NUR 521: Advanced Pharmacology STUDY GUIDE FOR
EXAM 2 (all you need to know about exam 2) 2025 -
University of Alabama
Hemodynamics- the study of movement of blood through the circulatory system along with the
regulatory mechanisms and driving forces that help to control it.
• The circulatory system is composed of: the heart and blood vessels
1. Blood vessels include: arteries, arterioles, capillaries, venules, and
veins.
2. Arteries: muscular and do not stretch easy. Large increases in
arterial pressure only result in small increases in arterial diameter.
3. Veins: less muscular and stretch 6-10x more than arteries. Small
increases in venous pressure causes large increases in vessel
diameter and increase in venous volume.
Primary Functions of the Circulatory System
- Delivers O2, nutrients, hormones, electrolytes, and other essential
items to cells
- Removes CO2 and waste products from cells
Major Divisions of the Circulatory System
• Pulmonary circulation
- Delivers blood to the lungs
• Systemic circulation
- Delivers blood to all other organs and tissues
• Blood moves within the vessels because the force that drives the blood flow is greater
than the resistance present.
• Resistance to flow is determined by diameter/ length of the vessel AND blood viscosity.
➢ From a pharmacological standpoint, the most important
determinant of resistance is the vessel diameter (the larger the
vessel, the smaller the resistance)
- When vessels dilate, the resistance declines
- When vessels constrict, the resistance Increases
- To maintain adequate flow when resistance rises: the blood pressure
must rise as well
• Cardiac Output (CO): HR x SV; an increase in HR or SV will increase CO; a
decrease in HR or SV will decrease CO
• HR is controlled by: The ANS; HR is increased by B1 adrenergic receptors in the SA node;
HR is decreased by the parasympathetic branches via muscarinic receptors in the SA node.
Parasympathetic impulses reach the heart through the vagus nerve.
, 3 factors that determine SV:
- (1) Myocardial contractility- the force with which ventricles contract.
, - (2) Preload- the tension or stretch applied to the muscle BEFORE contraction.
- (3) Afterload- what the muscle must overcome when it contracts
• Starling Law: the force of ventricular contraction is proportional to the muscle fiber
length.
• Venous Return: the primary determinant of SV and therefore CO. The systemic filling
pressure (the force that returns blood to the heart) is the most important factor for
pharmacology; blood volume and venous return can be altered by drugs resulting in
increased or decreased venous return
• Regulation of arterial pressure (AP) is what moves blood through the arterial side of the
systemic circulation. AP=PR x CO
Main systems that regulate AP
- ANS
- Renin-Angiotensin-Aldosterone System (RAAS)
- Kidneys
- Natriuretic peptides that come into play when there is volume overload
Main Implications of Diuretics
- Treatment of HTN
- Used to mobilize fluid (e.g. pt. with liver failure, kidney disease, HF)
• The basic functional unit of the kidney is: the nephron
4 Functionally Distinct Regions of the Nephron
- Glomerulus
- Proximal convoluted tubule
- Descending/ Ascending loop of Henle
- Distal convoluted tubule (early and late segments)
3 basic Functions of the Kidney
- (1) cleanses extracellular fluid (ECF)/ maintains ECF volume
- (2) helps to maintain acid base
- (3) helps to excrete metabolic waste and foreign substances from the
body.
Basic Processes of the Kidney
- Filtration
- Occurs at the glomerulus
- 1st step in urine formation
- Very small molecules get filtered (electrolytes, amino acids, glucose,
drugs, metabolic waste)
- Larger molecules like lipids and proteins remain in the blood stream
- Reabsorption- Na and Cl get reabsorbed
, - Active Secretion- 2 transport proteins help w/ secretion
Furosemide (Lasix)
- Class: Loop diuretic
- MOA: Acts in the thick segment of the ascending limb of the loop of
Henle. Blocks reabsorption of Na/ Cl, preventing reabsorption of H2O.
Produces profound diuresis
- Use: When rapid or massive mobilization of fluid is needed. Pulmonary
edema associated with CHF, Edema from heart, liver, or kidney that
has not responded well to other drugs, HTN
- Goal: Decrease edema (pulmonary, hepatic, heart, kidney), treat HTN
- Baseline data: Wt., VS, Electrolytes
- Monitoring: BP, Pulse, Wt., AE s/s
- Caution: CV disease, Renal impairment, DM, PMH of gout (can cause
a flare up), Pregnancy, Ototoxic drugs, NSAIDS, antihypertensives
- Dosing/ Admin: 20, 40, 80mg tabs; IV dose available; onset within
60min ; duration 6-8hrs; usual dosage 20-80mg (1-2 times/day); start at
low dose and gradually increase
➢ Especially helpful drug when patients have renal impairment
because diuresis can be produced even if there is a lack of renal
blood flow and even when GFR is decreased
- DI: Digoxin (due to loss of K it can INC Digoxin levels and cause
dysrhythmias), Other Ototoxic Drugs (gentamycin) should be
AVOIDED, K Sparing Diuretics (can negate the wasting some and is
sometimes combined w/ Furosemide), NSAIDS, Antihypertensive
agents, Lithium
- AE: Low Na, K, Cl, Hypotension, Dehydration, Hyperglycemia,
Hyperuricemia (uric acid), INC in LDL/ Triglycerides, DEC in HDL,
Ototoxicity
- Pt Edu: Monitor BP; S/S of ortho hypotn (rise slowly to avoid), K rich
foods, s/s of dehydration
- BBW: All loop diuretics can cause profound diuresis with water and
electrolyte depletion (hypokalemia s/s: constipation, palpitations,
fatigue, muscle weakness, tingling, numbness)
Hydrochlorothiazide (Microzide)
- Class: Thiazide diuretic
- MOA: Acts in the early segment of the distal convoluted tubule.
Promotes urine production by blocking reabsorption of Na and Cl
leading to water retention in the nephron and increased urine flow.
More mild diuresis compared to Furosemide (Lasix)
➢ Must have adequate GFR of at least 20mL/min
EXAM 2 (all you need to know about exam 2) 2025 -
University of Alabama
Hemodynamics- the study of movement of blood through the circulatory system along with the
regulatory mechanisms and driving forces that help to control it.
• The circulatory system is composed of: the heart and blood vessels
1. Blood vessels include: arteries, arterioles, capillaries, venules, and
veins.
2. Arteries: muscular and do not stretch easy. Large increases in
arterial pressure only result in small increases in arterial diameter.
3. Veins: less muscular and stretch 6-10x more than arteries. Small
increases in venous pressure causes large increases in vessel
diameter and increase in venous volume.
Primary Functions of the Circulatory System
- Delivers O2, nutrients, hormones, electrolytes, and other essential
items to cells
- Removes CO2 and waste products from cells
Major Divisions of the Circulatory System
• Pulmonary circulation
- Delivers blood to the lungs
• Systemic circulation
- Delivers blood to all other organs and tissues
• Blood moves within the vessels because the force that drives the blood flow is greater
than the resistance present.
• Resistance to flow is determined by diameter/ length of the vessel AND blood viscosity.
➢ From a pharmacological standpoint, the most important
determinant of resistance is the vessel diameter (the larger the
vessel, the smaller the resistance)
- When vessels dilate, the resistance declines
- When vessels constrict, the resistance Increases
- To maintain adequate flow when resistance rises: the blood pressure
must rise as well
• Cardiac Output (CO): HR x SV; an increase in HR or SV will increase CO; a
decrease in HR or SV will decrease CO
• HR is controlled by: The ANS; HR is increased by B1 adrenergic receptors in the SA node;
HR is decreased by the parasympathetic branches via muscarinic receptors in the SA node.
Parasympathetic impulses reach the heart through the vagus nerve.
, 3 factors that determine SV:
- (1) Myocardial contractility- the force with which ventricles contract.
, - (2) Preload- the tension or stretch applied to the muscle BEFORE contraction.
- (3) Afterload- what the muscle must overcome when it contracts
• Starling Law: the force of ventricular contraction is proportional to the muscle fiber
length.
• Venous Return: the primary determinant of SV and therefore CO. The systemic filling
pressure (the force that returns blood to the heart) is the most important factor for
pharmacology; blood volume and venous return can be altered by drugs resulting in
increased or decreased venous return
• Regulation of arterial pressure (AP) is what moves blood through the arterial side of the
systemic circulation. AP=PR x CO
Main systems that regulate AP
- ANS
- Renin-Angiotensin-Aldosterone System (RAAS)
- Kidneys
- Natriuretic peptides that come into play when there is volume overload
Main Implications of Diuretics
- Treatment of HTN
- Used to mobilize fluid (e.g. pt. with liver failure, kidney disease, HF)
• The basic functional unit of the kidney is: the nephron
4 Functionally Distinct Regions of the Nephron
- Glomerulus
- Proximal convoluted tubule
- Descending/ Ascending loop of Henle
- Distal convoluted tubule (early and late segments)
3 basic Functions of the Kidney
- (1) cleanses extracellular fluid (ECF)/ maintains ECF volume
- (2) helps to maintain acid base
- (3) helps to excrete metabolic waste and foreign substances from the
body.
Basic Processes of the Kidney
- Filtration
- Occurs at the glomerulus
- 1st step in urine formation
- Very small molecules get filtered (electrolytes, amino acids, glucose,
drugs, metabolic waste)
- Larger molecules like lipids and proteins remain in the blood stream
- Reabsorption- Na and Cl get reabsorbed
, - Active Secretion- 2 transport proteins help w/ secretion
Furosemide (Lasix)
- Class: Loop diuretic
- MOA: Acts in the thick segment of the ascending limb of the loop of
Henle. Blocks reabsorption of Na/ Cl, preventing reabsorption of H2O.
Produces profound diuresis
- Use: When rapid or massive mobilization of fluid is needed. Pulmonary
edema associated with CHF, Edema from heart, liver, or kidney that
has not responded well to other drugs, HTN
- Goal: Decrease edema (pulmonary, hepatic, heart, kidney), treat HTN
- Baseline data: Wt., VS, Electrolytes
- Monitoring: BP, Pulse, Wt., AE s/s
- Caution: CV disease, Renal impairment, DM, PMH of gout (can cause
a flare up), Pregnancy, Ototoxic drugs, NSAIDS, antihypertensives
- Dosing/ Admin: 20, 40, 80mg tabs; IV dose available; onset within
60min ; duration 6-8hrs; usual dosage 20-80mg (1-2 times/day); start at
low dose and gradually increase
➢ Especially helpful drug when patients have renal impairment
because diuresis can be produced even if there is a lack of renal
blood flow and even when GFR is decreased
- DI: Digoxin (due to loss of K it can INC Digoxin levels and cause
dysrhythmias), Other Ototoxic Drugs (gentamycin) should be
AVOIDED, K Sparing Diuretics (can negate the wasting some and is
sometimes combined w/ Furosemide), NSAIDS, Antihypertensive
agents, Lithium
- AE: Low Na, K, Cl, Hypotension, Dehydration, Hyperglycemia,
Hyperuricemia (uric acid), INC in LDL/ Triglycerides, DEC in HDL,
Ototoxicity
- Pt Edu: Monitor BP; S/S of ortho hypotn (rise slowly to avoid), K rich
foods, s/s of dehydration
- BBW: All loop diuretics can cause profound diuresis with water and
electrolyte depletion (hypokalemia s/s: constipation, palpitations,
fatigue, muscle weakness, tingling, numbness)
Hydrochlorothiazide (Microzide)
- Class: Thiazide diuretic
- MOA: Acts in the early segment of the distal convoluted tubule.
Promotes urine production by blocking reabsorption of Na and Cl
leading to water retention in the nephron and increased urine flow.
More mild diuresis compared to Furosemide (Lasix)
➢ Must have adequate GFR of at least 20mL/min
