lOMoARcPSD|12752097
NURS 5334
Final Exam
Study Guide
Latest
Version
2023/2024
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NURS 5334 Final Exam Study Guide
Prescribing basics - --Prescribing is regulated by state BON
Proper RX - --Providers name and address, Telephone
DEA
Pt name/DOB/Addres
Name of Drug, strength, SIG(direc琀椀ons) with indica琀椀on/Route and frequency, Quan琀椀ty and
signature.
Drug Schedules: Most addic琀椀ve to least - --1: Heroin,LSD, MJ
2: hydrocodone, cocaine, Methamphetamine, methadone, oxycodone, meperidine, fentanyl,
adderall, ritalin
3: codeine, ketamine, testosterone
4: xanax, valium, soma, ambient, tramadol
5: an琀椀diarrheal, an琀椀tussives, lomo琀椀l, lyrica
Pharmicodyamics - --The e昀昀ects of drug on the body. Receptors are large molecules usually
proteins, that interact and mediate the ac琀椀on of drugs
agonist - --produce receptor s琀椀mula琀椀on and a conforma琀椀onal change every 琀椀me they bind. Do
not need all available receptors to produce a maximum response
Par琀椀al agonist - --drugs that have proper琀椀es in b/w those of full agonist and antagonist. They
bind to receptors but when they occupy the receptor sites, they s琀椀mulate only some of the
receptors.
antagonist - --drugs with a昀케nity for a receptor but with no intrinsic ac琀椀vity. A昀케nity allows the
antagonist to bind to receptors, but lack of intrinsic ac琀椀vity prevents the bound antagonist
from causing receptor ac琀椀va琀椀on. The block ac琀椀on of drugs (ex. Narcan) Bioavailabity - --% of
administered dosage of the drug that survives the 昀椀rst pass through the liver and reaches the
blood stream
half life - --Time required for the amount of a drug in the body to decline by 50%, drugs with
shorter half lives must be administer frequently. 4.5-5.5 琀椀mes the half life to get steady state
and to be limited from the body
what the body does to the drug - --absorp琀椀on, distribu琀椀on, metabolism, excre琀椀on Distribu琀椀on -
--movement of absorbed drug in bodily 昀氀uids throughout the body to target 琀椀ssue. Proper琀椀es
a昀昀ec琀椀ng: lipid/water solubility, PH a昀昀ects ioniza琀椀on of drug, protein binding, size of molecule
(smaller molecules are more able to di昀昀use)
Tissue: fat, bone, blood/brain barrier (only lipid soluble will pass), placental barrier (many drugs
can pass)
Protein binding - --unbound drug is free which is ac琀椀ve, crosses membrane. Low plasma
proteins result in more free drug. Compe琀椀琀椀on: when 2 highly bound drugs are given it
increases the level of both drugs
Metabolism - --take place in the liver mostly. Chemical change of a drug structure to:
Enhance excre琀椀on, inac琀椀vate the drug, increase therapeu琀椀c ac琀椀on, ac琀椀ve a prodrug (inac琀椀ve
un琀椀l metabolized in the body into the ac琀椀ve compound, ex: levodopa), increase or decrease
toxicity
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CYP450 - --enzymes cons琀椀tutes the most important of the phase I metabolizing enzymes
(account for about 75% of drug metabolism in the liver)
Phase 2: conjuga琀椀on reac琀椀on occur leading to large increases in hydrophilicity of the substrates
rendering them more readily excretable
Substrate - --an agent that is metabolized by an enzyme into a metabolite and product and
eventually excreted
Inhibitors - --compete with other drugs for a par琀椀cular enzyme a昀昀ec琀椀ng the metabolism
(decreased) of the substrate and decreases the excre琀椀on of the substrate and increasing the
circula琀椀ng drug
inducer - --competes with other drugs for a par琀椀cular enzyme a昀昀ec琀椀ng metabolism of the
substrate (increases) decreasing the e昀케cacy of the drug
excre琀椀on - --renal: passive glomerular 昀椀ltra琀椀on, ac琀椀ve tubular secre琀椀on, tubular
reabsorp琀椀on, gi tract, lung, sweat and salivary, mammary
genomics - --study of the complete set of gene琀椀c informa琀椀on present in a cell, an organism, or
species
pharmacogene琀椀cs - --the study of the in昀氀uence of hereditary factors on the response of
individual organisms to drugs, and the study of varia琀椀ons of DNA and RNA characteris琀椀cs as
related to drug response
Pharmacogene琀椀cs tests - --Men琀椀oned on drug labels can be classi昀椀ed as "test required," "test
recommended," and "informa琀椀on only." Currently, four drugs are required to have
pharmacogene琀椀cs tes琀椀ng performed before they are prescribed: cetuximab, trastuzumab,
maraviroc and dasa琀椀nib
wafarin, carbamazepine, valproic acid and abacavir are recommended to tests prior to ini琀椀al
dosing
Carbamazepine and Asisans - --Ini琀椀a琀椀ng carbamazepine therapy in these pa琀椀ents (allele HLA-
B*1502) are at high risk for developing Steven Johnson syndrome or toxic epidermal necrolysis
(TEN)
The ability of the anesthe琀椀c to penetrate the axon membrane is determined by 3 proper琀椀es.
What are they? - --Molecular size, Lipid solubility, degree of ioniza琀椀on at 琀椀ssue pH
Why is epinephrine given with local anesthe琀椀cs? - --Decreases local blood 昀氀ow
(decreased risk of bleeding)
Delays systemic absorp琀椀on of the anesthe琀椀c
prolongs anesthesia reduces the risk of toxicity
What is the most widely used local anesthe琀椀c? - --Lidocaine
What is a possible fatal reac琀椀on to benzocaine - --Methemoglobinemia
What is included in applica琀椀on guidelines for topical anesthe琀椀cs - --avoid wrapping the site and
hea琀椀ng the site, avoid applica琀椀on to open skin
Which medica琀椀on will not cause rebound headaches from overuse? - --propranolol
(preventa琀椀ve)
What is the best op琀椀on for menstural migraine? - --low dose estrogen about 3 days prior to
menses
What food can trigger migraines? - --Hot dog d/t nitrates
What medica琀椀on is a Seratonin 1B1D receptor agonist? - --Sumatriptan
