NR565 / NR 565 MIDTERM EXAM STUDY GUIDE
(LATEST 2026 UPDATED): ADVANCED
PHARMACOLOGY FUNDAMENTALS –
CHAMBERLAIN
1. APRN prescribing role - ANSWER-Prescriptive authority for nurse
practitioners also regulates prescribing rights beyond medications and
controlled substances. These rights include therapeutic devices and
services and are outlined in state practice laws and regulations and
include Durable Medical Equipment (DME) such as wheelchairs, power
scooters, hospital beds, portable oxygen equipment, handicap placards,
etc. and medical services such as Physical Therapy (PT), Occupational
Therapy (OT), home health services, etc. Prescriptive authority
encompasses more than writing a prescription correctly. It requires
adherence to ethical guidelines to ensure that patients are safeguarded
from harm. Ethical prescribing starts with being well-informed about
medications. Mechanism of action, efficacy, and safety are important
considerations, 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
maximizing outcomes and minimizing adverse effects
2. benefits of full practice authority - ANSWER-Nurse practitioners have the
autonomy to evaluate patients, diagnose, order and interpret tests,
initiate and manage treatments and prescribe medications, including
controlled substances without physician oversight
,3. promoting positive outcomes through prudent prescribing practices -
ANSWER-Administering medications and prescribing medications are two
distinct processes. Prescription writing requires 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 based on clinical reasoning and the selection and
monitoring of the most appropriate pharmacological treatment
,Considerations include: Cost, guidelines, availability, interactions, side
effects, allergies, hepatic/renal functions, need for monitoring, & special
populations
4. Beer's Criteria - 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.
5. Pharmacodynamics - ANSWER-the study of the biochemical and
physiologic effects of drugs on the body and the molecular mechanisms
by which those effects are produced
6. Pharmacokinetics - ANSWER-the study of drug movement throughout the
body
7. Pharmacogenomics - 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 individualized, targeted, safe
drug therapies to patients
8. CYP450 inducers - ANSWER-Inducers are xenobiotics (medications and
environmental agents) that elevate CYP450 enzyme activity by increasing
enzyme 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.
, 9. Inducers = Increase medication metabolism
10.(Carbamazepine, Rifampin, Alcohol, Phenytoin, Griseofulvin,
Phenobarbital, Sulfonylureas)
11.CYP450 inhibitors - ANSWER-Inhibitors are medications that inhibit the
metabolic activity of one or more of the CYP450 enzymes. Medications
that inhibit an enzyme potentially slows that enzyme's activity or blocks
the activity required for the metabolism of other medications, thereby
increasing the levels of medications dependent on that particular enzyme
for biotransformation. Inhibitors = decrease medication metabolism
(Valproate, Isoniazid, Sulfonamides, Amiodarone, Chloramphenicol,
Ketoconazole, Grapefruit Juice, Quinidine)
12.cultural influences in prescribing - ANSWER-The greatest concern
surrounding race-based therapy has to do with genetic variability. We
know there is great diversity within and among racial groups; therefore, a
"one fits all" approach based on race is unwise. Still, we can use known
associations to guide choices. For example, differences in metabolism
between people with East Asian and European heritage are common. The
provider can use this knowledge to guide initial dosing (with adjustment,
as indicated based on response) if genetic testing is not feasible or
warranted
13.Polypharmacy: Definition, challenges, and outcomes - ANSWER-
treatment with multiple drugs
(LATEST 2026 UPDATED): ADVANCED
PHARMACOLOGY FUNDAMENTALS –
CHAMBERLAIN
1. APRN prescribing role - ANSWER-Prescriptive authority for nurse
practitioners also regulates prescribing rights beyond medications and
controlled substances. These rights include therapeutic devices and
services and are outlined in state practice laws and regulations and
include Durable Medical Equipment (DME) such as wheelchairs, power
scooters, hospital beds, portable oxygen equipment, handicap placards,
etc. and medical services such as Physical Therapy (PT), Occupational
Therapy (OT), home health services, etc. Prescriptive authority
encompasses more than writing a prescription correctly. It requires
adherence to ethical guidelines to ensure that patients are safeguarded
from harm. Ethical prescribing starts with being well-informed about
medications. Mechanism of action, efficacy, and safety are important
considerations, 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
maximizing outcomes and minimizing adverse effects
2. benefits of full practice authority - ANSWER-Nurse practitioners have the
autonomy to evaluate patients, diagnose, order and interpret tests,
initiate and manage treatments and prescribe medications, including
controlled substances without physician oversight
,3. promoting positive outcomes through prudent prescribing practices -
ANSWER-Administering medications and prescribing medications are two
distinct processes. Prescription writing requires 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 based on clinical reasoning and the selection and
monitoring of the most appropriate pharmacological treatment
,Considerations include: Cost, guidelines, availability, interactions, side
effects, allergies, hepatic/renal functions, need for monitoring, & special
populations
4. Beer's Criteria - 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.
5. Pharmacodynamics - ANSWER-the study of the biochemical and
physiologic effects of drugs on the body and the molecular mechanisms
by which those effects are produced
6. Pharmacokinetics - ANSWER-the study of drug movement throughout the
body
7. Pharmacogenomics - 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 individualized, targeted, safe
drug therapies to patients
8. CYP450 inducers - ANSWER-Inducers are xenobiotics (medications and
environmental agents) that elevate CYP450 enzyme activity by increasing
enzyme 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.
, 9. Inducers = Increase medication metabolism
10.(Carbamazepine, Rifampin, Alcohol, Phenytoin, Griseofulvin,
Phenobarbital, Sulfonylureas)
11.CYP450 inhibitors - ANSWER-Inhibitors are medications that inhibit the
metabolic activity of one or more of the CYP450 enzymes. Medications
that inhibit an enzyme potentially slows that enzyme's activity or blocks
the activity required for the metabolism of other medications, thereby
increasing the levels of medications dependent on that particular enzyme
for biotransformation. Inhibitors = decrease medication metabolism
(Valproate, Isoniazid, Sulfonamides, Amiodarone, Chloramphenicol,
Ketoconazole, Grapefruit Juice, Quinidine)
12.cultural influences in prescribing - ANSWER-The greatest concern
surrounding race-based therapy has to do with genetic variability. We
know there is great diversity within and among racial groups; therefore, a
"one fits all" approach based on race is unwise. Still, we can use known
associations to guide choices. For example, differences in metabolism
between people with East Asian and European heritage are common. The
provider can use this knowledge to guide initial dosing (with adjustment,
as indicated based on response) if genetic testing is not feasible or
warranted
13.Polypharmacy: Definition, challenges, and outcomes - ANSWER-
treatment with multiple drugs
