NR 565 PHARMACOLOGY STUDY GUIDE 2026/2027
QUESTIONS AND SOLUTIONS RATED A+
✔✔Beta-blockers - ✔✔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 - ✔✔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.
✔✔Thiazide diuretics - ✔✔thiazides increase renal excretion of sodium, chloride,
potassium, and water
✔✔ACEI - ✔✔
✔✔ARB - ✔✔
✔✔Labetalol - ✔✔
✔✔Protype drug for heart failure - ✔✔
✔✔Statins - ✔✔
✔✔Statin Intensity - ✔✔When to use each intensity statin
-cardiac case study
✔✔Non-statin therapy - ✔✔
✔✔Non-statin add-on drugs to statin therapy - ✔✔
✔✔antiplatelet agents - ✔✔
✔✔Anticoagulants - ✔✔
✔✔Colchincine - ✔✔
✔✔Allopurinol - ✔✔
✔✔Febuxostat - ✔✔
✔✔Indomethacin - ✔✔
✔✔Alendronate - ✔✔
✔✔Ibandronate - ✔✔
✔✔NSAIDs - ✔✔
, ✔✔DMARDs - ✔✔
✔✔Methotrexate - ✔✔
✔✔Lefluonomide - ✔✔
✔✔During what trimester is a pregnant woman most at risk for adverse drug reactions
with potential long term consequences? - ✔✔1st trimester (fetus most at risk d/t rapid
growth)
✔✔What is BEERS criteria? - ✔✔Recommendations of medications inappropriate for
elderly (65 and older), prescriber ultimately decides
✔✔What is the CYP450 (cytochrome P450) - ✔✔liver enzyme system where
medications are metabolized, can either be inducers or inhibitors and create drug-drug
interactions
✔✔CYP450 inducers - ✔✔Speed up metabolism of drugs (drug is cleared faster), drug
has lesser effect (decrease blood levels of drug), elevate CYP450 enzymes
✔✔CYP450 inducers pneumonic - ✔✔"Bullshit Crap GPS INDUCES rage"
✔✔CYP450 inducer drug names - ✔✔Barbituates, St John wort, Carbamazepine,
rifampin, alcohol, phenytoin, griseofulvin, phenobarbital, sulfonylureas
✔✔CYP450 inhibitors - ✔✔inhibit metabolism, increase blood levels of medications
✔✔CYP450 pneumonic - ✔✔"VISA credit card debt INHIBITS spending on designers
like CK to look GQ"
✔✔CYP450 inhibitors drug names - ✔✔Valproate, isoniazid, sulfonamides, amiodarone,
chloramphenicol, ketoconazole, grapefruit juice, quinidine
✔✔Physiological changes during pregnancy that impact pharmacodynamics and
pharmacokinetic properties of drugs? - ✔✔increase glomerular filtration rate leads to
increase durg excretion
increase hepatic metabolism
decrease tone and motility of bowel
increase drug absorption
✔✔Examples of medications that can be teratogenic - ✔✔Antiepileptic drugs,
antimicrobials such as tetracyclines and fluoroquinolones, vitamin A in large doses,
some anticoagulants, and hormonal medications such as diethylstilbestrol (DES).
QUESTIONS AND SOLUTIONS RATED A+
✔✔Beta-blockers - ✔✔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 - ✔✔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.
✔✔Thiazide diuretics - ✔✔thiazides increase renal excretion of sodium, chloride,
potassium, and water
✔✔ACEI - ✔✔
✔✔ARB - ✔✔
✔✔Labetalol - ✔✔
✔✔Protype drug for heart failure - ✔✔
✔✔Statins - ✔✔
✔✔Statin Intensity - ✔✔When to use each intensity statin
-cardiac case study
✔✔Non-statin therapy - ✔✔
✔✔Non-statin add-on drugs to statin therapy - ✔✔
✔✔antiplatelet agents - ✔✔
✔✔Anticoagulants - ✔✔
✔✔Colchincine - ✔✔
✔✔Allopurinol - ✔✔
✔✔Febuxostat - ✔✔
✔✔Indomethacin - ✔✔
✔✔Alendronate - ✔✔
✔✔Ibandronate - ✔✔
✔✔NSAIDs - ✔✔
, ✔✔DMARDs - ✔✔
✔✔Methotrexate - ✔✔
✔✔Lefluonomide - ✔✔
✔✔During what trimester is a pregnant woman most at risk for adverse drug reactions
with potential long term consequences? - ✔✔1st trimester (fetus most at risk d/t rapid
growth)
✔✔What is BEERS criteria? - ✔✔Recommendations of medications inappropriate for
elderly (65 and older), prescriber ultimately decides
✔✔What is the CYP450 (cytochrome P450) - ✔✔liver enzyme system where
medications are metabolized, can either be inducers or inhibitors and create drug-drug
interactions
✔✔CYP450 inducers - ✔✔Speed up metabolism of drugs (drug is cleared faster), drug
has lesser effect (decrease blood levels of drug), elevate CYP450 enzymes
✔✔CYP450 inducers pneumonic - ✔✔"Bullshit Crap GPS INDUCES rage"
✔✔CYP450 inducer drug names - ✔✔Barbituates, St John wort, Carbamazepine,
rifampin, alcohol, phenytoin, griseofulvin, phenobarbital, sulfonylureas
✔✔CYP450 inhibitors - ✔✔inhibit metabolism, increase blood levels of medications
✔✔CYP450 pneumonic - ✔✔"VISA credit card debt INHIBITS spending on designers
like CK to look GQ"
✔✔CYP450 inhibitors drug names - ✔✔Valproate, isoniazid, sulfonamides, amiodarone,
chloramphenicol, ketoconazole, grapefruit juice, quinidine
✔✔Physiological changes during pregnancy that impact pharmacodynamics and
pharmacokinetic properties of drugs? - ✔✔increase glomerular filtration rate leads to
increase durg excretion
increase hepatic metabolism
decrease tone and motility of bowel
increase drug absorption
✔✔Examples of medications that can be teratogenic - ✔✔Antiepileptic drugs,
antimicrobials such as tetracyclines and fluoroquinolones, vitamin A in large doses,
some anticoagulants, and hormonal medications such as diethylstilbestrol (DES).
