Pharmacology Exam Blueprint: Key Concepts and Study Guide

Posted on Apr 1, 2025 in Airports

Pharmacology Exam Blueprint

1. Pharmacodynamics and Pharmacokinetics

Pharmacodynamics: The science of dealing with interactions between living organisms and foreign chemicals. What does the drug do to the body?

  • Receptor Site

Pharmacokinetics: The study of absorption, distribution, metabolism (biotransformation), and excretion of drugs. What does the body do to the drug?

  1. Absorption – Route
  2. Distribution – Lipid soluble
  3. Metabolism – Liver
  4. Excretion – Kidney
  • Onset of drug action – How long it takes to feel the therapeutic effect?
  • Drug half-life – How frequent should the drug be taken?
  • Timing of peak effect – The timing that the drug reaches full potential
  • Duration of drug effect – How long the therapeutic effects last?
  • Metabolism of the drug – Breakdown of the drug so that they can be eliminated more easily.
  • Site of excretion – How does the body eliminate it?

2. Antimicrobial Therapy

A. Antibiotic therapy: Decrease the population of the invading bacteria to a point where the human immune system can effectively deal with the invader.

B. Antibiotic Resistance:

  1. Limit the use of antimicrobial agents to the treatment of specific pathogens sensitive to the drug being used.
  2. Make sure doses are high enough, and the duration of drug therapy long enough. Finish entire drug therapy.

C. Organ-Specific Toxicities: Signs and Symptoms

  • Gastrointestinal (GI) Tract Toxicity = Nausea, Vomiting, Diarrhea
  • Hepatotoxicity = Jaundice, elevated liver enzymes
  • Nephrotoxicity = Fluid retention, Blood in urine, Kidney failure
  • Neurotoxicity = Headache, Loss of memory and cognitive function, tingling and numbness in the limbs
  • Ocular toxicity = Visual changes/damages

3. Anti-Infective Agents

A. Penicillin: Broad spectrum, used to build their cell walls.

  1. Adverse Effects = Most significant GI tract, seizures, bone marrow suppression
  2. Nursing Interventions = Known allergy to any cephalosporins and Penicillins, Physical, Skin and mucous membranes for any rashes or lesions, Culture and sensitivity tests, Respiratory status, Abdomen and renal function

B. Cephalosporins (Cephalexin, Cefaclor): The lower the generation treats gram-positive, the higher the generation treats gram-negative, inhibit cell wall synthesis.

  1. Nursing Interventions = known allergy to any cephalosporin or penicillin, Renal function tests, monitor for bloody stools or watery diarrhea

C. Gentamicin: Gram-negative aerobic bacilli, inhibits protein synthesis.

  1. Adverse Effects = Ototoxicity and nephrotoxicity
  2. Nursing Interventions = Allergy to any aminoglycoside, Perform culture and sensitivity tests at the site of infection, Perform renal and liver function tests Renal Toxicity

D. Amphotericin B: Very potent – reserved for progressive potential fatal fungal infections.

  1. Adverse Effects = related to their toxic effects on the liver and kidneys, severe renal impairment and bone marrow suppression, electrolyte imbalance

E. Rifampicin/ Rifampin: Pathogens causing TB and leprosy, act on the DNA.

  1. Adverse Effect = CNS effects and GI irritation, Orange color tears, urine and sweat

F. Isoniazid: Pathogens causing TB and leprosy, act on the DNA.

  1. Adverse Effect = B6, Peripheral Neuropathy
  2. Nursing Intervention = LFT, resp. status, history of renal/hepatic disease

G. Clotrimazole

  1. Indications = less toxic than amphotericin B but also less effective, bind to sterols and can cause cell death, inhibit glucan synthesis
  2. Adverse effect = Liver toxicity and teratogenic effects

4. Pain and Inflammation

A. Aspirin: Inhibits synthesis of prostaglandin, used to treat mild to moderate pain and fever.

  1. Contraindications = Known allergy, bleeding abnormalities, impaired renal function
  2. Adverse Effect = clotting systems (Petechiae blood loss, bleeding abnormal, dizziness, ringing in the ears, difficulty hearing, Melena = Dark stools, Nephrotoxic, Reye’s Syndrome

B. NSAIDs, Ibuprofen: Block two enzymes, known as COX-1 and COX-2.

  1. Contraindications = Allergy to any NSAID or salicylate, and celecoxib is also contraindicated in the presence of allergy to sulfonamides
  2. Adverse Effects = GI effects of the drug. GI bleed, dizziness, somnolence, platelet inhibition, hypertension, and even bone marrow depression
  3. Nursing Interventions = Assess for GI bleeding or peptic ulcer, Tarry stools, CBC, liver and renal function tests, urinalysis, stool guaiac, and serum electrolytes. Take with meal

C. Acetaminophen: Acts directly on the thermoregulatory cells of the hypothalamus, treat pain and fever reducer.

  1. Antidote = NAC (N- acetylcysteine)

D. Morphine: Acts at specific opioid receptor sites in the CNS. Treats Severe pain or Chronic pain.

  1. Adverse effect = Respiratory depression with apnea, Cardiac arrest, Orthostatic hypotension
  2. Assessment = LOC, Respiratory, BP, Bowel Sounds/Movement
  3. Nursing Interventions = Give Naloxone (Narcan), Stool softener

E. Opioid Overdose Signs and Symptoms

  1. LOC- Lost of consciousness
  2. Respiratory – Bradypnea
  3. Hypotension- Low Blood Pressure
  4. Constipation

5. Narcotic Antagonist

A. Naloxone (Narcan): Drugs that bind strongly to opioid receptors, but they do not activate the receptors.

  1. Indications = indicated for reversal of the adverse effects of narcotic overdose. Antidote

6. Anxiolytic and Hypnotic Agents

A. Benzodiazepines: Diazepam: Act in the limbic system and the RAS, make GABA more effective.

  1. Adverse Effects = Sedation, Drowsiness, Confusion, Depression, Dry Mouth, Hypotension, Urinary Retention
  2. Antidote = Flumazenil

7. Antidepressant

A. TCA: Imipramine

  1. PharmacoDynamics = Reduce the reuptake of 5HT and NE into nerves
  2. Action = Reduce the reuptake of 5HT and NE into nerves
    • Relief of symptoms of depression
    • Used in patients with sleep disorders
    • Treatment of Enuresis- no bladder control
    • Treatment Chronic pain

B. MAOI: Phenelzine: Irreversibly inhibits MAO, allowing norepinephrine, serotonin, and dopamine to accumulate in the synaptic cleft.

  1. Adverse Effects = Hypertensive crisis, Coma, Agitation, liver toxicity, Dizziness, excitement, nervousness, mania, hyperreflexia, tremors, confusion, insomnia, agitation, liver toxicity, nausea, vomiting, diarrhea or constipation, anorexia, weight gain, dry mouth, and abdominal pain
  2. Nursing Intervention = Obtain baseline Na levels, keep an eye out for BP, hypoglycemia, administer at bedtime due to sedation
  3. Food-drug interactions = Tyramine- Avoid Cheese, Fermented meat, Red wine, Soy Sauce, Nava Beans

8. Anti-Psychotic

A. Chlorpromazine – Typical: Primarily dopamine receptor blockers.

  1. Adverse Effects = Photophobia, Extrapyramidal Side Effect, NMS
    1. Photophobia
      • Sunscreen
      • Eyeglasses
      • Umbrella
    2. Extrapyramidal Side Effect
      • Pseudoparkinsonism (Days)- Bradykinesia, rigidity, mask-like, cogwheel rigidity, perioral tremor
      • Acute Dystonia (minutes – hours)- Torticollis(neck), oculogyric crisis (bilateral elevation of the visual gaze), (laryngospasm)
      • Akathisia (Days-Weeks)
      • Tardive Dyskinesia (Long Term)
    3. Neuroleptic Malignant Syndrome- High fever, stiffness of the muscles, altered mental status (paranoid behavior), and autonomic dysfunction.
      • Autonomic dysfunction- Wide swing of blood pressure, excessive sweating and excessive secretion of saliva

B. Lithium Carbonate/ Salts: Inhibits the release of norepinephrine and dopamine, but not serotonin, from stimulated neurons. Treats Bipolar Disorders.

  1. Adverse Effects
    • Less than 1.5 – lethargy, slurred speech, muscle weakness, nausea, vomiting
    • Levels 1.5-2 – above reactions plus ECG changes
    • Levels 2-2.5 – ataxia, clonic movements, hyperreflexia, seizures
    • Levels >2.5 Complex multiorgan toxicity, significant risk of death
  2. Drug Toxicity = 0.6-1.2, Ibuprofen increases toxicity, as well as Diuretics
  3. Nursing Interventions = Assess Sodium Levels and TFT (FT4, FT3, TSH) Inhibits synthesis/release of TH

9. Antiseizure

A. Diazepam (Benzodiazepines)

  1. Indications = Limbic system, RAS, Increase effects of GABA Stabilize nerve membranes throughout the CNS to decrease excitability and hyperexcitability to stimulation
  2. Route of Administration = IV, Oral(GI tract) and Rectal form
  3. Contraindications = TERATOGENIC! Liver Function.

B. Phenytoin (Hydantoins): Influencing ionic channels, decreasing excitability and hyperexcitability to stimulation. Therapeutic Serum Phenytoin levels 10-20mcg/ml

  1. Adverse Effects = CNS depression (See Notes) , severe liver toxicity and bone marrow suppression, Gingival Hyperplasia
  2. Nursing Interventions = Mouth Care, Oral Care, See Dentist!
  3. Contraindications = TERATOGENIC! Liver Function. Psychoses

C. Parkinson’s Disease: Degeneration of Neurons, Decrease in Dopamine

  1. Causes
    • Viral Infection
    • Blows to the Head
    • Brain Infection
    • Atherosclerosis
    • Exposure to Certain Drugs
    • Environmental Factors
  2. Signs and Symptoms
    • Lack of Coordination
    • Rhythmic Tremors
    • Rigidity/Weakness
    • Trouble Maintaining Position or Posture
    • Bradykinesia
    • Difficulty Walking
    • Drooling and Affected Speech
    • Mask-like Expressions

D. Anti-Parkinson

  1. Levadopa + Carbidopa = Almost always given in combination
    • Increase Dopamine to get back to an equal balance to acetylcholine
    • Carbidopa decreases the amount of levodopa needed to reach a therapeutic level in the brain
    • The dosage of levodopa can be decreased to reduce adverse side effects

10. Laboratory Testing

A. Kidney Function Test = Creatinine/BUN

B. Liver Function Test = AST/ALT

C. Culture and Sensitivity = Obtain Culture of two different sites. Sensitivity test before administering Antibiotics