NURS 682 – Pharmacology Midterm Review – Advanced Nursing Drug Concepts and Therapeutic
Applications
what the body does to the drug (absorption, distribution, metabolism, excretion) - correct
answer Pharmacokinetics
what the drug does to the body; mechanism of action
Pharmacodynamic study= determining the effect of a specific medication dose in treating a
disease - correct answer Pharmacodynamics
-Percent of dose enter systemic circulation after PO administration
*Fraction of the administered drug that reaches systemic circulation* - correct answer
Bioavailability
LESS drug there is in circulation and in the tissue, higher first pass effect
ex. Simvastatin - correct answer Lower bioavailability
the more of the drug that reaches systemic circulation, Lower first pass effect
ex. Atorvastatin - correct answer Higher bioavailability
Time to maximum drug level observed - correct answer Tmax
maximum or peak concentration of drug observed after administration - correct answer Cmax
Vd = (amount of drug in the body) / (plasma drug concentration)
-distribution of a medication between plasma and the rest of the body; the volume in which the
amount of drug would need to be uniformly distributed to produce the observed blood
concentration
ex. Vancomycin in serum testing for trough levels - correct answer Volume of distribution
-Healthy adults 20-30 vs. 60-80
-Older adults get more dehydrated
-Medications that are lipophilic will stay longer in the older adult and older adults get
-Liver shrinks with age and albumin is synthesized in the liver. There is freer drug available in
highly protein bound drugs—->Decrease in serum albumin
,NURS 682 – Pharmacology Midterm Review – Advanced Nursing Drug Concepts and Therapeutic
Applications
-Most drugs are biotransformed in the liver, with older adults there is slower transformation
and longer half lives - correct answer Volume of distribution: age related changes
Aging
-less free water, more body fat
-lower average serum albumin
Hydration Status
Compartment and volume - correct answer Factors that influence volume of distribution
Biostranformation and/or excretion of oral drug by hepatic mechanisms
-occurs prior to entering GI tract
Drugs absorbed from the GI tract
Extensive hepatic metabolism.extraciton
Ex. IV vs oral dosages - correct answer First Pass Effect (pre-systemic elimination)
Works primarily by stimulating the activity of a receptor site
binds to a receptor, causes an effect similar to endogenous compound - correct answer
Agonists
Clinical action= occupying a receptor site and inhibiting its endogenous activity - correct answer
Antagonist
small differences in drug dose or blood concentration can be fatal
Any pharmaceutical which has <2-fold difference between the minimum toxic concentration
and minimum effective concentration in blood - correct answer Narrow therapeutic Index
Greater distance between effective dose and toxic dose
,NURS 682 – Pharmacology Midterm Review – Advanced Nursing Drug Concepts and Therapeutic
Applications
Ex. Fluoxetine does NOT need drug monitoring - correct answer Wide therapeutic index
Drug absorption, distribution, metabolism, excretion
Influence dose requirements and/or adverse effects - correct answer Pharmacogenetics: PK
genetic influences
Drug targets: Receptors, transporters, intracellular signaling pathways, enzymes and metabolic
pathways
Influence drug efficacy - correct answer Pharmacogenetics: PD genetic influences
Ventricular repolarization prolongation
Ectopic beats with long pause follow by baseline rhythm beat with marked prolonged QT
interval
Underlying risk factors + Adding medications with QT prolonging effects
Known: Amiodarone, Haldol - correct answer Drugs with QT prolongation
OLDER AGE - correct answer Known risk of QT prolongaiton
Older adults have....
-less % body weight as water
-less lean muscle mass
-higher % weight as fat
-LOWER SERIUM ALBUMIN**
-lower relative kidney weight
-less relative hepatic blood flow - correct answer Summary of Age-Related Changes
Unconditionally inappropriate meds & Generally best avoided regardless of circumstances
Usually alternative available
, NURS 682 – Pharmacology Midterm Review – Advanced Nursing Drug Concepts and Therapeutic
Applications
Conditioned upon disease state & dose
Likely only to be inappropriate in specific context - correct answer Beer's Criteria
Beer's Criteria
**Avoid medications with systemic anticholinergic ridged effect due to risk of confusion,
urinary retention, constipation, visual disturbance and hypotension
DO NOT continue unwise practices that are seen in daily clinical settings
Have multiple choices in a drug class, choose a product with a shorter half life
While PD (pharmakodynamics) doesn't change with gaining some age-related changes will
result in less drug effect
**In the elder: loss of B-2 receptor sites
Less bronchodilator effect with -terol meds - correct answer Age-related changes that impact
drug effect / general pharm rules for the elder
blood urea nitrogen
Evaluation of the amount of nitrogen in the blood in urea form
Urea= metabolism by-product of proteins by liver, removed from the blood by kidneys - correct
answer BUN
Breakdown product of muscle creatinine phosphate and is usually produced at fairly constant
rate by the body (depending on muscles mass)
**Creatinine is greater with higher muscle mass and lower with low muscle mass** - correct
answer Creatinine
Applications
what the body does to the drug (absorption, distribution, metabolism, excretion) - correct
answer Pharmacokinetics
what the drug does to the body; mechanism of action
Pharmacodynamic study= determining the effect of a specific medication dose in treating a
disease - correct answer Pharmacodynamics
-Percent of dose enter systemic circulation after PO administration
*Fraction of the administered drug that reaches systemic circulation* - correct answer
Bioavailability
LESS drug there is in circulation and in the tissue, higher first pass effect
ex. Simvastatin - correct answer Lower bioavailability
the more of the drug that reaches systemic circulation, Lower first pass effect
ex. Atorvastatin - correct answer Higher bioavailability
Time to maximum drug level observed - correct answer Tmax
maximum or peak concentration of drug observed after administration - correct answer Cmax
Vd = (amount of drug in the body) / (plasma drug concentration)
-distribution of a medication between plasma and the rest of the body; the volume in which the
amount of drug would need to be uniformly distributed to produce the observed blood
concentration
ex. Vancomycin in serum testing for trough levels - correct answer Volume of distribution
-Healthy adults 20-30 vs. 60-80
-Older adults get more dehydrated
-Medications that are lipophilic will stay longer in the older adult and older adults get
-Liver shrinks with age and albumin is synthesized in the liver. There is freer drug available in
highly protein bound drugs—->Decrease in serum albumin
,NURS 682 – Pharmacology Midterm Review – Advanced Nursing Drug Concepts and Therapeutic
Applications
-Most drugs are biotransformed in the liver, with older adults there is slower transformation
and longer half lives - correct answer Volume of distribution: age related changes
Aging
-less free water, more body fat
-lower average serum albumin
Hydration Status
Compartment and volume - correct answer Factors that influence volume of distribution
Biostranformation and/or excretion of oral drug by hepatic mechanisms
-occurs prior to entering GI tract
Drugs absorbed from the GI tract
Extensive hepatic metabolism.extraciton
Ex. IV vs oral dosages - correct answer First Pass Effect (pre-systemic elimination)
Works primarily by stimulating the activity of a receptor site
binds to a receptor, causes an effect similar to endogenous compound - correct answer
Agonists
Clinical action= occupying a receptor site and inhibiting its endogenous activity - correct answer
Antagonist
small differences in drug dose or blood concentration can be fatal
Any pharmaceutical which has <2-fold difference between the minimum toxic concentration
and minimum effective concentration in blood - correct answer Narrow therapeutic Index
Greater distance between effective dose and toxic dose
,NURS 682 – Pharmacology Midterm Review – Advanced Nursing Drug Concepts and Therapeutic
Applications
Ex. Fluoxetine does NOT need drug monitoring - correct answer Wide therapeutic index
Drug absorption, distribution, metabolism, excretion
Influence dose requirements and/or adverse effects - correct answer Pharmacogenetics: PK
genetic influences
Drug targets: Receptors, transporters, intracellular signaling pathways, enzymes and metabolic
pathways
Influence drug efficacy - correct answer Pharmacogenetics: PD genetic influences
Ventricular repolarization prolongation
Ectopic beats with long pause follow by baseline rhythm beat with marked prolonged QT
interval
Underlying risk factors + Adding medications with QT prolonging effects
Known: Amiodarone, Haldol - correct answer Drugs with QT prolongation
OLDER AGE - correct answer Known risk of QT prolongaiton
Older adults have....
-less % body weight as water
-less lean muscle mass
-higher % weight as fat
-LOWER SERIUM ALBUMIN**
-lower relative kidney weight
-less relative hepatic blood flow - correct answer Summary of Age-Related Changes
Unconditionally inappropriate meds & Generally best avoided regardless of circumstances
Usually alternative available
, NURS 682 – Pharmacology Midterm Review – Advanced Nursing Drug Concepts and Therapeutic
Applications
Conditioned upon disease state & dose
Likely only to be inappropriate in specific context - correct answer Beer's Criteria
Beer's Criteria
**Avoid medications with systemic anticholinergic ridged effect due to risk of confusion,
urinary retention, constipation, visual disturbance and hypotension
DO NOT continue unwise practices that are seen in daily clinical settings
Have multiple choices in a drug class, choose a product with a shorter half life
While PD (pharmakodynamics) doesn't change with gaining some age-related changes will
result in less drug effect
**In the elder: loss of B-2 receptor sites
Less bronchodilator effect with -terol meds - correct answer Age-related changes that impact
drug effect / general pharm rules for the elder
blood urea nitrogen
Evaluation of the amount of nitrogen in the blood in urea form
Urea= metabolism by-product of proteins by liver, removed from the blood by kidneys - correct
answer BUN
Breakdown product of muscle creatinine phosphate and is usually produced at fairly constant
rate by the body (depending on muscles mass)
**Creatinine is greater with higher muscle mass and lower with low muscle mass** - correct
answer Creatinine
