NSG 6005 PHARM MIDTERM STUDY GUIDE 2018 (word)

NSG 6005 PHARM MIDTERM STUDY GUIDE 2018 (word) NSG 6005 Advanced Pharmacology Midterm—Study Guide There will be 75 questions on the Midterm. Most will be multiple choice. There are a couple True/False and 5 matching questions. I suggest you review your PowerPoints and Textbook Assignments. I hope this study guide is helpful Make sure you know the following topics very well. • When a medication is listed below, make sure you know all about it and how to apply it to different patient situations: What disease process it is used for?, how does it work?, when should it not be used?, adverse effects, pros/cons, interactions, patient education factors (should it be taken w/ food? At bedtime?), tapering, preliminary and post treatment labs, black box warnings/CI, etc. • If a disease process is mentioned below—know how to diagnose and recommended treatment guidelines. 1) General principles of pharmacokinetics and dynamics? PHARMACOKINETICS- What the body does to the drug” Absorption –Entry of drug to the blood stream. Usually depends on passive diffusion of drug through cell membranes. • Absorption depends on: blood flow at site, drugs lipid soluability (> lipic, > soluabililty that directly penetrate the memebrane), local PH and drug ionization (non-ionized absorb better), pharmaceutical processing (coatings and additives. • Blood brain barrier: allow lipid soluable only. May pump out any drug that it sees as foreign, hard to treat CNS infections. • Placenta: allows lipid drugs so does not protect from lipid soluable drugs, which is why pregnant women are limited to drugs. Know gestation age. • Distribution : fat ratio changes may alter distribution, especially a people age. • Fat soluable drugs may be accumulated: weight loss will release these drugs. • Water soluable drugs are affected by dehydration Biotransformation (Metabolism) : Drugs become more hydrophilic (water soluable) for excretion. • Also referred to as the P450 system or cytochrome P450 system. (a group of enzymes in the liver identified for their ability to breakdown drugs.) • Hepatic “First Pass Effect” (parenteral (IV or IM) meds bypass this enzymatic effect) • breaks PO meds down to some degree, some are protected with coating but they don’t always work • Metabolites Usually less active, less toxic, easier • to excrete • Prodrugs - inactive in form given but metabolized to active drug (ex: enalapril) • Liver function determined by liver enzymes • Failing liver produces fewer enzymes, drugs available longer: caution • • Excretion: Process by which medications are eliminated from the body unchanged or as metabolites • Kidneys are main organ of excretion • If poor renal function, drug may accumulate, may wish to prescribe less of drug • Also eliminated via respiration, breast milk, defecation. Tears, sweat, saliva not as significant. • START LOW AND GO SLOW!!!! PHARMOCODYNAMICS- “effect of drug on the body” Receptors: Drugs must bind to for effect o Help a process happen: agonist o Block a process from happening: antagonist o Know that: • All drugs have an effect • A drug’s ability to cause a response is 
called its efficacy 
 • If you give a bigger dose you will get a bigger effect up to a point, most drugs have a ceiling. 
 2) CRITERIA FOR CHOOSING AND EFFECTIVE DRUG? • A.) Effectiveness: elicits responses for which it is given - most important • Safety: Cannot produce harmful effects even at very high dosages and for long time oNo such thing as completely safe drug • Selectivity: Only elicits response for which it is given, no side effects • No such thing as a selective drug, all have ADRs • ……………………………………………….CONTINUED………………………………………..