prevention (NCCMERP)
Food and Drug Administration (FDA) Safe Use Initiative - ANS ✔✔Medication safety organizations
Two basic type of ADRs: pharmacological and idiosyncratic.
85% to 90% of ADRs are pharmacological.
Adverse drug reactions are usually preventable, frequently occur in a hospital or nursing home setting,
and include medication errors, adverse drug effects, allergic and idiosyncratic type reactions.
ADRs are not commonly reported; the FDA does not mandate that ADRs be reported.
Polypharmacy involves using multiple healthcare providers for care, using multiple medications, and
using several pharmacies for prescription filling. - ANS ✔✔Adverse Drug Reactions (ADRs)
Lisinopril, captopril, enalapril, ramipril, benazepril, fosinopril;
*ACEIs reduce blood pressure by suppressing the release of angiotensin-converting enzyme.
*Important side effects of ACE inhibitors include cough and angioedema; discontinue the ACEI if
angioedema occurs. - ANS ✔✔Cardiovascular-Angiotensin converting enzyme inhibitors (ACEIs):
Candesartan (Atacand), eprosartan (Teveten), irbesartan (Avapro), losartan (Cozaar), telmisartan
(Micardis) and valsartan (Diovan).
ARBs reduce blood pressure by blocking angiotensin II receptors. - ANS ✔✔Angiotensin II receptor
blocking agents (ARBs):
Accounts for 90% of cases; secondary hypertension may be caused by chronic renal failure. - ANS
✔✔Cardiovascular-Essential (primary) hypertension
nitrate drug used in the treatment of angina; a nitrate drug that can be administered IV, SL, a topical
ointment and as a transdermal patch - ANS ✔✔Nitroglycerin
-Pulmonary hypertension therapy
-Include sildenafil. Inhibit cGMP PDE5 and prolong vasodilatory effect of nitric oxide. - ANS ✔✔PDE-5
inhibitors
NURSE EDUCATOR 2026/2027 | STUDY GUIDE, PRACTICE QUESTIONS & EXAM
REVIEW
Involves ADME (absorption, distribution, metabolism and elimination).
Absorption: absorption from the administration site either directly or indirectly into the blood/plasma.
Distribution: reversibly or irreversibly move from the bloodstream into the interstitial and intracellular
fluid.
Metabolism: bio-transformed via hepatic metabolism or by other tissues.
Elimination: lastly, the drug & its metabolites are eliminated from the body - ANS ✔✔Pharmacokinetics
Intravenous; putting entire dose into a patient's vein and bypassing absorption. Intravenous route avoids
first-pass metabolism in the liver. - ANS ✔✔The route of administration with the highest bio-availability
is
variable and erratic absorption - ANS ✔✔rectal administration disadvantages
is usually reached within 4-5 half-lives of a drug - ANS ✔✔Steady state (SS)
how long it takes for half the drug to be excreted from the body - ANS ✔✔The half-life of a drug is
defined as
Determines how frequently the drug must be administered
Predicts how long toxic effects can last
Half-life is constant with first-order pharmacokinetics of a drug
Zero-order (nonlinear) pharmacokinetics means a drug is metabolized at a constant rate per unit time. -
ANS ✔✔Half-life of a drug
May have enhanced activity if any CYP3A4 inducer drugs are used along with it. - ANS ✔✔CYP3A4
substrate drugs
Discovery: laboratory research to develop the new drug
Pre-clinical research with animal testing for safety (Phase I)
Clinical research on human subjects for medication safety (Phase II)
Clinical research in humans comparing the new drug to accepted medications or placebo depending on
the study (Phase III)
, FDA review of the results to determine approval
Post-marketing study to identify adverse effects not found in earlier clinical studies (Phase IV) - ANS
✔✔Drug development steps (according to the FDA)
The Institute for Safe Medication Practices (ISMP)
The Institute of Medicine (IOM)
The Joint Commission
The National Coordinating Council for Medication Error Reporting and Prevention (NCCMERP)
Food and Drug Administration (FDA) Safe Use Initiative - ANS ✔✔Medication safety organizations
Two basic type of ADRs: pharmacological and idiosyncratic.
85% to 90% of ADRs are pharmacological.
Adverse drug reactions are usually preventable, frequently occur in a hospital or nursing home setting,
and include medication errors, adverse drug effects, allergic and idiosyncratic type reactions.
ADRs are not commonly reported; the FDA does not mandate that ADRs be reported.
Polypharmacy involves using multiple healthcare providers for care, using multiple medications, and
using several pharmacies for prescription filling. - ANS ✔✔Adverse Drug Reactions (ADRs)
Lisinopril, captopril, enalapril, ramipril, benazepril, fosinopril;
*ACEIs reduce blood pressure by suppressing the release of angiotensin-converting enzyme.
*Important side effects of ACE inhibitors include cough and angioedema; discontinue the ACEI if
angioedema occurs. - ANS ✔✔Cardiovascular-Angiotensin converting enzyme inhibitors (ACEIs):
Candesartan (Atacand), eprosartan (Teveten), irbesartan (Avapro), losartan (Cozaar), telmisartan
(Micardis) and valsartan (Diovan).
ARBs reduce blood pressure by blocking angiotensin II receptors. - ANS ✔✔Angiotensin II receptor
blocking agents (ARBs):
Accounts for 90% of cases; secondary hypertension may be caused by chronic renal failure. - ANS
✔✔Cardiovascular-Essential (primary) hypertension
nitrate drug used in the treatment of angina; a nitrate drug that can be administered IV, SL, a topical
ointment and as a transdermal patch - ANS ✔✔Nitroglycerin
-Pulmonary hypertension therapy
-Include sildenafil. Inhibit cGMP PDE5 and prolong vasodilatory effect of nitric oxide. - ANS ✔✔PDE-5
inhibitors
