The University of Alabama
Capstone College of Nursing
NUR 521 Advanced Pharmacology
Exam 4 Blueprint and Study Guide
Fall 2023
General Tips for Exam Success: A review of anatomy and pathophysiology is included at the beginning of most
modules in the course. You will not see many direct questions about this information; however, this foundational
knowledge is necessary to understand how drugs work in the body and how the body responds to drugs. You will
be much more successful if you have a strong foundational knowledge and understanding of this information.
You are responsible for knowing the name, MOA, Use, Common AE, Serious AE, Dosing, Administration,
CI, Interactions, and Patient Education for all prototype drugs included in each module. Most of the exam
questions will focus on the prototype drugs presented in each module. You also need to know about the drug class
across the life span. There is content in each module that discusses use of each drug class in pediatric, pregnancy,
breastfeeding, and older adult populations. You will not necessarily need to know an exact dose for prescribing on
all of the prototype drugs, but if faculty stresses a certain dose in a lecture, you will be responsible for this
information. When attempting to narrow down the content, consider what you need to know to be a safe prescriber.
Also, listen for tips and what is emphasized in the lecture. This study guide is intended to help you focus your
studies, but it does not include a list of all necessary details about each individual drug. If any evidenced base
guidelines were presented in the module, I would be sure to review what information was discussed by faculty in
the lecture.
1
, Module Qs Topic
Module 10: 1 Antifungal
Antifungal, 0 When would you prescribe an antifungal for a superficial versus a systemic fungal infection? Which drugs are used to treat each
Antiviral, type? Be able to identify specific organisms that antifungal medications treat.
Anthelmintics
Which antifungals are best to use in pediatric patients? Elderly patients?
Infants: Nystatin is used to treat oral candidiasis in premature and full-term infants. Fluconazole is also used safely to treat
systemic candidiasis in newborn infants
Elderly: Older adults have a higher risk for achlorhydria (do not absorb) than do younger individuals and may not predictably
absorb some antifungal agents. In addition, many interactions; common drugs prescribed to older adults, including warfarin,
phenytoin, and oral hypoglycemic agents, are increased by azoles
o Achlorhydria: absence of hydrochloric acid in the gastric secretions.
Know which antifungal medications that you pretreat with? What meds do you pretreat with?
Premed with Benadryl, Tylenol, hydrocortisone/Demerol to prevent rigors
Know the CI for antifungal drugs. Think about this through the lens of the provider. What medical conditions do you need to ask
about before prescribing antifungal medications?
What will you teach your patient about antifungal medications? Go through each drug and determine the most important teaching
points.
Amphotericin B (Abelcet) (Ampha-terrible cuz terrible side effects) – Polyene antifungal (Nystatin is in this same family
of double bonds)
o BBW: Should only be used on terrible infections that could be fatal!
o Drug of choice (DOC) for most systemic mycosis infections, brown-black mold, leishmania spp, aspergillus spp (broad
spectrum)
o MOA: binds to fungal membranes that contain STEROL so ergosterol must be present on membrane
o CI: hypersensitivity, renal impairment
o Dosing: IV Only 6-8 week tx
o AE& pt education: fever, chills, n/v, HA, phlebitis, anemia, electrolyte imbalance, nephrotoxicity (s/s can start 1-3 hrs
after infusion)
2
, Azole drugs – like Amphotericin B, azoles are broad spectrum anti-fungal,
o Advantage: good alternative, can be given PO and lower toxicity (outpatient setting)
o Disadvantage: they inhibit hepatic cytochrome P450 drug-metabolizing enzymes and can increase the levels of many
other drugs. Only six—itraconazole, ketoconazole, fluconazole, voriconazole, posaconazole, and isavuconazonium—are
indicated for systemic mycoses
Itraconazole (Sporanox) – azole antifungal
o MOA: inhibits synthesis of ergosterol (part of the fungal cell membrane)
o USE: Broad spectrum, DOC for blastomycosis, histoplasmosis, sporotrichosis, paracoccidiodomycosis, alt to
amphotericin B for systemic infection with aspergillosis, candidiasis, and coccidioidomycosis, also used for superficial
mycosis
o CI: HF, ventricular dysfxn, liver disease
o AE: well tolerated, GI effects common, CV suppression & liver injury, hepatotoxicity can also happen but is rare
o BBW: negative inotropic actions, exacerbation or cause of CHF, NEVER use for superficial fungal infections in HF
patients
o Interactions: Causes increased levels of many drugs because it inhibits the CYP3A4 isoenzyme, PPIs & H2 agonists can
reduce absorption of oral itraconazole
o Pt education: Administer gastric acidity drugs 1 hr before or 2 hrs after & report s/s liver dysfunction (abd pain, edema,
dark urine, itchy skin, fatigue)
Fluconazole (Diflucan) – Azole antifungal
o MOA: interferes with fungal cytochrome P45 activity which = stops cell membrane formation
o USE: Candidiasis, cryptococcal meningitis, antifungal prophylaxis in stem cell patients
o CI: Hypersensitivity, coadministration with CYP34A substrates may cause prolonged QT interval
o Interactions: drugs that increase QT interval
o AE: HA, D, well tolerated
o Pt education: AE & USE
Antiviral
Review herpes drugs across the lifespan. Which antiviral medication is ok to use in our specialty populations (peds, pregnancy,
older)?
Acyclovir is approved for children as young as 3 months of age. Valacyclovir is approved for children 2 years of age.
Foscarnet, which is deposited in bone and teeth, has caused abnormal development of tooth enamel in animal students and
3
Capstone College of Nursing
NUR 521 Advanced Pharmacology
Exam 4 Blueprint and Study Guide
Fall 2023
General Tips for Exam Success: A review of anatomy and pathophysiology is included at the beginning of most
modules in the course. You will not see many direct questions about this information; however, this foundational
knowledge is necessary to understand how drugs work in the body and how the body responds to drugs. You will
be much more successful if you have a strong foundational knowledge and understanding of this information.
You are responsible for knowing the name, MOA, Use, Common AE, Serious AE, Dosing, Administration,
CI, Interactions, and Patient Education for all prototype drugs included in each module. Most of the exam
questions will focus on the prototype drugs presented in each module. You also need to know about the drug class
across the life span. There is content in each module that discusses use of each drug class in pediatric, pregnancy,
breastfeeding, and older adult populations. You will not necessarily need to know an exact dose for prescribing on
all of the prototype drugs, but if faculty stresses a certain dose in a lecture, you will be responsible for this
information. When attempting to narrow down the content, consider what you need to know to be a safe prescriber.
Also, listen for tips and what is emphasized in the lecture. This study guide is intended to help you focus your
studies, but it does not include a list of all necessary details about each individual drug. If any evidenced base
guidelines were presented in the module, I would be sure to review what information was discussed by faculty in
the lecture.
1
, Module Qs Topic
Module 10: 1 Antifungal
Antifungal, 0 When would you prescribe an antifungal for a superficial versus a systemic fungal infection? Which drugs are used to treat each
Antiviral, type? Be able to identify specific organisms that antifungal medications treat.
Anthelmintics
Which antifungals are best to use in pediatric patients? Elderly patients?
Infants: Nystatin is used to treat oral candidiasis in premature and full-term infants. Fluconazole is also used safely to treat
systemic candidiasis in newborn infants
Elderly: Older adults have a higher risk for achlorhydria (do not absorb) than do younger individuals and may not predictably
absorb some antifungal agents. In addition, many interactions; common drugs prescribed to older adults, including warfarin,
phenytoin, and oral hypoglycemic agents, are increased by azoles
o Achlorhydria: absence of hydrochloric acid in the gastric secretions.
Know which antifungal medications that you pretreat with? What meds do you pretreat with?
Premed with Benadryl, Tylenol, hydrocortisone/Demerol to prevent rigors
Know the CI for antifungal drugs. Think about this through the lens of the provider. What medical conditions do you need to ask
about before prescribing antifungal medications?
What will you teach your patient about antifungal medications? Go through each drug and determine the most important teaching
points.
Amphotericin B (Abelcet) (Ampha-terrible cuz terrible side effects) – Polyene antifungal (Nystatin is in this same family
of double bonds)
o BBW: Should only be used on terrible infections that could be fatal!
o Drug of choice (DOC) for most systemic mycosis infections, brown-black mold, leishmania spp, aspergillus spp (broad
spectrum)
o MOA: binds to fungal membranes that contain STEROL so ergosterol must be present on membrane
o CI: hypersensitivity, renal impairment
o Dosing: IV Only 6-8 week tx
o AE& pt education: fever, chills, n/v, HA, phlebitis, anemia, electrolyte imbalance, nephrotoxicity (s/s can start 1-3 hrs
after infusion)
2
, Azole drugs – like Amphotericin B, azoles are broad spectrum anti-fungal,
o Advantage: good alternative, can be given PO and lower toxicity (outpatient setting)
o Disadvantage: they inhibit hepatic cytochrome P450 drug-metabolizing enzymes and can increase the levels of many
other drugs. Only six—itraconazole, ketoconazole, fluconazole, voriconazole, posaconazole, and isavuconazonium—are
indicated for systemic mycoses
Itraconazole (Sporanox) – azole antifungal
o MOA: inhibits synthesis of ergosterol (part of the fungal cell membrane)
o USE: Broad spectrum, DOC for blastomycosis, histoplasmosis, sporotrichosis, paracoccidiodomycosis, alt to
amphotericin B for systemic infection with aspergillosis, candidiasis, and coccidioidomycosis, also used for superficial
mycosis
o CI: HF, ventricular dysfxn, liver disease
o AE: well tolerated, GI effects common, CV suppression & liver injury, hepatotoxicity can also happen but is rare
o BBW: negative inotropic actions, exacerbation or cause of CHF, NEVER use for superficial fungal infections in HF
patients
o Interactions: Causes increased levels of many drugs because it inhibits the CYP3A4 isoenzyme, PPIs & H2 agonists can
reduce absorption of oral itraconazole
o Pt education: Administer gastric acidity drugs 1 hr before or 2 hrs after & report s/s liver dysfunction (abd pain, edema,
dark urine, itchy skin, fatigue)
Fluconazole (Diflucan) – Azole antifungal
o MOA: interferes with fungal cytochrome P45 activity which = stops cell membrane formation
o USE: Candidiasis, cryptococcal meningitis, antifungal prophylaxis in stem cell patients
o CI: Hypersensitivity, coadministration with CYP34A substrates may cause prolonged QT interval
o Interactions: drugs that increase QT interval
o AE: HA, D, well tolerated
o Pt education: AE & USE
Antiviral
Review herpes drugs across the lifespan. Which antiviral medication is ok to use in our specialty populations (peds, pregnancy,
older)?
Acyclovir is approved for children as young as 3 months of age. Valacyclovir is approved for children 2 years of age.
Foscarnet, which is deposited in bone and teeth, has caused abnormal development of tooth enamel in animal students and
3
