FAMILY NURSE PRACTITIONER
CERTIFICATION INTENSIVE REVIEW |
PRACTICE QUESTIONS & ANSWERS,
COMPREHENSIVE STUDY GUIDE, EXAM
PREP & REVIEW MATERIALS
| GRADED A+ | GUARANTEED SUCCESS
Updated Questions and Answers
100% Verified Exam Prep
,Pharmacology The study of the interaction between the body and drugs
Pharmacokinetics The movement of drugs through the body (absorption, bioavailability, distribution,
metabolism, and excretion).
Pharmacodynamics The study of the physiologic and biochemical effects of the drug
Pharmacogenomics The study of how a person's genes affect response to medications.
FDA recently recommended genotyping all asians for HLA-B*1502 before starting
carbamazepine therapy. (This allele is highly associated with fatal carbamazepine therapy
induced Steven-Johnson Syndrome and toxic epidermal necrolysis).
Half-life The amount of time in which drug concentration decreases by 50%
Area under the curve (AUC) The average amount of drug in the blood after a dose is given. It is a measure of the
bioavailability of a drug that is administered.
Minimum Inhibitory Concentration (MIC) The lowest concentration of an antibiotic that will inhibit the growth of organisms (after
overnight incubation).
Maximum Concentration The highest concentration of a drug after a dose.
Trough (Minimum concentration) the lowest dose of a drug after a dose
First pass effect all oral drugs (except SL) must go through the first pass metabolism before they can be
released in the body.
Swallow pill > esophagus > stomach > small intestine > portal circulation > liver > (in liver,
CYP450 system is responsible for metabolism) > when completed, released in it's active
form into the body.
A few are also broken down in the small intestine by bacteria (for example: oral
contraceptives) in addition to being metabolized in the liver.
Clinical Pearl: Some drugs cannot be given by oral route simply because there is not
enough of the active drug left after metabolism (I.E Insulin).
,Drug metabolism Main Organ: Liver
The CYP450 system is the most active. It can either be induced (increase metabolism) or
inhibited (decrease metabolism). Ex: Carbamazepine increases metabolism- resulting in
numerous drug interactions. Other organs are involved in metabolism such as the
kidneys, GI tract, lungs, plasma, and skin.
Drug excretion Renal filtration accounts for most drug excretion. Renal drug excretion is deceased
because of physiologic decline in GFR.
Drugs affected by Kidney Disease NSAIDS> Decrease renal blood flow will damage kidneys.
ACEI > Increase risk for hyperkalemia
Warfarin > increase risk of over coagulation, hemorrhagic complications.
Lithium > increase risk for kidney injury
Contrast dyes > can injure kidneys
Potassium-sparing diuretics > increase risk for hyperkalemia
Sodium-phosphate > may cause sudden loss of kidney function as well as blood mineral
disturbances.
Potent Inhibitors CYP450 system These drugs are responsible for a large number of drug-drug interactions. Drugs that act
as inhibitors slow down drug clearance which increases risk of drug overdose and ASE.
- Macrolides (erythromycin, clarithyromycin)
- Antifungals (ketoconazole, fluconazole)
-Cimetidine (Tagamet)
-Celexa
-Protease inhibitors (saquinarvir, indinavir)
-Grapefruit juice
Narrow Therapeutic index drugs Warfarin > Monitor INR
Digoxin > Monitor Digoxin level, EKG, electrolytes
Theophylline > Monitor blood levels
Carbamazepine and Phenytoin > Monitor blood levels
Levothyroxine > Monitor TSH
Lithium > Monitor blood levels and TSH (Risk of hypothyroid).
, H2 antagonist safety issues ex: famotidine, cimetidine, nizatidine
Mental status changes with kidney disease. Avoid kidney disease with creatinine
clearance of < 50 ml/min.
Proton-pump inhibitors safety issues ex: omeprazole
Increase risk of fractures (post-menopausal women), pneumonia, c-diff, decreased mag,
B12 and iron Mal-absorption, atrophic gastritis, and kidney disease.
Interacts with warfarin, diazepam, carbamazepine, phenytoin, and ketoconazole.
Vitamin K antagonist safety issues Ex: warfarin
interacts with "G" herbs such as garlic, ginger, gingko, and ginseng. other
herbs/supplements: feverfew, green tea, and fish oil.
Numerous drug interactions.
Discontinue 7 days before surgery.
Thiazides safety issues ex: Pioglitazore (DM/TZD's)
Black box warning: cause or exacerbate CHF in some patients. do not use in class III or
IV.
Contraindications: history of mI, stroke, bladder cancer, T2DM, eye or liver problems.
Stop if causes dyspnea, weight gain, cough (HF).
Atypical antipsychotic safety issues ex: Risperiodone, olanzapine, quetiapine
increase risk of weight gain, metabolic syndrome, T2DM, monitor weight gain every 3
months.
Black box warning: increase mortality in elderly patients. Monitor TSH, lipids, A1C,
WT/BMI.
CERTIFICATION INTENSIVE REVIEW |
PRACTICE QUESTIONS & ANSWERS,
COMPREHENSIVE STUDY GUIDE, EXAM
PREP & REVIEW MATERIALS
| GRADED A+ | GUARANTEED SUCCESS
Updated Questions and Answers
100% Verified Exam Prep
,Pharmacology The study of the interaction between the body and drugs
Pharmacokinetics The movement of drugs through the body (absorption, bioavailability, distribution,
metabolism, and excretion).
Pharmacodynamics The study of the physiologic and biochemical effects of the drug
Pharmacogenomics The study of how a person's genes affect response to medications.
FDA recently recommended genotyping all asians for HLA-B*1502 before starting
carbamazepine therapy. (This allele is highly associated with fatal carbamazepine therapy
induced Steven-Johnson Syndrome and toxic epidermal necrolysis).
Half-life The amount of time in which drug concentration decreases by 50%
Area under the curve (AUC) The average amount of drug in the blood after a dose is given. It is a measure of the
bioavailability of a drug that is administered.
Minimum Inhibitory Concentration (MIC) The lowest concentration of an antibiotic that will inhibit the growth of organisms (after
overnight incubation).
Maximum Concentration The highest concentration of a drug after a dose.
Trough (Minimum concentration) the lowest dose of a drug after a dose
First pass effect all oral drugs (except SL) must go through the first pass metabolism before they can be
released in the body.
Swallow pill > esophagus > stomach > small intestine > portal circulation > liver > (in liver,
CYP450 system is responsible for metabolism) > when completed, released in it's active
form into the body.
A few are also broken down in the small intestine by bacteria (for example: oral
contraceptives) in addition to being metabolized in the liver.
Clinical Pearl: Some drugs cannot be given by oral route simply because there is not
enough of the active drug left after metabolism (I.E Insulin).
,Drug metabolism Main Organ: Liver
The CYP450 system is the most active. It can either be induced (increase metabolism) or
inhibited (decrease metabolism). Ex: Carbamazepine increases metabolism- resulting in
numerous drug interactions. Other organs are involved in metabolism such as the
kidneys, GI tract, lungs, plasma, and skin.
Drug excretion Renal filtration accounts for most drug excretion. Renal drug excretion is deceased
because of physiologic decline in GFR.
Drugs affected by Kidney Disease NSAIDS> Decrease renal blood flow will damage kidneys.
ACEI > Increase risk for hyperkalemia
Warfarin > increase risk of over coagulation, hemorrhagic complications.
Lithium > increase risk for kidney injury
Contrast dyes > can injure kidneys
Potassium-sparing diuretics > increase risk for hyperkalemia
Sodium-phosphate > may cause sudden loss of kidney function as well as blood mineral
disturbances.
Potent Inhibitors CYP450 system These drugs are responsible for a large number of drug-drug interactions. Drugs that act
as inhibitors slow down drug clearance which increases risk of drug overdose and ASE.
- Macrolides (erythromycin, clarithyromycin)
- Antifungals (ketoconazole, fluconazole)
-Cimetidine (Tagamet)
-Celexa
-Protease inhibitors (saquinarvir, indinavir)
-Grapefruit juice
Narrow Therapeutic index drugs Warfarin > Monitor INR
Digoxin > Monitor Digoxin level, EKG, electrolytes
Theophylline > Monitor blood levels
Carbamazepine and Phenytoin > Monitor blood levels
Levothyroxine > Monitor TSH
Lithium > Monitor blood levels and TSH (Risk of hypothyroid).
, H2 antagonist safety issues ex: famotidine, cimetidine, nizatidine
Mental status changes with kidney disease. Avoid kidney disease with creatinine
clearance of < 50 ml/min.
Proton-pump inhibitors safety issues ex: omeprazole
Increase risk of fractures (post-menopausal women), pneumonia, c-diff, decreased mag,
B12 and iron Mal-absorption, atrophic gastritis, and kidney disease.
Interacts with warfarin, diazepam, carbamazepine, phenytoin, and ketoconazole.
Vitamin K antagonist safety issues Ex: warfarin
interacts with "G" herbs such as garlic, ginger, gingko, and ginseng. other
herbs/supplements: feverfew, green tea, and fish oil.
Numerous drug interactions.
Discontinue 7 days before surgery.
Thiazides safety issues ex: Pioglitazore (DM/TZD's)
Black box warning: cause or exacerbate CHF in some patients. do not use in class III or
IV.
Contraindications: history of mI, stroke, bladder cancer, T2DM, eye or liver problems.
Stop if causes dyspnea, weight gain, cough (HF).
Atypical antipsychotic safety issues ex: Risperiodone, olanzapine, quetiapine
increase risk of weight gain, metabolic syndrome, T2DM, monitor weight gain every 3
months.
Black box warning: increase mortality in elderly patients. Monitor TSH, lipids, A1C,
WT/BMI.
