NR565 Advanced Pharm Midterm
Question and answers verified to pass
2025/2026
Which schedule drugs can APRNs prescribe? - correct answer ✔Schedule II-V
Prescriptive authority - correct answer ✔2 components
(1) the right to prescribe independently
(2) the right to prescribe without limitation
Physicians have full prescriptive authority. APPs are limited depending on state laws
Who determines and regulates prescriptive authority? - correct answer ✔State laws & State Board of
Nursing
How does limited prescriptive authority impact patients within the healthcare system? - correct answer
✔Limited prescriptive authority creates barriers to quality, affordable and accessible healthcare
Ex. Restrictions on the distance of the APP from the MD providing supervision/collaboration can prevent
outreach to areas of greatest need
Ex. Needing a MD co-signature can cause delays in care.
Ex. Currently we have a physician shortage, so less are able to oversee APPs
,What are the key responsibilities of prescribing? - correct answer ✔Protect patients from harm
Know MOA, safety, efficacy, and select right med/dose to maximize outcome and minimize adverse
effects
What should be used to make prescribing decisions? - correct answer ✔- Have a documented provider-
patient relationship
- Document H&P
- Discuss & document risk factors, side effects, and therapy options
- Document plan for monitoring and/or titration
- Consider cost, drug availability, and clinical practice guidelines
- Consider side effects, allergies, hepatic/renal function, need for monitoring, and lifespan
considerations
Elements of a prescription - correct answer ✔Prescriber name, license, contact info, and DEA (if
applicable)
Patient name, DOB, allergies
Medication name, indication, strength, dose, frequency, dispense quantity and number of refills
May be telephone, written, e-script, or refill
-Schedule II cannot be prescribed or refilled by phone
-Written scripts must be legible, in ink, no abbreviations, and never sign a blank script
-Not all DEA drugs can be e-prescribed
-With refills, consider monitoring needs
,Pharmacokinetics - correct answer ✔How the drug moves ("kinetic") through the body (absorption,
distribution, metabolism, excretion)
Absorption - Drug entering blood (ex. Absorbed from GI tract)
Distribution - Drug moving from blood to tissues/cells of liver, kidneys or other site
Metabolism - Drug-structure altered by enzymes
Excretion - Drugs & their metabolites move out of the body via bile or urine
Pharmacodynamics - correct answer ✔PharmacoDynamics
(What Drugs Do to the body)
MOA (interactions between drug and receptors or enzymes), dose, tolerance, dependence, interactions,
adverse effects; drugs affects individuals differently
Relates to agonists, antagonists
Agonists & Antagonists - correct answer ✔Agonists mimic the body's own regulatory molecules and
activate receptors. Ex. Dobutamine (drug) mimics norepinephrine at receptors on the heart, allowing it
to bind and cause the heart rate to increase.
Antagonists block the actions of regulating molecules. They do not activate receptors. Ex. Antihistamines
suppress allergy symptoms by binding to the receptors of histamine and preventing activation of these
receptors by histamine released in response to allergens.
, Pharmacokinetic changes in older adults - correct answer ✔Older adults have slower rates of
absorption and delayed gastric emptying, leading to delayed drug response.
Older adults have less total body water so drug concentration can increase, causing more intense
effects.
Older adults have a decreased ability to metabolize drugs in the liver. meaning they can stay in the body
longer and increase risk for toxicity.
Older adults also have declining renal function, which caused a decrease in excretion of drugs.
Drug dosages may need to be reduced to prevent toxicity.
Pharmacodynamic changes in older adults - correct answer ✔Limited information currently - think
RECEPTORS and AFFINITY
Ex. Beta blockers are less effective in older adults. Possible explanations: there are fewer beta receptors
OR the receptors have a lesser affinity for the blocking agents
Ex. Warfarin and CNS depressants produce more intense effects in older adults. Possible explanations:
there are more receptors OR the receptors have an increased affinity for the medication
What is Beer's Criteria and why is it important? - correct answer ✔Providers should avoid prescribing
drugs in Beer's Criteria to older adults unless the benefits outweigh the risks
Drugs on this list are likely to cause adverse effects in older adults
Ex. Benzodiazepines, Methocarbamol, PPIs for >8 weeks
Question and answers verified to pass
2025/2026
Which schedule drugs can APRNs prescribe? - correct answer ✔Schedule II-V
Prescriptive authority - correct answer ✔2 components
(1) the right to prescribe independently
(2) the right to prescribe without limitation
Physicians have full prescriptive authority. APPs are limited depending on state laws
Who determines and regulates prescriptive authority? - correct answer ✔State laws & State Board of
Nursing
How does limited prescriptive authority impact patients within the healthcare system? - correct answer
✔Limited prescriptive authority creates barriers to quality, affordable and accessible healthcare
Ex. Restrictions on the distance of the APP from the MD providing supervision/collaboration can prevent
outreach to areas of greatest need
Ex. Needing a MD co-signature can cause delays in care.
Ex. Currently we have a physician shortage, so less are able to oversee APPs
,What are the key responsibilities of prescribing? - correct answer ✔Protect patients from harm
Know MOA, safety, efficacy, and select right med/dose to maximize outcome and minimize adverse
effects
What should be used to make prescribing decisions? - correct answer ✔- Have a documented provider-
patient relationship
- Document H&P
- Discuss & document risk factors, side effects, and therapy options
- Document plan for monitoring and/or titration
- Consider cost, drug availability, and clinical practice guidelines
- Consider side effects, allergies, hepatic/renal function, need for monitoring, and lifespan
considerations
Elements of a prescription - correct answer ✔Prescriber name, license, contact info, and DEA (if
applicable)
Patient name, DOB, allergies
Medication name, indication, strength, dose, frequency, dispense quantity and number of refills
May be telephone, written, e-script, or refill
-Schedule II cannot be prescribed or refilled by phone
-Written scripts must be legible, in ink, no abbreviations, and never sign a blank script
-Not all DEA drugs can be e-prescribed
-With refills, consider monitoring needs
,Pharmacokinetics - correct answer ✔How the drug moves ("kinetic") through the body (absorption,
distribution, metabolism, excretion)
Absorption - Drug entering blood (ex. Absorbed from GI tract)
Distribution - Drug moving from blood to tissues/cells of liver, kidneys or other site
Metabolism - Drug-structure altered by enzymes
Excretion - Drugs & their metabolites move out of the body via bile or urine
Pharmacodynamics - correct answer ✔PharmacoDynamics
(What Drugs Do to the body)
MOA (interactions between drug and receptors or enzymes), dose, tolerance, dependence, interactions,
adverse effects; drugs affects individuals differently
Relates to agonists, antagonists
Agonists & Antagonists - correct answer ✔Agonists mimic the body's own regulatory molecules and
activate receptors. Ex. Dobutamine (drug) mimics norepinephrine at receptors on the heart, allowing it
to bind and cause the heart rate to increase.
Antagonists block the actions of regulating molecules. They do not activate receptors. Ex. Antihistamines
suppress allergy symptoms by binding to the receptors of histamine and preventing activation of these
receptors by histamine released in response to allergens.
, Pharmacokinetic changes in older adults - correct answer ✔Older adults have slower rates of
absorption and delayed gastric emptying, leading to delayed drug response.
Older adults have less total body water so drug concentration can increase, causing more intense
effects.
Older adults have a decreased ability to metabolize drugs in the liver. meaning they can stay in the body
longer and increase risk for toxicity.
Older adults also have declining renal function, which caused a decrease in excretion of drugs.
Drug dosages may need to be reduced to prevent toxicity.
Pharmacodynamic changes in older adults - correct answer ✔Limited information currently - think
RECEPTORS and AFFINITY
Ex. Beta blockers are less effective in older adults. Possible explanations: there are fewer beta receptors
OR the receptors have a lesser affinity for the blocking agents
Ex. Warfarin and CNS depressants produce more intense effects in older adults. Possible explanations:
there are more receptors OR the receptors have an increased affinity for the medication
What is Beer's Criteria and why is it important? - correct answer ✔Providers should avoid prescribing
drugs in Beer's Criteria to older adults unless the benefits outweigh the risks
Drugs on this list are likely to cause adverse effects in older adults
Ex. Benzodiazepines, Methocarbamol, PPIs for >8 weeks
