______________________________________
NR 565
ADVANCED PHARMACOLOGY
FUNDAMENTALS
MIDTERM STUDY GUIDE
(WEEK 1 – 4)
(AT CHAMBERLAIN COLLEGE OF NURSING)
EXAM- QUESTIONS & (UPDATED)
ANSWERS
EXAM COVER SHEET
COURSE NAME: NR 565 – Advanced Pharmacology Fundamentals
EXAM NAME: NR 565 Advanced Pharmacology Fundamentals Midterm
ExamStudy Guide
PROGRAM: Nursing
KEY TOPICS & EXAM PREPARATION STRATEGIES
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, NR565 Midterm Study Guide
This study guide covers content for the question bank for this course. There are 100 questions on
the exam and more content in the exam study bank than will be seen on any given exam.
Therefore, you may note more than 100 topic items noted in this study guide. However, there
may also be more than one question for a topic listed so you should know each one well. Some
items listed are more specific than others. If the item listed seems vague, if it’s a more general
question and to be more specific would be to risk the integrity of the question itself.
Number of Questions on Exam: 100
Styles of Questions of Exam: Multiple Choice Only
Knowledge Levels: Various (remember, understand, apply)
Time Limit: 150 minutes
Number of Attempts: 1
Platform Used for Exam: ExamSoft/Examplify
Exam Expectations: Review Exam Expectations in Course
Announcements
Tips on Using this Study Guide
1. Review the topics each week to take notes as you move through the course and focus
your reading and content review in the course.
2. You can make notes directly on each tab for the respective week or print out and hand
write your notes.
3. If you choose to print, you will want to adjust the size of columns so the table width will fit
on a printed page.
4. Re-write your notes if you type them to connect the content to your memory more readily
as the activity of writing and saying it again as you write it creates repetition that helps
commit the content to memory.
5. Create your own practice questions that are clinical scenario based to move the content
from a memorization (Remember) level of learning to an application type of learning. Much
of your exam will be at the application level so it's not enough to memorize your notes.
6. Review your study guide and notes as often as you can. Read them out loud so you hear
the words externally as well as internally. The more senses you can engage while studying,
the more likely you are to remember it.
messages.downloaded_by
, Week One
Section I.01 Chapter 1
1. State laws impact on prescriptive authority
o Prescriptive Authority is the legal right to prescribe drugs
o Prescriptive authority is determined by state law
o Regulation of prescriptive authority is under jurisdiction of a health professional
board (Ex: State Board of Nursing)
o Two components of prescriptive authority:
▪ Right to prescribe independently
▪ Right to prescribe without limitation (dependent upon contract)
2. Full Practice Authority
o Depends on their legal right to prescribe without a supervisory or collaborative
requirement
3. Role: Prescriptive Authority
o Affords the legal right to prescribe independently and without limitation.
Section I.02 Chapter 2
1. Assessing Drug Interactions
o Polypharmacy increases the risk for interactions
▪ Adverse drug reactions are 7x more prevalent in older adults and contribute
to 16% of all hospitalizations and half of all medication related fatalities.
o Always check for interactions when adding new medications
o Ask patients about side effects after initiating, stopping, or changing dosages
o Risk vs Benefit
2. Prescription Writing
o Ethical prescribing requires informed decision making, considering drug
interactions, side effects, and individual needs of the patient
o Off label prescribing means it is not approved by FDA
o Only 50% of patients take their medications as prescribed.
Section I.03 Chapter 3
1. Generic vs Brand Name: Value of Knowing
o Knowing the generic name of your medication empowers the patient to catch
medication errors in the event that two different prescribers prescribe the same
generic drug name under different brand names
o Knowing the reason the medication is prescribed helps the patient to follow
messages.downloaded_by
, through with the medication plan because the patient is aware that this action
helps achieve the therapeutic goal.
2. Duration of Therapy
o Duration of therapy: short term vs long term therapy (abx vs thyroid meds)
o Failure to recognize the need for prolonged therapy is a common reason patients
stop medications prematurely when a prescription runs out
3. Role of Formularies
o Every facility and pharmacy provide drugs according to a formulary
o A formulary is a list of prescription medications that a health insurance plan
covers
o Formularies are selected by a panel of pharmacists and providers and may be
subject to following guidelines created by regulatory agencies (Ex: Centers for
Medicare and Medicaid Services (CMS))
o Often there are substitutes or similar medications you can order in place of what
you originally intended.
o Formularies ensure patients receive the safest and most effective medications at
a reasonable cost
4. Blood Flow Impact on Absorption
o More blood flow can help the body absorb medication faster and more effectively.
messages.downloaded_by
,Section I.04 Chapter 4
Pharmacokinetics: Study of drug movement throughout the body
Pharmacokinetics
o Study of drug movement throughout the body
o 4 Processes: Absorption, Distribution, Metabolism, and Excretion
Pharmacodynamics
o Describes how drugs influence the response in the body at the site of action
4. Absorption Process
o The process in which a drug moves from administration site into the blood stream.
Determines how quickly a drug enters the blood stream.
o Two other terms associated with absorption are chemical equivalence and
bioavailability.
o Factors affecting Absorption:
▪ Rate of Dissolution of the Drug
▪ Before a drug can be absorbed it must first dissolve. The rate of
dissolution helps determine the rate of absorption.
▪ Different formularies: immediate release IR, extended-release ER
▪ Surface Area
▪ Larger surface area = faster absorption
▪ Absorption of oral drugs is greater in the small intestine than in
stomach because the surface area is larger in the small intestine
compared to the stomach.
▪ Microvilli in small intestine leads to extremely large surface area
▪ Blood Flow
▪ Drugs are absorbed more rapidly from sites where blood flow is high
because blood containing a newly absorbed drug will be replaced
rapidly by drug-free blood, thereby maintaining a large gradient
between the concentration of drug outside the blood and the
concentration of drug in the blood.
▪ The greater the concentration gradient, the more rapid absorption
will be” p.15
▪ Lipid Solubility
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, ▪ Highly lipid soluble drugs = faster absorption
▪ This occurs because lipid-soluble drugs can readily cross the
membranes that separate them from the blood, whereas drugs of
low lipid solubility cannot.
▪ pH Partitioning
▪ Absorption is enhanced when the difference between pH of plasma
and the pH at site of administration is such that drug molecules will
have a greater tendency to be ionized in the plasma
5. Distribution Process
o The movement of drugs from the systemic circulation (blood) to the interstitial
space of tissues and from there into the cells (site of drug action)
o Distribution is affected by three major factors: blood flow to tissues, ability of a
drug to exit the vascular system and ability of drug to enter cells.
6. Metabolism Process
o The enzymatic alteration of the drug structure
o Most commonly taking place in the liver, using cytochrome CYP450 enzymes
(group of 12 enzyme families) to convert the drug into metabolites
o Factors Affecting Metabolism:
▪ Age
• Limited in infants
• Liver not fully developed to metabolize drugs until 1 year
• Older adults have depressed metabolism leading to risk for drug
toxicity
▪ Induction and Inhibition of Drug-Metabolizing Enzymes
• Drugs that increase the rate of metabolism are called inducers
• Inducers act on the liver to stimulate enzyme synthesis called
Induction
• Increased rate of metabolism = the active drug amount is decreased
and plasma drug level fall. Dose adjustments need to be made to
achieve therapeutic levels
• Drugs that decrease the rate of metabolism are called inhibitors
and can lead to toxic drug levels in the blood
▪ First-Pass Effect
• First pass effect refers to the rapid hepatic inactivation of certain oral
drugs.
• Drug can be completely inactivated on its first pass through the liver,
therefore no therapeutic effect can occur
▪ Nutritional Status
▪ Competition Between Multiple Drugs
• When two drugs are metabolized by the same pathway, they may
compete for metabolism
• This leads to a decrease in the rate at one or both drugs are
metabolized
• If the metabolism is depressed enough, a drug can accumulate to
messages.downloaded_by
NR 565
ADVANCED PHARMACOLOGY
FUNDAMENTALS
MIDTERM STUDY GUIDE
(WEEK 1 – 4)
(AT CHAMBERLAIN COLLEGE OF NURSING)
EXAM- QUESTIONS & (UPDATED)
ANSWERS
EXAM COVER SHEET
COURSE NAME: NR 565 – Advanced Pharmacology Fundamentals
EXAM NAME: NR 565 Advanced Pharmacology Fundamentals Midterm
ExamStudy Guide
PROGRAM: Nursing
KEY TOPICS & EXAM PREPARATION STRATEGIES
messages.downloaded_by
, NR565 Midterm Study Guide
This study guide covers content for the question bank for this course. There are 100 questions on
the exam and more content in the exam study bank than will be seen on any given exam.
Therefore, you may note more than 100 topic items noted in this study guide. However, there
may also be more than one question for a topic listed so you should know each one well. Some
items listed are more specific than others. If the item listed seems vague, if it’s a more general
question and to be more specific would be to risk the integrity of the question itself.
Number of Questions on Exam: 100
Styles of Questions of Exam: Multiple Choice Only
Knowledge Levels: Various (remember, understand, apply)
Time Limit: 150 minutes
Number of Attempts: 1
Platform Used for Exam: ExamSoft/Examplify
Exam Expectations: Review Exam Expectations in Course
Announcements
Tips on Using this Study Guide
1. Review the topics each week to take notes as you move through the course and focus
your reading and content review in the course.
2. You can make notes directly on each tab for the respective week or print out and hand
write your notes.
3. If you choose to print, you will want to adjust the size of columns so the table width will fit
on a printed page.
4. Re-write your notes if you type them to connect the content to your memory more readily
as the activity of writing and saying it again as you write it creates repetition that helps
commit the content to memory.
5. Create your own practice questions that are clinical scenario based to move the content
from a memorization (Remember) level of learning to an application type of learning. Much
of your exam will be at the application level so it's not enough to memorize your notes.
6. Review your study guide and notes as often as you can. Read them out loud so you hear
the words externally as well as internally. The more senses you can engage while studying,
the more likely you are to remember it.
messages.downloaded_by
, Week One
Section I.01 Chapter 1
1. State laws impact on prescriptive authority
o Prescriptive Authority is the legal right to prescribe drugs
o Prescriptive authority is determined by state law
o Regulation of prescriptive authority is under jurisdiction of a health professional
board (Ex: State Board of Nursing)
o Two components of prescriptive authority:
▪ Right to prescribe independently
▪ Right to prescribe without limitation (dependent upon contract)
2. Full Practice Authority
o Depends on their legal right to prescribe without a supervisory or collaborative
requirement
3. Role: Prescriptive Authority
o Affords the legal right to prescribe independently and without limitation.
Section I.02 Chapter 2
1. Assessing Drug Interactions
o Polypharmacy increases the risk for interactions
▪ Adverse drug reactions are 7x more prevalent in older adults and contribute
to 16% of all hospitalizations and half of all medication related fatalities.
o Always check for interactions when adding new medications
o Ask patients about side effects after initiating, stopping, or changing dosages
o Risk vs Benefit
2. Prescription Writing
o Ethical prescribing requires informed decision making, considering drug
interactions, side effects, and individual needs of the patient
o Off label prescribing means it is not approved by FDA
o Only 50% of patients take their medications as prescribed.
Section I.03 Chapter 3
1. Generic vs Brand Name: Value of Knowing
o Knowing the generic name of your medication empowers the patient to catch
medication errors in the event that two different prescribers prescribe the same
generic drug name under different brand names
o Knowing the reason the medication is prescribed helps the patient to follow
messages.downloaded_by
, through with the medication plan because the patient is aware that this action
helps achieve the therapeutic goal.
2. Duration of Therapy
o Duration of therapy: short term vs long term therapy (abx vs thyroid meds)
o Failure to recognize the need for prolonged therapy is a common reason patients
stop medications prematurely when a prescription runs out
3. Role of Formularies
o Every facility and pharmacy provide drugs according to a formulary
o A formulary is a list of prescription medications that a health insurance plan
covers
o Formularies are selected by a panel of pharmacists and providers and may be
subject to following guidelines created by regulatory agencies (Ex: Centers for
Medicare and Medicaid Services (CMS))
o Often there are substitutes or similar medications you can order in place of what
you originally intended.
o Formularies ensure patients receive the safest and most effective medications at
a reasonable cost
4. Blood Flow Impact on Absorption
o More blood flow can help the body absorb medication faster and more effectively.
messages.downloaded_by
,Section I.04 Chapter 4
Pharmacokinetics: Study of drug movement throughout the body
Pharmacokinetics
o Study of drug movement throughout the body
o 4 Processes: Absorption, Distribution, Metabolism, and Excretion
Pharmacodynamics
o Describes how drugs influence the response in the body at the site of action
4. Absorption Process
o The process in which a drug moves from administration site into the blood stream.
Determines how quickly a drug enters the blood stream.
o Two other terms associated with absorption are chemical equivalence and
bioavailability.
o Factors affecting Absorption:
▪ Rate of Dissolution of the Drug
▪ Before a drug can be absorbed it must first dissolve. The rate of
dissolution helps determine the rate of absorption.
▪ Different formularies: immediate release IR, extended-release ER
▪ Surface Area
▪ Larger surface area = faster absorption
▪ Absorption of oral drugs is greater in the small intestine than in
stomach because the surface area is larger in the small intestine
compared to the stomach.
▪ Microvilli in small intestine leads to extremely large surface area
▪ Blood Flow
▪ Drugs are absorbed more rapidly from sites where blood flow is high
because blood containing a newly absorbed drug will be replaced
rapidly by drug-free blood, thereby maintaining a large gradient
between the concentration of drug outside the blood and the
concentration of drug in the blood.
▪ The greater the concentration gradient, the more rapid absorption
will be” p.15
▪ Lipid Solubility
messages.downloaded_by
, ▪ Highly lipid soluble drugs = faster absorption
▪ This occurs because lipid-soluble drugs can readily cross the
membranes that separate them from the blood, whereas drugs of
low lipid solubility cannot.
▪ pH Partitioning
▪ Absorption is enhanced when the difference between pH of plasma
and the pH at site of administration is such that drug molecules will
have a greater tendency to be ionized in the plasma
5. Distribution Process
o The movement of drugs from the systemic circulation (blood) to the interstitial
space of tissues and from there into the cells (site of drug action)
o Distribution is affected by three major factors: blood flow to tissues, ability of a
drug to exit the vascular system and ability of drug to enter cells.
6. Metabolism Process
o The enzymatic alteration of the drug structure
o Most commonly taking place in the liver, using cytochrome CYP450 enzymes
(group of 12 enzyme families) to convert the drug into metabolites
o Factors Affecting Metabolism:
▪ Age
• Limited in infants
• Liver not fully developed to metabolize drugs until 1 year
• Older adults have depressed metabolism leading to risk for drug
toxicity
▪ Induction and Inhibition of Drug-Metabolizing Enzymes
• Drugs that increase the rate of metabolism are called inducers
• Inducers act on the liver to stimulate enzyme synthesis called
Induction
• Increased rate of metabolism = the active drug amount is decreased
and plasma drug level fall. Dose adjustments need to be made to
achieve therapeutic levels
• Drugs that decrease the rate of metabolism are called inhibitors
and can lead to toxic drug levels in the blood
▪ First-Pass Effect
• First pass effect refers to the rapid hepatic inactivation of certain oral
drugs.
• Drug can be completely inactivated on its first pass through the liver,
therefore no therapeutic effect can occur
▪ Nutritional Status
▪ Competition Between Multiple Drugs
• When two drugs are metabolized by the same pathway, they may
compete for metabolism
• This leads to a decrease in the rate at one or both drugs are
metabolized
• If the metabolism is depressed enough, a drug can accumulate to
messages.downloaded_by
