Key Takeaways
- The DEA classifies controlled substances into 5 schedules (Schedule I = highest abuse potential, no accepted medical use; Schedule V = lowest)
- The "seven rights" of medication administration: right patient, right drug, right dose, right route, right time, right documentation, right reason
- Common drug routes include oral (PO), sublingual (SL), intramuscular (IM), subcutaneous (SubQ), intravenous (IV), and topical
- Drug interactions can be synergistic (enhanced effect), antagonistic (reduced effect), or cause adverse reactions
- Medical assistants must understand prescription abbreviations: bid (twice daily), tid (three times daily), qid (four times daily), prn (as needed)
- The six essential nutrients are carbohydrates, proteins, fats, vitamins, minerals, and water
- MyPlate replaced the food pyramid in 2011 as the USDA dietary guideline visual, emphasizing fruits, vegetables, grains, protein, and dairy
- Pharmacokinetics involves four processes: absorption, distribution, metabolism (primarily in the liver), and excretion (primarily by the kidneys)
Last updated: February 2026
Pharmacology & Nutrition
Pharmacology and nutrition are key components of the General Knowledge domain. Medical assistants must understand drug classifications, safe medication administration practices, controlled substance regulations, and basic nutrition principles to support patient care and education.
DEA Controlled Substance Schedules
The Drug Enforcement Administration (DEA) classifies controlled substances based on their potential for abuse and accepted medical use:
| Schedule | Abuse Potential | Medical Use | Examples |
|---|---|---|---|
| Schedule I | Highest | No accepted medical use | Heroin, LSD, marijuana (federal), ecstasy |
| Schedule II | High | Accepted with severe restrictions | Oxycodone, morphine, fentanyl, Adderall, Ritalin |
| Schedule III | Moderate | Accepted | Codeine combinations, testosterone, ketamine, Tylenol with codeine |
| Schedule IV | Lower | Accepted | Benzodiazepines (diazepam, alprazolam), zolpidem, tramadol |
| Schedule V | Lowest | Accepted | Cough syrups with small amounts of codeine, pregabalin, lacosamide |
Controlled Substance Requirements for Medical Offices
- Must be stored in a double-locked cabinet or safe
- Inventory log must be maintained and reconciled regularly
- Provider must have a valid DEA number to prescribe
- Medical assistant can administer controlled substances only under direct supervision of the physician
- Disposal: Must be witnessed by two people and documented
- Prescription rules: Schedule II drugs require a written prescription (no refills); Schedules III-V allow limited refills
The Seven Rights of Medication Administration
Every time a medication is administered, the medical assistant must verify:
- Right Patient — Verify identity using two identifiers (name + DOB)
- Right Drug — Check the medication label three times (when selecting, preparing, and before administering)
- Right Dose — Verify the correct amount and calculate if necessary
- Right Route — Confirm the correct administration route (oral, IM, SubQ, etc.)
- Right Time — Administer at the prescribed time
- Right Documentation — Record the administration immediately
- Right Reason — Confirm the medication is appropriate for the condition
Three Label Checks
Medical assistants should verify the medication label at three points:
- When removing the medication from the shelf or drawer
- When preparing the medication for administration
- Before administering the medication to the patient
Routes of Administration
| Route | Abbreviation | Description | Onset |
|---|---|---|---|
| Oral | PO | By mouth | 30-60 minutes |
| Sublingual | SL | Under the tongue (dissolved, not swallowed) | 5-10 minutes |
| Buccal | — | Between cheek and gum | 5-10 minutes |
| Intramuscular | IM | Into the muscle | 15-30 minutes |
| Subcutaneous | SubQ/SC | Under the skin into fatty tissue | 15-30 minutes |
| Intravenous | IV | Directly into a vein | Immediate |
| Topical | TOP | Applied to the skin surface | Varies |
| Inhalation | INH | Breathed into the lungs | 1-5 minutes |
| Rectal | PR | Inserted into the rectum | 15-30 minutes |
| Transdermal | TD | Absorbed through the skin via a patch | 30-60 minutes |
| Ophthalmic | — | Applied to the eye (drops or ointment) | Minutes |
| Otic | — | Applied to the ear (drops) | Minutes |
| Nasal | — | Sprayed or dropped into the nose | Minutes |
| Vaginal | PV | Inserted into the vagina | Varies |
Common Prescription Abbreviations
| Abbreviation | Meaning |
|---|---|
| bid | Twice daily (bis in die) |
| tid | Three times daily (ter in die) |
| qid | Four times daily (quater in die) |
| q4h | Every 4 hours |
| q6h | Every 6 hours |
| qd / daily | Once daily |
| prn | As needed (pro re nata) |
| ac | Before meals (ante cibum) |
| pc | After meals (post cibum) |
| hs | At bedtime (hora somni) |
| stat | Immediately |
| NPO | Nothing by mouth (nil per os) |
| Rx | Prescription |
| Sig | Directions (write on label) |
| Disp | Dispense |
| DAW | Dispense as written (no generic substitution) |
| tab | Tablet |
| cap | Capsule |
| gtt | Drop(s) |
| mL | Milliliter |
Pharmacokinetics: What the Body Does to the Drug
| Phase | Description | Key Organ |
|---|---|---|
| Absorption | Drug enters the bloodstream from the site of administration | GI tract (oral), muscle/skin (injection) |
| Distribution | Drug travels through the blood to target tissues | Blood/cardiovascular system |
| Metabolism | Drug is broken down (biotransformation) | Liver (primary) — cytochrome P450 enzymes |
| Excretion | Drug and metabolites are eliminated from the body | Kidneys (primary), also lungs, bowel, sweat, breast milk |
Factors Affecting Drug Action
- Age: Elderly and pediatric patients metabolize drugs differently
- Weight: Larger patients may require higher doses
- Liver function: Impaired liver reduces drug metabolism
- Kidney function: Impaired kidneys reduce drug excretion
- Genetics: Genetic variations affect drug metabolism rates
- Diet: Some foods interact with drugs (e.g., grapefruit juice with statins, leafy greens with warfarin)
- Other medications: Drug-drug interactions can increase or decrease effectiveness
Common Drug Classifications
| Drug Class | Purpose | Common Examples | Key Side Effects |
|---|---|---|---|
| Analgesics (non-opioid) | Pain relief | Acetaminophen (Tylenol), ibuprofen (Advil), naproxen (Aleve) | GI upset (NSAIDs), liver damage (acetaminophen overdose) |
| Analgesics (opioid) | Severe pain relief | Oxycodone, hydrocodone, morphine, fentanyl | Respiratory depression, constipation, addiction |
| Antibiotics | Fight bacterial infections | Amoxicillin, azithromycin (Z-pack), ciprofloxacin, cephalexin | Allergic reactions, GI upset, C. diff risk |
| Antihypertensives | Lower blood pressure | Lisinopril (ACE inhibitor), amlodipine (CCB), metoprolol (beta-blocker) | Dizziness, cough (ACE), fatigue (beta-blockers) |
| Antidiabetics | Manage blood glucose | Metformin, insulin, glipizide, empagliflozin | Hypoglycemia, GI upset (metformin) |
| Anticoagulants | Prevent blood clots | Warfarin (Coumadin), heparin, enoxaparin (Lovenox), apixaban (Eliquis) | Bleeding risk, bruising |
| Bronchodilators | Open airways | Albuterol (ProAir/Ventolin), ipratropium (Atrovent) | Tachycardia, tremor, nervousness |
| Antidepressants | Treat depression/anxiety | Sertraline (Zoloft), fluoxetine (Prozac), escitalopram (Lexapro) | Nausea, weight changes, sexual dysfunction |
| Diuretics | Reduce fluid retention | Furosemide (Lasix), hydrochlorothiazide (HCTZ), spironolactone | Dehydration, electrolyte imbalances |
| Statins | Lower cholesterol | Atorvastatin (Lipitor), simvastatin (Zocor), rosuvastatin (Crestor) | Muscle pain (myalgia), liver enzyme elevation |
| Antihistamines | Treat allergies | Diphenhydramine (Benadryl), cetirizine (Zyrtec), loratadine (Claritin) | Drowsiness (1st gen), dry mouth |
| Proton pump inhibitors | Reduce stomach acid | Omeprazole (Prilosec), pantoprazole (Protonix), esomeprazole (Nexium) | Long-term: bone fracture risk, B12 deficiency |
| Corticosteroids | Reduce inflammation | Prednisone, methylprednisolone, dexamethasone | Weight gain, blood sugar elevation, immune suppression |
Nutrition Fundamentals
The Six Essential Nutrients
| Nutrient | Function | Calories/gram | Sources |
|---|---|---|---|
| Carbohydrates | Primary energy source | 4 cal/g | Grains, fruits, vegetables, sugar |
| Proteins | Build/repair tissue, enzymes, hormones | 4 cal/g | Meat, fish, eggs, beans, dairy |
| Fats | Energy storage, insulation, hormone production | 9 cal/g | Oils, butter, nuts, avocado |
| Vitamins | Regulate body processes (no calories) | 0 cal/g | Fruits, vegetables, fortified foods |
| Minerals | Structural/regulatory functions (no calories) | 0 cal/g | Dairy (calcium), meat (iron), bananas (potassium) |
| Water | Transport, temperature regulation, chemical reactions | 0 cal/g | Beverages, foods with high water content |
Key Vitamins and Their Functions
| Vitamin | Function | Deficiency |
|---|---|---|
| Vitamin A | Vision, immune function, skin | Night blindness |
| Vitamin B12 | RBC formation, nerve function | Pernicious anemia, neuropathy |
| Vitamin C | Collagen formation, immune function, wound healing | Scurvy |
| Vitamin D | Calcium absorption, bone health | Rickets (children), osteomalacia (adults) |
| Vitamin E | Antioxidant, cell protection | Hemolytic anemia |
| Vitamin K | Blood clotting (coagulation factors) | Bleeding disorders |
| Folic acid (B9) | DNA synthesis, cell division | Neural tube defects in pregnancy, megaloblastic anemia |
MyPlate Guidelines (USDA)
- Fruits: Fill about 10% of the plate
- Vegetables: Fill about 40% of the plate
- Grains: Fill about 30% of the plate (at least half whole grains)
- Protein: Fill about 20% of the plate
- Dairy: One serving alongside the meal
Therapeutic Diets
| Diet | Purpose | Restrictions |
|---|---|---|
| Low-sodium | Hypertension, heart failure, edema | Limit sodium to <2,000 mg/day |
| Diabetic/carb-controlled | Diabetes management | Consistent carbohydrate intake, limit simple sugars |
| Low-fat/low-cholesterol | Heart disease prevention | Limit saturated and trans fats |
| Renal diet | Kidney disease | Restrict sodium, potassium, phosphorus, and protein |
| Clear liquid | Pre-procedure, post-surgery | Broth, gelatin, clear juices, popsicles, water |
| Full liquid | Transition diet | Clear liquids plus milk, cream soups, pudding, ice cream |
| BRAT diet | Diarrhea/GI upset | Bananas, rice, applesauce, toast |
| High-fiber | Constipation, diverticulosis | Increase fruits, vegetables, whole grains, legumes |
| Gluten-free | Celiac disease | Eliminate wheat, barley, rye |
Psychology and Human Development
Basic Psychology Concepts for Medical Assistants
Heredity vs. Environment
- Heredity (nature): Traits passed genetically from parents (eye color, blood type, genetic diseases)
- Environment (nurture): External influences that shape behavior and health (diet, education, social interactions, stress)
- Most traits are influenced by both heredity and environment
Types of Psychological Disorders (Recognition Level for Medical Assistants)
| Disorder | Characteristics | Key Signs |
|---|---|---|
| Major depression | Persistent sadness, loss of interest for 2+ weeks | Sleep changes, appetite changes, fatigue, hopelessness |
| Generalized anxiety disorder | Excessive worry about multiple areas of life | Restlessness, muscle tension, difficulty concentrating |
| Bipolar disorder | Alternating episodes of mania and depression | Elevated mood, decreased sleep need, impulsive behavior |
| PTSD | Following a traumatic event | Flashbacks, nightmares, avoidance, hyperarousal |
| Substance use disorders | Compulsive use despite negative consequences | Tolerance, withdrawal, loss of control |
| Eating disorders | Abnormal eating behaviors | Anorexia (restriction), bulimia (binge-purge), binge eating |
Developmental Considerations
Piaget's Cognitive Development Stages
| Stage | Age | Characteristics |
|---|---|---|
| Sensorimotor | Birth-2 years | Learning through senses and motor actions; object permanence develops |
| Preoperational | 2-7 years | Symbolic thinking, egocentrism, magical thinking |
| Concrete operational | 7-11 years | Logical thinking about concrete events; conservation develops |
| Formal operational | 11+ years | Abstract and hypothetical thinking; moral reasoning |
Substance Abuse Screening
Medical assistants may use screening questionnaires to identify patients with substance use concerns:
- CAGE questionnaire: 4 questions about alcohol use (Cut down, Annoyed, Guilty, Eye-opener)
- AUDIT: Alcohol Use Disorders Identification Test (10 questions)
- PHQ-9: Patient Health Questionnaire for depression screening
- GAD-7: Generalized Anxiety Disorder 7-item scale
- Results should be documented and communicated to the provider
Pathophysiology of Common Conditions
Diabetes Mellitus
| Feature | Type 1 | Type 2 |
|---|---|---|
| Cause | Autoimmune destruction of beta cells | Insulin resistance + relative insulin deficiency |
| Onset | Usually childhood/adolescence | Usually adulthood (increasing in younger populations) |
| Body type | Usually thin | Often overweight/obese |
| Insulin | Always required | May require insulin, often managed with oral medications |
| Ketoacidosis | Common if untreated | Rare |
| Prevalence | 5-10% of diabetes cases | 90-95% of diabetes cases |
Hypertension
- Primary (essential): No identifiable cause; 90-95% of cases; managed with lifestyle changes and medication
- Secondary: Caused by another condition (kidney disease, endocrine disorders); treat the underlying cause
- Risk factors: Age, family history, obesity, high sodium diet, sedentary lifestyle, stress, smoking, excessive alcohol
Asthma
- Pathophysiology: Chronic airway inflammation → bronchospasm + mucus production → air trapping
- Triggers: Allergens, exercise, cold air, respiratory infections, stress, smoke
- Treatment: Quick-relief (albuterol inhaler) and long-term control (inhaled corticosteroids)
- Peak flow monitoring: Patients track PEFR to assess control (Green 80-100%, Yellow 50-80%, Red <50%)
Coronary Artery Disease (CAD)
- Pathophysiology: Atherosclerosis (plaque buildup) in coronary arteries → reduced blood flow to heart muscle
- Risk factors: Smoking, hypertension, high cholesterol, diabetes, obesity, family history, sedentary lifestyle
- Angina: Chest pain from reduced blood flow (stable vs. unstable)
- Myocardial infarction: Complete blockage → heart muscle death → medical emergency
Test Your Knowledge
Which DEA Schedule has the highest potential for abuse and no accepted medical use?
A
B
C
D
Test Your Knowledge
A physician writes a prescription with the abbreviation "bid." This means the medication should be taken:
A
B
C
D
Test Your Knowledge
The primary organ responsible for drug metabolism (biotransformation) is the:
A
B
C
D
Test Your Knowledge
A patient taking warfarin (Coumadin) should be counseled to limit intake of foods high in:
A
B
C
D
Test Your KnowledgeMulti-Select
Which of the following are included in the "seven rights" of medication administration? (Select all that apply)
Select all that apply
Right patient
Right cost
Right dose
Right documentation
Right insurance
Right reason
Test Your KnowledgeOrdering
Arrange the four phases of pharmacokinetics in the correct order:
Arrange the items in the correct order
1
Excretion
2
Distribution
3
Absorption
4
Metabolism
Test Your KnowledgeFill in the Blank
Fats provide ___ calories per gram, which is more than double the calories provided by carbohydrates or proteins.
Type your answer below
Test Your KnowledgeMatching
Match each drug classification to its primary purpose.
Match each item on the left with the correct item on the right
1
Antihypertensives
2
Bronchodilators
3
Anticoagulants
4
Statins
5
Diuretics
6
Proton pump inhibitors
Test Your Knowledge
A vitamin K deficiency would most likely result in which of the following conditions?
A
B
C
D
Test Your Knowledge
Type 2 diabetes mellitus is characterized by:
A
B
C
D
Test Your Knowledge
Which Schedule of controlled substance may be refilled with the prescriber's authorization?
A
B
C
D
Test Your Knowledge
A patient on a renal diet should restrict which of the following nutrients?
A
B
C
D
Test Your Knowledge
The autonomic nervous system division responsible for the "fight or flight" response is the:
A
B
C
D
Test Your KnowledgeMulti-Select
Which of the following are functions of the liver? (Select all that apply)
Select all that apply
Production of bile for fat digestion
Drug metabolism (biotransformation)
Production of insulin
Detoxification of harmful substances
Storage of glycogen
Production of clotting factors
Test Your KnowledgeMatching
Match each vitamin to the condition caused by its deficiency.
Match each item on the left with the correct item on the right
1
Vitamin A
2
Vitamin C
3
Vitamin D
4
Vitamin K
5
Vitamin B12
Test Your Knowledge
The medical term for difficulty swallowing is:
A
B
C
D