NSG 251 Exam 1 Test Plan Summer 2022

NSG 251 Exam 1 Test Plan 15 questions (each worth 2 points) over Module 1 (Chapters 1-8)  Define pharmacology o Pharmacology is the broadest term for the study or science of drugs o Pharmaceutics is the science of preparing and dispensing drugs including dosage form design (enteral, parenteral (IV fastest, IM, subcutaneous , IA), or topical (eyes, ears, inhalation through lungs, rectal or vaginal suppositories)  Differentiate between chemical, generic and trade names of drugs o Chemical: chemical composition and molecular structure o Generic: non proprietary name o Trade: owner of the patent (usually what we call brand name) o Patten life usually…  Newly discovered drug molecule 17 years  10 for research and development and 7 for sales and profit  then open for generic drugs – lots of issues with generic drugs some that have come over from India with impurities and skew data, needs to be more research on where drugs are developed and oversight.  Describe the four processes involved in pharmacokinetics (absorption, distribution, metabolism, excretion) o Absorption: looking at bioavailability – the extent of the drug that is absorbed, we look at the first-pass effect.  A large portion is chemically changed into inactive metabolites by the liver. A much smaller amount is bioavailable. The extent of the drug absorption.  If the drug has a high first pass effect, when it goes though the liver, a large portion of it will be changed into inactive metabolites and only a smaller amount will pass into circulation.  Most absorption of oral drug happens in the small intestine – if missing part of small intestine, drug absorption decreases because of reduced surface area and reduced time in small intestine  Drugs absorbed by small intestine are transported to the liver first, liver may then metabolize much of the drug before it enters circulation (first-pass effect).  Increased blood flow to absorption site improves drug absorption.  Drugs are typically absorbed through active or passive transport – oral drugs use passive transport. Active transport is used to absorb electrolytes like sodium and potassium as well as some drugs such as levodopa  Factors that affect absorption include  route of administration  amount of blood flow  form of the drug  Fastest absorption is sublingual, IV, or inhalation  Slower absorption rates or oral, IM or subcutaneous routes  Drug distribution of an absorbed drug depends on, blood flow, solubility, and protein binding.  o Distribution is the transport of a drug by the bloodstream to its site of action. The most common blood protein that carries the majority protein bound drug molecules is albumin. Very important to know patient’s albumin levels  When drug enters the blood stream it starts being eliminated by the organs that metabolize and excrete drugs (liver and kidney primarily)  Drug molecules not attached to plasma are only ones that can distribute to extravascular tissue  A bound drug is pharmacologically inactive  Albumin – most common blood protein  Carries most of the protein bound drug molecules  If someone has decreased albumin (malnourishment or burns, or older adult have lower albumin) there may be liver dysfunction. You may have increased toxicity because you have more free drug in your system because albumin will bind with drug, making the drug inactive.  Less albumin more free drug you have – increase level of drug and will have toxicity occurring.  If you give two drugs together that are both highly protein bound then you will have a conflict  Medications will complete for binding sites which will lead to an unpredictable drug response (drug-drug interaction) one drug may be bound more than the other then one would increase toxic levels. One may have increased effect while other has decreased effect  After a drug as reach the blood stream its distribution in the body depends on blood flow, the drug is distributed quickly to those organs with a large supply of blood (heart, liver, and kidneys), distribution to organs, skin and fat is slower  o Metabolism: is biotransformation. Biochemical transformation of a drug into an inactive metabolite. A more soluble compound, more potent active metabolite, as in the ***look in book  Most drugs are metabolized by enzymes in the liver, however it can also occur in plasma, kidneys, and membranes of the intestines.  Drugs are most commonly metabolized into inactive metabolites which are then excreted  Some drugs can be converted to active metabolites, meaning they’re capable of exerting their own pharmacologic action. These metabolites may undergo further metabolism or may be excreted from the body unchanged.  Some drugs, prodrugs, are administered inactive and don’t become active until they are metabolized  Liver disease, cirrhosis, and heart failure reduces drug metabolism  Infants have immature livers that reduce the rate of metabolism and elderly patients experience a decline in liver size, blood flow, and enzyme production that also slows metabolism  P450 enzymes – used to converge drugs o Excretion: elimination of drugs from body  Kidneys are major site of excretion (most drugs leave though urine)  If they have kidney failure they will have problems with excretion and will build up in body.  Also can be excreted through the lungs, exocrine glands, sweat, skin and intestinal track  Drug excretion is the elimination of drugs  From the body. Most drugs are excreted by the kidneys and leave the body through urine, they can also be excreted through the lungs, exocrine glands, skin , and intestinal tract the  o Half life- time required 50% of