Test Bank for Advanced Pharmacology for
Prescribers ,Actual exam 2025/2026.All
charpters covered ,For A+ Students
Once you graduate from an NP program, in order to prescribe you'll need: - answers -
Advanced nurse prescriber license
-DEA #
What is the purpose of a DEA #? - answers Needed to prescribed scheduled drugs
Rules for prescribing Schedule II drugs: - answers -Written script needed
-1 month supply only
-No refills
What is the PDMP? - answers 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? - answers 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: - answers -Illegible writing
-Drug names that sound alike
-Medications that look alike
-Administering a drug with the wrong route
What is pharmacokinetics? What are its 4 categories? - answers What the body does to
the drug
1. Absorption
2. Metabolism
3. Distribution
4. Excretion
Quickest route of absorption? Slowest? - answers IV = quickest
IM = slowest
What is the most common way drugs pass through cell membranes? - answers Passive
diffusion
,What characteristics of a drug allow it to pass most quickly through cell membranes
(usually through passive diffusion)? - answers Small, uncharged (unionized), lipid
soluble--pass through membrane without any energy
What does it mean when a drug is ionized? - answers 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? - answers Stomach
Where do weak bases absorb? - answers Small intestine
pH of stomach: - answers 2-4
pH of small intestine: - answers 6-7
pH of large intestine: - answers 6-7
pH of bloodstream: - answers 7.35-7.45
pH of bladder: - answers 5-8
pH of breastmilk: - answers 7.1
Where will a drug absorb if it is a weak base that ionizes at a pH of 4 and lower? -
answers In the small intestine (since the stomach has a pH of 2-4, so 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 cases of overdose? - answers Drugs that are
weak acids (aspirin) can be trapped and 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? - answers 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: - answers -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: - answers -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 protein binding for medications? - answers
Albumin
Why do we monitor albumin? - answers 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 drug when the patient is elderly and has
very low levels of albumin? - answers The drug does not bind to the protein (albumin)
as much as expected, so there is a lot of free drug floating in the plasma; high risk for
drug toxicity
Protein bound means: - answers Inactive form of the drug; does not have any
therapeutic effect when bound to a protein
Free drug means: - answers Active form of the drug (available for therapeutic effect)
What happens when a patient is on two drugs that are competing for the same protein
binding site on the albumin? - answers Some drug interactions can occur. Drugs fight
for binding position, but both drugs do not get enough as the usually would. Leads to
higher free drug levels, decreased overall albumin binding, and potential toxicity for both
drugs.
**Unpredictable**
What is the 1st pass effect? - answers PO drug goes through GI tract and absorbs in
the stomach or intestines into local circulation that reaches the liver. The liver
inactivates portions of the drug before it goes into systemic circulation. Some drugs with
a very high 1st pass effect may have to be given IV (goes directly into systemic
circulation) or in higher PO doses (watch for side effects)
What does a substrate for an enzyme mean? - answers It needs it to undergo
metabolism
, What is an enzyme inducer? - answers It increases clearance of the drug (decreased
blood levels of drug--may need dose increase)
What is an enzyme inhibitor? - answers It reduces clearance (increased blood levels of
drug--may need dose decrease)
Who is at risk for drug toxicity? - answers Elderly, those with decreased renal function
-Cannot properly excrete the drug
What are the key pharmacokinetic changes that occur during pregnancy? - answers -
Decreased absorption
-Increased hepatic metabolism
-Increased renal excretion
**Dose adjustments are common during pregnancy
What is the safest drug category for pregnant women? - answers Category A
What is the contraindicated drug category for pregnant women? - answers Category X
What is pharmacodynamics? - answers What the drug does to the body
What is a drug's half-life? - answers The time it takes for the concentration of a drug in
the body to be reduced by 50%
How many half-lives does it take to remove most of the drug from the body? - answers
Appx 4
Why is knowing half-life important? - answers When switching to another drug that
cannot be given with the previous drug.
How to determine when drug will be cleared from body: - answers Multiply half-life of
drug by 4
Ex: Half-life of drug A = 8 hours
8 x 4 = 32 hours (how long you'd need to wait before starting the contraindicated new
drug B)
What is therapeutic index? - answers Statement of the relative safety of a drug
Which is safer: a wide TI or a narrow TI? - answers A wide TI is safer (more dosing
options before reaching toxic effects)
Prescribers ,Actual exam 2025/2026.All
charpters covered ,For A+ Students
Once you graduate from an NP program, in order to prescribe you'll need: - answers -
Advanced nurse prescriber license
-DEA #
What is the purpose of a DEA #? - answers Needed to prescribed scheduled drugs
Rules for prescribing Schedule II drugs: - answers -Written script needed
-1 month supply only
-No refills
What is the PDMP? - answers 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? - answers 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: - answers -Illegible writing
-Drug names that sound alike
-Medications that look alike
-Administering a drug with the wrong route
What is pharmacokinetics? What are its 4 categories? - answers What the body does to
the drug
1. Absorption
2. Metabolism
3. Distribution
4. Excretion
Quickest route of absorption? Slowest? - answers IV = quickest
IM = slowest
What is the most common way drugs pass through cell membranes? - answers Passive
diffusion
,What characteristics of a drug allow it to pass most quickly through cell membranes
(usually through passive diffusion)? - answers Small, uncharged (unionized), lipid
soluble--pass through membrane without any energy
What does it mean when a drug is ionized? - answers 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? - answers Stomach
Where do weak bases absorb? - answers Small intestine
pH of stomach: - answers 2-4
pH of small intestine: - answers 6-7
pH of large intestine: - answers 6-7
pH of bloodstream: - answers 7.35-7.45
pH of bladder: - answers 5-8
pH of breastmilk: - answers 7.1
Where will a drug absorb if it is a weak base that ionizes at a pH of 4 and lower? -
answers In the small intestine (since the stomach has a pH of 2-4, so 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 cases of overdose? - answers Drugs that are
weak acids (aspirin) can be trapped and 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? - answers 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: - answers -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: - answers -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 protein binding for medications? - answers
Albumin
Why do we monitor albumin? - answers 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 drug when the patient is elderly and has
very low levels of albumin? - answers The drug does not bind to the protein (albumin)
as much as expected, so there is a lot of free drug floating in the plasma; high risk for
drug toxicity
Protein bound means: - answers Inactive form of the drug; does not have any
therapeutic effect when bound to a protein
Free drug means: - answers Active form of the drug (available for therapeutic effect)
What happens when a patient is on two drugs that are competing for the same protein
binding site on the albumin? - answers Some drug interactions can occur. Drugs fight
for binding position, but both drugs do not get enough as the usually would. Leads to
higher free drug levels, decreased overall albumin binding, and potential toxicity for both
drugs.
**Unpredictable**
What is the 1st pass effect? - answers PO drug goes through GI tract and absorbs in
the stomach or intestines into local circulation that reaches the liver. The liver
inactivates portions of the drug before it goes into systemic circulation. Some drugs with
a very high 1st pass effect may have to be given IV (goes directly into systemic
circulation) or in higher PO doses (watch for side effects)
What does a substrate for an enzyme mean? - answers It needs it to undergo
metabolism
, What is an enzyme inducer? - answers It increases clearance of the drug (decreased
blood levels of drug--may need dose increase)
What is an enzyme inhibitor? - answers It reduces clearance (increased blood levels of
drug--may need dose decrease)
Who is at risk for drug toxicity? - answers Elderly, those with decreased renal function
-Cannot properly excrete the drug
What are the key pharmacokinetic changes that occur during pregnancy? - answers -
Decreased absorption
-Increased hepatic metabolism
-Increased renal excretion
**Dose adjustments are common during pregnancy
What is the safest drug category for pregnant women? - answers Category A
What is the contraindicated drug category for pregnant women? - answers Category X
What is pharmacodynamics? - answers What the drug does to the body
What is a drug's half-life? - answers The time it takes for the concentration of a drug in
the body to be reduced by 50%
How many half-lives does it take to remove most of the drug from the body? - answers
Appx 4
Why is knowing half-life important? - answers When switching to another drug that
cannot be given with the previous drug.
How to determine when drug will be cleared from body: - answers Multiply half-life of
drug by 4
Ex: Half-life of drug A = 8 hours
8 x 4 = 32 hours (how long you'd need to wait before starting the contraindicated new
drug B)
What is therapeutic index? - answers Statement of the relative safety of a drug
Which is safer: a wide TI or a narrow TI? - answers A wide TI is safer (more dosing
options before reaching toxic effects)
