NURS
NURS 682 Pharmacology Opener Review
Exam 2025
what the body does to the drug (absorption, distribution, metabolism, excretion) -
Correct Ans-Pharmacokinetics
what the drug does to the body; mechanism of action
Pharmacodynamic study= determining the effect of a specific medication dose in
treating a disease - Correct Ans-Pharmacodynamics
-Percent of dose enter systemic circulation after PO administration
*Fraction of the administered drug that reaches systemic circulation* - Correct Ans-
Bioavailability
LESS drug there is in circulation and in the tissue, higher first pass effect
ex. Simvastatin - Correct Ans-Lower bioavailability
the more of the drug that reaches systemic circulation, Lower first pass effect
ex. Atorvastatin - Correct Ans-Higher bioavailability
Time to maximum drug level observed - Correct Ans-Tmax
maximum or peak concentration of drug observed after administration - Correct Ans-
Cmax
Vd = (amount of drug in the body) / (plasma drug concentration)
-distribution of a medication between plasma and the rest of the body; the volume in
which the amount of drug would need to be uniformly distributed to produce the
observed blood concentration
ex. Vancomycin in serum testing for trough levels - Correct Ans-Volume of distribution
-Healthy adults 20-30 vs. 60-80
-Older adults get more dehydrated
-Medications that are lipophilic will stay longer in the older adult and older adults get
-Liver shrinks with age and albumin is synthesized in the liver. There is freer drug
available in highly protein bound drugs—->Decrease in serum albumin
-Most drugs are biotransformed in the liver, with older adults there is slower
transformation and longer half lives - Correct Ans-Volume of distribution: age related
changes
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Aging
-less free water, more body fat
-lower average serum albumin
Hydration Status
Compartment and volume - Correct Ans-Factors that influence volume of distribution
Biostranformation and/or excretion of oral drug by hepatic mechanisms
-occurs prior to entering GI tract
Drugs absorbed from the GI tract
Extensive hepatic metabolism.extraciton
Ex. IV vs oral dosages - Correct Ans-First Pass Effect (pre-systemic elimination)
Works primarily by stimulating the activity of a receptor site
binds to a receptor, causes an effect similar to endogenous compound - Correct Ans-
Agonists
Clinical action= occupying a receptor site and inhibiting its endogenous activity - Correct
Ans-Antagonist
small differences in drug dose or blood concentration can be fatal
Any pharmaceutical which has <2-fold difference between the minimum toxic
concentration and minimum effective concentration in blood - Correct Ans-Narrow
therapeutic Index
Greater distance between effective dose and toxic dose
Ex. Fluoxetine does NOT need drug monitoring - Correct Ans-Wide therapeutic index
Drug absorption, distribution, metabolism, excretion
Influence dose requirements and/or adverse effects - Correct Ans-Pharmacogenetics:
PK genetic influences
Drug targets: Receptors, transporters, intracellular signaling pathways, enzymes and
metabolic pathways
Influence drug efficacy - Correct Ans-Pharmacogenetics: PD genetic influences
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Ventricular repolarization prolongation
Ectopic beats with long pause follow by baseline rhythm beat with marked prolonged
QT interval
Underlying risk factors + Adding medications with QT prolonging effects
Known: Amiodarone, Haldol - Correct Ans-Drugs with QT prolongation
OLDER AGE - Correct Ans-Known risk of QT prolongaiton
Older adults have....
-less % body weight as water
-less lean muscle mass
-higher % weight as fat
-LOWER SERIUM ALBUMIN**
-lower relative kidney weight
-less relative hepatic blood flow - Correct Ans-Summary of Age-Related Changes
Unconditionally inappropriate meds & Generally best avoided regardless of
circumstances
Usually alternative available
Conditioned upon disease state & dose
Likely only to be inappropriate in specific context - Correct Ans-Beer's Criteria
Beer's Criteria
**Avoid medications with systemic anticholinergic ridged effect due to risk of confusion,
urinary retention, constipation, visual disturbance and hypotension
DO NOT continue unwise practices that are seen in daily clinical settings
Have multiple choices in a drug class, choose a product with a shorter half life
While PD (pharmakodynamics) doesn't change with gaining some age-related changes
will result in less drug effect
**In the elder: loss of B-2 receptor sites
Less bronchodilator effect with -terol meds - Correct Ans-Age-related changes that
impact drug effect / general pharm rules for the elder
blood urea nitrogen
Evaluation of the amount of nitrogen in the blood in urea form
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Urea= metabolism by-product of proteins by liver, removed from the blood by kidneys -
Correct Ans-BUN
Breakdown product of muscle creatinine phosphate and is usually produced at fairly
constant rate by the body (depending on muscles mass)
**Creatinine is greater with higher muscle mass and lower with low muscle mass** -
Correct Ans-Creatinine
Usually less than 20:1 in presence of appropriate hydration
-Reduced in order hydration
Often elevated in renal disease
-In absence of renal disease, can be transiently elevated in dehydration, ingestion of
extreme amounts of protein, upper/lower GI bleed - Correct Ans-BUN: Creatinine
(BUN:Cr)
Used to calculate GFR to take into account differences b/t male and female
USE IBW
Cr Cl in men
(140-age) x wt in kg/(72 x sCr)
Cr Cl in women
(140-age) x wt in kg/(72 x sCr) x 0.85 - Correct Ans-Cockcroft-Gault equation
Category B= best
Animal studies have not demonstrated fetal risk but no controlled study in humans OR
Animal studies have shown adverse effect but not demonstrated in human study
Beta-lactation abx
-Penicillins
-Cephalosporins
Macrolides
-Azithromycin, erythromycin but NOT clarithromycin - Correct Ans-Antibiotic use in
pregnancy: Category B
No controlled study in humans available
Studies in animals have revealed. Adverse effects on the fetus
-Embryocidal
-Teratogenic
-Other
NURS
NURS 682 Pharmacology Opener Review
Exam 2025
what the body does to the drug (absorption, distribution, metabolism, excretion) -
Correct Ans-Pharmacokinetics
what the drug does to the body; mechanism of action
Pharmacodynamic study= determining the effect of a specific medication dose in
treating a disease - Correct Ans-Pharmacodynamics
-Percent of dose enter systemic circulation after PO administration
*Fraction of the administered drug that reaches systemic circulation* - Correct Ans-
Bioavailability
LESS drug there is in circulation and in the tissue, higher first pass effect
ex. Simvastatin - Correct Ans-Lower bioavailability
the more of the drug that reaches systemic circulation, Lower first pass effect
ex. Atorvastatin - Correct Ans-Higher bioavailability
Time to maximum drug level observed - Correct Ans-Tmax
maximum or peak concentration of drug observed after administration - Correct Ans-
Cmax
Vd = (amount of drug in the body) / (plasma drug concentration)
-distribution of a medication between plasma and the rest of the body; the volume in
which the amount of drug would need to be uniformly distributed to produce the
observed blood concentration
ex. Vancomycin in serum testing for trough levels - Correct Ans-Volume of distribution
-Healthy adults 20-30 vs. 60-80
-Older adults get more dehydrated
-Medications that are lipophilic will stay longer in the older adult and older adults get
-Liver shrinks with age and albumin is synthesized in the liver. There is freer drug
available in highly protein bound drugs—->Decrease in serum albumin
-Most drugs are biotransformed in the liver, with older adults there is slower
transformation and longer half lives - Correct Ans-Volume of distribution: age related
changes
NURS
,NURS
Aging
-less free water, more body fat
-lower average serum albumin
Hydration Status
Compartment and volume - Correct Ans-Factors that influence volume of distribution
Biostranformation and/or excretion of oral drug by hepatic mechanisms
-occurs prior to entering GI tract
Drugs absorbed from the GI tract
Extensive hepatic metabolism.extraciton
Ex. IV vs oral dosages - Correct Ans-First Pass Effect (pre-systemic elimination)
Works primarily by stimulating the activity of a receptor site
binds to a receptor, causes an effect similar to endogenous compound - Correct Ans-
Agonists
Clinical action= occupying a receptor site and inhibiting its endogenous activity - Correct
Ans-Antagonist
small differences in drug dose or blood concentration can be fatal
Any pharmaceutical which has <2-fold difference between the minimum toxic
concentration and minimum effective concentration in blood - Correct Ans-Narrow
therapeutic Index
Greater distance between effective dose and toxic dose
Ex. Fluoxetine does NOT need drug monitoring - Correct Ans-Wide therapeutic index
Drug absorption, distribution, metabolism, excretion
Influence dose requirements and/or adverse effects - Correct Ans-Pharmacogenetics:
PK genetic influences
Drug targets: Receptors, transporters, intracellular signaling pathways, enzymes and
metabolic pathways
Influence drug efficacy - Correct Ans-Pharmacogenetics: PD genetic influences
NURS
,NURS
Ventricular repolarization prolongation
Ectopic beats with long pause follow by baseline rhythm beat with marked prolonged
QT interval
Underlying risk factors + Adding medications with QT prolonging effects
Known: Amiodarone, Haldol - Correct Ans-Drugs with QT prolongation
OLDER AGE - Correct Ans-Known risk of QT prolongaiton
Older adults have....
-less % body weight as water
-less lean muscle mass
-higher % weight as fat
-LOWER SERIUM ALBUMIN**
-lower relative kidney weight
-less relative hepatic blood flow - Correct Ans-Summary of Age-Related Changes
Unconditionally inappropriate meds & Generally best avoided regardless of
circumstances
Usually alternative available
Conditioned upon disease state & dose
Likely only to be inappropriate in specific context - Correct Ans-Beer's Criteria
Beer's Criteria
**Avoid medications with systemic anticholinergic ridged effect due to risk of confusion,
urinary retention, constipation, visual disturbance and hypotension
DO NOT continue unwise practices that are seen in daily clinical settings
Have multiple choices in a drug class, choose a product with a shorter half life
While PD (pharmakodynamics) doesn't change with gaining some age-related changes
will result in less drug effect
**In the elder: loss of B-2 receptor sites
Less bronchodilator effect with -terol meds - Correct Ans-Age-related changes that
impact drug effect / general pharm rules for the elder
blood urea nitrogen
Evaluation of the amount of nitrogen in the blood in urea form
NURS
, NURS
Urea= metabolism by-product of proteins by liver, removed from the blood by kidneys -
Correct Ans-BUN
Breakdown product of muscle creatinine phosphate and is usually produced at fairly
constant rate by the body (depending on muscles mass)
**Creatinine is greater with higher muscle mass and lower with low muscle mass** -
Correct Ans-Creatinine
Usually less than 20:1 in presence of appropriate hydration
-Reduced in order hydration
Often elevated in renal disease
-In absence of renal disease, can be transiently elevated in dehydration, ingestion of
extreme amounts of protein, upper/lower GI bleed - Correct Ans-BUN: Creatinine
(BUN:Cr)
Used to calculate GFR to take into account differences b/t male and female
USE IBW
Cr Cl in men
(140-age) x wt in kg/(72 x sCr)
Cr Cl in women
(140-age) x wt in kg/(72 x sCr) x 0.85 - Correct Ans-Cockcroft-Gault equation
Category B= best
Animal studies have not demonstrated fetal risk but no controlled study in humans OR
Animal studies have shown adverse effect but not demonstrated in human study
Beta-lactation abx
-Penicillins
-Cephalosporins
Macrolides
-Azithromycin, erythromycin but NOT clarithromycin - Correct Ans-Antibiotic use in
pregnancy: Category B
No controlled study in humans available
Studies in animals have revealed. Adverse effects on the fetus
-Embryocidal
-Teratogenic
-Other
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