Advanced Pharmacology Exam 1
Once you graduate from an NP program, in order to prescribe you'll need: - ANS -Advanced
nurse prescriber license
-DEA #
What is the purpose of a DEA #? - ANS Needed to prescribed scheduled drugs
Rules for prescribing Schedule II drugs: - ANS -Written script needed
-1 month supply only
-No refills
What is the PDMP? - ANS Prescription Drug Monitoring Program
Used to effectively track patient's controlled substance uses across different health facilities (in
the same state)
What are clinical practice guidelines? - ANS Recommendations that are intended to optimize
patient care that are informed by a systematic review of the evidence and an assessment of the
benefits/harms of alternative care practices
Ex: sepsis, CAP
Common causes of medication errors: - ANS -Illegible writing
-Drug names that sound alike
-Medications that look alike
-Administering a drug with the wrong route
What is pharmacokinetics? What are its 4 categories? - ANS What the body does to the drug
1. Absorption
2. Metabolism
3. Distribution
4. Excretion
Quickest route of absorption? Slowest? - ANS IV = quickest
IM = slowest
What is the most common way drugs pass through cell membranes? - ANS Passive diffusion
,What characteristics of a drug allow it to pass most quickly through cell membranes (usually
through passive diffusion)? - ANS Small, uncharged (unionized), lipid soluble--pass through
membrane without any energy
What does it mean when a drug is ionized? - ANS It means that the drug is stuck in the
compartment it was ionized in and has to be moved to the next compartment (cannot be
absorbed into the bloodstream)
Where do weak acids absorb? - ANS Stomach
Where do weak bases absorb? - ANS Small intestine
pH of stomach: - ANS 2-4
pH of small intestine: - ANS 6-7
pH of large intestine: - ANS 6-7
pH of bloodstream: - ANS 7.35-7.45
pH of bladder: - ANS 5-8
pH of breastmilk: - ANS 7.1
Where will a drug absorb if it is a weak base that ionizes at a pH of 4 and lower? - ANS In the
small intestine (since the stomach has a pH of 2-4, so the drug will become ionized and move to
the small intestine where it will be able to absorb into the bloodstream)
How can we manipulate the urine pH in cases of overdose? - ANS Drugs that are weak acids
(aspirin) can be trapped and excreted through the urine.
We raise pH of the urine (with sodium bicarb) to force the drug to ionize and allow it to be
excreted, not reabsorbed through the bloodstream.
What is distribution? - ANS How a drug will be transported to the tissues it needs to go to in
order for it to exert its effects
Drug factors related to distribution: - ANS -Lipid solubility
-Molecular size
-Degree of ionization
-Duration of action
-Cellular binding
-Therapeutic effects
-Toxic effects
, (lipid soluble, small, and non-ionized drugs will distribute more quickly)
Body factors related to distribution: - ANS -Vascularity (poor perfusion, disruption of blood flow
due to trauma--difficulty distributing)
-Blood barriers (blood-brain-barrier can be problematic if we need to get drugs to the brain--will
need very high dosing since only a small amount of the drug will get through)
-Transport mechanisms
-Plasma binding proteins
-Disease states
-Volume of distribution
-Drug interactions
What is the key plasma protein involved with protein binding for medications? - ANS Albumin
Why do we monitor albumin? - ANS Indicative of nutritional status and how well protein-bound
drugs will be transported to their target locations
What happens to the therapeutic effect of a drug when the patient is elderly and has very low
levels of albumin? - ANS The drug does not bind to the protein (albumin) as much as expected,
so there is a lot of free drug floating in the plasma; high risk for drug toxicity
Protein bound means: - ANS Inactive form of the drug; does not have any therapeutic effect
when bound to a protein
Free drug means: - ANS Active form of the drug (available for therapeutic effect)
What happens when a patient is on two drugs that are competing for the same protein binding
site on the albumin? - ANS Some drug interactions can occur. Drugs fight for binding position,
but both drugs do not get enough as the usually would. Leads to higher free drug levels,
decreased overall albumin binding, and potential toxicity for both drugs.
**Unpredictable**
What is the 1st pass effect? - ANS PO drug goes through GI tract and absorbs in the stomach
or intestines into local circulation that reaches the liver. The liver inactivates portions of the drug
before it goes into systemic circulation. Some drugs with a very high 1st pass effect may have to
be given IV (goes directly into systemic circulation) or in higher PO doses (watch for side
effects)
What does a substrate for an enzyme mean? - ANS It needs it to undergo metabolism
What is an enzyme inducer? - ANS It increases clearance of the drug (decreased blood levels
of drug--may need dose increase)
Once you graduate from an NP program, in order to prescribe you'll need: - ANS -Advanced
nurse prescriber license
-DEA #
What is the purpose of a DEA #? - ANS Needed to prescribed scheduled drugs
Rules for prescribing Schedule II drugs: - ANS -Written script needed
-1 month supply only
-No refills
What is the PDMP? - ANS Prescription Drug Monitoring Program
Used to effectively track patient's controlled substance uses across different health facilities (in
the same state)
What are clinical practice guidelines? - ANS Recommendations that are intended to optimize
patient care that are informed by a systematic review of the evidence and an assessment of the
benefits/harms of alternative care practices
Ex: sepsis, CAP
Common causes of medication errors: - ANS -Illegible writing
-Drug names that sound alike
-Medications that look alike
-Administering a drug with the wrong route
What is pharmacokinetics? What are its 4 categories? - ANS What the body does to the drug
1. Absorption
2. Metabolism
3. Distribution
4. Excretion
Quickest route of absorption? Slowest? - ANS IV = quickest
IM = slowest
What is the most common way drugs pass through cell membranes? - ANS Passive diffusion
,What characteristics of a drug allow it to pass most quickly through cell membranes (usually
through passive diffusion)? - ANS Small, uncharged (unionized), lipid soluble--pass through
membrane without any energy
What does it mean when a drug is ionized? - ANS It means that the drug is stuck in the
compartment it was ionized in and has to be moved to the next compartment (cannot be
absorbed into the bloodstream)
Where do weak acids absorb? - ANS Stomach
Where do weak bases absorb? - ANS Small intestine
pH of stomach: - ANS 2-4
pH of small intestine: - ANS 6-7
pH of large intestine: - ANS 6-7
pH of bloodstream: - ANS 7.35-7.45
pH of bladder: - ANS 5-8
pH of breastmilk: - ANS 7.1
Where will a drug absorb if it is a weak base that ionizes at a pH of 4 and lower? - ANS In the
small intestine (since the stomach has a pH of 2-4, so the drug will become ionized and move to
the small intestine where it will be able to absorb into the bloodstream)
How can we manipulate the urine pH in cases of overdose? - ANS Drugs that are weak acids
(aspirin) can be trapped and excreted through the urine.
We raise pH of the urine (with sodium bicarb) to force the drug to ionize and allow it to be
excreted, not reabsorbed through the bloodstream.
What is distribution? - ANS How a drug will be transported to the tissues it needs to go to in
order for it to exert its effects
Drug factors related to distribution: - ANS -Lipid solubility
-Molecular size
-Degree of ionization
-Duration of action
-Cellular binding
-Therapeutic effects
-Toxic effects
, (lipid soluble, small, and non-ionized drugs will distribute more quickly)
Body factors related to distribution: - ANS -Vascularity (poor perfusion, disruption of blood flow
due to trauma--difficulty distributing)
-Blood barriers (blood-brain-barrier can be problematic if we need to get drugs to the brain--will
need very high dosing since only a small amount of the drug will get through)
-Transport mechanisms
-Plasma binding proteins
-Disease states
-Volume of distribution
-Drug interactions
What is the key plasma protein involved with protein binding for medications? - ANS Albumin
Why do we monitor albumin? - ANS Indicative of nutritional status and how well protein-bound
drugs will be transported to their target locations
What happens to the therapeutic effect of a drug when the patient is elderly and has very low
levels of albumin? - ANS The drug does not bind to the protein (albumin) as much as expected,
so there is a lot of free drug floating in the plasma; high risk for drug toxicity
Protein bound means: - ANS Inactive form of the drug; does not have any therapeutic effect
when bound to a protein
Free drug means: - ANS Active form of the drug (available for therapeutic effect)
What happens when a patient is on two drugs that are competing for the same protein binding
site on the albumin? - ANS Some drug interactions can occur. Drugs fight for binding position,
but both drugs do not get enough as the usually would. Leads to higher free drug levels,
decreased overall albumin binding, and potential toxicity for both drugs.
**Unpredictable**
What is the 1st pass effect? - ANS PO drug goes through GI tract and absorbs in the stomach
or intestines into local circulation that reaches the liver. The liver inactivates portions of the drug
before it goes into systemic circulation. Some drugs with a very high 1st pass effect may have to
be given IV (goes directly into systemic circulation) or in higher PO doses (watch for side
effects)
What does a substrate for an enzyme mean? - ANS It needs it to undergo metabolism
What is an enzyme inducer? - ANS It increases clearance of the drug (decreased blood levels
of drug--may need dose increase)
