ADVANCED PHARMACOLOGY EXAM
1 QUESTIONS & VERIFIED ANSWERS
PASSED ALREADY GRADED A+
Once you graduate from an NP program, in order to prescribe you'll need: - CORRECT
ANSWER -Advanced nurse prescriber license
-DEA #
What is the purpose of a DEA #? - CORRECT ANSWER Needed to prescribed
scheduled drugs
Rules for prescribing Schedule II drugs: - CORRECT ANSWER -Written script needed
-1 month supply only
-No refills
What is the PDMP? - CORRECT ANSWER 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? - CORRECT ANSWER 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: - CORRECT ANSWER -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? - CORRECT ANSWER What the
body does to the drug
1. Absorption
2. Metabolism
3. Distribution
4. Excretion
Quickest route of absorption? Slowest? - CORRECT ANSWER IV = quickest
IM = slowest
,What is the most common way drugs pass through cell membranes? - CORRECT
ANSWER Passive diffusion
What characteristics of a drug allow it to pass most quickly through cell membranes
(usually through passive diffusion)? - CORRECT ANSWER Small, uncharged
(unionized), lipid soluble--pass through membrane without any energy
What does it mean when a drug is ionized? - CORRECT ANSWER 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? - CORRECT ANSWER Stomach
Where do weak bases absorb? - CORRECT ANSWER Small intestine
pH of stomach: - CORRECT ANSWER 2-4
pH of small intestine: - CORRECT ANSWER 6-7
pH of large intestine: - CORRECT ANSWER 6-7
pH of bloodstream: - CORRECT ANSWER 7.35-7.45
pH of bladder: - CORRECT ANSWER 5-8
pH of breastmilk: - CORRECT ANSWER 7.1
Where will a drug absorb if it is a weak base that ionizes at a pH of 4 and lower? -
CORRECT ANSWER 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? - CORRECT ANSWER
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.
Body factors related to distribution: - CORRECT ANSWER -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 distribution? - CORRECT ANSWER 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: - CORRECT ANSWER -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)
What is the key plasma protein involved with protein binding for medications? -
CORRECT ANSWER Albumin
Why do we monitor albumin? - CORRECT ANSWER 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? - CORRECT ANSWER 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: - CORRECT ANSWER Inactive form of the drug; does not have
any therapeutic effect when bound to a protein
Free drug means: - CORRECT ANSWER 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? - CORRECT ANSWER 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? - CORRECT ANSWER 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)
1 QUESTIONS & VERIFIED ANSWERS
PASSED ALREADY GRADED A+
Once you graduate from an NP program, in order to prescribe you'll need: - CORRECT
ANSWER -Advanced nurse prescriber license
-DEA #
What is the purpose of a DEA #? - CORRECT ANSWER Needed to prescribed
scheduled drugs
Rules for prescribing Schedule II drugs: - CORRECT ANSWER -Written script needed
-1 month supply only
-No refills
What is the PDMP? - CORRECT ANSWER 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? - CORRECT ANSWER 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: - CORRECT ANSWER -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? - CORRECT ANSWER What the
body does to the drug
1. Absorption
2. Metabolism
3. Distribution
4. Excretion
Quickest route of absorption? Slowest? - CORRECT ANSWER IV = quickest
IM = slowest
,What is the most common way drugs pass through cell membranes? - CORRECT
ANSWER Passive diffusion
What characteristics of a drug allow it to pass most quickly through cell membranes
(usually through passive diffusion)? - CORRECT ANSWER Small, uncharged
(unionized), lipid soluble--pass through membrane without any energy
What does it mean when a drug is ionized? - CORRECT ANSWER 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? - CORRECT ANSWER Stomach
Where do weak bases absorb? - CORRECT ANSWER Small intestine
pH of stomach: - CORRECT ANSWER 2-4
pH of small intestine: - CORRECT ANSWER 6-7
pH of large intestine: - CORRECT ANSWER 6-7
pH of bloodstream: - CORRECT ANSWER 7.35-7.45
pH of bladder: - CORRECT ANSWER 5-8
pH of breastmilk: - CORRECT ANSWER 7.1
Where will a drug absorb if it is a weak base that ionizes at a pH of 4 and lower? -
CORRECT ANSWER 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? - CORRECT ANSWER
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.
Body factors related to distribution: - CORRECT ANSWER -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 distribution? - CORRECT ANSWER 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: - CORRECT ANSWER -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)
What is the key plasma protein involved with protein binding for medications? -
CORRECT ANSWER Albumin
Why do we monitor albumin? - CORRECT ANSWER 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? - CORRECT ANSWER 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: - CORRECT ANSWER Inactive form of the drug; does not have
any therapeutic effect when bound to a protein
Free drug means: - CORRECT ANSWER 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? - CORRECT ANSWER 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? - CORRECT ANSWER 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)
