NR 565
NR565 - NR 565 Midterm Exam Study
Guide (Latest 2025 UPDATED): Advanced
Pharmacology Fundamentals - Chamberlain
APRN prescribing role -Correct Answers ✔-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 -Correct Answers ✔-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 -Correct
Answers ✔-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
NR 565
,NR 565
*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 -Correct Answers ✔-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 Answers ✔-the study of the biochemical and
physiologic effects of drugs on the body and the molecular mechanisms by which
those effects are produced
Pharmacokinetics -Correct Answers ✔-the study of drug movement throughout the
body
Pharmacogenomics -Correct Answers ✔-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
NR 565
,NR 565
CYP450 inducers -Correct Answers ✔-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)
CYP450 inhibitors -Correct Answers ✔-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)
cultural influences in prescribing -Correct Answers ✔-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
Polypharmacy: Definition, challenges, and outcomes -Correct Answers ✔-
treatment with multiple drugs
greatly increases the risk for interactions. Some of these interactions are negligible,
but some can have life-threatening consequences. It is of crucial importance to ask
the patient about all current drugs, including over-the-counter (OTC) medications
NR 565
, NR 565
and other herbal preparations. Many patients do not consider OTC or alternative
pharmaceuticals as "medications" and may not mention them unless you ask
specifically.
Acute Pain Management -Correct Answers ✔-
Chronic Pain Management -Correct Answers ✔-
Opioid Management -Correct Answers ✔-
Regulations of Controlled Substances -Correct Answers ✔-The U.S. Department
of Justice Drug Enforcement Agency (DEA) coordinates with local, state, and
federal agents to reduce illicit drug use. The DEA enacted the Controlled
Substances Act (CSA) in 1970 to regulate drugs and other substances based on
their potential for abuse and dependency. Five schedules of controlled substances
were created that are updated annually. Classes of scheduled substances include
narcotics, depressants, stimulants, hallucinogens, and anabolic 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=nurse 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
Opioid Epidemic & Responsible Prescribing -Correct Answers ✔-
Opioid Use Disorder -Correct Answers ✔-a pattern of use that leads to significant
impairment or distress. Typically, this disorder is marked by unsuccessful efforts to
reduce or control use resulting in the inability to fulfill work, school, or home
responsibilities. Opioid use disorder is different from drug tolerance and physical
dependence, which may also exist. Opioid use creates high levels of positive
NR 565
NR565 - NR 565 Midterm Exam Study
Guide (Latest 2025 UPDATED): Advanced
Pharmacology Fundamentals - Chamberlain
APRN prescribing role -Correct Answers ✔-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 -Correct Answers ✔-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 -Correct
Answers ✔-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
NR 565
,NR 565
*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 -Correct Answers ✔-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 Answers ✔-the study of the biochemical and
physiologic effects of drugs on the body and the molecular mechanisms by which
those effects are produced
Pharmacokinetics -Correct Answers ✔-the study of drug movement throughout the
body
Pharmacogenomics -Correct Answers ✔-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
NR 565
,NR 565
CYP450 inducers -Correct Answers ✔-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)
CYP450 inhibitors -Correct Answers ✔-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)
cultural influences in prescribing -Correct Answers ✔-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
Polypharmacy: Definition, challenges, and outcomes -Correct Answers ✔-
treatment with multiple drugs
greatly increases the risk for interactions. Some of these interactions are negligible,
but some can have life-threatening consequences. It is of crucial importance to ask
the patient about all current drugs, including over-the-counter (OTC) medications
NR 565
, NR 565
and other herbal preparations. Many patients do not consider OTC or alternative
pharmaceuticals as "medications" and may not mention them unless you ask
specifically.
Acute Pain Management -Correct Answers ✔-
Chronic Pain Management -Correct Answers ✔-
Opioid Management -Correct Answers ✔-
Regulations of Controlled Substances -Correct Answers ✔-The U.S. Department
of Justice Drug Enforcement Agency (DEA) coordinates with local, state, and
federal agents to reduce illicit drug use. The DEA enacted the Controlled
Substances Act (CSA) in 1970 to regulate drugs and other substances based on
their potential for abuse and dependency. Five schedules of controlled substances
were created that are updated annually. Classes of scheduled substances include
narcotics, depressants, stimulants, hallucinogens, and anabolic 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=nurse 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
Opioid Epidemic & Responsible Prescribing -Correct Answers ✔-
Opioid Use Disorder -Correct Answers ✔-a pattern of use that leads to significant
impairment or distress. Typically, this disorder is marked by unsuccessful efforts to
reduce or control use resulting in the inability to fulfill work, school, or home
responsibilities. Opioid use disorder is different from drug tolerance and physical
dependence, which may also exist. Opioid use creates high levels of positive
NR 565
