NUR 521 Exam 1 Study Guide
& Blueprint for Advanced
Pharmacology
Phase 1 Reaction - answer-Process: Oxidation (via CYP enzyme system), reduction,
hydrolysis
Effect: Water-soluble metabolites, chemically active compounds, substrates for Phase 2
***usually precedes Phase 2 but not always
Phase 2 Reaction - answer-Process: Add hydrophilic groups to drug compounds via
glucoronidation, involves parent drug of phase 1 metabolized drug
Effect: makes drug inactive or active, makes drug excretable as water-soluble
compound
Half life - answer-Time for half of the total drug amount in the body to be eliminated
Bioavailability - answer-Proportion of drug dose that reaches systemic circulation (IV
drugs are 100%)
Steady state - answer-Achieved in 3-5 half lives
Clearance - answer-The process by which the volume of plasma is cleared of a
medication, removal of drug from the plasma or organ
Therapeutic level - answer-the concentration of a drug in the blood serum that produces
the desired effect without toxicity
Therapeutic index - answer-Ratio of lethality to therapeutic effect (higher is better)
1:1 = death
2:1 some chemotx drugs
Agonist - answer-Elicit a response when they bind to a receptor
Antagonist - answer-Binding does not allow a response
,Partial agonist - answer-a drug that binds to a receptor and causes a response that is
less than that caused by a full agonist
Time Concentration Curve - answer-
MEC - answer-Minimum effective concentration
MTC - answer-Minimum toxic/max therapeutic concentration
Cmax - answer-Peak concentration
Tmax - answer-Time to peak concentration
AUC - answer-Area under curve, represents drug concentration in the body
Pharmacokinetic changes in aging - answer-Absorption, first pass, bioavailability,
distribution, protein binding, renal/hepatic clearance
Delayed stomach emptying, altered pH, slowed GI motility, reduced hepatic
metabolism, reduced liver function, reduced renal function and clearance
Pediatric dosing - answer-Weight-based
Calculated by body surface area (antineoplastics)
Physiologic-based PK (PBPK): based on organ size, used in environmental toxicology
Pediatric dosing formula - answer-(BSA x adult dose)/1.73 m2 = dose
Done for you
How do changes in body composition in childhood affect how drugs are metabolized? -
answer-Higher body fat: decreased Vd of lipophilic drugs
Increased total body protein: more unbound drug in young infants
Young infants have higher body water ratio: higher hydrophilic drug doses to maintain
plasma concentration
Autonomy - answer-Patients have the right to make informed choices
Beneficence - answer-The goal of maximizing benefits and making efforts to enhance
well-being
Nonmalificence - answer-Do no harm
, Justice - answer-Benefits and consequences should be equitably distributed, according
to need
Medication adherence - answer-Ratio of number of drug doses taken to the number of
drug doses prescribed over a given time period
Medication possession ratio (MPR)
Pharmacoeconomics - answer-Scientific discipline that assesses health care outcomes
and the costs of using or not using health care services, goods, programs
CYP Poor metabolizers - answer-•Experience the most adverse drug reactions
•Homozygous for dysfunction/deletion of gene activity
CYP intermediate metabolizers - answer-Heterozygous alleles
Normal
CYP extensive metabolizers - answer-2 fully functioning alleles
Faster than normal
CYP ultrarapid metabolizers - answer-•2+ active genes on the same allele
•Non-responders to drugs at a normal dose
Type 1 hypersensitivity reaction - answer-•"Immediate" drug reaction = drug allergy
•Mediated by drug-specific IgE antibodies
Type 2 hypersensitivity reaction - answer-•Cytotoxic, mediated by drug-specific IgG or
IgM antibodies
Thrombocytopenia, hemolytic anemia
Type 3 hypersensitivity reaction - answer-•Reactions that deposit immune complexes in
blood serum
Lupus, serum sickness
Type 4 hypersensitivity reaction - answer-Delayed 1-3 days
T-cell dependent TB test
Anaphylaxis - answer-IgE driven, mast cell degranulation and histamine release
Dyspnea, wheezing, urticaria, pruritus, nausea, GI cramps, tachycardia, hypotension
Onset usually in 30 minutes-2hrs; requires immediate treatment and monitoring
& Blueprint for Advanced
Pharmacology
Phase 1 Reaction - answer-Process: Oxidation (via CYP enzyme system), reduction,
hydrolysis
Effect: Water-soluble metabolites, chemically active compounds, substrates for Phase 2
***usually precedes Phase 2 but not always
Phase 2 Reaction - answer-Process: Add hydrophilic groups to drug compounds via
glucoronidation, involves parent drug of phase 1 metabolized drug
Effect: makes drug inactive or active, makes drug excretable as water-soluble
compound
Half life - answer-Time for half of the total drug amount in the body to be eliminated
Bioavailability - answer-Proportion of drug dose that reaches systemic circulation (IV
drugs are 100%)
Steady state - answer-Achieved in 3-5 half lives
Clearance - answer-The process by which the volume of plasma is cleared of a
medication, removal of drug from the plasma or organ
Therapeutic level - answer-the concentration of a drug in the blood serum that produces
the desired effect without toxicity
Therapeutic index - answer-Ratio of lethality to therapeutic effect (higher is better)
1:1 = death
2:1 some chemotx drugs
Agonist - answer-Elicit a response when they bind to a receptor
Antagonist - answer-Binding does not allow a response
,Partial agonist - answer-a drug that binds to a receptor and causes a response that is
less than that caused by a full agonist
Time Concentration Curve - answer-
MEC - answer-Minimum effective concentration
MTC - answer-Minimum toxic/max therapeutic concentration
Cmax - answer-Peak concentration
Tmax - answer-Time to peak concentration
AUC - answer-Area under curve, represents drug concentration in the body
Pharmacokinetic changes in aging - answer-Absorption, first pass, bioavailability,
distribution, protein binding, renal/hepatic clearance
Delayed stomach emptying, altered pH, slowed GI motility, reduced hepatic
metabolism, reduced liver function, reduced renal function and clearance
Pediatric dosing - answer-Weight-based
Calculated by body surface area (antineoplastics)
Physiologic-based PK (PBPK): based on organ size, used in environmental toxicology
Pediatric dosing formula - answer-(BSA x adult dose)/1.73 m2 = dose
Done for you
How do changes in body composition in childhood affect how drugs are metabolized? -
answer-Higher body fat: decreased Vd of lipophilic drugs
Increased total body protein: more unbound drug in young infants
Young infants have higher body water ratio: higher hydrophilic drug doses to maintain
plasma concentration
Autonomy - answer-Patients have the right to make informed choices
Beneficence - answer-The goal of maximizing benefits and making efforts to enhance
well-being
Nonmalificence - answer-Do no harm
, Justice - answer-Benefits and consequences should be equitably distributed, according
to need
Medication adherence - answer-Ratio of number of drug doses taken to the number of
drug doses prescribed over a given time period
Medication possession ratio (MPR)
Pharmacoeconomics - answer-Scientific discipline that assesses health care outcomes
and the costs of using or not using health care services, goods, programs
CYP Poor metabolizers - answer-•Experience the most adverse drug reactions
•Homozygous for dysfunction/deletion of gene activity
CYP intermediate metabolizers - answer-Heterozygous alleles
Normal
CYP extensive metabolizers - answer-2 fully functioning alleles
Faster than normal
CYP ultrarapid metabolizers - answer-•2+ active genes on the same allele
•Non-responders to drugs at a normal dose
Type 1 hypersensitivity reaction - answer-•"Immediate" drug reaction = drug allergy
•Mediated by drug-specific IgE antibodies
Type 2 hypersensitivity reaction - answer-•Cytotoxic, mediated by drug-specific IgG or
IgM antibodies
Thrombocytopenia, hemolytic anemia
Type 3 hypersensitivity reaction - answer-•Reactions that deposit immune complexes in
blood serum
Lupus, serum sickness
Type 4 hypersensitivity reaction - answer-Delayed 1-3 days
T-cell dependent TB test
Anaphylaxis - answer-IgE driven, mast cell degranulation and histamine release
Dyspnea, wheezing, urticaria, pruritus, nausea, GI cramps, tachycardia, hypotension
Onset usually in 30 minutes-2hrs; requires immediate treatment and monitoring
