lOMoARcPSD| 63525276
NR 565 – Advanced Pharmacology Fundamentals
Exam Study Guide – Midterm Exam
Exam Format: Non-Cumulative exam
Question Type: Multiple Choice
Number of Questions: 100
Time Allotted: 120 minutes (1.2 minutes per question)
Testing Timeframe: The midterm exam will be available starting on Wednesday week #4 at 12:01 am
MT until Saturday week #4 at 11:59 pm MT.
1. Exam Coverage Content Areas:
● Week 1: Foundations in Pharmacology
● Week 2: Pharmacotherapy for Cardiovascular Conditions
● Week 3: Pharmacotherapy for Pain
● Week 4: Pharmacotherapy for Musculoskeletal and Rheumatologic Conditions
2. Key Concepts to Study
Week 1: Chapters 1–10 – Foundations in Pharmacology
● Prescriptive authority
○ Defined by state law and nurse practice acts ○
Determines:
■ Which drugs can be prescribed
■ Level of autonomy (independent vs collaborative) ○ APRNs
are accountable for:
■ Safe, ethical prescribing
■ Practicing within legal scope
○ Prescribing outside scope = legal and ethical violation
● Prescription writing
○ A valid prescription must include: ■
Patient name and identifiers
■ Drug name (generic preferred)
■ Dose, route, frequency
■ Quantity and refills
■ Prescriber name, credentials, signature ○ Types
of prescriptions:
■ Written
■ Electronic
■ Verbal (limited use)
● Prescribing considerations
○ Prescribing must consider:
, lOMoARcPSD| 63525276
○ Diagnosis and indication
○ Patient age, weight, comorbidities
○ Renal and hepatic function
○ Pregnancy and lactation status
○ Genetic variability
○ Cost and adherence
● Medication education
○ Patient education includes:
■ Purpose of medication
■ How and when to take it
■ Expected benefits
■ Common adverse effects
■ When to seek medical attention
■ Importance of adherence
○ Education improves outcomes and reduces errors.
● Drug absorption
○ Entry of drug into bloodstream ○
Influenced by:
■ Route of administration
■ Blood flow
■ GI motility and pH
○ First-pass metabolism reduces oral bioavailability
■ How First-Pass Metabolism Reduces Bioavailability
● Bioavailability = the fraction of administered drug that reaches systemic
circulation unchanged.
● If a large portion of the drug is metabolized in the liver
● Less active drug is available to produce therapeutic effects
● Exam wording: Extensive first-pass metabolism = low oral bioavailability
■ First-pass metabolism does NOT:
● Increase drug effect
● Occur with IV drugs
● Affect distribution directly
● Drug distribution
○ Movement from blood to tissues ○
Influenced by:
■ Plasma protein binding
■ Tissue perfusion
■ Body fat and water
○ Only unbound drug is active ● Drug
metabolism
, lOMoARcPSD| 63525276
○ Primarily hepatic ○
Converts drugs to:
■ Inactive metabolites
■ Active metabolites ○
Influenced by:
■ Genetics
■ Age
■ Disease
■ Drug interactions
● Renal drug excretion
○ Primary route of elimination ○ Reduced renal function leads to: ■ Drug accumulation
■ Increased adverse effects
○ Dose adjustment often required
● Agonists and antagonists
○ Agonists: activate receptors
○ Antagonists: block receptors
○ Partial agonists: weaker activation ○ Key
properties: ■ Affinity
■ Efficacy
■ Potency
● Drug interactions
○ Types:
■ Pharmacokinetic (absorption, metabolism, excretion) ■
Pharmacodynamic (additive, synergistic, antagonistic) ○ Polypharmacy
greatly increases risk.
● Hepatic drug metabolism
○ Cytochrome P450 enzyme system
○ Inducers ↓ drug levels
○ Inhibitors ↑ drug levels
○ Liver disease reduces clearance → toxicity risk
● Half-life
○ Time required for drug level to decrease by 50% ○ Determines:
■ Dosing frequency
■ Time to steady state
○ Longer half-life = accumulation risk
● Ways to minimize adverse drug reactions ○ Use lowest effective dose
○ Adjust for renal/hepatic impairment
○ Avoid unnecessary polypharmacy ○
Monitor labs and clinical response
○ Educate patients
NR 565 – Advanced Pharmacology Fundamentals
Exam Study Guide – Midterm Exam
Exam Format: Non-Cumulative exam
Question Type: Multiple Choice
Number of Questions: 100
Time Allotted: 120 minutes (1.2 minutes per question)
Testing Timeframe: The midterm exam will be available starting on Wednesday week #4 at 12:01 am
MT until Saturday week #4 at 11:59 pm MT.
1. Exam Coverage Content Areas:
● Week 1: Foundations in Pharmacology
● Week 2: Pharmacotherapy for Cardiovascular Conditions
● Week 3: Pharmacotherapy for Pain
● Week 4: Pharmacotherapy for Musculoskeletal and Rheumatologic Conditions
2. Key Concepts to Study
Week 1: Chapters 1–10 – Foundations in Pharmacology
● Prescriptive authority
○ Defined by state law and nurse practice acts ○
Determines:
■ Which drugs can be prescribed
■ Level of autonomy (independent vs collaborative) ○ APRNs
are accountable for:
■ Safe, ethical prescribing
■ Practicing within legal scope
○ Prescribing outside scope = legal and ethical violation
● Prescription writing
○ A valid prescription must include: ■
Patient name and identifiers
■ Drug name (generic preferred)
■ Dose, route, frequency
■ Quantity and refills
■ Prescriber name, credentials, signature ○ Types
of prescriptions:
■ Written
■ Electronic
■ Verbal (limited use)
● Prescribing considerations
○ Prescribing must consider:
, lOMoARcPSD| 63525276
○ Diagnosis and indication
○ Patient age, weight, comorbidities
○ Renal and hepatic function
○ Pregnancy and lactation status
○ Genetic variability
○ Cost and adherence
● Medication education
○ Patient education includes:
■ Purpose of medication
■ How and when to take it
■ Expected benefits
■ Common adverse effects
■ When to seek medical attention
■ Importance of adherence
○ Education improves outcomes and reduces errors.
● Drug absorption
○ Entry of drug into bloodstream ○
Influenced by:
■ Route of administration
■ Blood flow
■ GI motility and pH
○ First-pass metabolism reduces oral bioavailability
■ How First-Pass Metabolism Reduces Bioavailability
● Bioavailability = the fraction of administered drug that reaches systemic
circulation unchanged.
● If a large portion of the drug is metabolized in the liver
● Less active drug is available to produce therapeutic effects
● Exam wording: Extensive first-pass metabolism = low oral bioavailability
■ First-pass metabolism does NOT:
● Increase drug effect
● Occur with IV drugs
● Affect distribution directly
● Drug distribution
○ Movement from blood to tissues ○
Influenced by:
■ Plasma protein binding
■ Tissue perfusion
■ Body fat and water
○ Only unbound drug is active ● Drug
metabolism
, lOMoARcPSD| 63525276
○ Primarily hepatic ○
Converts drugs to:
■ Inactive metabolites
■ Active metabolites ○
Influenced by:
■ Genetics
■ Age
■ Disease
■ Drug interactions
● Renal drug excretion
○ Primary route of elimination ○ Reduced renal function leads to: ■ Drug accumulation
■ Increased adverse effects
○ Dose adjustment often required
● Agonists and antagonists
○ Agonists: activate receptors
○ Antagonists: block receptors
○ Partial agonists: weaker activation ○ Key
properties: ■ Affinity
■ Efficacy
■ Potency
● Drug interactions
○ Types:
■ Pharmacokinetic (absorption, metabolism, excretion) ■
Pharmacodynamic (additive, synergistic, antagonistic) ○ Polypharmacy
greatly increases risk.
● Hepatic drug metabolism
○ Cytochrome P450 enzyme system
○ Inducers ↓ drug levels
○ Inhibitors ↑ drug levels
○ Liver disease reduces clearance → toxicity risk
● Half-life
○ Time required for drug level to decrease by 50% ○ Determines:
■ Dosing frequency
■ Time to steady state
○ Longer half-life = accumulation risk
● Ways to minimize adverse drug reactions ○ Use lowest effective dose
○ Adjust for renal/hepatic impairment
○ Avoid unnecessary polypharmacy ○
Monitor labs and clinical response
○ Educate patients
