N 5334 FINAL EXAM ADVANCED PHARMACOLOGY

NURS 5334 FINAL EXAM ADVANCED PHARMACOLOGY Exam (elaborations) NURS 5334 FINAL EXAM ADVANCED PHARMACOLOGY (NURS 5334 FINAL EXAM ADVANCED PHARMACOLOGY)

Final Exam Blueprint

Prescribing Basics: 2 questions

Prescriptive authority regulated by the state BON in each state.

Tall man lettering to highlight dissimilaries with look-alike names

*Prescription contains… Physicians Name, Address, and telephone number are required to be included in

the prescription. DEA number (two letters, five numbers) if the prescription is for controlled substance,

Patient name and DOB (also may include address and weight), Date Rx is written (expires 1 year after

date issued), Name of drug and strength- avoid trailing zeroes, use leading zeroes, Directions with

indications/route of administration and frequency, write out number of refills, quantity of drug,

signature, NPI number (9 or 11 numbers), sign as A-PNP or role recognized by the BON

Drug schedules – one is most addictive, up to schedule 5.

1) heroin, LSD, marijuana.

2) oxycodone, hydrocodone, methamphetamines.

3) codeine, ketamine, testosterone.

4) Xanax, valium, ambien, tramadol.

5) antidiarrheal, antitussives, Lomotil, lyrica.

*calculation question

Pharmacology Principles: 3 questions

Pharmacodynamics – effect of drugs on body. Works by receptors. Usually proteins that interact with

drugs.

Agonist – produce receptor stimulation, conformational change every time they bind.

Partial agonist – properties between agonists and antagonists. Submaximal effect. Stimulate only some

of the receptors.

Antagonist – affinity for receptor but NO intrinsic activity. Affinity allows antagonist to bind to receptors,

but lack of intrinsic activity prevents receptor activation. Blocks action of drugs (example Narcan).

Therapeutic range – between minimum effective concentration and toxic concentration. Working

effectivity with no toxicity or adverse effects. Wider therapeutic range is better! Easiest to control.

Bioavailability – percentage of dose of drug that survives first pass through liver and reaches blood

stream.

Half life – time required for amount of drug to decline by 50%. Shorter half life admin more frequently.

4.5-5 half lives to get to steady state and to eliminate from body.

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Pharmacokinetics – what body does to drug. Absorption, distribution, metabolism, elimination. (ADME)

Parenteral (bypass first pass), then oral, then lungs, then skin, eye and ears for best absorption.

Distribution affected by lipid/water solubility, PH, protein binding, size of molecule.

Protein binding – unbound drug is free drug which is active. When 2 highly bound drugs are given it

increases the level of one of the drugs, leading to toxicity. IE warfarin and phenytoin are both highly

protein bound. Low plasma protein result in more free drug. May be in elderly, so decrease dose of

medication. T3 and T4 both highly protein bound. 1% of drug is powerful.

Distribution – BBB (only lipid soluble will pass) – these such as narcotics, only work because they do

cross BBB. Some meds we do not want to pass. Placental barrier (many drugs can pass) so be careful

with drugs in pregnancy.

Metabolism – liver. Chemical change of a drug structure to enhance excretion, inactivate drug, increase

therapeutic action, activate prodrug, increase or decrease toxicity.

Substrate – 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 (decreases) of

the substrate and decreases the excretion of the substrate and increasing the circulating drug. Need to

decrease dose of substrate if start on an inhibitor. INH increases substrate.

*Inducer – competes with other drugs for a particular enzyme affecting metabolism of the substrate

(increases) decreasing the efficacy of the drug. Need to increase dose of substrate if start on an inducer.

IND decreases substrate.

Renal excretion – passive glomerular filtration, active tubular secretion, tubular reabsorption.

Pharmacogenomics: 1 question

Pharmacogenomics- the study of the influence of hereditary factors on the response of individual

organism to drugs, and the study of variations of DNA and RNA characteristics as related to drug

response.

Pharmacogenetic tests mentioned on drug labels can be classified as “test required”, “test

recommended”, and “information only”. Currently there are 4 drugs requiring to have pharmacogenetic

testing performed before they are prescribed: Cetuximab, Trastuzumab, Maraviroc, and Dasatinib.

No genetic testing is required by the FDA for the initiation of medications such as warfarin,

carbamazepine, valproic avid and abacavir are currently in place, such tests are recommended prior to

initial dosing.

BBW initiated in December 2007- on carbamazepine label – testing recommended for HLA-B 1502 in

patient with Asian ancestry due to high risk of developing SJS or toxic epidermal necrolysis (TEN).

Drugs across the lifespan: 3 questions

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