NUR 565 Midterm Exam Study Guide
] ] ] ] ] ] ]
(Latest 2026 UPDATED)-
] ]
Advanced Pharmacology Fundamental
] ]
s Questions with Correct Answers
] ] ] ]
APRN ]prescribing ]role ]- ]correct ]answer: ]Prescriptive ]authority ]for ]nurse ]practitioners ]also ]regulat
es ]prescribing ]rights ]beyond ]medications ]and ]controlled ]substances. ]These ]rights ]include ]therap
eutic ]devices ]and ]services ]and ]are ]outlined ]in ]state ]practice ]laws ]and ]regulations ]and ]include ]Du
rable ]Medical ]Equipment ]
(DME) ]such ]as ]wheelchairs, ]power ]scooters, ]hospital ]beds, ]portable ]oxygen ]equipment, ]handica
p ]placards, ]etc. ]and ]medical ]services ]such ]as ]Physical ]Therapy ](PT), ]Occupational ]Therapy ]
(OT), ]home ]health ]services, ]etc. ]Prescriptive ]authority ]encompasses ]more ]than ]writing ]a ]prescri
ption ]correctly. ]It ]requires ]adherence ]to ]ethical ]guidelines ]to ]ensure ]that ]patients ]are ]safeguard
ed ]from ]harm. ]Ethical ]prescribing ]starts ]with ]being ]well-
informed ]about ]medications. ]Mechanism ]of ]action, ]efficacy, ]and ]safety ]are ]important ]considera
tions, ]as ]are ]a ]patient's ]distinct ]needs ]and ]circumstances, ]including ]the ]number ]of ]medications ]
prescribed ]
(Mitchell ]& ]Oliphant, ]2016). ]Most ]patients ]receiving ]a ]prescription ]are ]taking ]other ]medications,
]whether ]prescription ]or ]over-the-
counter. ]Appropriate ]selection, ]dosing, ]and ]duration ]of ]pharmaceutical ]agents ]are ]key ]to ]maximi
zing ]outcomes ]and ]minimizing ]adverse ]effects
benefits ]of ]full ]practice ]authority ]- ]correct ]answer: ]Nurse ]practitioners ]have ]the ]autonomy ]to ]ev
aluate ]patients, ]diagnose, ]order ]and ]interpret ]tests, ]initiate ]and ]manage ]treatments ]and ]prescri
be ]medications, ]including ]controlled ]substances ]without ]physician ]oversight
promoting ]positive ]outcomes ]through ]prudent ]prescribing ]practices ]- ]correct ]answer: ]Administe
ring ]medications ]and ]prescribing ]medications ]are ]two ]distinct ]processes. ]Prescription ]writing ]re
quires ]prudent ]and ]deliberate ]decision-
making ]processes ]to ]maintain ]patient ]safety ]and ]reduce ]liability, ]including:
,*documentation ]of ]a ]provider-
patient ]relationship ]for ]the ]recipient ]of ]the ]prescribed ]medications
*documentation ]of ]a ]thorough ]history ]and ]physical ]examination ]for ]the ]recipient
*documentation ]of ]discussions ]regarding ]risk ]factors, ]side ]effects, ]or ]therapy ]options
*documentation ]of ]drug ]monitoring ]or ]titration ]plan, ]if ]applicable
*documentation ]of ]consultations, ]if ]any
avoidance ]of ]prescribing ]medications ]for ]self, ]family, ]or ]friends
Rational ]drug ]selection ]requires ]a ]logical ]approach ]that ]includes ]the ]formulation ]of ]a ]diagnosis ]b
ased ]on ]clinical ]reasoning ]and ]the ]selection ]and ]monitoring ]of ]the ]most ]appropriate ]pharmacol
ogical ]treatment ]
Considerations ]include: ]Cost, ]guidelines, ]availability, ]interactions, ]side ]effects, ]allergies, ]hepatic/
renal ]functions, ]need ]for ]monitoring, ]& ]special ]populations
Beer's ]Criteria ]- ]correct ]answer: ]identifies ]drugs ]with ]a ]high ]likelihood ]of ]causing ]adverse ]effects ]
in ]older ]adults. ]Accordingly, ]drugs ]on ]this ]list ]should ]generally ]be ]avoided ]in ]adults ]older ]than ]65
]years ]except ]when ]the ]benefits ]are ]significantly ]greater ]than ]the ]risks.
Pharmacodynamics ]- ]correct ]answer: ]the ]study ]of ]the ]biochemical ]and ]physiologic ]effects ]of ]dru
gs ]on ]the ]body ]and ]the ]molecular ]mechanisms ]by ]which ]those ]effects ]are ]produced
Pharmacokinetics ]- ]correct ]answer: ]the ]study ]of ]drug ]movement ]throughout ]the ]body
,Pharmacogenomics ]- ]correct ]answer: ]the ]study ]of ]how ]genes ]affect ]a ]person's ]response ]to ]drugs
. ]The ]purpose ]of ]this ]is ]to ]combine ]the ]sciences ]of ]genomics ]and ]pharmacology ]to ]provide ]indivi
dualized, ]targeted, ]safe ]drug ]therapies ]to ]patients
CYP450 ]inducers ]- ]correct ]answer: ]Inducers ]are ]xenobiotics ]
(medications ]and ]environmental ]agents) ]that ]elevate ]CYP450 ]enzyme ]activity ]by ]increasing ]enzy
me ]synthesis. ]This ]action ]leads ]to ]additional ]sites ]available ]for ]biotransformation. ]The ]increased ]
number ]of ]sites ]enhances ]medication ]metabolism, ]decreasing ]the ]concentration ]of ]the ]"parent ]
drug" ]while ]increasing ]metabolite ]production.
Inducers ]= ]Increase ]medication ]metabolism ]
(Carbamazepine, ]Rifampin, ]Alcohol, ]Phenytoin, ]Griseofulvin, ]Phenobarbital, ]Sulfonylureas)
CYP450 ]inhibitors ]- ]correct ]answer: ]Inhibitors ]are ]medications ]that ]inhibit ]the ]metabolic ]activity ]
of ]one ]or ]more ]of ]the ]CYP450 ]enzymes. ]Medications ]that ]inhibit ]an ]enzyme ]potentially ]slows ]th
at ]enzyme's ]activity ]or ]blocks ]the ]activity ]required ]for ]the ]metabolism ]of ]other ]medications, ]the
reby ]increasing ]the ]levels ]of ]medications ]dependent ]on ]that ]particular ]enzyme ]for ]biotransform
ation. ]Inhibitors ]= ]decrease ]medication ]metabolism ]
(Valproate, ]Isoniazid, ]Sulfonamides, ]Amiodarone, ]Chloramphenicol, ]Ketoconazole, ]Grapefruit ]Jui
ce, ]Quinidine)
cultural ]influences ]in ]prescribing ]- ]correct ]answer: ]The ]greatest ]concern ]surrounding ]race-
based ]therapy ]has ]to ]do ]with ]genetic ]variability. ]We ]know ]there ]is ]great ]diversity ]within ]and ]am
ong ]racial ]groups; ]therefore, ]a ]"one ]fits ]all" ]approach ]based ]on ]race ]is ]unwise. ]Still, ]we ]can ]use ]k
nown ]associations ]to ]guide ]choices. ]For ]example, ]differences ]in ]metabolism ]between ]people ]wit
h ]East ]Asian ]and ]European ]heritage ]are ]common. ]The ]provider ]can ]use ]this ]knowledge ]to ]guide ]i
nitial ]dosing ]
(with ]adjustment, ]as ]indicated ]based ]on ]response) ]if ]genetic ]testing ]is ]not ]feasible ]or ]warranted
Polypharmacy: ]Definition, ]challenges, ]and ]outcomes ]- ]correct ]answer: ]treatment ]with ]multiple ]d
rugs
, greatly ]increases ]the ]risk ]for ]interactions. ]Some ]of ]these ]interactions ]are ]negligible, ]but ]some ]ca
n ]have ]life-
threatening ]consequences. ]It ]is ]of ]crucial ]importance ]to ]ask ]the ]patient ]about ]all ]current ]drugs, ]i
ncluding ]over-the-counter ]
(OTC) ]medications ]and ]other ]herbal ]preparations. ]Many ]patients ]do ]not ]consider ]OTC ]or ]alterna
tive ]pharmaceuticals ]as ]"medications" ]and ]may ]not ]mention ]them ]unless ]you ]ask ]specifically.
Acute ]Pain ]Management ]- ]correct ]answer: ]
Chronic ]Pain ]Management ]- ]correct ]answer: ]
Opioid ]Management ]- ]correct ]answer: ]
Regulations ]of ]Controlled ]Substances ]- ]correct ]answer: ]The ]U.S. ]Department ]of ]Justice ]Drug ]Enfo
rcement ]Agency ]
(DEA) ]coordinates ]with ]local, ]state, ]and ]federal ]agents ]to ]reduce ]illicit ]drug ]use. ]The ]DEA ]enacte
d ]the ]Controlled ]Substances ]Act ]
(CSA) ]in ]1970 ]to ]regulate ]drugs ]and ]other ]substances ]based ]on ]their ]potential ]for ]abuse ]and ]dep
endency. ]Five ]schedules ]of ]controlled ]substances ]were ]created ]that ]are ]updated ]annually. ]Classe
s ]of ]scheduled ]substances ]include ]narcotics, ]depressants, ]stimulants, ]hallucinogens, ]and ]anaboli
c ]steroids. ]The ]DEA ]issues ]eligible ]providers ]with ]a ]registration ]number ]to ]write ]prescriptions ]for
]controlled ]substances. ]Characteristics ]of ]a ]valid ]DEA ]number ]include:
-
The ]first ]letter ]identifies ]the ]type ]of ]provider: ]A=before ]1985; ]B=after ]1985; ]F=after ]2007; ]M=nu
rse ]practitioner ]or ]physician ]assistant
-The ]2nd ]letter ]the ]1st ]letter ]of ]the ]provider's ]last ]name ]at ]the ]time ]of ]initial ]registration
Example: ]Tammy ]Greene ]applies ]for ]and ]receives ]a ]DEA ]number ]of ]MG2705208
M=nurse ]practitioner ]and ]G=Greene
] ] ] ] ] ] ]
(Latest 2026 UPDATED)-
] ]
Advanced Pharmacology Fundamental
] ]
s Questions with Correct Answers
] ] ] ]
APRN ]prescribing ]role ]- ]correct ]answer: ]Prescriptive ]authority ]for ]nurse ]practitioners ]also ]regulat
es ]prescribing ]rights ]beyond ]medications ]and ]controlled ]substances. ]These ]rights ]include ]therap
eutic ]devices ]and ]services ]and ]are ]outlined ]in ]state ]practice ]laws ]and ]regulations ]and ]include ]Du
rable ]Medical ]Equipment ]
(DME) ]such ]as ]wheelchairs, ]power ]scooters, ]hospital ]beds, ]portable ]oxygen ]equipment, ]handica
p ]placards, ]etc. ]and ]medical ]services ]such ]as ]Physical ]Therapy ](PT), ]Occupational ]Therapy ]
(OT), ]home ]health ]services, ]etc. ]Prescriptive ]authority ]encompasses ]more ]than ]writing ]a ]prescri
ption ]correctly. ]It ]requires ]adherence ]to ]ethical ]guidelines ]to ]ensure ]that ]patients ]are ]safeguard
ed ]from ]harm. ]Ethical ]prescribing ]starts ]with ]being ]well-
informed ]about ]medications. ]Mechanism ]of ]action, ]efficacy, ]and ]safety ]are ]important ]considera
tions, ]as ]are ]a ]patient's ]distinct ]needs ]and ]circumstances, ]including ]the ]number ]of ]medications ]
prescribed ]
(Mitchell ]& ]Oliphant, ]2016). ]Most ]patients ]receiving ]a ]prescription ]are ]taking ]other ]medications,
]whether ]prescription ]or ]over-the-
counter. ]Appropriate ]selection, ]dosing, ]and ]duration ]of ]pharmaceutical ]agents ]are ]key ]to ]maximi
zing ]outcomes ]and ]minimizing ]adverse ]effects
benefits ]of ]full ]practice ]authority ]- ]correct ]answer: ]Nurse ]practitioners ]have ]the ]autonomy ]to ]ev
aluate ]patients, ]diagnose, ]order ]and ]interpret ]tests, ]initiate ]and ]manage ]treatments ]and ]prescri
be ]medications, ]including ]controlled ]substances ]without ]physician ]oversight
promoting ]positive ]outcomes ]through ]prudent ]prescribing ]practices ]- ]correct ]answer: ]Administe
ring ]medications ]and ]prescribing ]medications ]are ]two ]distinct ]processes. ]Prescription ]writing ]re
quires ]prudent ]and ]deliberate ]decision-
making ]processes ]to ]maintain ]patient ]safety ]and ]reduce ]liability, ]including:
,*documentation ]of ]a ]provider-
patient ]relationship ]for ]the ]recipient ]of ]the ]prescribed ]medications
*documentation ]of ]a ]thorough ]history ]and ]physical ]examination ]for ]the ]recipient
*documentation ]of ]discussions ]regarding ]risk ]factors, ]side ]effects, ]or ]therapy ]options
*documentation ]of ]drug ]monitoring ]or ]titration ]plan, ]if ]applicable
*documentation ]of ]consultations, ]if ]any
avoidance ]of ]prescribing ]medications ]for ]self, ]family, ]or ]friends
Rational ]drug ]selection ]requires ]a ]logical ]approach ]that ]includes ]the ]formulation ]of ]a ]diagnosis ]b
ased ]on ]clinical ]reasoning ]and ]the ]selection ]and ]monitoring ]of ]the ]most ]appropriate ]pharmacol
ogical ]treatment ]
Considerations ]include: ]Cost, ]guidelines, ]availability, ]interactions, ]side ]effects, ]allergies, ]hepatic/
renal ]functions, ]need ]for ]monitoring, ]& ]special ]populations
Beer's ]Criteria ]- ]correct ]answer: ]identifies ]drugs ]with ]a ]high ]likelihood ]of ]causing ]adverse ]effects ]
in ]older ]adults. ]Accordingly, ]drugs ]on ]this ]list ]should ]generally ]be ]avoided ]in ]adults ]older ]than ]65
]years ]except ]when ]the ]benefits ]are ]significantly ]greater ]than ]the ]risks.
Pharmacodynamics ]- ]correct ]answer: ]the ]study ]of ]the ]biochemical ]and ]physiologic ]effects ]of ]dru
gs ]on ]the ]body ]and ]the ]molecular ]mechanisms ]by ]which ]those ]effects ]are ]produced
Pharmacokinetics ]- ]correct ]answer: ]the ]study ]of ]drug ]movement ]throughout ]the ]body
,Pharmacogenomics ]- ]correct ]answer: ]the ]study ]of ]how ]genes ]affect ]a ]person's ]response ]to ]drugs
. ]The ]purpose ]of ]this ]is ]to ]combine ]the ]sciences ]of ]genomics ]and ]pharmacology ]to ]provide ]indivi
dualized, ]targeted, ]safe ]drug ]therapies ]to ]patients
CYP450 ]inducers ]- ]correct ]answer: ]Inducers ]are ]xenobiotics ]
(medications ]and ]environmental ]agents) ]that ]elevate ]CYP450 ]enzyme ]activity ]by ]increasing ]enzy
me ]synthesis. ]This ]action ]leads ]to ]additional ]sites ]available ]for ]biotransformation. ]The ]increased ]
number ]of ]sites ]enhances ]medication ]metabolism, ]decreasing ]the ]concentration ]of ]the ]"parent ]
drug" ]while ]increasing ]metabolite ]production.
Inducers ]= ]Increase ]medication ]metabolism ]
(Carbamazepine, ]Rifampin, ]Alcohol, ]Phenytoin, ]Griseofulvin, ]Phenobarbital, ]Sulfonylureas)
CYP450 ]inhibitors ]- ]correct ]answer: ]Inhibitors ]are ]medications ]that ]inhibit ]the ]metabolic ]activity ]
of ]one ]or ]more ]of ]the ]CYP450 ]enzymes. ]Medications ]that ]inhibit ]an ]enzyme ]potentially ]slows ]th
at ]enzyme's ]activity ]or ]blocks ]the ]activity ]required ]for ]the ]metabolism ]of ]other ]medications, ]the
reby ]increasing ]the ]levels ]of ]medications ]dependent ]on ]that ]particular ]enzyme ]for ]biotransform
ation. ]Inhibitors ]= ]decrease ]medication ]metabolism ]
(Valproate, ]Isoniazid, ]Sulfonamides, ]Amiodarone, ]Chloramphenicol, ]Ketoconazole, ]Grapefruit ]Jui
ce, ]Quinidine)
cultural ]influences ]in ]prescribing ]- ]correct ]answer: ]The ]greatest ]concern ]surrounding ]race-
based ]therapy ]has ]to ]do ]with ]genetic ]variability. ]We ]know ]there ]is ]great ]diversity ]within ]and ]am
ong ]racial ]groups; ]therefore, ]a ]"one ]fits ]all" ]approach ]based ]on ]race ]is ]unwise. ]Still, ]we ]can ]use ]k
nown ]associations ]to ]guide ]choices. ]For ]example, ]differences ]in ]metabolism ]between ]people ]wit
h ]East ]Asian ]and ]European ]heritage ]are ]common. ]The ]provider ]can ]use ]this ]knowledge ]to ]guide ]i
nitial ]dosing ]
(with ]adjustment, ]as ]indicated ]based ]on ]response) ]if ]genetic ]testing ]is ]not ]feasible ]or ]warranted
Polypharmacy: ]Definition, ]challenges, ]and ]outcomes ]- ]correct ]answer: ]treatment ]with ]multiple ]d
rugs
, greatly ]increases ]the ]risk ]for ]interactions. ]Some ]of ]these ]interactions ]are ]negligible, ]but ]some ]ca
n ]have ]life-
threatening ]consequences. ]It ]is ]of ]crucial ]importance ]to ]ask ]the ]patient ]about ]all ]current ]drugs, ]i
ncluding ]over-the-counter ]
(OTC) ]medications ]and ]other ]herbal ]preparations. ]Many ]patients ]do ]not ]consider ]OTC ]or ]alterna
tive ]pharmaceuticals ]as ]"medications" ]and ]may ]not ]mention ]them ]unless ]you ]ask ]specifically.
Acute ]Pain ]Management ]- ]correct ]answer: ]
Chronic ]Pain ]Management ]- ]correct ]answer: ]
Opioid ]Management ]- ]correct ]answer: ]
Regulations ]of ]Controlled ]Substances ]- ]correct ]answer: ]The ]U.S. ]Department ]of ]Justice ]Drug ]Enfo
rcement ]Agency ]
(DEA) ]coordinates ]with ]local, ]state, ]and ]federal ]agents ]to ]reduce ]illicit ]drug ]use. ]The ]DEA ]enacte
d ]the ]Controlled ]Substances ]Act ]
(CSA) ]in ]1970 ]to ]regulate ]drugs ]and ]other ]substances ]based ]on ]their ]potential ]for ]abuse ]and ]dep
endency. ]Five ]schedules ]of ]controlled ]substances ]were ]created ]that ]are ]updated ]annually. ]Classe
s ]of ]scheduled ]substances ]include ]narcotics, ]depressants, ]stimulants, ]hallucinogens, ]and ]anaboli
c ]steroids. ]The ]DEA ]issues ]eligible ]providers ]with ]a ]registration ]number ]to ]write ]prescriptions ]for
]controlled ]substances. ]Characteristics ]of ]a ]valid ]DEA ]number ]include:
-
The ]first ]letter ]identifies ]the ]type ]of ]provider: ]A=before ]1985; ]B=after ]1985; ]F=after ]2007; ]M=nu
rse ]practitioner ]or ]physician ]assistant
-The ]2nd ]letter ]the ]1st ]letter ]of ]the ]provider's ]last ]name ]at ]the ]time ]of ]initial ]registration
Example: ]Tammy ]Greene ]applies ]for ]and ]receives ]a ]DEA ]number ]of ]MG2705208
M=nurse ]practitioner ]and ]G=Greene
