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NSG 6005 MIDTERM STUDY GUIDE (Advanced Pharmacology)
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
, 2
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!!!!
, 3
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
• Reversible action: most drugs should be reversible
• Predictability: Know with certainty exactly how individual patient will
respond – impossible, must individualize
• Ease of administration: simple, convenient route - enhances compliance
and decreases errors
, 4
• Freedom from drug interactions: few drugs are without drug interaction
• Low cost: easy to afford; significant factor in adherence, esp. with elderly
• Chemical stability: drugs ability to be stored for long time without loss of
effectiveness – variable between drugs
• Possession of simple generic name: easier to remember and less
confusion amongst drugs
3) SYNERGISTIC EFFECT: When two or more drugs are given
together they can react with each other: An effect arising between two or more agents,
entities, factors, or substances that produces an effect greater than the sum of their individual
effects. It is opposite of antagonism.
o Can be positive (synergistic) • Morphine and Motrin
o Can be negative (compete with each other) • Asa and Coumadin
4) Therapeutic drug levels: (not sure if this is correct)
Minimal Effective Concentration (MEC) – plasma drug level below which
therapeutic effects will not occur.
Therapeutic Index or Range- margin of safety
• •The wider or bigger it is, the safer the drug. o Example 1: Drug A:
normal dose is 1 mg, toxic dose is 10 mg
• Acetaminophen’s therapeutic range is 30 times the MEC
o Example 2: Drug B: normal dose is 9 mg, toxic dose is 10 mg o
Lithium’s therapeutic range is 3 times the MEC.
5) WHAT IS MEANT BY A SIGNIFICANT FIRST-PASS EFFECT?
Metabolism is the process of changing one chemical into another. The
liver is a major organ for drug metabolism because it contains high amounts
NSG 6005 MIDTERM STUDY GUIDE (Advanced Pharmacology)
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
, 2
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!!!!
, 3
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
• Reversible action: most drugs should be reversible
• Predictability: Know with certainty exactly how individual patient will
respond – impossible, must individualize
• Ease of administration: simple, convenient route - enhances compliance
and decreases errors
, 4
• Freedom from drug interactions: few drugs are without drug interaction
• Low cost: easy to afford; significant factor in adherence, esp. with elderly
• Chemical stability: drugs ability to be stored for long time without loss of
effectiveness – variable between drugs
• Possession of simple generic name: easier to remember and less
confusion amongst drugs
3) SYNERGISTIC EFFECT: When two or more drugs are given
together they can react with each other: An effect arising between two or more agents,
entities, factors, or substances that produces an effect greater than the sum of their individual
effects. It is opposite of antagonism.
o Can be positive (synergistic) • Morphine and Motrin
o Can be negative (compete with each other) • Asa and Coumadin
4) Therapeutic drug levels: (not sure if this is correct)
Minimal Effective Concentration (MEC) – plasma drug level below which
therapeutic effects will not occur.
Therapeutic Index or Range- margin of safety
• •The wider or bigger it is, the safer the drug. o Example 1: Drug A:
normal dose is 1 mg, toxic dose is 10 mg
• Acetaminophen’s therapeutic range is 30 times the MEC
o Example 2: Drug B: normal dose is 9 mg, toxic dose is 10 mg o
Lithium’s therapeutic range is 3 times the MEC.
5) WHAT IS MEANT BY A SIGNIFICANT FIRST-PASS EFFECT?
Metabolism is the process of changing one chemical into another. The
liver is a major organ for drug metabolism because it contains high amounts
