NUR-641E Final Exam Study Guide
Note: When taking the final exam, read each question carefully. The exam questions have only
one answer, unless the question specifically states there is more than one correct answer.
For the exam, make sure to have a clear understanding and be able to explain the following:
Pharmacokinetics
1. Pharmacokinetics involves ADME (absorption, distribution, metabolism and elimination).
a. Absorption: Absorption from the administration site either directly or indirectly into
the blood/plasma.
b. Distribution: Reversibly or irreversibly move from the bloodstream into the
interstitial and intracellular fluid.
c. Metabolism: Biotransformed via hepatic metabolism or by other tissues.
d. Elimination: Lastly, the drug and its metabolites are eliminated from the body.
2. The route of administration with the highest bioavailability is intravenous; putting an entire
dose into a patient’s vein and bypassing absorption.
3. Intravenous route avoids first-pass metabolism in the liver.
4. Rectal administration has variable and erratic absorption.
5. Steady state (SS) is usually reached within 4-5 half-lives of a drug.
6. Half-life of a drug is how long it takes for half the drug to be excreted from the body.
a. Determines how frequently the drug must be administered.
b. Predicts how long toxic effects can last.
7. First-order (linear) pharmacokinetics means the metabolism is directly proportional to the
free concentration of the drug .
8. Zero-order (nonlinear) pharmacokinetics means a drug is metabolized at a constant rate per
unit time.
9. CYP3A4 substrate drugs may have decreased activity if any CYP3A4 inducer drugs are used
along with it.
Drug Development
1. Drug development process involves these steps according to the FDA:
a. Discovery: Laboratory research to develop the new drug.
b. Preclinical research with animal testing for safety.
c. Clinical research on healthy human subjects to assess medication pharmacokinetics
(Phase I).
© 2024. Grand Canyon University. All Rights Reserved.
, d. Clinical research in humans primarily for medication safety usually in a population
for which the treatment is intended (Phase II).
e. Clinical research in humans comparing the new drug to accepted medications or
placebo for efficacy and safety (Phase III).
f. FDA review of the results to determine approval.
g. Postmarketing study to identify adverse effects not found in earlier clinical studies
(Phase IV).
2. Medication safety organizations include the Food and Drug Administration (FDA), the
Institute for Safe Medication Practices (ISMP), and the Joint Commission on Accreditation
of Healthcare Organizations (JCAHO).
a. The Institute for Safe Medication Practices (ISMP)
b. The Institute of Medicine (IOM)
c. The Joint Commission
d. The National Coordinating Council for Medication Error Reporting and Prevention
(NCC MERP)
e. Food and Drug Administration (FDA) Safe Use Initiative
Adverse Drug Reactions (ADRs)
1. Two basic type of ADRs: Pharmacological and idiosyncratic.
2. 85% to 90% of ADRs are pharmacological.
3. Adverse drug reactions are usually preventable, frequently occur in a hospital or nursing
home setting, and include medication errors, adverse drug effects, and allergic and
idiosyncratic type reactions.
4. ADRs are not commonly reported; the FDA does not mandate that ADRs be reported.
5. Polypharmacy involves using multiple health care providers for care, using multiple
medications, and using several pharmacies for prescription filling.
Cardiovascular
1. Angiotensin converting enzyme inhibitors (ACEIs): Lisinopril, captopril, enalapril, ramipril,
benazepril, fosinopril.
2. ACEIs reduce blood pressure by suppressing the release of angiotensin-converting enzyme.
3. Important side effects of ACE inhibitors include cough and angioedema; discontinue the
ACEI if angioedema occurs.
4. Angiotensin II receptor blocking agents (ARBs): Candesartan (Atacand), eprosartan
(Teveten), irbesartan (Avapro), losartan (Cozaar), telmisartan (Micardis) and valsartan
(Diovan).
5. ARBs reduce blood pressure by blocking angiotensin II receptors.
6. Essential (primary) hypertension accounts for 90% of cases; secondary hypertension may be
caused by chronic renal failure.
2
Note: When taking the final exam, read each question carefully. The exam questions have only
one answer, unless the question specifically states there is more than one correct answer.
For the exam, make sure to have a clear understanding and be able to explain the following:
Pharmacokinetics
1. Pharmacokinetics involves ADME (absorption, distribution, metabolism and elimination).
a. Absorption: Absorption from the administration site either directly or indirectly into
the blood/plasma.
b. Distribution: Reversibly or irreversibly move from the bloodstream into the
interstitial and intracellular fluid.
c. Metabolism: Biotransformed via hepatic metabolism or by other tissues.
d. Elimination: Lastly, the drug and its metabolites are eliminated from the body.
2. The route of administration with the highest bioavailability is intravenous; putting an entire
dose into a patient’s vein and bypassing absorption.
3. Intravenous route avoids first-pass metabolism in the liver.
4. Rectal administration has variable and erratic absorption.
5. Steady state (SS) is usually reached within 4-5 half-lives of a drug.
6. Half-life of a drug is how long it takes for half the drug to be excreted from the body.
a. Determines how frequently the drug must be administered.
b. Predicts how long toxic effects can last.
7. First-order (linear) pharmacokinetics means the metabolism is directly proportional to the
free concentration of the drug .
8. Zero-order (nonlinear) pharmacokinetics means a drug is metabolized at a constant rate per
unit time.
9. CYP3A4 substrate drugs may have decreased activity if any CYP3A4 inducer drugs are used
along with it.
Drug Development
1. Drug development process involves these steps according to the FDA:
a. Discovery: Laboratory research to develop the new drug.
b. Preclinical research with animal testing for safety.
c. Clinical research on healthy human subjects to assess medication pharmacokinetics
(Phase I).
© 2024. Grand Canyon University. All Rights Reserved.
, d. Clinical research in humans primarily for medication safety usually in a population
for which the treatment is intended (Phase II).
e. Clinical research in humans comparing the new drug to accepted medications or
placebo for efficacy and safety (Phase III).
f. FDA review of the results to determine approval.
g. Postmarketing study to identify adverse effects not found in earlier clinical studies
(Phase IV).
2. Medication safety organizations include the Food and Drug Administration (FDA), the
Institute for Safe Medication Practices (ISMP), and the Joint Commission on Accreditation
of Healthcare Organizations (JCAHO).
a. The Institute for Safe Medication Practices (ISMP)
b. The Institute of Medicine (IOM)
c. The Joint Commission
d. The National Coordinating Council for Medication Error Reporting and Prevention
(NCC MERP)
e. Food and Drug Administration (FDA) Safe Use Initiative
Adverse Drug Reactions (ADRs)
1. Two basic type of ADRs: Pharmacological and idiosyncratic.
2. 85% to 90% of ADRs are pharmacological.
3. Adverse drug reactions are usually preventable, frequently occur in a hospital or nursing
home setting, and include medication errors, adverse drug effects, and allergic and
idiosyncratic type reactions.
4. ADRs are not commonly reported; the FDA does not mandate that ADRs be reported.
5. Polypharmacy involves using multiple health care providers for care, using multiple
medications, and using several pharmacies for prescription filling.
Cardiovascular
1. Angiotensin converting enzyme inhibitors (ACEIs): Lisinopril, captopril, enalapril, ramipril,
benazepril, fosinopril.
2. ACEIs reduce blood pressure by suppressing the release of angiotensin-converting enzyme.
3. Important side effects of ACE inhibitors include cough and angioedema; discontinue the
ACEI if angioedema occurs.
4. Angiotensin II receptor blocking agents (ARBs): Candesartan (Atacand), eprosartan
(Teveten), irbesartan (Avapro), losartan (Cozaar), telmisartan (Micardis) and valsartan
(Diovan).
5. ARBs reduce blood pressure by blocking angiotensin II receptors.
6. Essential (primary) hypertension accounts for 90% of cases; secondary hypertension may be
caused by chronic renal failure.
2
