NSG 511: FINAL
Where in the nephron does furosemide act on? - Answer- -Loop
Furosemide MOA - Answer- - blocks reabsorption of sodium, chloride and water in
the ascending loop of Henle
- termed high ceiling diuretics
2 Furosemide uses - Answer- 1. Hypertension
2. Fluid overload/edema
3 Furosemide Side Effects - Answer- 1. Induce dehydration
2. Electrolyte disturbances
3. Ototoxicity
Furosemide: 4 Electrolyte disturbances - Answer- r/t dehydration can cause:
- hyponatremia
- hypochloremia
- hypokalemia
- hypomagnesemia
Furosemide: Ototoxicity - Answer- especially with other known ototoxic drugs: think
"mycin" antibiotics
Where in the nephron does Hydrochlorothiazide (HCTZ)? - Answer- - early distal
tubule
Is hydrochlorothiazide (HCTZ) similar to furosemide? - Answer- HCTZ is similar to
furosemide but not as powerful and ineffective with low glomerular filtration
- oral formulation
How is Hydrochlorothiazide (HCTZ) electrolyte and laboratory disturbances? -
Answer- - similar to furosemide in electrolyte and laboratory disturbances
How do you simplify hydrochlorothiazide (HCTZ) treatment? - Answer- - combined
with antihypertensives as a single pill to simplify treatment
Function of Loop of Henle - Answer- - reabsorption Na/Cl
- H2O follows
Function of Proximal convoluted tubule - Answer- - reabsorption Na/Cl
- H2O follows
Function of P-glycoprotien Transporter - Answer- - transport systems to move drugs
across membranes and out!!
,Ionization - Answer- - ions with molecules with a net charge
- most drugs are in a weak acid or weak based form and ionize easily when in an
environment opposite the pH of drug
Can ionized drugs cross the lipid membrane easily? - Answer- - NO!!! they do not
cross easily
What is AIB? - Answer- acids ionize in bases
What is BID? - Answer- Bases ionize in acids
What will happen to an acid drug in an acid environment? - Answer- it will NOT
ionize and can cross the GI membrane into the blood stream
What will happen to an acid drug in a basic enviornment? - Answer- will ionize and
cannot cross the GI membrane to get into the blood stream
How should you take aspirin? - Answer- -must take food with it to increase pH of the
stomach and a full glass of water
Will non ionized drugs cross the membrane? Will ionized drugs? - Answer- non-
ionized drugs will cross a membrane
ionized drugs will NOT cross a membrane
Will a patient with low albumin levels need high or low dose of a drug that is highly
protein bound? - Answer- will need LOWER dose of drug
- b/c there are fewer binding sites thus more free drug
What will happen to a patient who is taking a highly protein bound drug, then start
another highly protein bound drug? - Answer- -may have adverse effects from both
drugs since they are competing for the same albumin binding sites
4 Steps of Pharmacokinetics - Answer- 1. Absorption
2. Distribution
3. Metabolism
4. Excretion
Define Absorption - Answer- the movement of a drug from site of administration into
the blood
Define Distribution - Answer- the movement of the drug from bloodstream to
interstitium to cells
-blood flow
- exiting the vasculature
,Define Excretion - Answer- - removal of the drug from the body, typically by the
kidney
Define Metabolism - Answer- the chemical alteration of the drug, usually by the liver,
in preparation for excretion
- hepatic enzymes (CYP P450) convert drug from lipid to polar/water form in
preparation for renal excretion
What is the first pass effect? - Answer- - orally administered drugs are absorbed
from the GI tract into the hepatic circulation, delivered to the liver and metabolized
- this decreases their immediate effectiveness
Effects of teratogens during Preimplantation period - Answer- Week 1-3
all or nothing = death or recovery
Effects of teratogens during Embryonic period - Answer- weeks 3-8
gross malformations
- highly vulnerable period
Effects of teratogens during Fetal period - Answer- weeks 9-40
functional malformations: especially the brain CNS
What does tetracycline cause for babies? - Answer- cause teeth staining and bones
How do you minimize drug exposure when breast feeding? (3) - Answer- -should
take medication immediately after breast feeding
- avoid drugs that are sustained release or have long half life
- use the lowest dose for the shortest interval
Parasympathetic (cholinergic)
-Neurotransmitters
-Functions
-Receptors - Answer- -Neurotransmitter: Acetylcholine
-Functions: rest, digestion and secretions
- Receptors: Muscarinic
Sympathetic (adrenergic)
- 2 Neurotransmitters
- Functions
- 4 Receptors - Answer- - Neurotransmitter: epinephrine, norepinephrine
- Functions: fight or flight
- Receptors: alpha 1, alpha 2, beta 1, beta 2
What does Alpha 1 stimulate? - Answer- Vascular
What does Beta 1 stimulate? - Answer- heart
What does Beta 2 stimulate? - Answer- lungs
, Which 5 target organs have muscarinic (acetylcoline) receptors? What is the
function? - Answer- 1. eye: miosis = constriction
2. Heart: decreased rate
3. Lung: bronchoconstriction & secretions
4. GI tract: salivation, gastric secretions, peristalsis, defecation
5. Sweat glands: sweating
Which 4 target organs DO NOT have muscarinic receptors? - Answer- 1. arterioles &
venuoles of the skin and viscera
2. arterioles of heart, lung, and MSK
3. kidney
4. liver
Which 3 target organs are affected by Alpha 1? What are the functions? - Answer- 1.
eye: mydriasis = dilation
2. arterioles & venuoles of the skin and viscera = vasoconstriction shunts blood to
the central circulation
3. Bladder: contraction trigone/sphincter
Which 4 target organs are affected by Beta 2? What are the functions? - Answer- 1.
Lungs = bronchodilation
2. Arterioles and venuoles of the skin and viscera: vasodilation
3. Liver: glycogenolysis
4. Uterus: Muscular relaxation
Which 2 target organs are affected by Beta 1? What are the functions? - Answer- 1.
Heart: increased heart rate & cardiac output
2. kidney: renin release & activation of RAA
What are the 2 diuretics used for fluid volume overload? - Answer- 1. HCTZ
2. Furosemide
What drug has the ending -olol and -ilol? - Answer- beta blockers !!!
What drug has the ending -prils? - Answer- ACEi
-Angiotensin converting enzyme inhibitor
aPRIL always ACEs exams
What drug has the ending - sartan? - Answer- ARBs
-angiotensin receptor blocker
What does Nifidipine do to arteries? - Answer- DIALTES arteries
peripheral arterioles -> decreased resistance -> decreased BP
coronary arteries -> increased blood flow
What does Labetalol do? - Answer- beta blocker!
Where in the nephron does furosemide act on? - Answer- -Loop
Furosemide MOA - Answer- - blocks reabsorption of sodium, chloride and water in
the ascending loop of Henle
- termed high ceiling diuretics
2 Furosemide uses - Answer- 1. Hypertension
2. Fluid overload/edema
3 Furosemide Side Effects - Answer- 1. Induce dehydration
2. Electrolyte disturbances
3. Ototoxicity
Furosemide: 4 Electrolyte disturbances - Answer- r/t dehydration can cause:
- hyponatremia
- hypochloremia
- hypokalemia
- hypomagnesemia
Furosemide: Ototoxicity - Answer- especially with other known ototoxic drugs: think
"mycin" antibiotics
Where in the nephron does Hydrochlorothiazide (HCTZ)? - Answer- - early distal
tubule
Is hydrochlorothiazide (HCTZ) similar to furosemide? - Answer- HCTZ is similar to
furosemide but not as powerful and ineffective with low glomerular filtration
- oral formulation
How is Hydrochlorothiazide (HCTZ) electrolyte and laboratory disturbances? -
Answer- - similar to furosemide in electrolyte and laboratory disturbances
How do you simplify hydrochlorothiazide (HCTZ) treatment? - Answer- - combined
with antihypertensives as a single pill to simplify treatment
Function of Loop of Henle - Answer- - reabsorption Na/Cl
- H2O follows
Function of Proximal convoluted tubule - Answer- - reabsorption Na/Cl
- H2O follows
Function of P-glycoprotien Transporter - Answer- - transport systems to move drugs
across membranes and out!!
,Ionization - Answer- - ions with molecules with a net charge
- most drugs are in a weak acid or weak based form and ionize easily when in an
environment opposite the pH of drug
Can ionized drugs cross the lipid membrane easily? - Answer- - NO!!! they do not
cross easily
What is AIB? - Answer- acids ionize in bases
What is BID? - Answer- Bases ionize in acids
What will happen to an acid drug in an acid environment? - Answer- it will NOT
ionize and can cross the GI membrane into the blood stream
What will happen to an acid drug in a basic enviornment? - Answer- will ionize and
cannot cross the GI membrane to get into the blood stream
How should you take aspirin? - Answer- -must take food with it to increase pH of the
stomach and a full glass of water
Will non ionized drugs cross the membrane? Will ionized drugs? - Answer- non-
ionized drugs will cross a membrane
ionized drugs will NOT cross a membrane
Will a patient with low albumin levels need high or low dose of a drug that is highly
protein bound? - Answer- will need LOWER dose of drug
- b/c there are fewer binding sites thus more free drug
What will happen to a patient who is taking a highly protein bound drug, then start
another highly protein bound drug? - Answer- -may have adverse effects from both
drugs since they are competing for the same albumin binding sites
4 Steps of Pharmacokinetics - Answer- 1. Absorption
2. Distribution
3. Metabolism
4. Excretion
Define Absorption - Answer- the movement of a drug from site of administration into
the blood
Define Distribution - Answer- the movement of the drug from bloodstream to
interstitium to cells
-blood flow
- exiting the vasculature
,Define Excretion - Answer- - removal of the drug from the body, typically by the
kidney
Define Metabolism - Answer- the chemical alteration of the drug, usually by the liver,
in preparation for excretion
- hepatic enzymes (CYP P450) convert drug from lipid to polar/water form in
preparation for renal excretion
What is the first pass effect? - Answer- - orally administered drugs are absorbed
from the GI tract into the hepatic circulation, delivered to the liver and metabolized
- this decreases their immediate effectiveness
Effects of teratogens during Preimplantation period - Answer- Week 1-3
all or nothing = death or recovery
Effects of teratogens during Embryonic period - Answer- weeks 3-8
gross malformations
- highly vulnerable period
Effects of teratogens during Fetal period - Answer- weeks 9-40
functional malformations: especially the brain CNS
What does tetracycline cause for babies? - Answer- cause teeth staining and bones
How do you minimize drug exposure when breast feeding? (3) - Answer- -should
take medication immediately after breast feeding
- avoid drugs that are sustained release or have long half life
- use the lowest dose for the shortest interval
Parasympathetic (cholinergic)
-Neurotransmitters
-Functions
-Receptors - Answer- -Neurotransmitter: Acetylcholine
-Functions: rest, digestion and secretions
- Receptors: Muscarinic
Sympathetic (adrenergic)
- 2 Neurotransmitters
- Functions
- 4 Receptors - Answer- - Neurotransmitter: epinephrine, norepinephrine
- Functions: fight or flight
- Receptors: alpha 1, alpha 2, beta 1, beta 2
What does Alpha 1 stimulate? - Answer- Vascular
What does Beta 1 stimulate? - Answer- heart
What does Beta 2 stimulate? - Answer- lungs
, Which 5 target organs have muscarinic (acetylcoline) receptors? What is the
function? - Answer- 1. eye: miosis = constriction
2. Heart: decreased rate
3. Lung: bronchoconstriction & secretions
4. GI tract: salivation, gastric secretions, peristalsis, defecation
5. Sweat glands: sweating
Which 4 target organs DO NOT have muscarinic receptors? - Answer- 1. arterioles &
venuoles of the skin and viscera
2. arterioles of heart, lung, and MSK
3. kidney
4. liver
Which 3 target organs are affected by Alpha 1? What are the functions? - Answer- 1.
eye: mydriasis = dilation
2. arterioles & venuoles of the skin and viscera = vasoconstriction shunts blood to
the central circulation
3. Bladder: contraction trigone/sphincter
Which 4 target organs are affected by Beta 2? What are the functions? - Answer- 1.
Lungs = bronchodilation
2. Arterioles and venuoles of the skin and viscera: vasodilation
3. Liver: glycogenolysis
4. Uterus: Muscular relaxation
Which 2 target organs are affected by Beta 1? What are the functions? - Answer- 1.
Heart: increased heart rate & cardiac output
2. kidney: renin release & activation of RAA
What are the 2 diuretics used for fluid volume overload? - Answer- 1. HCTZ
2. Furosemide
What drug has the ending -olol and -ilol? - Answer- beta blockers !!!
What drug has the ending -prils? - Answer- ACEi
-Angiotensin converting enzyme inhibitor
aPRIL always ACEs exams
What drug has the ending - sartan? - Answer- ARBs
-angiotensin receptor blocker
What does Nifidipine do to arteries? - Answer- DIALTES arteries
peripheral arterioles -> decreased resistance -> decreased BP
coronary arteries -> increased blood flow
What does Labetalol do? - Answer- beta blocker!
