Advanced Pharmacology – Midterm practice exam
questions and verified answers with complete solutions.
Once you graduate from an NP program, in order to prescribe you'll need: -
ANSWER: -Advanced nurse prescriber license
-DEA #
What is the purpose of a DEA #? - ANSWER: Needed to prescribed scheduled
drugs
Rules for prescribing Schedule II drugs: - ANSWER: -Written script needed
-1 month supply only
-No refills
What is the PDMP? - ANSWER: Prescription Drug Monitoring Program
Used to effectively track patient's controlled substance uses across different health
facilities (in the same state)
What are clinical practice guidelines? - ANSWER: Recommendations that are
intended to optimize patient care that are informed by a systematic review of the
evidence and an assessment of the benefits/harms of alternative care practices
Ex: sepsis, CAP
Common causes of medication errors: - ANSWER: -Illegible writing
-Drug names that sound alike
-Medications that look alike
-Administering a drug with the wrong route
What is pharmacokinetics? What are its 4 categories? - ANSWER: What the body
does to the drug
1. Absorption
2. Metabolism
3. Distribution
4. Excretion
Quickest route of absorption? Slowest? - ANSWER: IV = quickest
IM = slowest
What is the most common way drugs pass through cell membranes? - ANSWER:
Passive diffusion
What characteristics of a drug allow it to pass most quickly through cell membranes
(usually through passive diffusion)? - ANSWER: Small, uncharged (unionized),
lipid soluble--pass through membrane without any energy
,What does it mean when a drug is ionized? - ANSWER: It means that the drug is
stuck in the compartment it was ionized in and has to be moved to the next
compartment (cannot be absorbed into the bloodstream)
Where do weak acids absorb? - ANSWER: Stomach
Where do weak bases absorb? - ANSWER: Small intestine
pH of stomach: - ANSWER: 2-4
pH of small intestine: - ANSWER: 6-7
pH of large intestine: - ANSWER: 6-7
pH of bloodstream: - ANSWER: 7.35-7.45
pH of bladder: - ANSWER: 5-8
pH of breastmilk: - ANSWER: 7.1
Where will a drug absorb if it is a weak base that ionizes at a pH of 4 and lower? -
ANSWER: In the small intestine (since the stomach has a pH of 2-4, so the drug
will become ionized and move to the small intestine where it will be able to absorb
into the bloodstream)
How can we manipulate the urine pH in cases of overdose? - ANSWER: Drugs
that are weak acids (aspirin) can be trapped and excreted through the urine.
We raise pH of the urine (with sodium bicarb) to force the drug to ionize and allow it
to be excreted, not reabsorbed through the bloodstream.
What is distribution? - ANSWER: How a drug will be transported to the tissues it
needs to go to in order for it to exert its effects
Drug factors related to distribution: - ANSWER: -Lipid solubility
-Molecular size
-Degree of ionization
-Duration of action
-Cellular binding
-Therapeutic effects
-Toxic effects
(lipid soluble, small, and non-ionized drugs will distribute more quickly)
Body factors related to distribution: - ANSWER: -Vascularity (poor perfusion,
disruption of blood flow due to trauma--difficulty distributing)
,-Blood barriers (blood-brain-barrier can be problematic if we need to get drugs to the
brain--will need very high dosing since only a small amount of the drug will get
through)
-Transport mechanisms
-Plasma binding proteins
-Disease states
-Volume of distribution
-Drug interactions
What is the key plasma protein involved with protein binding for medications? -
ANSWER: Albumin
Why do we monitor albumin? - ANSWER: Indicative of nutritional status and how
well protein-bound drugs will be transported to their target locations
What happens to the therapeutic effect of a drug when the patient is elderly and has
very low levels of albumin? - ANSWER: The drug does not bind to the protein
(albumin) as much as expected, so there is a lot of free drug floating in the plasma;
high risk for drug toxicity
Protein bound means: - ANSWER: Inactive form of the drug; does not have any
therapeutic effect when bound to a protein
Free drug means: - ANSWER: Active form of the drug (available for therapeutic
effect)
What happens when a patient is on two drugs that are competing for the same
protein binding site on the albumin? - ANSWER: Some drug interactions can
occur. Drugs fight for binding position, but both drugs do not get enough as the
usually would. Leads to higher free drug levels, decreased overall albumin binding,
and potential toxicity for both drugs.
**Unpredictable**
What is the 1st pass effect? - ANSWER: PO drug goes through GI tract and
absorbs in the stomach or intestines into local circulation that reaches the liver. The
liver inactivates portions of the drug before it goes into systemic circulation. Some
drugs with a very high 1st pass effect may have to be given IV (goes directly into
systemic circulation) or in higher PO doses (watch for side effects)
What does a substrate for an enzyme mean? - ANSWER: It needs it to undergo
metabolism
What is an enzyme inducer? - ANSWER: It increases clearance of the drug
(decreased blood levels of drug--may need dose increase)
What is an enzyme inhibitor? - ANSWER: It reduces clearance (increased blood
levels of drug--may need dose decrease)
, Who is at risk for drug toxicity? - ANSWER: Elderly, those with decreased renal
function
-Cannot properly excrete the drug
What are the key pharmacokinetic changes that occur during pregnancy? -
ANSWER: -Decreased absorption
-Increased hepatic metabolism
-Increased renal excretion
**Dose adjustments are common during pregnancy
What is the safest drug category for pregnant women? - ANSWER: Category A
What is the contraindicated drug category for pregnant women? - ANSWER:
Category X
What is pharmacodynamics? - ANSWER: What the drug does to the body
What is a drug's half-life? - ANSWER: The time it takes for the concentration of a
drug in the body to be reduced by 50%
How many half-lives does it take to remove most of the drug from the body? -
ANSWER: Appx 4
Why is knowing half-life important? - ANSWER: When switching to another drug
that cannot be given with the previous drug.
How to determine when drug will be cleared from body: - ANSWER: Multiply half-
life of drug by 4
Ex: Half-life of drug A = 8 hours
8 x 4 = 32 hours (how long you'd need to wait before starting the contraindicated
new drug B)
What is therapeutic index? - ANSWER: Statement of the relative safety of a drug
Which is safer: a wide TI or a narrow TI? - ANSWER: A wide TI is safer (more
dosing options before reaching toxic effects)
What is the minimum effective concentration? - ANSWER: The minimum amount
of drug required to produce a therapeutic effect
What is receptor desensitization? - ANSWER: Decreased responsiveness of the
receptor to the drug; decreased overall effects
questions and verified answers with complete solutions.
Once you graduate from an NP program, in order to prescribe you'll need: -
ANSWER: -Advanced nurse prescriber license
-DEA #
What is the purpose of a DEA #? - ANSWER: Needed to prescribed scheduled
drugs
Rules for prescribing Schedule II drugs: - ANSWER: -Written script needed
-1 month supply only
-No refills
What is the PDMP? - ANSWER: Prescription Drug Monitoring Program
Used to effectively track patient's controlled substance uses across different health
facilities (in the same state)
What are clinical practice guidelines? - ANSWER: Recommendations that are
intended to optimize patient care that are informed by a systematic review of the
evidence and an assessment of the benefits/harms of alternative care practices
Ex: sepsis, CAP
Common causes of medication errors: - ANSWER: -Illegible writing
-Drug names that sound alike
-Medications that look alike
-Administering a drug with the wrong route
What is pharmacokinetics? What are its 4 categories? - ANSWER: What the body
does to the drug
1. Absorption
2. Metabolism
3. Distribution
4. Excretion
Quickest route of absorption? Slowest? - ANSWER: IV = quickest
IM = slowest
What is the most common way drugs pass through cell membranes? - ANSWER:
Passive diffusion
What characteristics of a drug allow it to pass most quickly through cell membranes
(usually through passive diffusion)? - ANSWER: Small, uncharged (unionized),
lipid soluble--pass through membrane without any energy
,What does it mean when a drug is ionized? - ANSWER: It means that the drug is
stuck in the compartment it was ionized in and has to be moved to the next
compartment (cannot be absorbed into the bloodstream)
Where do weak acids absorb? - ANSWER: Stomach
Where do weak bases absorb? - ANSWER: Small intestine
pH of stomach: - ANSWER: 2-4
pH of small intestine: - ANSWER: 6-7
pH of large intestine: - ANSWER: 6-7
pH of bloodstream: - ANSWER: 7.35-7.45
pH of bladder: - ANSWER: 5-8
pH of breastmilk: - ANSWER: 7.1
Where will a drug absorb if it is a weak base that ionizes at a pH of 4 and lower? -
ANSWER: In the small intestine (since the stomach has a pH of 2-4, so the drug
will become ionized and move to the small intestine where it will be able to absorb
into the bloodstream)
How can we manipulate the urine pH in cases of overdose? - ANSWER: Drugs
that are weak acids (aspirin) can be trapped and excreted through the urine.
We raise pH of the urine (with sodium bicarb) to force the drug to ionize and allow it
to be excreted, not reabsorbed through the bloodstream.
What is distribution? - ANSWER: How a drug will be transported to the tissues it
needs to go to in order for it to exert its effects
Drug factors related to distribution: - ANSWER: -Lipid solubility
-Molecular size
-Degree of ionization
-Duration of action
-Cellular binding
-Therapeutic effects
-Toxic effects
(lipid soluble, small, and non-ionized drugs will distribute more quickly)
Body factors related to distribution: - ANSWER: -Vascularity (poor perfusion,
disruption of blood flow due to trauma--difficulty distributing)
,-Blood barriers (blood-brain-barrier can be problematic if we need to get drugs to the
brain--will need very high dosing since only a small amount of the drug will get
through)
-Transport mechanisms
-Plasma binding proteins
-Disease states
-Volume of distribution
-Drug interactions
What is the key plasma protein involved with protein binding for medications? -
ANSWER: Albumin
Why do we monitor albumin? - ANSWER: Indicative of nutritional status and how
well protein-bound drugs will be transported to their target locations
What happens to the therapeutic effect of a drug when the patient is elderly and has
very low levels of albumin? - ANSWER: The drug does not bind to the protein
(albumin) as much as expected, so there is a lot of free drug floating in the plasma;
high risk for drug toxicity
Protein bound means: - ANSWER: Inactive form of the drug; does not have any
therapeutic effect when bound to a protein
Free drug means: - ANSWER: Active form of the drug (available for therapeutic
effect)
What happens when a patient is on two drugs that are competing for the same
protein binding site on the albumin? - ANSWER: Some drug interactions can
occur. Drugs fight for binding position, but both drugs do not get enough as the
usually would. Leads to higher free drug levels, decreased overall albumin binding,
and potential toxicity for both drugs.
**Unpredictable**
What is the 1st pass effect? - ANSWER: PO drug goes through GI tract and
absorbs in the stomach or intestines into local circulation that reaches the liver. The
liver inactivates portions of the drug before it goes into systemic circulation. Some
drugs with a very high 1st pass effect may have to be given IV (goes directly into
systemic circulation) or in higher PO doses (watch for side effects)
What does a substrate for an enzyme mean? - ANSWER: It needs it to undergo
metabolism
What is an enzyme inducer? - ANSWER: It increases clearance of the drug
(decreased blood levels of drug--may need dose increase)
What is an enzyme inhibitor? - ANSWER: It reduces clearance (increased blood
levels of drug--may need dose decrease)
, Who is at risk for drug toxicity? - ANSWER: Elderly, those with decreased renal
function
-Cannot properly excrete the drug
What are the key pharmacokinetic changes that occur during pregnancy? -
ANSWER: -Decreased absorption
-Increased hepatic metabolism
-Increased renal excretion
**Dose adjustments are common during pregnancy
What is the safest drug category for pregnant women? - ANSWER: Category A
What is the contraindicated drug category for pregnant women? - ANSWER:
Category X
What is pharmacodynamics? - ANSWER: What the drug does to the body
What is a drug's half-life? - ANSWER: The time it takes for the concentration of a
drug in the body to be reduced by 50%
How many half-lives does it take to remove most of the drug from the body? -
ANSWER: Appx 4
Why is knowing half-life important? - ANSWER: When switching to another drug
that cannot be given with the previous drug.
How to determine when drug will be cleared from body: - ANSWER: Multiply half-
life of drug by 4
Ex: Half-life of drug A = 8 hours
8 x 4 = 32 hours (how long you'd need to wait before starting the contraindicated
new drug B)
What is therapeutic index? - ANSWER: Statement of the relative safety of a drug
Which is safer: a wide TI or a narrow TI? - ANSWER: A wide TI is safer (more
dosing options before reaching toxic effects)
What is the minimum effective concentration? - ANSWER: The minimum amount
of drug required to produce a therapeutic effect
What is receptor desensitization? - ANSWER: Decreased responsiveness of the
receptor to the drug; decreased overall effects
