ANCC AGPCNP Study Guide with
Complete Solutions
Pharmacology - ANSWER-study of the interaction between the body and drugs
Pharmacokinetics - ANSWER-the movement of drugs trough the body (absorption,
bioavailability, distribution, metabolism, and excretion)
Pharmacodynamics - ANSWER-The study of the physiologic and biochemical effects of
drugs (what a drug does to the body)
Pharmacogenomics - ANSWER-the study of how a person's genes affect response to
medications.
Area under the curve (AUC) - ANSWER-the average amount of a drug in the blood after
a dose is given. It is a measure of the availability (bioavailability) of a drug after it is
administered.
maximum concentration (Cmax) - ANSWER-The peak serum concentration of a drug
Minimum inhibitory concentration (MIC) - ANSWER-the lowest concentration of an
antibiotic that will inhibit the growth of organisms (after overnight incubation).
Trough - ANSWER-the lowest concentration of a drug after a dose
First-pass effect - ANSWER-All oral drugs (except sublingual) must go through first-
pass metabolism before released and used by body.
In the liver the CYP450 system metabolizes the drug and then the active drug is
released to the body to be used.
What drug cannot be given orally because of extensive first-pass effect? - ANSWER-
insulin
Drug Excretion - ANSWER-Renal filtration accounts for most of drug excretion. Kidney
is the principle organ for drug elimination.
Age related change to pharmacokinetics - ANSWER-- Increase in fat-to-water ratio
- Decrease in albumin and plasma proteins
- Decrease in liver blood flow and size
- Decrease in some CYP450 enzyme pathways (decreased drug clearance)
- Decrease in glomerular filtration rate (GFR)
, Specific Drugs affected by Kidney Disease - ANSWER-- NSAIDS (reduction of renal
blood flow will damage kidneys)
- ACE inhibitors (higher risk of hyperkalemia)
- Warfarin (Higher risk of over coagulation (INR >4). Severe CKD and ESRD at risk of
hemorrhagic complications. Need more frequent monitoring
- Lithium (increase risk of kidney injury. Monitor renal fxn closely)
- Contrast dye (IV contrast can injure kidneys)
- Potassium sparing diuretics (increased risk of hyperkalemia)
- Oral sodium phosphate (used to cleanse bowel before colonoscopies) (May cause
sudden loss of kidney fxn (AKI) as well as blood mineral disturbances)
Potent CYP450 Inhibitors - ANSWER-- THESE DRUGS SLOW DOWN CLEARANCE
((increase drug concentration, high risk for drug overdose or ASEs)) --high likelihood of
drug-drug interactions
- Macrolides (erythromycin, clarithromycin, telithromycin)
- Antifungals (ketoconazole, fluconazole, phenytoin)
- Cimetidine (Tagamet)
- Citalopram (Celexa)
- Protease inhibitors (saquinavir, indinavir, nelfinavir)
- Grapefruit Juice (affects CYP450 system)
Thiazide Diuretics - ANSWER-- Use: HTN, HF, edema, diabetes insipidus
-Ex: Hydrochlorothiazide (HCTZ), chlorthalidone, indapamide (Lozol)
- DO NOT combine with Lithium (increased risk of Lithium toxicity)
-Contraindications: Sulfa allergy (instead use K+ sparing diuretics like triamterene or
amiloride)
- AEs: Increased plasma glucose (careful with diabetics)
---Elevates cholesterol and LDL
---Elevates uric acid
---Hypokalemia (sever muscle weakness, arrhythmias)
PEARLS
-Chlorthalidone is longer acting and more "effective" than HCTZ
-Pts with HTN and osteoporosis benefit from thiazides
-Thiazides reduce calcium excretion by kidneys and stimulate the osteoblasts (helps
build bone)
K+ Sparing Diuretics - ANSWER-Use: HTN (alternative for pts with severe sulfa allergy)
- Triameterene, Amiloride, spironolactone (also comes as combos with HCTZ)
-BB Warning: Hyperkalemia: can be fatal, higher risk with renal impairment, diabetes,
elderly and severely ill
-Monitor K+ (baseline, during, dose changes, illness)
Mineralcorticoid Receptor Antagonists - ANSWER-- Spironolactone
-Use: HTN, HF, Hirsutism
-DO NOT give K+ supplement, avoid salt substitutes that contain K+
Complete Solutions
Pharmacology - ANSWER-study of the interaction between the body and drugs
Pharmacokinetics - ANSWER-the movement of drugs trough the body (absorption,
bioavailability, distribution, metabolism, and excretion)
Pharmacodynamics - ANSWER-The study of the physiologic and biochemical effects of
drugs (what a drug does to the body)
Pharmacogenomics - ANSWER-the study of how a person's genes affect response to
medications.
Area under the curve (AUC) - ANSWER-the average amount of a drug in the blood after
a dose is given. It is a measure of the availability (bioavailability) of a drug after it is
administered.
maximum concentration (Cmax) - ANSWER-The peak serum concentration of a drug
Minimum inhibitory concentration (MIC) - ANSWER-the lowest concentration of an
antibiotic that will inhibit the growth of organisms (after overnight incubation).
Trough - ANSWER-the lowest concentration of a drug after a dose
First-pass effect - ANSWER-All oral drugs (except sublingual) must go through first-
pass metabolism before released and used by body.
In the liver the CYP450 system metabolizes the drug and then the active drug is
released to the body to be used.
What drug cannot be given orally because of extensive first-pass effect? - ANSWER-
insulin
Drug Excretion - ANSWER-Renal filtration accounts for most of drug excretion. Kidney
is the principle organ for drug elimination.
Age related change to pharmacokinetics - ANSWER-- Increase in fat-to-water ratio
- Decrease in albumin and plasma proteins
- Decrease in liver blood flow and size
- Decrease in some CYP450 enzyme pathways (decreased drug clearance)
- Decrease in glomerular filtration rate (GFR)
, Specific Drugs affected by Kidney Disease - ANSWER-- NSAIDS (reduction of renal
blood flow will damage kidneys)
- ACE inhibitors (higher risk of hyperkalemia)
- Warfarin (Higher risk of over coagulation (INR >4). Severe CKD and ESRD at risk of
hemorrhagic complications. Need more frequent monitoring
- Lithium (increase risk of kidney injury. Monitor renal fxn closely)
- Contrast dye (IV contrast can injure kidneys)
- Potassium sparing diuretics (increased risk of hyperkalemia)
- Oral sodium phosphate (used to cleanse bowel before colonoscopies) (May cause
sudden loss of kidney fxn (AKI) as well as blood mineral disturbances)
Potent CYP450 Inhibitors - ANSWER-- THESE DRUGS SLOW DOWN CLEARANCE
((increase drug concentration, high risk for drug overdose or ASEs)) --high likelihood of
drug-drug interactions
- Macrolides (erythromycin, clarithromycin, telithromycin)
- Antifungals (ketoconazole, fluconazole, phenytoin)
- Cimetidine (Tagamet)
- Citalopram (Celexa)
- Protease inhibitors (saquinavir, indinavir, nelfinavir)
- Grapefruit Juice (affects CYP450 system)
Thiazide Diuretics - ANSWER-- Use: HTN, HF, edema, diabetes insipidus
-Ex: Hydrochlorothiazide (HCTZ), chlorthalidone, indapamide (Lozol)
- DO NOT combine with Lithium (increased risk of Lithium toxicity)
-Contraindications: Sulfa allergy (instead use K+ sparing diuretics like triamterene or
amiloride)
- AEs: Increased plasma glucose (careful with diabetics)
---Elevates cholesterol and LDL
---Elevates uric acid
---Hypokalemia (sever muscle weakness, arrhythmias)
PEARLS
-Chlorthalidone is longer acting and more "effective" than HCTZ
-Pts with HTN and osteoporosis benefit from thiazides
-Thiazides reduce calcium excretion by kidneys and stimulate the osteoblasts (helps
build bone)
K+ Sparing Diuretics - ANSWER-Use: HTN (alternative for pts with severe sulfa allergy)
- Triameterene, Amiloride, spironolactone (also comes as combos with HCTZ)
-BB Warning: Hyperkalemia: can be fatal, higher risk with renal impairment, diabetes,
elderly and severely ill
-Monitor K+ (baseline, during, dose changes, illness)
Mineralcorticoid Receptor Antagonists - ANSWER-- Spironolactone
-Use: HTN, HF, Hirsutism
-DO NOT give K+ supplement, avoid salt substitutes that contain K+
