Pharmacotherapeutics
Pharmacotherapeutics for Advanced Practice
Nurse Prescribers, 6th Edition Covering Chapters
1-56 Updated 2025/2026 with Solutions Updated
Version
_____________________________________________________________________________________
What pharmacokinetic changes occur by age 1?
➢ Most pharmacokinetic parameters in children are similar to those in adults.
True or false, children metabolize some drugs faster than adults.
➢ True, theophylline for example.
What is the relation between topical medications and children?
➢ Children absorb topical medications MORE READILY than adults due to larger body surface area.
Why is there a great concern for topical corticosteroids in children?
➢ HPA axis suppression.
What happens to body fat as children get older?
➢ Body fat drops.
If a child is poisoned, what is recommended?
➢ Contact poison control, do not use activated charcoal/ipecac syrup.
What puts the geriatric population at risk for drug usage?
➢ Polypharmacy, cognitive/social issues affected adherence, and lack of tested drugs in this
population.
What physiologic factors affect the geriatric population regarding drug absorption?
➢ Decreased motility/gastric emptying, colon motility, gastric secretion, peristalsis, esophageal
sphincter pressure.
What is the 1st pass elimination in geriatrics like?
➢ Decreased 1st pass elimination and hepatic function results in increased amount of drug
entering the systemic circulation and prolonged half-life.
What occurs as a result of decreased albumin in the geriatric population?
, ➢ Decrease serum albumin may result in increased concentration of free drug and more intense
effect.
How does old age affect metabolism?
➢ Decrease in phase I metabolism, particularly oxidation causing decreased total body clearance.
Phase II not affected
What does a decrease in renal blood flow in the geriatric population cause?
➢ Decreased GFR which affects drug elimination.
What are the general principles for prescribing meds to older adults?
➢ Before prescribing, collect a complete drug history, evaluate for duplications, review ADR's,
prescribe nonpharmacological when possible.
What is the Beers criteria?
➢ List of drugs that are dangerous in the elderly.
What is the Enhanced National Standards of Culturally and Linguistically Appropriate Services (CLAS)?
➢ Required by all organizations receiving federal funds, HCP responsibility to elicit correct
information to make a diagnosis and that the pt understands.
What is ethnopharmacology?
➢ Study of racial differences in drug metabolism and response.
What pharmacokinetic differences do African Americans have?
➢ Hypertension, less renin depending htn, more sensitive to bradykinin (ACEI angioedema), higher
gastric bicarb (affects drug absorption).
What pharmacokinetic differences to Asians have?
➢ Fast acetylators meaning faster hepatic metabolism of certain drugs (need higher doses), may
metabolize antidepressants slower (lower doses).
How many recommended doses leads to decreased compliance?
➢ More than 2 per day.
What are the five spheres of influence regarding factors that impact adherence?
1. Personal
2. Biomedical
3. Socioeconomic
4. Interpersonal
5. Health system
What are the three prescribing rules for APP's?
, 1. All states have title protection for NPs.
2. The Board of Nursing regulates practice.
3. Scope of Practice is determined by NP license.
What is full practice authority?
➢ Autonomy to evaluate patients, diagnose, order and interpret tests, initiate and manage
treatments and prescribe medications, including controlled substances without physician
oversight.
What is reduced practice authority?
➢ Limited in at least one element of practice. The state requires a formal collaborative agreement
with an outside health discipline for the nurse practitioner to provide patient care.
What is restricted practice authority?
➢ Limited in at least one element of practice by requiring career long supervision, delegation, or
team management by an outside health discipline for the nurse practitioner to provide patient
care.
What questions should an APRN ask prior to prescribing?
➢ Risk vs benefit, is this the best drug, and is there a need for this drug?
What is drug sampling?
➢ PDMA act of 1988 protects consumer and creates rules for receipt and distribution of sample
drugs.
What is rational prescribing?
➢ Maximizing clinical effectiveness, minimize harm, avoid wasting resources, respect patient
choice.
What is the first step in rational drug prescribing?
➢ Define the patient's problem.
What is the second step in rational drug prescribing?
➢ Specify the therapeutic objective.
What is the third step in rational drug prescribing?
➢ Choose the treatment (two step process)
What is the fourth step in rational drug prescribing?
➢ Start treatment.
What is the fifth step in rational drug prescribing?
Pharmacotherapeutics for Advanced Practice
Nurse Prescribers, 6th Edition Covering Chapters
1-56 Updated 2025/2026 with Solutions Updated
Version
_____________________________________________________________________________________
What pharmacokinetic changes occur by age 1?
➢ Most pharmacokinetic parameters in children are similar to those in adults.
True or false, children metabolize some drugs faster than adults.
➢ True, theophylline for example.
What is the relation between topical medications and children?
➢ Children absorb topical medications MORE READILY than adults due to larger body surface area.
Why is there a great concern for topical corticosteroids in children?
➢ HPA axis suppression.
What happens to body fat as children get older?
➢ Body fat drops.
If a child is poisoned, what is recommended?
➢ Contact poison control, do not use activated charcoal/ipecac syrup.
What puts the geriatric population at risk for drug usage?
➢ Polypharmacy, cognitive/social issues affected adherence, and lack of tested drugs in this
population.
What physiologic factors affect the geriatric population regarding drug absorption?
➢ Decreased motility/gastric emptying, colon motility, gastric secretion, peristalsis, esophageal
sphincter pressure.
What is the 1st pass elimination in geriatrics like?
➢ Decreased 1st pass elimination and hepatic function results in increased amount of drug
entering the systemic circulation and prolonged half-life.
What occurs as a result of decreased albumin in the geriatric population?
, ➢ Decrease serum albumin may result in increased concentration of free drug and more intense
effect.
How does old age affect metabolism?
➢ Decrease in phase I metabolism, particularly oxidation causing decreased total body clearance.
Phase II not affected
What does a decrease in renal blood flow in the geriatric population cause?
➢ Decreased GFR which affects drug elimination.
What are the general principles for prescribing meds to older adults?
➢ Before prescribing, collect a complete drug history, evaluate for duplications, review ADR's,
prescribe nonpharmacological when possible.
What is the Beers criteria?
➢ List of drugs that are dangerous in the elderly.
What is the Enhanced National Standards of Culturally and Linguistically Appropriate Services (CLAS)?
➢ Required by all organizations receiving federal funds, HCP responsibility to elicit correct
information to make a diagnosis and that the pt understands.
What is ethnopharmacology?
➢ Study of racial differences in drug metabolism and response.
What pharmacokinetic differences do African Americans have?
➢ Hypertension, less renin depending htn, more sensitive to bradykinin (ACEI angioedema), higher
gastric bicarb (affects drug absorption).
What pharmacokinetic differences to Asians have?
➢ Fast acetylators meaning faster hepatic metabolism of certain drugs (need higher doses), may
metabolize antidepressants slower (lower doses).
How many recommended doses leads to decreased compliance?
➢ More than 2 per day.
What are the five spheres of influence regarding factors that impact adherence?
1. Personal
2. Biomedical
3. Socioeconomic
4. Interpersonal
5. Health system
What are the three prescribing rules for APP's?
, 1. All states have title protection for NPs.
2. The Board of Nursing regulates practice.
3. Scope of Practice is determined by NP license.
What is full practice authority?
➢ Autonomy to evaluate patients, diagnose, order and interpret tests, initiate and manage
treatments and prescribe medications, including controlled substances without physician
oversight.
What is reduced practice authority?
➢ Limited in at least one element of practice. The state requires a formal collaborative agreement
with an outside health discipline for the nurse practitioner to provide patient care.
What is restricted practice authority?
➢ Limited in at least one element of practice by requiring career long supervision, delegation, or
team management by an outside health discipline for the nurse practitioner to provide patient
care.
What questions should an APRN ask prior to prescribing?
➢ Risk vs benefit, is this the best drug, and is there a need for this drug?
What is drug sampling?
➢ PDMA act of 1988 protects consumer and creates rules for receipt and distribution of sample
drugs.
What is rational prescribing?
➢ Maximizing clinical effectiveness, minimize harm, avoid wasting resources, respect patient
choice.
What is the first step in rational drug prescribing?
➢ Define the patient's problem.
What is the second step in rational drug prescribing?
➢ Specify the therapeutic objective.
What is the third step in rational drug prescribing?
➢ Choose the treatment (two step process)
What is the fourth step in rational drug prescribing?
➢ Start treatment.
What is the fifth step in rational drug prescribing?
