NR 565 ADVANCED PHARMACOLOGY MIDTERM
Question and Answer (2026/2027) | Complete
Revision Guide | A+ Verified
• benefits of full practice authority -✓✓ Nurse practitioners have the autonomy to
evaluate patients, diagnose, order and interpret tests, initiate and manage
treatments and prescribe medications, including controlled substances without
physician oversight
• promoting positive outcomes through prudent prescribing practices -✓✓
Administering medications and prescribing medications are two distinct
processes. 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
*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
,Rational drug selection requires a logical approach that includes the formulation
of a diagnosis based on clinical reasoning and the selection and monitoring of the
most appropriate pharmacological treatment
Considerations include: Cost, guidelines, availability, interactions, side effects,
allergies, hepatic/renal functions, need for monitoring, & special populations
• Beer's Criteria -✓✓ identifies drugs with a high likelihood of causing adverse
effects in older adults. Accordingly, drugs on this list should generally be avoided
in adults older than 65 years except when the benefits are significantly greater
than the risks.
• Pharmacodynamics -✓✓ the study of the biochemical and physiologic effects of
drugs on the body and the molecular mechanisms by which those effects are
produced
• Pharmacokinetics -✓✓ the study of drug movement throughout the body
• Pharmacogenomics -✓✓ the study of how genes affect a person's response to
drugs. The purpose of this is to combine the sciences of genomics and
pharmacology to provide individualized, targeted, safe drug therapies to patients
• CYP450 inducers -✓✓ Inducers are xenobiotics (medications and environmental
agents) that elevate CYP450 enzyme activity by increasing enzyme synthesis. This
action leads to additional sites available for biotransformation. The increased
number of sites enhances medication metabolism, decreasing the concentration
of the "parent drug" while increasing metabolite production.
,Inducers = Increase medication metabolism
(Carbamazepine, Rifampin, Alcohol, Phenytoin, Griseofulvin, Phenobarbital,
Sulfonylureas)
• 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.
Inhibitors = decrease medication metabolism (Valproate, Isoniazid, Sulfonamides,
Amiodarone, Chloramphenicol, Ketoconazole, Grapefruit Juice, Quinidine)
• cultural influences in prescribing -✓✓ The greatest concern surrounding race-
based therapy has to do with genetic variability. We know there is great diversity
within and among racial groups; therefore, a "one fits all" approach based on race
is unwise. Still, we can use known associations to guide choices. For example,
differences in metabolism between people with East Asian and European heritage
are common. The provider can use this knowledge to guide initial dosing (with
adjustment, as indicated based on response) if genetic testing is not feasible or
warranted
• Polypharmacy: Definition, challenges, and outcomes -✓✓ treatment with
multiple drugs
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.
• Acute Pain Management -✓✓
• Chronic Pain Management -✓✓
• Opioid Management -✓✓
• Regulations of Controlled Substances -✓✓ The U.S. Department of Justice Drug
Enforcement Agency (DEA) coordinates with local, state, and federal agents to
reduce illicit drug use. The DEA enacted the Controlled Substances Act (CSA) in
1970 to regulate drugs and other substances based on their potential for abuse
and dependency. Five schedules of controlled substances were created that are
updated annually. Classes of scheduled substances include narcotics, depressants,
stimulants, hallucinogens, and anabolic steroids. The DEA issues eligible providers
with a registration number to write prescriptions for controlled substances.
Characteristics of a valid DEA number include:
-The first letter identifies the type of provider: A=before 1985; B=after 1985;
F=after 2007; M=nurse practitioner or physician assistant
-The 2nd letter the 1st letter of the provider's last name at the time of initial
registration
Example: Tammy Greene applies for and receives a DEA number of MG2705208
M=nurse practitioner and G=Greene
• Opioid Epidemic & Responsible Prescribing -✓✓
Question and Answer (2026/2027) | Complete
Revision Guide | A+ Verified
• benefits of full practice authority -✓✓ Nurse practitioners have the autonomy to
evaluate patients, diagnose, order and interpret tests, initiate and manage
treatments and prescribe medications, including controlled substances without
physician oversight
• promoting positive outcomes through prudent prescribing practices -✓✓
Administering medications and prescribing medications are two distinct
processes. 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
*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
,Rational drug selection requires a logical approach that includes the formulation
of a diagnosis based on clinical reasoning and the selection and monitoring of the
most appropriate pharmacological treatment
Considerations include: Cost, guidelines, availability, interactions, side effects,
allergies, hepatic/renal functions, need for monitoring, & special populations
• Beer's Criteria -✓✓ identifies drugs with a high likelihood of causing adverse
effects in older adults. Accordingly, drugs on this list should generally be avoided
in adults older than 65 years except when the benefits are significantly greater
than the risks.
• Pharmacodynamics -✓✓ the study of the biochemical and physiologic effects of
drugs on the body and the molecular mechanisms by which those effects are
produced
• Pharmacokinetics -✓✓ the study of drug movement throughout the body
• Pharmacogenomics -✓✓ the study of how genes affect a person's response to
drugs. The purpose of this is to combine the sciences of genomics and
pharmacology to provide individualized, targeted, safe drug therapies to patients
• CYP450 inducers -✓✓ Inducers are xenobiotics (medications and environmental
agents) that elevate CYP450 enzyme activity by increasing enzyme synthesis. This
action leads to additional sites available for biotransformation. The increased
number of sites enhances medication metabolism, decreasing the concentration
of the "parent drug" while increasing metabolite production.
,Inducers = Increase medication metabolism
(Carbamazepine, Rifampin, Alcohol, Phenytoin, Griseofulvin, Phenobarbital,
Sulfonylureas)
• 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.
Inhibitors = decrease medication metabolism (Valproate, Isoniazid, Sulfonamides,
Amiodarone, Chloramphenicol, Ketoconazole, Grapefruit Juice, Quinidine)
• cultural influences in prescribing -✓✓ The greatest concern surrounding race-
based therapy has to do with genetic variability. We know there is great diversity
within and among racial groups; therefore, a "one fits all" approach based on race
is unwise. Still, we can use known associations to guide choices. For example,
differences in metabolism between people with East Asian and European heritage
are common. The provider can use this knowledge to guide initial dosing (with
adjustment, as indicated based on response) if genetic testing is not feasible or
warranted
• Polypharmacy: Definition, challenges, and outcomes -✓✓ treatment with
multiple drugs
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.
• Acute Pain Management -✓✓
• Chronic Pain Management -✓✓
• Opioid Management -✓✓
• Regulations of Controlled Substances -✓✓ The U.S. Department of Justice Drug
Enforcement Agency (DEA) coordinates with local, state, and federal agents to
reduce illicit drug use. The DEA enacted the Controlled Substances Act (CSA) in
1970 to regulate drugs and other substances based on their potential for abuse
and dependency. Five schedules of controlled substances were created that are
updated annually. Classes of scheduled substances include narcotics, depressants,
stimulants, hallucinogens, and anabolic steroids. The DEA issues eligible providers
with a registration number to write prescriptions for controlled substances.
Characteristics of a valid DEA number include:
-The first letter identifies the type of provider: A=before 1985; B=after 1985;
F=after 2007; M=nurse practitioner or physician assistant
-The 2nd letter the 1st letter of the provider's last name at the time of initial
registration
Example: Tammy Greene applies for and receives a DEA number of MG2705208
M=nurse practitioner and G=Greene
• Opioid Epidemic & Responsible Prescribing -✓✓
