lOMoARcPSD| 56927468
NR565 Final Study Guide Verified Study Solutions
With Updated Solutions
Week 1
Blood flow impact on distribution
• Well-perfused organs and tissues (heart, liver, and kidneys) receive drugs more rapidly.
• Pathological conditions (abscesses or tumors) can be difficult to treat with drug therapy
due to their low regional blood flow. o May require different therapeutic approaches
such as direct drug injection or alternative treatments. Blood-Brain Barrier Impact
• Passage is limited to lipid-soluble agents and to drugs that cross by way of specific
transport systems.
o Protein-bound drugs and highly ionized drugs cannot cross.
• Protects the brain from injury from toxic substances
• Is not fully developed at birth so infants are much more sensitive to CNS drugs than
older children and adults. First-Pass Effect
• Drug concentration is significantly reduced after metabolism within the liver before
reaching systemic circulation
• Leads to reduction in bioavailability and is seen with PO drugs. Lipid solubility and
Absorption
• Highly lipid-soluble drugs are absorbed more rapidly than drugs whose lipid solubility is
low.
o Lipid-soluble drugs can readily cross the membranes that separate them from
the blood (placenta and blood/brain barrier), whereas drugs of low lipid
solubility cannot.
Medication Administration Placental Drug
Transfer
• Lipid-soluble, non-ionized drugs can cross the placenta and are likely to enter breast
milk.
,Week 2
ACE Inhibitors
• Advantages of ACE Inhibitors
o Used to treat hypertension, heart failure, diabetic nephropathy, and MI.
Benefits result from suppressing formation of angiotensin
II. o Can also prevent adverse cardiovascular events in patients at
risk. o MOA:
(1) reducing levels of angiotensin II (through inhibition of ACE)
(2) increasing levels of bradykinin (through inhibition of kinase II).
Reducing levels of angiotensin II -> dilation of blood vessels which
reduces blood volume (through effects on the kidney) and
prevents/reverses pathologic changes in the heart and blood vessels
mediated by angiotensin II and aldosterone.
Inhibition of ACE can also cause hyperkalemia and fetal injury. Elevation
of bradykinin causes vasodilation (secondary to increased production of
prostaglandins and nitric oxide) and can also promote cough and
angioedema. Loop Diuretics
• Site of action – loop of Henle; causes the most loss of fluids and electrolytes within the
diuretic class of drugs (***Ototoxicity)
• MOA: blocks the reabsorption of sodium and chloride which prevents passive
reabsorption of water -> profound diuresis. Regulation of Arterial Pressure
• AP = PR X CO o PR – peripheral resistance o CO – cardiac output
• Arterial pressure regulated by three systems:
1. The ANS (Autonomic Nervous System)
a. Sympathetic tone to the heart increases HR and contractility -> increasing
CO
b. Parasympathetic tone slows the heart -> reduces CO.
c. The Baroreceptor Reflex serves to maintain AP at a predetermined level
and attempts to restore AP to the preset value.
i. Baroreceptors (pressure sensors) in the aortic arch and carotid
sinus sense AP and relay this information to the vasoconstrictor
center of the medulla.
ii. As the AP changes, the vasoconstrictor center compensates by
sending appropriate instructions to arterioles, veins, and heart.
2. The Renin-Angiotensin-Aldosterone system (RAAS)
a. Mediates AP by:
, lOMoARcPSD| 56927468
i. Constriction of arterioles and veins (mediated by
Angiotensin II) ii. Retention of water by the kidneys.
(Mediated by aldosterone through retention of sodium)
3. The Kidneys.
a. Senses low AP and therefore, retains more water to increase
pressures/CO/PR/etc.
b. Produces opposite effects when sensing elevate pressures and works to
filter urine and decrease pressures.
4. (A family of natriuretic peptides which react under conditions of volume
overload – not a primary regulator of arterial pressure)
a. Protects the cardiovascular system in the event of volume overload
(Increased preload, CO, and AP). Volume overload is caused by excessive
retention of sodium and water.
b. Natriuretic peptides work primarily by (1) reducing blood volume and (2)
promoting dilation of arterioles and veins.
c. Three members of natriuretic peptides: atrial natriuretic peptide (ANP),
B- or brain natriuretic peptide (BNP), and Cnatriuretic peptide (CNP).
i. ANP and BNP are similar in that they both reduce blood volume
and increase venous capacitance and thereby reduce cardiac preload. ii. CNP primarily
promotes vasodilation. Spironolactone
• MOA: blocks the actions of aldosterone in the distal nephron -> retention of potassium
and increased excretion of sodium. o The diuresis caused by spironolactone is scanty
because most of the filtered sodium load has already been reabsorbed by the time the
filtrate reaches the distal nephron. Potassium-sparing Diuretic
Week 3
Adverse Psychological Effects of High-Dose Marijuana
• High-Dose: hallucinations, delusions, paranoia, euphoria now displaced by intense
anxiety, and a dissociative state may occur in which the user feels “outside of himself or
herself.” o In extremely high doses, marijuana can produce a state resembling toxic
psychosis, which may persist for weeks.
• Chronic-Use o Amotivational Syndrome - apathy, dullness, poor grooming, reduced
interest in achievement, and disinterest in the pursuit of conventional goals. o
Cannabinoid Hyperemesis Syndrome - a pattern of cyclic nausea and vomiting often
relieved by taking hot showers or baths.
Codeine and Analgesic Efficiency
• Indicated for relief of mild to moderate pain.
, • The degree of pain relief that can be achieved safely is quite low— much lower than
with morphine. With normal dose (30 mg), codeine produces about as much pain relief
as 325 mg of aspirin or 325 mg of acetaminophen.
Fentanyl Transmucosal Use
• Approved only for breakthrough cancer pain in patients at least 18 years old who are
already taking opioids around-the-clock and have developed some degree of tolerance,
defined as needing, for 1 week or longer, at least: 60 mg of oral morphine a day, or 30
mg of oral oxycodone a day, or 25 mg of oral oxymorphone a day, or 8 mg of oral
hydromorphone a day, or 25 mcg of fentanyl per hour, or an equianalgesic dose of
another opioid.
• Must not be used for acute pain, postoperative pain, headache, or athletic injuries.
• Due to bioavailability from administration route, transmucosal fentanyl products are not
interchangeable on a microgram-for-microgram basis.
o Ex: 100-mcg buccal tablet produces about the same fentanyl blood level as does
a 200-mcg lozenge. o If a patient switches from one transmucosal product to
another, dosage of the new product must be titrated to determine a strength
that is safe and effective.
Opioids
• Withdrawal
o Abrupt withdrawal will precipitate an abstinence syndrome.
Should be withdrawn slowly, tapering the dosage over 3 days. If high
dependency, taper over 7 to 10 days.
o Naloxone causes immediate withdrawal.
o Opioid Antagonists [Methylnaltrexone (Relistor), naloxegol (Movantik), and
naldemedine (Symproic)] are selective µ opioid antagonists for opioid-induced
constipation.
These drugs work in the periphery (GI tract) and hence do not block
opioid receptors in the CNS -> do not decrease analgesia and cannot
precipitate opioid withdrawal.
• Pregnancy
o Tylenol only..
Week 4
Alendronate
NR565 Final Study Guide Verified Study Solutions
With Updated Solutions
Week 1
Blood flow impact on distribution
• Well-perfused organs and tissues (heart, liver, and kidneys) receive drugs more rapidly.
• Pathological conditions (abscesses or tumors) can be difficult to treat with drug therapy
due to their low regional blood flow. o May require different therapeutic approaches
such as direct drug injection or alternative treatments. Blood-Brain Barrier Impact
• Passage is limited to lipid-soluble agents and to drugs that cross by way of specific
transport systems.
o Protein-bound drugs and highly ionized drugs cannot cross.
• Protects the brain from injury from toxic substances
• Is not fully developed at birth so infants are much more sensitive to CNS drugs than
older children and adults. First-Pass Effect
• Drug concentration is significantly reduced after metabolism within the liver before
reaching systemic circulation
• Leads to reduction in bioavailability and is seen with PO drugs. Lipid solubility and
Absorption
• Highly lipid-soluble drugs are absorbed more rapidly than drugs whose lipid solubility is
low.
o Lipid-soluble drugs can readily cross the membranes that separate them from
the blood (placenta and blood/brain barrier), whereas drugs of low lipid
solubility cannot.
Medication Administration Placental Drug
Transfer
• Lipid-soluble, non-ionized drugs can cross the placenta and are likely to enter breast
milk.
,Week 2
ACE Inhibitors
• Advantages of ACE Inhibitors
o Used to treat hypertension, heart failure, diabetic nephropathy, and MI.
Benefits result from suppressing formation of angiotensin
II. o Can also prevent adverse cardiovascular events in patients at
risk. o MOA:
(1) reducing levels of angiotensin II (through inhibition of ACE)
(2) increasing levels of bradykinin (through inhibition of kinase II).
Reducing levels of angiotensin II -> dilation of blood vessels which
reduces blood volume (through effects on the kidney) and
prevents/reverses pathologic changes in the heart and blood vessels
mediated by angiotensin II and aldosterone.
Inhibition of ACE can also cause hyperkalemia and fetal injury. Elevation
of bradykinin causes vasodilation (secondary to increased production of
prostaglandins and nitric oxide) and can also promote cough and
angioedema. Loop Diuretics
• Site of action – loop of Henle; causes the most loss of fluids and electrolytes within the
diuretic class of drugs (***Ototoxicity)
• MOA: blocks the reabsorption of sodium and chloride which prevents passive
reabsorption of water -> profound diuresis. Regulation of Arterial Pressure
• AP = PR X CO o PR – peripheral resistance o CO – cardiac output
• Arterial pressure regulated by three systems:
1. The ANS (Autonomic Nervous System)
a. Sympathetic tone to the heart increases HR and contractility -> increasing
CO
b. Parasympathetic tone slows the heart -> reduces CO.
c. The Baroreceptor Reflex serves to maintain AP at a predetermined level
and attempts to restore AP to the preset value.
i. Baroreceptors (pressure sensors) in the aortic arch and carotid
sinus sense AP and relay this information to the vasoconstrictor
center of the medulla.
ii. As the AP changes, the vasoconstrictor center compensates by
sending appropriate instructions to arterioles, veins, and heart.
2. The Renin-Angiotensin-Aldosterone system (RAAS)
a. Mediates AP by:
, lOMoARcPSD| 56927468
i. Constriction of arterioles and veins (mediated by
Angiotensin II) ii. Retention of water by the kidneys.
(Mediated by aldosterone through retention of sodium)
3. The Kidneys.
a. Senses low AP and therefore, retains more water to increase
pressures/CO/PR/etc.
b. Produces opposite effects when sensing elevate pressures and works to
filter urine and decrease pressures.
4. (A family of natriuretic peptides which react under conditions of volume
overload – not a primary regulator of arterial pressure)
a. Protects the cardiovascular system in the event of volume overload
(Increased preload, CO, and AP). Volume overload is caused by excessive
retention of sodium and water.
b. Natriuretic peptides work primarily by (1) reducing blood volume and (2)
promoting dilation of arterioles and veins.
c. Three members of natriuretic peptides: atrial natriuretic peptide (ANP),
B- or brain natriuretic peptide (BNP), and Cnatriuretic peptide (CNP).
i. ANP and BNP are similar in that they both reduce blood volume
and increase venous capacitance and thereby reduce cardiac preload. ii. CNP primarily
promotes vasodilation. Spironolactone
• MOA: blocks the actions of aldosterone in the distal nephron -> retention of potassium
and increased excretion of sodium. o The diuresis caused by spironolactone is scanty
because most of the filtered sodium load has already been reabsorbed by the time the
filtrate reaches the distal nephron. Potassium-sparing Diuretic
Week 3
Adverse Psychological Effects of High-Dose Marijuana
• High-Dose: hallucinations, delusions, paranoia, euphoria now displaced by intense
anxiety, and a dissociative state may occur in which the user feels “outside of himself or
herself.” o In extremely high doses, marijuana can produce a state resembling toxic
psychosis, which may persist for weeks.
• Chronic-Use o Amotivational Syndrome - apathy, dullness, poor grooming, reduced
interest in achievement, and disinterest in the pursuit of conventional goals. o
Cannabinoid Hyperemesis Syndrome - a pattern of cyclic nausea and vomiting often
relieved by taking hot showers or baths.
Codeine and Analgesic Efficiency
• Indicated for relief of mild to moderate pain.
, • The degree of pain relief that can be achieved safely is quite low— much lower than
with morphine. With normal dose (30 mg), codeine produces about as much pain relief
as 325 mg of aspirin or 325 mg of acetaminophen.
Fentanyl Transmucosal Use
• Approved only for breakthrough cancer pain in patients at least 18 years old who are
already taking opioids around-the-clock and have developed some degree of tolerance,
defined as needing, for 1 week or longer, at least: 60 mg of oral morphine a day, or 30
mg of oral oxycodone a day, or 25 mg of oral oxymorphone a day, or 8 mg of oral
hydromorphone a day, or 25 mcg of fentanyl per hour, or an equianalgesic dose of
another opioid.
• Must not be used for acute pain, postoperative pain, headache, or athletic injuries.
• Due to bioavailability from administration route, transmucosal fentanyl products are not
interchangeable on a microgram-for-microgram basis.
o Ex: 100-mcg buccal tablet produces about the same fentanyl blood level as does
a 200-mcg lozenge. o If a patient switches from one transmucosal product to
another, dosage of the new product must be titrated to determine a strength
that is safe and effective.
Opioids
• Withdrawal
o Abrupt withdrawal will precipitate an abstinence syndrome.
Should be withdrawn slowly, tapering the dosage over 3 days. If high
dependency, taper over 7 to 10 days.
o Naloxone causes immediate withdrawal.
o Opioid Antagonists [Methylnaltrexone (Relistor), naloxegol (Movantik), and
naldemedine (Symproic)] are selective µ opioid antagonists for opioid-induced
constipation.
These drugs work in the periphery (GI tract) and hence do not block
opioid receptors in the CNS -> do not decrease analgesia and cannot
precipitate opioid withdrawal.
• Pregnancy
o Tylenol only..
Week 4
Alendronate
