Advanced Pharmacology Exam 1 – Comprehensive
Practice Questions, Medication Review, and Exam
Preparation Guide
Once you graduate from an NP program, in -Advanced nurse prescriber license
order to prescribe you'll need: -DEA #
What is the purpose of a DEA #? Needed to prescribed scheduled drugs
Rules for prescribing Schedule II drugs: -Written script needed
-1 month supply only
-No refills
What is the PDMP? 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? 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: -Illegible writing
-Drug names that sound alike
-Medications that look alike
-Administering a drug with the wrong route
What is pharmacokinetics? What are its What the body does to the drug
4 categories?
1. Absorption
2.Metabolism
3.Distribution
4. Excretion
Quickest route of absorption? Slowest? IV = quickest
IM = slowest
What is the most common way drugs pass Passive diffusion
through cell membranes?
What characteristics of a drug allow it to Small, uncharged (unionized), lipid soluble--pass through
pass most quickly through cell membranes membrane without any energy
(usually through passive diffusion)?
What does it mean when a drug is ionized? 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? Stomach
Where do weak bases absorb? Small intestine
pH of stomach: 2-4
pH of small intestine: 6-7
pH of large intestine: 6-7
pH of bloodstream: 7.35-7.45
pH of bladder: 5-8
pH of breastmilk: 7.1
, Where will a drug absorb if it is a weak base In the small intestine (since the stomach has a pH of 2-4, so
that ionizes at a pH of 4 and lower? 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 Drugs that are weak acids (aspirin) can be trapped and
cases of overdose? 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? 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: -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: -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 Albumin
protein binding for medications?
Why do we monitor albumin? 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 The drug does not bind to the protein (albumin) as much as
drug when the patient is elderly and has expected, so there is a lot of free drug floating in the plasma;
very low levels of albumin? high risk for drug toxicity
Protein bound means: Inactive form of the drug; does not have any therapeutic
effect when bound to a protein
Free drug means: Active form of the drug (available for therapeutic effect)
Practice Questions, Medication Review, and Exam
Preparation Guide
Once you graduate from an NP program, in -Advanced nurse prescriber license
order to prescribe you'll need: -DEA #
What is the purpose of a DEA #? Needed to prescribed scheduled drugs
Rules for prescribing Schedule II drugs: -Written script needed
-1 month supply only
-No refills
What is the PDMP? 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? 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: -Illegible writing
-Drug names that sound alike
-Medications that look alike
-Administering a drug with the wrong route
What is pharmacokinetics? What are its What the body does to the drug
4 categories?
1. Absorption
2.Metabolism
3.Distribution
4. Excretion
Quickest route of absorption? Slowest? IV = quickest
IM = slowest
What is the most common way drugs pass Passive diffusion
through cell membranes?
What characteristics of a drug allow it to Small, uncharged (unionized), lipid soluble--pass through
pass most quickly through cell membranes membrane without any energy
(usually through passive diffusion)?
What does it mean when a drug is ionized? 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? Stomach
Where do weak bases absorb? Small intestine
pH of stomach: 2-4
pH of small intestine: 6-7
pH of large intestine: 6-7
pH of bloodstream: 7.35-7.45
pH of bladder: 5-8
pH of breastmilk: 7.1
, Where will a drug absorb if it is a weak base In the small intestine (since the stomach has a pH of 2-4, so
that ionizes at a pH of 4 and lower? 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 Drugs that are weak acids (aspirin) can be trapped and
cases of overdose? 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? 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: -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: -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 Albumin
protein binding for medications?
Why do we monitor albumin? 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 The drug does not bind to the protein (albumin) as much as
drug when the patient is elderly and has expected, so there is a lot of free drug floating in the plasma;
very low levels of albumin? high risk for drug toxicity
Protein bound means: Inactive form of the drug; does not have any therapeutic
effect when bound to a protein
Free drug means: Active form of the drug (available for therapeutic effect)
