NURS 5334-ADVANCED PHARMACOLOGY FINAL
EXAM | WITH 100% VERIFIED SOLUTIONS.
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(directions) with indication/Route and frequency, Quantity
and signature.
Drug Schedules: Most addictive 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: antidiarrheal, antitussives, lomotil, lyrica
Pharmicodyamics - The effects of drug on the body. Receptors are large molecules
usually proteins, that interact and mediate the action of drugs
agonist - produce receptor stimulation and a conformational change every time they
bind. Do not need all available receptors to produce a maximum response
Partial agonist - drugs that have properties in b/w those of full agonist and antagonist.
They bind to receptors but when they occupy the receptor sites, they stimulate only
some of the receptors.
antagonist - drugs with affinity for a receptor but with no intrinsic activity. Affinity allows
the antagonist to bind to receptors, but lack of intrinsic activity prevents the bound
antagonist from causing receptor activation. The block action of drugs (ex. Narcan)
Bioavailabity - % of administered dosage of the drug that survives the first 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 times the half life to get
steady state and to be limited from the body
what the body does to the drug - absorption, distribution, metabolism, excretion
,Distribution - movement of absorbed drug in bodily fluids throughout the body to target
tissue. Properties affecting: lipid/water solubility, PH affects ionization of drug, protein
binding, size of molecule (smaller molecules are more able to diffuse)
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 active, crosses membrane. Low plasma
proteins result in more free drug. Competition: 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 excretion, inactivate the drug, increase therapeutic action, active a prodrug
(inactive until metabolized in the body into the active compound, ex: levodopa), increase
or decrease toxicity
CYP450 - enzymes constitutes the most important of the phase I metabolizing
enzymes (account for about 75% of drug metabolism in the liver)
Phase 2: conjugation reaction 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 particular enzyme affecting the metabolism
(decreased) of the substrate and decreases the excretion of the substrate and
increasing the circulating drug
inducer - competes with other drugs for a particular enzyme affecting metabolism of the
substrate (increases) decreasing the efficacy of the drug
excretion - renal: passive glomerular filtration, active tubular secretion, tubular
reabsorption, gi tract, lung, sweat and salivary, mammary
genomics - study of the complete set of genetic information present in a cell, an
organism, or species
pharmacogenetics - the study of the influence of hereditary factors on the response of
individual organisms to drugs, and the study of variations of DNA and RNA
characteristics as related to drug response
Pharmacogenetics tests - Mentioned on drug labels can be classified as "test required,"
"test recommended," and "information only." Currently, four drugs are required to have
pharmacogenetics testing performed before they are prescribed: cetuximab,
trastuzumab, maraviroc and dasatinib
, wafarin, carbamazepine, valproic acid and abacavir are recommended to tests prior to
initial dosing
Carbamazepine and Asisans - Initiating carbamazepine therapy in these patients (allele
HLA-B*1502) are at high risk for developing Steven Johnson syndrome or toxic
epidermal necrolysis (TEN)
The ability of the anesthetic to penetrate the axon membrane is determined by 3
properties. What are they? - Molecular size, Lipid solubility, degree of ionization at
tissue pH
Why is epinephrine given with local anesthetics? - Decreases local blood flow
(decreased risk of bleeding)
Delays systemic absorption of the anesthetic
prolongs anesthesia
reduces the risk of toxicity
What is the most widely used local anesthetic? - Lidocaine
What is a possible fatal reaction to benzocaine - Methemoglobinemia
What is included in application guidelines for topical anesthetics - avoid wrapping the
site and heating the site, avoid application to open skin
Which medication will not cause rebound headaches from overuse? - propranolol
(preventative)
What is the best option for menstural migraine? - low dose estrogen about 3 days prior
to menses
What food can trigger migraines? - Hot dog d/t nitrates
What medication is a Seratonin 1B1D receptor agonist? - Sumatriptan
Butterbur can help as prevention for migraine therapy. What side effect can occur? -
Liver damage
What are the 3 main classes of opiod receptors? - Mu kappa delta
Which of the following will reserve he effects caused by opioid agonist? - naloxone
Which of the medications are used to treat OIC? - Naloxegol, methylinaltrexone,
lubiprostone
Tolerance is defined as - increased does of a med needed to obtain the same response
