NSG 6005 Advanced Pharmacology Midterm—Study Guide]

NSG 6005 Advanced Pharmacology Midterm—Study Guide] There will be 75 questions on the Midterm. Most will be multiple choice. There are a couple True/False and 5 matching questions. I suggest you review your PowerPoints and Textbook Assignments. I hope this study guide is helpful Make sure you know the following topics very well. • When a medication is listed below, make sure you know all about it and how to apply it to different patient situations: What disease process it is used for?, how does it work?, when should it not be used?, adverse effects, pros/cons, interactions, patient education factors (should it be taken w/ food? At bedtime?), tapering, preliminary and post treatment labs, black box warnings/CI, etc. • If a disease process is mentioned below—know how to diagnose and recommended treatment guidelines. 1) General principles of pharmacokinetics and dynamics? PHARMACOKINETICS- What the body does to the drug” Absorption –Entry of drug to the blood stream. Usually depends on passive diffusion of drug through cell membranes. • Absorption depends on: blood flow at site, drugs lipid soluability (> lipic, > soluabililty that directly penetrate the memebrane), local PH and drug ionization (non-ionized absorb better), pharmaceutical processing (coatings and additives. • Blood brain barrier: allow lipid soluable only. May pump out any drug that it sees as foreign, hard to treat CNS infections. • Placenta: allows lipid drugs so does not protect from lipid soluable drugs, which is why pregnant women are limited to drugs. Know gestation age. • Distribution : fat ratio changes may alter distribution, especially a people age. • Fat soluable drugs may be accumulated: weight loss will release these drugs. • Water soluable drugs are affected by dehydration Biotransformation (Metabolism) : Drugs become more hydrophilic (water soluable) for excretion. • Also referred to as the P450 system or cytochrome P450 system. (a group of enzymes in the liver identified for their ability to breakdown drugs.) • Hepatic “First Pass Effect” (parenteral (IV or IM) meds bypass this enzymatic effect) • breaks PO meds down to some degree, some are protected with coating but they don’t always work • Metabolites Usually less active, less toxic, easier • to excrete • Prodrugs - inactive in form given but metabolized to active drug (ex: enalapril) • Liver function determined by liver enzymes • Failing liver produces fewer enzymes, drugs available longer: caution • • Excretion: Process by which medications are eliminated from the body unchanged or as metabolites • Kidneys are main organ of excretion • If poor renal function, drug may accumulate, may wish to prescribe less of drug • Also eliminated via respiration, breast milk, defecation. Tears, sweat, saliva not as significant. • START LOW AND GO SLOW!!!! PHARMOCODYNAMICS- “effect of drug on the body” Receptors: Drugs must bind to for effect o Help a process happen: agonist o Block a process from happening: antagonist o Know that: • All drugs have an effect • A drug’s ability to cause a response is 
called its efficacy 
 • If you give a bigger dose you will get a bigger effect up to a point, most drugs have a ceiling. 
 2) CRITERIA FOR CHOOSING AND EFFECTIVE DRUG? • A.) Effectiveness: elicits responses for which it is given - most important • Safety: Cannot produce harmful effects even at very high dosages and for long time oNo such thing as completely safe drug • Selectivity: Only elicits response for which it is given, no side effects • No such thing as a selective drug, all have ADRs • Reversible action: most drugs should be reversible • Predictability: Know with certainty exactly how individual patient will respond – impossible, must individualize • Ease of administration: simple, convenient route - enhances compliance and decreases errors • Freedom from drug interactions: few drugs are without drug interaction • Low cost: easy to afford; significant factor in adherence, esp. with elderly • Chemical stability: drugs ability to be stored for long time without loss of effectiveness – variable between drugs • Possession of simple generic name: easier to remember and less confusion amongst drugs …………………………..CONTINUED………………………………………………….