NR565 Midterm Study Guide 2026 | Key
Topics, Pharmacology Review & Exam
Prep Strategies | Practice Questions
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
,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
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
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.
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
,Pharmacokinetics - ✔✔ANSWER✔✔->>the study of drug movement throughout the body
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
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.
Inducers = Increase medication metabolism
(Carbamazepine, Rifampin, Alcohol, Phenytoin, Griseofulvin, Phenobarbital, Sulfonylureas)
Beta-blockers - ✔✔ANSWER✔✔->>β blockers (e.g., propranolol, metoprolol) are first-line drugs
for angina of effort, but are not effective against vasospastic angina
β blockers should not be used by patients with sick sinus syndrome, heart failure, or second-degree or
third-degree AV block.
β blockers reduce anginal pain primarily by decreasing cardiac oxygen demand, principally through
blockade of β1 receptors in the heart, which decreases heart rate and contractility.
β blockers should be used with caution by patients with asthma. If an asthmatic individual absolutely
must use a β blocker, a β1-selective agent (e.g., metoprolol) should be chosen. β blockers can mask signs
of hypoglycemia and therefore must be used with caution in patients with diabetes.
When starting or restarting sotalol, patients should be in a facility that can provide continuous
electrocardiogram monitoring and cardiopulmonary resuscitation for a minimum of 3 days to minimize
problems associated with induced arrhythmia.
Creatinine clearance should be established before initiating this drug.
Betapace cannot be substituted for Betapace AF when treating atrial fibrillation.
, Therapeutic Goal: Principal indications are hypertension, angina pectoris, heart failure, and cardiac
dysrhythmias. Indications for individual agents are shown in Table 16.5.
Baseline Data: Heart rate, blood pressure (supine, sitting, and standing depending on patient status),
ECG (if indicated by patient age and status), and general cardiovascular status
Monitoring: Heart rate, blood pressure, evaluation for adverse effects (with symptom-focused
assessment if indicated). Advise patients to record the incidence, circumstances, and severity of any
symptoms that may indicate inadequate control of symptoms for which the drug is given (e.g., angina)
or a new onset of adverse effects.
Identifying High-Risk Pat
Calcium Channel Blockers - ✔✔ANSWER✔✔->>The CCBs used most frequently are verapamil,
diltiazem, and nifedipine (a dihydropyridine-type calcium channel blocker). Accordingly, our discussion
focuses on these three drugs. All three can block calcium channels in VSM, primarily in arterioles.
Verapamil and Diltiazem
Therapeutic Goal: Verapamil and diltiazem are indicated for hypertension, angina, and cardiac
dysrhythmias.
Baseline Data: Determine blood pressure and pulse rate and obtain laboratory evaluations of liver and
kidney function.
Monitoring: No routine blood monitoring required.
Identifying High-Risk Patients: These drugs are contraindicated in patients with hypotension, sick sinus
syndrome, and second- or third-degree atrioventricular block.
Evaluating Therapeutic Effects: Monitor blood pressure periodically. For angina, the patient should keep
ongoing records of time and intensity of anginal attacks.
Minimizing Adverse Effects: Initiate therapy with low doses, adjust doses carefully, monitor weight loss
daily, and use an intermittent dosing schedule.
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)
Topics, Pharmacology Review & Exam
Prep Strategies | Practice Questions
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
,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
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
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.
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
,Pharmacokinetics - ✔✔ANSWER✔✔->>the study of drug movement throughout the body
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
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.
Inducers = Increase medication metabolism
(Carbamazepine, Rifampin, Alcohol, Phenytoin, Griseofulvin, Phenobarbital, Sulfonylureas)
Beta-blockers - ✔✔ANSWER✔✔->>β blockers (e.g., propranolol, metoprolol) are first-line drugs
for angina of effort, but are not effective against vasospastic angina
β blockers should not be used by patients with sick sinus syndrome, heart failure, or second-degree or
third-degree AV block.
β blockers reduce anginal pain primarily by decreasing cardiac oxygen demand, principally through
blockade of β1 receptors in the heart, which decreases heart rate and contractility.
β blockers should be used with caution by patients with asthma. If an asthmatic individual absolutely
must use a β blocker, a β1-selective agent (e.g., metoprolol) should be chosen. β blockers can mask signs
of hypoglycemia and therefore must be used with caution in patients with diabetes.
When starting or restarting sotalol, patients should be in a facility that can provide continuous
electrocardiogram monitoring and cardiopulmonary resuscitation for a minimum of 3 days to minimize
problems associated with induced arrhythmia.
Creatinine clearance should be established before initiating this drug.
Betapace cannot be substituted for Betapace AF when treating atrial fibrillation.
, Therapeutic Goal: Principal indications are hypertension, angina pectoris, heart failure, and cardiac
dysrhythmias. Indications for individual agents are shown in Table 16.5.
Baseline Data: Heart rate, blood pressure (supine, sitting, and standing depending on patient status),
ECG (if indicated by patient age and status), and general cardiovascular status
Monitoring: Heart rate, blood pressure, evaluation for adverse effects (with symptom-focused
assessment if indicated). Advise patients to record the incidence, circumstances, and severity of any
symptoms that may indicate inadequate control of symptoms for which the drug is given (e.g., angina)
or a new onset of adverse effects.
Identifying High-Risk Pat
Calcium Channel Blockers - ✔✔ANSWER✔✔->>The CCBs used most frequently are verapamil,
diltiazem, and nifedipine (a dihydropyridine-type calcium channel blocker). Accordingly, our discussion
focuses on these three drugs. All three can block calcium channels in VSM, primarily in arterioles.
Verapamil and Diltiazem
Therapeutic Goal: Verapamil and diltiazem are indicated for hypertension, angina, and cardiac
dysrhythmias.
Baseline Data: Determine blood pressure and pulse rate and obtain laboratory evaluations of liver and
kidney function.
Monitoring: No routine blood monitoring required.
Identifying High-Risk Patients: These drugs are contraindicated in patients with hypotension, sick sinus
syndrome, and second- or third-degree atrioventricular block.
Evaluating Therapeutic Effects: Monitor blood pressure periodically. For angina, the patient should keep
ongoing records of time and intensity of anginal attacks.
Minimizing Adverse Effects: Initiate therapy with low doses, adjust doses carefully, monitor weight loss
daily, and use an intermittent dosing schedule.
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)
