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Summary NUR 243 Final Exam Study Guide
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This is a comprehensive and detailed final exam study guide for Nur 243. *Essential Study Material!!
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Study Guide Final ExamNUR 234
Fall 2016
It is important that you understand the terminology discussed in each unit. The recommended concepts
to focus on include: basic principles of pharmacology, introduction to the peripheral nervous system and
central nervous system, and basic principles of antimicrobial therapy. Closely examine agents used for
analgesia, agents that affect the heart and blood vessels, agents used in the treatment of diabetes,
agents used in respiratory disorders such as asthma and COPD, and agents used in peptic ulcer
disease. In addition, sedative-hypnotics, antiseizure agents, NSAIDS, and glucocorticoids should be
understood. Remember therapeutics is our principle concern. Below is the blueprint of the final exam.
There are 100 questions.
Chapter 1, 2, & 3……………………………………………………….. 5
1. Orientation to Pharmacology
a. Most important part of an ideal drug are effectiveness, safety, selectivity
i. If not effective it should not be used
ii. No such thing as a wholly selective drug
b. Provide maximum benefit with minimal harm
c. Drug therapy is tailored to the individual
2. Application of Pharmacology in Nursing Practice
a. Nurses responsibilities go beyond the Rights of Drug Administration
i. You are the last line of defense against medication errors
ii. Knowledge of pharmacology is important for practical patient care and
education
b. Nursing process is directed at providing individual drug therapy – vital to achieving the
therapeutic objective
i. Preadministration assessment
1. Evaluation of therapeutic and adverse effects
2. Identification of high risk patients
3. Assessment of capacity for self-care
ii. Analysis and Diagnosis Phase
1. Judging the appropriateness of prescribed therapy
2. Identifying potential health problems treatment may cause
3. Characterizing the patient’s capacity for self care
iii. Planning
1. Define goals
2. Establish Priorities
3. Establish criteria for evaluating success
iv. Evaluation
1. Evaluate therapeutic response
2. Evaluate adverse reactions and interactions
3. Patient adherence
4. Patient satisfaction with treatment
, 3. Drug Regulation, Development, Names, and Information
a. Food, Drug, and Cosmetic act of 1938 – first regulation of drug safety
b. Harris-Kefauver Amendments 1962 – demanded that drugs be of some benefit
c. Controlled Substances Act 1970 – rules for the manufacturing and distribution of drugs
with potential for abuse
d. FDA Amendment Act 2007 – expanded FDA mission to oversee drugs even after they
have been released for marketing
e. Clinical Trials occur in 4 phases – 4th occurs after marketing has begun
i. Phase II and III are limited to a small amount of patients who take the drug for a
relatively short time
ii. Preclinical testing (in animals)
iii. Clinical Testing
1. Phase 1 – healthy volunteers – metabolism, pharmacokinetics, biologic
effects
2. Phase 2 – patients- therapeutic utility and dosage range
3. Phase 3 – patients – safety and effectiveness
4. Conditional Approval of New Drug Application (NDA) Post – Market
Surveillance
f. Safety and efficacy knowledge in pregnant women and children in limited
g. Watch for unreported adverse effects with new drugs
h. Each drug has only ONE generic name but can have MULTIPLE trade names
i. Drug development is very expensive
j. Randomized controlled trial is the most reliable way to assess efficacy and safety
Chapter 4, 5, 6, 7, & 8…………………………………………………10
4. Pharmacokinetics
a. 4 Basic processes
i. Absorption – movement of a drug from its site of administration to the blood
stream
1. Enhanced by rapid drug dissolution, high lipid solubility, large surface
area, high blood flow at the site of administration
2. Ionized or Polar drugs can not cross membranes easily
a. Acidic drugs ionize in Alkaline media
b. Basic drugs ionize in Acidic media
ii. Distribution – movement of drugs throughout the body
1. Drugs easily leave the vasculature through the capillary bed
2. BBB – tight junction between capillary cell walls that are in the CNS,
drugs must pass through the cells of the capillary wall rather than
between them
3. When drugs bind to plasma albumin they can not leave the vaculature
iii. Metabolism – enzymatic alteration of drug structure (biotransformation)
1. P-450 system of the liver
2. Most important consequence of metabolism is promotion of renal drug
excretion by converting lipid soluble drugs into more hydrophilic forms
, a. Other consequences – conversion to less active/inactive form,
conversion to more active form, conversion of prodrugs to their
active form, conversion to more toxic or less toxic forms
3. Drugs metabolized by the P450 system = substrates
a. Rate at which substrates are metabolized is effected by drugs
that work as p450 inducers or inhibitors
b. Inducers - As the rate of drug metabolism increases, plasma
drug levels decrease
c. Inhibitors – slower metabolism can lead to active drug
accumulation and possible toxicity
4. First- Pass Effect – rapid inactivation of drugs as they pass through the
liver after being absorbed
5. Enterohepatic Recirculation – drug undergoes glucuronidation in the
liver transport to the duodenum via bile hydrolytic release of free
drug by intestinal enzymes transport in the portal blood back to the
liver cycle begins again
iv. Excretion – most drugs are excreted from the kidneys
1. Renal drug excretion – glomerular filtration passive tubular
reabsorption active tubular secretion
2. Highly lipid soluble drugs are not excreted by the kidneys
3. Drugs can be excreted into breast milk
b. Pharmacokinetics determines concentration, site of action, intensity, and course of
responses
c. Drugs pass through membranes in 3 ways – pores, undergoing transport, and direct
penetration
d. P-glycoprotein (found in the liver, kidney, placenta) can carry transport a variety of drugs
out of the cell
e. Lipid soluble drugs can cross membranes easily
f. Direct correlation between the plasma drug level and the intensity of therapeutic and
toxic effects
g. Half-life – time required for the amount of drug in the body to decline by 50%
h. Time required to reach plateau is equivalent to about 4 half lives
i. If plasma drug levels fluctuate too much between doses – give smaller doses more
frequently, continuous infusion, or use a depot preparation
j. Drugs with long half-lives may need a loading dose to achieve plateau quickly
k. When a drug is discontinued, it takes 4 half lives for 94% of drug to be eliminated from
the body
l. IV Therapy
i. Advantages – rapid onset, precise control of the amount of drug entering the
blood, used for large fluid volumes and irritating drugs
ii. Disadvantages – high cost, difficult, inconvenient, danger because or
irreversibility, potential for fluid overload, infection, embolism
m. IM Therapy/ SubQ Therapy
i. 2 advantages – suitable for insoluble drugs and depot preparations
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