Pharm exam one CONTENT

What is Pharmacology?

The study of drugs that alter the functions of living organisms.

What is Drug Therapy?

The use of drugs to prevent, diagnose, or treat signs, symptoms, and disease processes.

What are the three common sources of drugs?

Plants, animals, and minerals; they can also be synthetic (made in a lab) or semi-synthetic (natural substances modified in a lab)

What is a drug "prototype"?

An individual drug that represents a whole group or class of medications

Which drug name is the official name not protected by trademark and required for the NCLEX?

The Generic Name (ex. acetaminophen)

What are the Five phases of FDA drug development?

• Preclinical (Phase 0) – Animals testing

• Phase 1 (healthy volunteers)

• Phase 2 (patients with the disease)

• Phase 3 (large-scale testing with placebos)

• Phase 4 (post-market monitoring)

What is a Black Box Warning (BBW)?

A warning issued by the FDA for drugs that have the most serious, potentially life-threatening adverse effects.

What is a Schedule I Controlled Substance?

A drug with high abuse potential and no accepted medical use (ex. heroin, LSD)

What is a Schedule II Controlled Substance?

A drug with high abuse potential but with a currently accepted medical use (ex. morphine, oxycodone)

What is a Schedule III Controlled Substance?

Less potential for abuse and it’s used medically.

What is a Schedule IV Controlled Substance?

Less potential for abuse and it’s used medically.

What is a Schedule V Controlled Substance?

These are medications that have the smallest amount of risk.

What are medications?

Drugs given for therapeutic purposes.

Why are synthetic compounds used?

They are more standardized in chemical compounds, more consistent in affect, and less likely to produce allergies.

What are semisynthetic drugs?

Naturally occurring substances that have been chemically modified. Ex: many antibiotics.

What are the four steps of Pharmacokinetics (ADME)?

1. Absorption

2. Distribution

3. Metabolism

4. Excretion

What is Absorption?

what happens from the time the drug enters the body to the time it enters the bloodstream to be circulated.

What is Agonist drug?

A drug that activates receptors to produce a response similar to naturally occurring hormones (it "starts" an action)

What Is an Antagonist drug ?

A drug that blocks or inhibits a cell's response by clogging receptor sites (it "stops" or prevents an action

What is an Antidote?

Is going to relieve, prevent, or counteract the effects of a poison.

What is distribution?

The transport of a drug within the body.

What is Excretion?

Eliminating the drug from the body. How we are going to get rid of it.

What is the "First-Pass Effect"?

The initial metabolism of an oral drug by the liver before it reaches the systemic circulation, which decreases the amount of active drug available

What is a loading dose?

A dose that's larger than the regularly prescribed dose to get to a therapeutic level faster.

What is Maintenance drug?

Happens after loading dose it is the drug that's needed to keep the blood levels at a steady state. Something you take all the time to keep the drug at a steady pace.

Define Serum Half-life

The time required for the concentration of a drug in the blood to decrease by 50%

Define Serum drug level

Lab measurement of drug in blood at a certain time.

What is pharmacokinetics?

Drug movement through the body: absorption, distribution, metabolism, excretion. *What the body does to the drug*

Which administration route bypasses the first-pass effect and is 100% bioavailable?

Intravenous (IV)

Define Distribution

The transport of drug molecules within the body to its target tissues

What is the primary plasma protein that drugs bind to during distribution?

Albumin (Only "unbound" or free drugs can exert an effect)

What is the Blood-Brain Barrier?

A protective mechanism that only allows highly lipid-soluble drugs to enter the brain

Where does drug Metabolism primarily occur?

The Liver

What is the Hepatic enzyme system aka Cytochrome P450 system?

A system of liver enzymes that metabolizes most drugs; inhibited by substances like grapefruit juice

Where does drug Excretion primarily occur?

The Kidneys

Define Pharmacodynamics

The drug's action on target cells and the resulting alterations in cellular biochemical reactions *What the drug does to the body*

What are the signs of Anaphylaxis?

Hives, shortness of breath (SOB), and hypotension (low blood pressure)—this is a medical emergency

Define Teratogenicity

The ability of a drug to cause fetal abnormalities or birth defects

What is Bone Marrow Depression?

A drug effect that leads to low Red Blood Cells (anemia), White Blood Cells (infection risk), and Platelets (bleeding risk) = Monitor CBC

What are Anticholinergic side effects?

Dry, retention = Oral care, Checking void

Signs of Liver Impairment?

Jaundice, light stool/dark urine, lab values : High AST/ALT, Bili

Signs of Renal (Kidney) Impairment?

High BUN/Cr, Electrolytes, Anemia

Signs of CNS Impairment

Confusion, Drowsiness = Safety : don’t drive

Signs of Stomatitis?

Red, sore mouth = mouth care - Not eating hot spicy foods not eating acidic foods using a soft toothbrush things like that can help

Universal Antidote for oral poisonings?

Activated Charcoal

What is teratogenicity?

Ability of drug to harm a fetus.

What is carcinogenicity?

Ability of drug to cause cancer.

What is drug dependence?

Physical or psychological “need” for a medication

What are Black Box Warnings?

Strongest FDA warnings for dangerous side effects.

What is toxicology?

Study of drug overdose and poisoning.

Antidote for Acetaminophen?

Acetylcysteine

Antidote for Opioids analgesics?

Naloxone (Narcan)

Antidote for Benzodiazepines?

Flumazenil

Antidote for Warfarin?

Vitamin K1

Antidote for Heparin?

Protamine Sulfate

Antidote for Digoxin?

Digoxin immune Fab

What are the 10 "Rights" of Medication Administration?

1. Right Patient

2. Right Medication

3. Right Dose

4. Right Route

5. Right Time

6. Right Education

7. Right Documentation

8. Right to Refuse

9. Right Assessment

10. Right Evaluation

Who is legally responsible for safe and accurate drug administration?

The Registered Nurse (RN) is legally responsible, including monitoring patient response and teaching self-administration

What is a Medication Reconciliation?

The process of comparing a patient's medication orders to all the medications the patient has been taking (at home, hospital, or nursing home) during transitions of care.

Which dosage forms should NEVER be crushed and why?

Enteric-coated (prevents stomach irritation) and Controlled-release (CR/SR/XL, dissolves slowly) tablets; crushing them causes improper dosing or damage to the stomach

Define Enteral vs. Parenteral routes.

Enteral enters through the GI tract (oral, feeding tubes); Parenteral bypasses the GI tract (IV, IM, Sub-Q)

What are the five steps of the Nursing Process in drug therapy?

1. Assessment (gathering clues)

2. Diagnosis (naming the problem)

3. Planning (forming interventions)

4. Implementation (giving the med)

5. Evaluation (did it work?)

What are the "Three G’s" of herbal supplements that often interact with medications?

Garlic, Ginkgo, and Ginger

Where are the primary sites for a Sub-Q injection?

The back of the upper arm, the abdomen (at least 1 inch from the belly button), and the side of the thigh.

What is the most accurate method for calculating pediatric medication doses?

Body Surface Area (BSA), which considers both the size and weight of the child

Why are infants at a higher risk for Central Nervous System (CNS) side effects?

They have an immature, "leaky" blood-brain barrier that allows more drugs to reach the brain

How does total body water percentage differ in infants vs. adults?

infants are up to 80% water, compared to 60% in adults; this significantly affects drug distribution

At what age do a child’s organs typically begin processing medications like an adult's?

Around age 12

Why are drug effects "longer and stronger" in infants?

Due to delayed gastric emptying, reduced gastric acidity, and immature liver and kidney function

What are the common IV sites for infants?

The scalp, hands, or feet, usually using a 22–24-gauge needle

What is the "Beers Criteria"?

A list of potentially inappropriate medications that should be avoided or used with caution in older adults.

Define Polypharmacy.

The use of multiple medications (prescription and non-prescription) simultaneously, which increases the risk of drug interaction.

What is the primary physiological change in seniors that increases the risk of drug toxicity?

Decreased kidney function (reduced excretion), which causes drugs to stay in the body longer

What absorption changes occur in older adults?

Slower absorption due to GI changes, less circulation, less muscle mass.

What happens to drug distribution in older adults?

Poor heart function can reduce circulation and slow distribution. Increased body fat and decreased albumin affect drug binding and distribution, causing medications to act differently than expected.

What metabolic changes occur in older adults?

Liver function slows down, so drugs are metabolized more slowly and stay in the body longer, increasing the risk of side effects.

What excretion changes occur in older adults?

Kidney function declines, so drugs are not cleared as quickly. This leads to increased drug levels in the body and a higher risk of toxicity and adverse effects.

How does body composition change in older adults, and how does it affect drug distribution?

Older adults have increased body fat and decreased albumin (protein), which alters how drugs bind and distribute in the body

What is the golden rule for geriatric dosing?

"Start low and go slow"—begin with the lowest dose and increase slowly to monitor for adverse effects

What are some common barriers to medication adherence in the elderly?

Decreased vision, economic factors (cost of meds), asymptomatic conditions, and complex schedules (polypharmacy)

What are the two primary divisions of the nervous system, and what does each encompass?

1. Central Nervous System (CNS): The brain and the spinal cord.

2. Peripheral Nervous System (PNS): Everything else outside the brain and spinal cord.

Into which two functional branches does the Peripheral Nervous System (PNS) divide?

1. Somatic Nervous System: Controls voluntary skeletal muscle movements.

2. Autonomic Nervous System (ANS): Operates involuntarily on autopilot.

What body operations are run by the Autonomic Nervous System (ANS), and which primary structures regulate it?

Operations: Vital, involuntary actions like heart rate, breathing, digestion, and pupil size.

Regulators: The hypothalamus, brainstem, and spinal cord. (Severe injuries here are often incompatible with life due to the loss of automatic regulation).

In simple terms how does a nerve impulse travel through the ANS to cause an effect?

1. Initial Text Sent: Pre-ganglionic nerve impulse fires. → Out into the World: Travels across the synapse (microscopic gap). → Recipient Sees It: Post-ganglionic impulse hits the target tissue/effector organ. → Text Back: The tissue produces a physiological response.

Who are the two primary neurotransmitters that handle "texting" in the Autonomic Nervous System?

Acetylcholine (ACH): "Archie" — brings the chill, relaxed, parasympathetic vibes.

Norepinephrine (NE): "Nora" — brings the locked-in, focused, sympathetic rage vibes.

What triggers the Sympathetic Nervous System, and what broad term describes its physiological effects?

Triggers: Physical stress, emotional stress, and temperature extremes.

Term: Adrenergic effects (Fight or Flight).

Name at least 6 physiological body responses that occur when the Sympathetic Nervous System is activated.

1. Increased heart rate, blood pressure, and myocardial contractility.

2. Increased respiratory rate and bronchodilation (airways open wide).

3. Pupil dilation (mydriasis) to see danger clearly.

4. Glycogenolysis (glucose release to raise blood sugar for energy).

5. Vasoconstriction diverting blood to skeletal muscles and away from visceral organs.

6. Sphincter contraction and decreased GI activity (you don't poop during an emergency!).

Who are the three specific sister neurotransmitters of the Sympathetic Nervous System?

Norepinephrine (NE): Targets alpha-1 and beta-1 to elevate blood pressure and heart rate.

Epinephrine (Epi): "Adrenaline" — hits alpha-1, beta-1, and beta-2 for full-scale airway dilation and emergency backup.

Dopamine: The little sister; works with NE and Epi to improve overall circulation.

How do the clinical effects of an intravenous Dopamine infusion change based on the dose administered?

Low Doses: Improves blood flow directly to the kidneys and heart.

Moderate Doses: Stimulates Beta-1 receptors to improve heart rate and muscle contractility.

High Doses: Stimulates Alpha-1 receptors, causing massive vasoconstriction to spike blood pressure.

Where are Alpha-1 receptors located, and what happens when they are stimulated?

Location: Blood vessels, eyes, bladder, and prostate.

Stimulation Effect: Think of Alpha-1 as a constrictor; it causes increased blood pressure, pupil dilation, and urinary retention.

Where are Alpha-2 receptors primarily located, and how do they impact blood pressure?

Location: Mostly within the Central Nervous System (CNS).

Stimulation Effect: They block the further release of norepinephrine, which actually decreases blood pressure. 

Where are Beta-1 receptors located, what do they do when stimulated, and what is the memory trick?

Location/Effect: Located mostly in the heart. It acts as the cardiac accelerator—increasing heart rate, conduction, contractility, and blood pressure.

Memory Trick: You have 1 heart → Beta-1.

Where are Beta-2 receptors located, what do they do when stimulated, and what is the memory trick?

Located in the lungs, skeletal muscles, uterus, and liver. It causes bronchodilation (opens airways), uterine smooth muscle relaxation, and a release of stored sugar for energy.

Memory Trick: You have 2 lungs —> Beta-2

What is the difference between a Selective drug and a Non-selective drug?

Selective: Extremely accurate, like a sniper. It only hits the one specific receptor needed, minimizing extra side effects.

Non-selective: Inaccurate, like a grenade. It activates or blocks multiple receptors at once, hitting unintended targets.

What broad term describes the Parasympathetic Nervous System's activity, and what are its core physical effects?

Cholinergic response (Rest and Digest)

Effects: Pupils constrict, heart rate decreases, bronchi relax/constrict, blood vessels dilate (moving blood back to organs), GI tract wakes up, and bladder muscles contract so you can urinate.

What specific receptor type binds with Acetylcholine (ACH) in the parasympathetic nervous system?

Muscarinic receptors. When ACH binds here, it slows down organs, increases digestion, and ramps up body secretions.

What is the clinical difference between a Cholinergic state and an Anticholinergic state?

Cholinergic: "Wet and relaxed" (heavy secretions, active bladder/bowels, slow heart rate).

Anticholinergic: "Dry and fast" (blocked parasympathetic system resulting in dry mouth, urinary retention, and an accelerated heart rate).

What are Lisa's two fundamental memory acronyms for keeping the divisions of the autonomic nervous system straight?

S-A-M-E: Sympathetic → Adrenergic → Medulla → Epinephrine

P-A-C: Parasympathetic → Acetylcholine → Cholinergic

What is the underlying pathophysiology of Myasthenia Gravis?

The patient's own immune system is the problem; it destroys the acetylcholine (ACH) receptors. Specifically, the disease affects the nicotinic receptors of the somatic nervous system, which blocks muscle contraction and leads to muscle weakness.

What are the manifestations and "essential symptom" of Myasthenia Gravis? How do symptoms change with physical activity?

Primary Symptom: Eye and eyelid muscle weakness (eyelid drooping).

Other Manifestations: Difficulty swallowing. Weakness and drooping are usually only seen in the facial and swallowing muscles.

Activity Changes: Symptoms often get worse with exertion and improve with rest.