1
NR565 MIDTERM WEEK 1-4 STUDY GUIDE ADVANCED
PHARMACOLOGY FUNDAMENTALS ACTUAL 2026-27 EXAM
QUESTIONS AND ANSWERS
Week 1
• Which schedule drugs can APRNs prescribe? II-IV depending on
which state.
• Who determines and regulates prescriptive authority?
The extent to which they can accomplish this as an autonomous
practice component is
determined by legislation that varies depending on professional
licensure, physician affiliation requirements, and state laws.
• How does limited prescriptive authority impact patients within
the healthcare system? Limited prescriptive authority creates
numerous barriers to quality, affordable, and
accessible patient care. For example, restrictions on the distance
of the APRN or PA from the physician providing supervision or
collaboration may prevent outreach to areas of greatest need. A
requirement to obtain the physician's cosignature on
prescriptions can increase patient waits. Despite the use of terms
such as collaborative arrangement, these relationships create a
situation in which one partner holds the power. In the event of
dissolution of the arrangement, the ultimate loss is commonly
assumed by the advanced practice provider rather than the
physician.
• What are the key responsibilities of prescribing?
• What should be used to make prescribing decisions?
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
,2
• 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
• Be familiar with pharmacokinetic and pharmacodynamic
changes of older adults and how that would translate to
baseline information needed to prescribe.
Absorption of Drugs
Increased gastric pH, Decreased absorptive surface area,
Decreased splanchnic blood flow, Decreased gastrointestinal
motility, Delayed gastric emptying
Distribution of Drugs
Increased body fat, Decreased lean body mass, Decreased total
body water, Decreased serum albumin, Decreased cardiac output
Metabolism of Drugs
Decreased hepatic blood flow, Decreased hepatic mass, Decreased
activity of hepatic enzymes
, 3
Excretion of Drugs
Decreased renal blood flow, Decreased glomerular filtration rate,
Decreased tubular secretion. Decreased number of nephrons
• Beer’s Criteria
o What is it? These guidelines include a safety component
aimed to protect older adults by helping prescribers avoid
medications that are or can be harmful to older adults. The
Beers Criteria is updated annually, and it is applicable in all
health care settings except hospice and palliative care.
o Why is it important?
• Impacts/outcomes of polypharmacy
Polypharmacy 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 and other herbal
preparations. Many patients do not consider OTC or alternative
pharmaceuticals as “medications” and may not mention them
unless you ask specifically.
• CYP450 inhibitors: 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. This inhibition prolongs the
pharmacological effect, which may result in toxicity.
o Examples: Valproate, Isoniazid, sulfonamides,
amiodarone, chloramphenicol, ketoconazole, grapefruit
juice, quinidine. VISACKGQ
o What do they do?
o What do they cause if not used correctly? (aka: What
would the patient experience?) toxicity, increased
medication effect.
NR565 MIDTERM WEEK 1-4 STUDY GUIDE ADVANCED
PHARMACOLOGY FUNDAMENTALS ACTUAL 2026-27 EXAM
QUESTIONS AND ANSWERS
Week 1
• Which schedule drugs can APRNs prescribe? II-IV depending on
which state.
• Who determines and regulates prescriptive authority?
The extent to which they can accomplish this as an autonomous
practice component is
determined by legislation that varies depending on professional
licensure, physician affiliation requirements, and state laws.
• How does limited prescriptive authority impact patients within
the healthcare system? Limited prescriptive authority creates
numerous barriers to quality, affordable, and
accessible patient care. For example, restrictions on the distance
of the APRN or PA from the physician providing supervision or
collaboration may prevent outreach to areas of greatest need. A
requirement to obtain the physician's cosignature on
prescriptions can increase patient waits. Despite the use of terms
such as collaborative arrangement, these relationships create a
situation in which one partner holds the power. In the event of
dissolution of the arrangement, the ultimate loss is commonly
assumed by the advanced practice provider rather than the
physician.
• What are the key responsibilities of prescribing?
• What should be used to make prescribing decisions?
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
,2
• 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
• Be familiar with pharmacokinetic and pharmacodynamic
changes of older adults and how that would translate to
baseline information needed to prescribe.
Absorption of Drugs
Increased gastric pH, Decreased absorptive surface area,
Decreased splanchnic blood flow, Decreased gastrointestinal
motility, Delayed gastric emptying
Distribution of Drugs
Increased body fat, Decreased lean body mass, Decreased total
body water, Decreased serum albumin, Decreased cardiac output
Metabolism of Drugs
Decreased hepatic blood flow, Decreased hepatic mass, Decreased
activity of hepatic enzymes
, 3
Excretion of Drugs
Decreased renal blood flow, Decreased glomerular filtration rate,
Decreased tubular secretion. Decreased number of nephrons
• Beer’s Criteria
o What is it? These guidelines include a safety component
aimed to protect older adults by helping prescribers avoid
medications that are or can be harmful to older adults. The
Beers Criteria is updated annually, and it is applicable in all
health care settings except hospice and palliative care.
o Why is it important?
• Impacts/outcomes of polypharmacy
Polypharmacy 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 and other herbal
preparations. Many patients do not consider OTC or alternative
pharmaceuticals as “medications” and may not mention them
unless you ask specifically.
• CYP450 inhibitors: 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. This inhibition prolongs the
pharmacological effect, which may result in toxicity.
o Examples: Valproate, Isoniazid, sulfonamides,
amiodarone, chloramphenicol, ketoconazole, grapefruit
juice, quinidine. VISACKGQ
o What do they do?
o What do they cause if not used correctly? (aka: What
would the patient experience?) toxicity, increased
medication effect.
