Summary NUR 2407 - Pharm Exam 1 Study Guide.

Pharm Exam 1
Chapter 2

 Agonists- drugs that produce a response
o Ex) Beta adrenergic agonist: epinephrine
 Antagonists- drugs that prevent or block a response
o Ex) Beta adrenergic blocker: metoprolol
 Half-life- the time it takes for one half of a drug concentration to be eliminated from the body
 Therapeutic Index (Window)- the level of the drug between the minimum trough concentration in the plasm a
for obtaining desired drug action and the minimum peak concentration
o Peak- the point at which plasma drug levels are the HIGHEST
o Trough- the point at which plasma drug levels are the LOWEST
 Loading dose- given to achieve a rapid concentration
 A patient on two highly protein-bound drugs is at risk for accumulation of one or both drugs and toxicity.
 Tolerance- a decreased responsiveness over the course of therapy which may lead to the need to increase
dosages to attain the same effect
 Drugs in the same class share many common features, it is extremely helpful to learn drugs by their
classifications
 Drugs can be in a class with other drugs because…
o The drugs are related by their chemical structure
o The drugs work in the same way
o The drugs are used for the same purpose
 Pharmaceutic Stage: ONLY TABLETS & CAPSULES GIVEN PO
o This is the process by which the tablet/capsule becomes a solution to pass the membrane of the
stomach or small intestines
 Pharmacokinetic Phase: the process of drug MOVEMENT through the body to achieve drug action
o Absorption: movement of the drug into the bloodstream after administration
 Most oral drugs are absorbed through the action of mucosal villi in the small intestines
 Fat-soluble (lipid soluble) & Non-Ionized drugs are MOST EASILY absorbed by the GI tract
 PARENTERAL DRUGS DO NOT PASS THROUGH THE GI TRACT
o Distribution- the process by which the drug becomes available to body fluids and body tissues from the
bloodstream
 Affected by rate of blood flow, the drug’s affinity to the tissue, and protein binding
 Protein binding- some drugs have a HIGH affinity for binding to the plasma proteins while others
have a LOW affinity to binding
 Warfarin & furosemide HIGH
 Lisinopril & metoprolol LOW
 Drugs that are STUCK onto proteins AREN’T FREE to go to their target and do their job
 Portion that remains FREE is the ACTIVE DRUG
 2 highly protein bound drugs fight for binding sites leaving more FREE DRUGS leading to
accumulation & toxicity
 Low PROTEIN (ALBUMIN) DECREASES binding sites
o Metabolism/biotransformation- the process in which the body chemically changes drugs into a form that
can be excreted
 LIVER IS THE MAIN SITE OF METABOLISM
 FIRST PASS EFFECT-also called hepatic 1st pass
 Drugs are altered by passing through the intestinal lumen into the portal vein into the
liver
 This is the reason some drugs CANNOT be given PO

,  Bioavailability- the % of the administered dose that reaches systemic circulation (%
available for activity)
 HALF-LIFE- the time it takes for the amount of drug to be reduced by ½
 Affected by the amount of drug administered, the amount of drug remaining,
metabolism, & elimination
 DRUGS WITH A ½ LIFE >24H SHOULD NOT BE GIVEN MORE THAN BID (DIGOXIN &
COUMADIN)
o Excretion/Elimination- process by which the drug is excreted
 Kidneys, lungs, bile, saliva, sweat, breast milk
o Pharmacodynamics- onset, peak and duration of action
 Onset- the time until minimum effective action/concentration
 Peak- when the drug reaches its HIGHEST blood concentration
 Duration of action- the length of time the drug produces a therapeutic or pharmacologic effect
o 7 MECHANISMS OF ACTION
 Stimulation- fight or flight responseadrenergic drugs
 Depression- decrease neural activityseizure & pain drugs
 Irritation- noxious effectastringents
 Replacement- replace body compoundsinsulins and hormones
 Cytotoxic action- kill invading cancers or parasiteschemo
 Antimicrobial action- prevent, inhibit, kill infectious organismsantibiotics
 Modification of immune status- modify, enhance, depress immune systemmethotrexate
o Drug Names
 Generic- chosen by a variety of official bodies
 Usually are r/t the chemical components of the drug
 Brand- chosen by the manufacturer; there can be many brand names for a drug

Chapter 15- autonomic nervous system

 CNS- brain & spinal cord
 Peripheral Nervous system
o Somatic (voluntary)- skeletal muscle movement
o Autonomic (Involuntary)- smooth muscles and glands
 Sympathetic (adrenergic) FIGHT OR FLIGHT
 Dilates pupil
 Inhibits saliva production
 Dilates bronchi- RELAX AIRWAYS
 Accelerates heart
 Stimulates epinephrine & norepinephrine release
 Stimulates glucose release
 Inhibits stomach, pancreas, and intestines
 Inhibit gall bladder
 Relax bladder
 Inhibits urination
 Promotes ejaculation & vaginal contractions
 NOREPINEPHRINE (CATECHOLAMINE) neurotransmitter
o Receptors
 ALPHA 1 & 2
 BETA 1 & 2
 Parasympathetic (cholinergic)- REST & DIGEST
 Constricts pupil

, Stimulates saliva production

Constricts bronchi

Slows heart

Stimulates stomach, pancreas, & intestines

Stimulate gall bladder

Contract bladder

Stimulates urination

Promotes erection of genitals

ACETYLCHOLINE (neurotransmitter)

o Receptors
 NICOTINIC- neuromusclular; affects skeletal muscles
 MUSCARINIC- stimulates smooth muscle; slows heart rate
 Adrenergic Antagonist: mimic parasympathetic by blocking access to the adrenergic receptor sites

o Adrenergic blockers
o Sympatholytic
o Rest & digest
o Beta blocker- specifically block beta receptor sites & inhibit norepinephrine and epinephrine
 Decrease BP & HR
 Cause bronchoconstriction
 End in -LOL
o Alpha Adrenergic blockers- inhibit release of epinephrine
 End in -ZOSIN
o Bronchospasm
o Metoprolol Advers
o Labetalol
o e
Atenolol: treat HTN, migraine prophylaxis, angina, MI, HF (Side effects: depression, sexual dysfunction,
cool extremities, bronchoconstriction
rxna
 Adrenergic Agonist: mimic sympathetic
drenerg
o Adrenergics
ic
o Sympathomimetic- mimic the sympathetic neurotransmitters norepinephrine & epinephrine
o Fight or flight antago
o Increased heart rate
o Increased blood sugar nist
o Vasoconstriction effects
Adverse rxnadrenergic effects
o Albuterol- treats bronchoconstriction
o Epinephrine- treats allergy, anaphylaxis, asthma, cardiac arrest, severe hypotension

 Patient has a cold and wonders if OTC medications are okay. You know that many of the products contain
sympathomimetics. Your patient is currently being treated for HTN. What do you tell her?
o Advise patient to consult PCP as OTC meds may elevate her already high blood pressure and increase
heart rate putting her at risk for hemorrhagic stroke.
 You have been asked to administer metoprolol to a hospitalized patient. Which 2 vital signs will you check?
o Heartrate
o BP

Chapter 16

 Cholinergic Agonists