Pharmacotherapeutics for Advanced Practice Nursing: NUSC 531
NUSC 531 is an advanced pharmacology course. NUSC 531 expands on the
knowledge of general principles and concepts related to broad classifications of drugs
required at the undergraduate level for entry into clinical practice. Human anatomy,
physiology, and pathophysiology are prerequisites for this course. These topics may be
briefly (but not always consistently) reviewed by selected speakers, but only as they
relate to certain drug topics. Comprehensive reviews of the above content are beyond the
scope of this course.
Below is a list that includes the prerequisites for successful entry and completion
of this course. Students should refer to basic or advanced anatomy, physiology,
pathophysiology, and biochemistry texts to review areas of deficiency to prepare for this
course. Students who have not recently satisfactorily completed a graduate level
physiology course may, with the instructor’s approval, be permitted to register for this
course. However, these students will be held to the same standards with regard to these
prerequisites listed below.
Prerequisites for NUSC 531:
1. Successful completion of, or concurrent registration in, NUSC 530 are both
acceptable. This presumes that the prerequisites for NUSC 530 have also been
met.
2. Define the following terms: pharmacodynamics, pharmacokinetics, and
pharmacotherapeutics.
3. Define the following pharmacokinetic phases: absorption, distribution,
biotransformation, and elimination.
4. Describe what is occurring in each of the pharmacokinetic phases.
5. Describe general physiologic changes in the child and elderly individual that may
affect each pharmacokinetic phase.
6. Understand the major types of transport mechanisms that allow drugs to enter and
exit the cell, and the carrier and/or energy requirements for each.
7. Describe the characteristics of a drug that crosses a cell membrane via passive
diffusion.
8. Understand what is meant by the pKa (ionization constant) of a drug, and the pH
of the environment, and how manipulating the pH influences the extent of
absorption and elimination of a drug.
9. Understand the term bioavailabilty, and factors that can enhance or decrease the
bioavailability.
10. Define the term volume of distribution.
11. Describe how changes in water consumption within compartments in the body
affect the volume of distribution of a drug.
12. Describe the expected relationship between volume of distribution and plasma
concentration for drugs with reported high and low volumes of distribution.
13. Understand how plasma protein binding affects the amount of drug that is free in
plasma to bind to receptors.
14. Describe why drugs that are highly bound to plasma proteins may potentially
interact with a large number of other drugs.
15. Describe why it is necessary for a drug to undergo biotransformation.
16. Describe the two major categories of biotransformation (synthetic and nonsynthetic), and the requirements and events that occur in each.
17. Understand the normal anatomy and physiology of the kidney and describe the
movement of water and solutes throughout the kidney.
18. Define and understand the following terms: agonist, antagonist, competitive
antagonist, non-competitive antagonist, and partial agonist/antagonist. Be able to
identify each of these on a dose-response graph.
19. Describe the relationship between drugs (agonists and antagonists) and their
receptors.
20. Define, understand, and apply the terms affinity, efficacy, and potency when
describing and/or comparing different drugs.
21. For each class of drugs listed below:
a. Understand normal anatomy and physiology and major pathology of each
system.
b. Describe how the drugs modify normal physiologic processes, along with
their site(s) and mechanism(s) of action.
c. Describe the role of the nurse in monitoring individual response and
evaluating effectiveness of drug therapy.
d. Differentiate between therapeutic effects, side effects, and toxicities of
drugs with specific attention to particular characteristics related to the life
cycle.
DRUG CLASSES:
Autonomic/peripheral nervous system
Alpha agonists
Alpha antagonists
Beta agonists
Beta antagonists
Muscarinic agonists Muscarinic antagonists
Ganglionic agonists Acetylcholinesterase inhibitors
Respiratory Drugs
Antimicrobial
Antibacterial (including anti-TB)
Antiviral
Antifungal
Drugs to Manage Diabetes
Anticonvulsants
Drugs to Manage Pain
Opioids
Non-opioids (including NSAIDS)
Anesthetics
Local and General
Antihistamines
Antiulcer Drugs
Drugs to Manage Hypo/hyperthyroidism
Antineoplastic Drugs
Antiemetics and Laxatives
Drugs that Affect the Immune System
Immunostimulants
Immunosuppressants
Uterine Agonists
Oral Contraceptives
Cardiovascular Drugs
Inotropics
Antihypertensives
Antidysrhythmics
Antilipidemics
Psychiatric Drugs
Antidepressants
Sedatives
Diuretics
Antianginals
Anticoagulants and Thrombolytics
Antipsychotics
Hypnotics
Key Terms:
Student should be able to define or briefly discuss the terms listed below. The list is not
complete or comprehensive for each topic, but does reflect most of the areas and drug
classes that will be covered in more depth in NUSC 531.
Pharmacotherapeutics
Pharmacodynamics
Pharmacokinetics
Absorption
Distribution
Biotransformation or metabolism
Synthetic biotransformation
Non-synthetic biotransformation
Conjugation
Enzyme induction/inhibition
Acetylation
First order kinetics
Steady state
Dosing
Ionization
Ionization constant
pH
Cell membrane composition
Lipid bilayer
Passive diffusion
Active transport
Facilitated diffusion
GFR
Passive tubular reabsorption
Tubular secretion
Enterohepatic recycling
First-pass effect
Therapeutic index
Duration of Action
Lag phase
Elimination
Excretion
Bioavailability
Volume of Distribution
Plasma protein binding
Albumin
Drug interaction
Hypersensitivity reactions (I, II, III, IV)
Controlled substances
Components of a prescription
Tolerance tachyphylaxis
Addiction
Dependence, physiologic/psychologic
Withdraw
Autonomic nervous system
Parasympathetic nervous system
Sympathetic nervous system
Ganglia
Neurotransmitter
Acetylcholine
Norepinephrine
Epinephrine
Dopamine
Serotonin
GABA
Receptor
Neuromuscular junction
Neuroeffector sites
Alpha agonist
Alpha antagonist
Minimum effective concentration
Minimum inhibitory concentration
Toxic concentration
Onset of action
Termination of action
Agonist
Antagonist
Competitive antagonist
Non-competitive antagonist
Partial agonist/ antagonist
Affinity
Efficacy
Potency
Pharmacologic antagonist
Physiologic antagonist
Additive effect
Synergy
Idiosyncratic reaction
Adverse reaction
Transcription
Translation
Ribosome
Virus
Viral replication
Bacteria
Fungus
Tuberculosis
Antimicrobial Drugs
Protease inhibitor
Reverse transcriptase
Polymerase
Insulin
Glucose
Glucagon
Gluconeogenesis
Glycogenolysis
Oral hypoglycemic agents
Insulin resistance
Insulin sensitivity
Anticonvulsants
Seizures (types)
Barbiturates
Benzodiazepines
Neural pain pathways
Synapse
Substance P
Beta agonist
Beta antagonist
Muscarinic agonists
Muscarinic antagonists
Ganglionic blocker
Acetylcholinesterase inhibitor
Methylxanthine
Corticosteroid
Culture and sensitivity
Gram stain
Resistance
Plasmid
Mutagenesis
Nucleic acid
Nucleoside
Nucleotide
Nucleic acid
DNA
RNA
Peptic ulcer disease
Helicobacter pylori
Mycobacterium tuberculosis
H2 antagonist
H+/K+ ATPase pump
Na+/K+ ATPase pump
Thyroid
Goiter
S/S of hyper/hypothyroidism
Radioactive isotopes
Antineoplastic drugs
Phases of cell cycle
Log kill
S/S of hypo/hyperglycemia
Analogue
Cell-cycle phase specific
Chemoreceptor trigger zone
Vomiting center
Neural pathways for nausea and vomiting
Constipation
Laxatives
Osmotic
Surface tension
Immune system
antibodies (IgG, IgE, IgM, IgD, IgA)
T cells
B cells
Opioids
Non-opioids
Prostaglandins
Leukotrienes
Phospholipase A2
Cyclooxygenase
Thromboxane
Prostacycline
NSAIDS
Anesthetics (local & general)
Histamine
Antihistamine
“Sensitized” mast cells
IgE antibodies
Anaphylaxis
Progesterone
Testosterone
Estrogen replacement therapy
Fertility drugs
Inotropic drugs
Stroke volume
Cardiac output
Total peripheral resistance
Contractile force
Frank Starling curve
Normal renal physiology
Diuretics
Antihypertensives
Preload
Afterload
Antianginals
Re-entrant phenomena
Genesis of dysrhythmias
Types of dysrhythmias
Plasma proteins
Intrinsic pathway
Extrinsic pathway
Cell-mediated immunity
Humoral immunity
Passive and acquired immunity
Immunization
Immunostimulants
Immunosuppressants
Leukocytes
Monocytes
Macrophages
Opsonization
Complement system
Female and male hormones
Hormonal regulation
Oral contraceptives
Estrogen
Clotting cascade
Coagulation factors
Anticoagulants
Thrombolytics
Lipid
Lipoprotein
Normal lipid pathway
HDL
LDL
VLDL
Chylomicron
Antilipidemic drugs
Antidepressants
Sedatives
Hypnotics
Anti-anxiety drugs
Schizophrenia
Bi-polar disorder
Mania
Depression
Antipsychotic drugs
Recommended Review Books:
A.J. Vander, J.H. Sherman, D.S. Luciano. Human physiology. (6th Ed.) McGraw-Hill,
New York, 1994.
R.L. Malvin, M.D. Johnson, G.M. Malvin. Concepts of human physiology. Addison
Wesley Longman, Menlo Park, CA, 1997.
R.A. Lehne, L. Moore, L. Crosby, D. Hamilton. Pharmacology for nursing care. (2nd
Ed.) W.B. Saunders Co., Philadelphia, 1994.