ADVANCE PHARMACY NR565 MIDTERM EXAM QUESTIONS AND
CORRECT ANSWERS
·· cWhich cschedule cdrugs ccan cAPRNs cprescribe? c- cCORRECT cANS✔✔Schedule cII-V
· cWho cdetermines cand cregulates cprescriptive cauthority? c- cCORRECT cANS✔✔Nurse cpractitioner cscope cof cpractice cis
cdetermined cby cstate cpractice cand clicensure claws.
· cHow cdoes climited cprescriptive cauthority cimpact cpatients cwithin cthe chealthcare csystem? c- cCORRECT cANS✔✔limited
cauthority ccreates cproblems cfor cthe cpatient. cThe cpatient cis cnot cable cto cget cthe ccare cthey cneed
· cWhat care cthe ckey cresponsibilities cof cprescribing? c- cCORRECT cANS✔✔1. cBe cprudent cand cdeliberate cin cyour cdecision-
making cprocess
2. cHave ca cdocumented cprovider-patient crelationship cwith cthe cperson cfor cwhom cyou care cprescribing
3. cDo cnot cprescribe cmedications cfor cfamily cor cfriends cor cfor cyourself
4. cDocument ca cthorough chistory cand cphysical cexamination cin cyour crecords
5.Include cany cdiscussions cyou chave cwith cthe cpatient cregarding crisk cfactors, cside ceffects, cor ctherapy coptions
6. cHave ca cdocumented cplan cregarding cdrug cmonitoring cor ctitration, cif capplicable
· cWhat cshould cbe cused cto cmake cprescribing cdecisions? c- cCORRECT cANS✔✔
Pharmakinetiscs cand cPharmodynamics cof colder cadults c- cCORRECT cANS✔✔drug caccumulation csecondary cto creduced crenal
cfunction
polypharmacy c(the cuse cof cfive cor cmore cmedications cdaily)
greater cseverity cof cillness
presence cof ccomorbidities
use cof cdrugs cthat chave ca clow ctherapeutic cindex c(e.g., cdigoxin)
increased cindividual cvariation csecondary cto caltered cpharmacokinetics
inadequate csupervision cof clong-term ctherapy
poor cpatient cadherence
· cBeer's cCriteria c- cCORRECT cANS✔✔•potentially cInappropriate cMedication c(PIM) cuse cin colder cadults
•PIM cuse cin colder cadults cdue cto cmedication-disease cor cmedication-syndrome cinteractions cthat cmay cexacerbate cthe cdisease
cor csyndrome
•medications cto cbe cused ccautiously cin colder cadults
•clinically csignificant cdrug cinteractions cthat cshould cbe cavoided cin colder cadults
•medications cto cbe cavoided cor cdosage cdecreased cin cthe cpresence cof cimpaired ckidney cfunction cin colder cadults c(American
cGeriatric cSociety cBeers cCriteria cUpdate cExpert cPanel, c2019)
CYP450 c- cCORRECT cANS✔✔Many cmedications care cmetabolized cthrough cthe cliver cenzyme csystem ccalled ccytochrome cP450
c(CYP450). cMetabolization ccan cbe cinhibited cor cinduced cby cdrugs cand conce cthis chappens cdrug-drug cinteractions ccan coccur.
VISA ccredit ccard cdept cInhibits cSpending con cCK cand cGQ c- cCORRECT cANS✔✔Valproate
I-soniazid
S-ulfamids
A-miodarone
C-hloramphenical
Ketoconazole
G-rapefruit cJuice c
Q-uinidine
CYP450 cInhibitors c- cCORRECT cANS✔✔- cDecreases cthe cCYP450 cwhich ckeeps cthe cmedication cin cyour cbody clonger cwhich
ccan ccause ctoxicity
CYP450 cINDUCERS c- cCORRECT cANS✔✔Increase cCYP450 cto cwork cfaster ccauses c
Drugs cto cleave cyour cbody cfaster.
Inducers cfor cPY450 cChronic cAlcholics cSteal cPhen cPhen cand cNever cRefuse cGreasy cCarbs c- cCORRECT cANS✔✔Chronic
cAlcoholics c
St. cJohns cWort c
, Phenytoin c
Phenobarbital c
Nevirapine
cRefiampin c
Griseofalvin c
Carbamazepine
· cWhat chappens cwhen csomeone chas ca cpoor cmetabolism cphenotype? c- cCORRECT cANS✔✔Metabolizes cto cslow cor cto cfast.
How cis cabsorption cof cintramuscular cmedication cdifferent cin cneonates? c- cCORRECT cANS✔✔•Slow cand cerratic cdue cto clow
cblood cflow cin cmuscles cfirst cfew cdays cof clife
•Why cis cabsorption cof cmedication cin cthe cstomach cincreased cin cinfancy? c- cCORRECT cANS✔✔Delayed cgastric cemptying
c(adult cvalues creached cby c6-8 cmonths)
What care csome cmedications cthat cshould cbe cavoided cin cthe cpediatric cpatient? c- cCORRECT cANS✔✔glucocorticoids,
cdiscoloration cof cdeveloping cteeth cwith ctetracyclines, cand ckernicterus cwith csulfonamides
•What cshould cbe cincluded cin cmedication cadministration cpatient ceducation? c- cCORRECT cANS✔✔1. cdosage csize cand ctiming c
2. croute cand ctechnique cof cadministration c
3. cduration cof ctreatment c
4.drug cstorage
c5.nature cand ctime ccourse cof cdesired cresponses c
6. cnature cand ctime ccourse cof cadverse cresponses
•What care csome cof cthe cPhysiologic cchanges cthat coccur cin cthe cbody cwhen ca cwoman cis cpregnant cthat ccan cchange cthe
cpharmacodynamic cand cpharmacokinetic cproperties cof cmany cdrugs? c- cCORRECT cANS✔✔- cIncreased cGFR= cIncreased cdrug
cexcretion
- cIncreased chepatic cmetabolism cfor csome cdrugs.
- cDecreased ctone cand cmobility cof cbowel
- cIncreased cdrug cabsorption.
•During cwhat ctrimester cis ca cpregnant cwoman cmost cat crisk cfor cadverse cdrug creactions cwith cpotential clong-term
cconsequences? c- cCORRECT cANS✔✔1 ctrimester
•What care csome cmedications cthat cwe cknow cto cbe cteratogenic? c- cCORRECT cANS✔✔•Antiepileptic cdrugs, cantimicrobials
csuch cas ctetracyclines cand cfluoroquinolones, cvitamin cA cin clarge cdoses, csome canticoagulants, cand chormonal cmedications
csuch cas cdiethylstilbestrol c(DES).
•How ccan cwe cas chealthcare cproviders cdecrease cthe clikelihood cof ca celderly cpatient cexperiencing can cadverse cdrug creaction?
c- cCORRECT cANS✔✔•- cobtaining ca cthorough cdrug chistory cthat cincludes cover-the-counter cmedications
•considering cpharmacokinetic cand cpharmacodynamic cchanges cdue cto cage
•monitoring cthe cpatient's cclinical cresponse cand cplasma cdrug clevels
•using cthe csimplest cregimen cpossible
•monitoring cfor cdrug-drug cinteractions cand ciatrogenic cillness
•periodically creviewing cthe cneed cfor ccontinued cdrug ctherapy
•encouraging cthe cpatient cto cdispose cof cold cmedications
•taking csteps cto cpromote cadherence cand cto cavoid cdrugs con cthe cBeers clist
Why cdo cNitrates cneed cto cbe ctaken cno clater cthan c4 cpm? c- cCORRECT cANS✔✔Need cnitrate cfree cinterval cso ctolerance
cdoesn't cdevelop
•What care cthe cnine cfactors cthat cimpact cthe coutcome cof cmedication caccording cto cRosenthal c& cBurcham? c- cCORRECT
cANS✔✔•Gender cand crace
•Genetics cand cpharmacogenomics
•Variability cin cabsorption
•placebo ceffect
•Tolerance
•patho
•age
•bodyweight
•What cis cthe cdifference cbetween cNP cpractice cauthority cand cprescriptive cauthority? c- cCORRECT cANS✔✔Practice cauthority
crefers cto cthe cnurse cpractitioner's cability cto cpractice cwithout cphysician coversight, cwhereas cprescriptive cauthority crefers cto cthe
cnurse cpractitioner's cauthority cto cprescribe cmedications cindependently cand cwithout climitations.
•Who cregulates cprescription cauthority? c- cCORRECT cANS✔✔The cregulation cof cprescriptive cauthority cis cunder cthe cjurisdiction
cof ca chealth cprofessional cboard. cThis cmay cbe cthe cState cBoard cof cNursing, cthe cState cBoard cof cMedicine, cor cthe cState
cBoard cof cPharmacy, cas cdetermined cby ceach cstate. cAlthough cthe cfederal cgovernment ccontrols cdrug cregulation, cit chas cno
ccontrol cover cprescriptive cauthority.
•What cis cscope cof cpractice cdetermined cby? c- cCORRECT cANS✔✔Nurse cpractitioner cscope cof cpractice cis cdetermined cby
cstate cpractice cand clicensure claws.
CORRECT ANSWERS
·· cWhich cschedule cdrugs ccan cAPRNs cprescribe? c- cCORRECT cANS✔✔Schedule cII-V
· cWho cdetermines cand cregulates cprescriptive cauthority? c- cCORRECT cANS✔✔Nurse cpractitioner cscope cof cpractice cis
cdetermined cby cstate cpractice cand clicensure claws.
· cHow cdoes climited cprescriptive cauthority cimpact cpatients cwithin cthe chealthcare csystem? c- cCORRECT cANS✔✔limited
cauthority ccreates cproblems cfor cthe cpatient. cThe cpatient cis cnot cable cto cget cthe ccare cthey cneed
· cWhat care cthe ckey cresponsibilities cof cprescribing? c- cCORRECT cANS✔✔1. cBe cprudent cand cdeliberate cin cyour cdecision-
making cprocess
2. cHave ca cdocumented cprovider-patient crelationship cwith cthe cperson cfor cwhom cyou care cprescribing
3. cDo cnot cprescribe cmedications cfor cfamily cor cfriends cor cfor cyourself
4. cDocument ca cthorough chistory cand cphysical cexamination cin cyour crecords
5.Include cany cdiscussions cyou chave cwith cthe cpatient cregarding crisk cfactors, cside ceffects, cor ctherapy coptions
6. cHave ca cdocumented cplan cregarding cdrug cmonitoring cor ctitration, cif capplicable
· cWhat cshould cbe cused cto cmake cprescribing cdecisions? c- cCORRECT cANS✔✔
Pharmakinetiscs cand cPharmodynamics cof colder cadults c- cCORRECT cANS✔✔drug caccumulation csecondary cto creduced crenal
cfunction
polypharmacy c(the cuse cof cfive cor cmore cmedications cdaily)
greater cseverity cof cillness
presence cof ccomorbidities
use cof cdrugs cthat chave ca clow ctherapeutic cindex c(e.g., cdigoxin)
increased cindividual cvariation csecondary cto caltered cpharmacokinetics
inadequate csupervision cof clong-term ctherapy
poor cpatient cadherence
· cBeer's cCriteria c- cCORRECT cANS✔✔•potentially cInappropriate cMedication c(PIM) cuse cin colder cadults
•PIM cuse cin colder cadults cdue cto cmedication-disease cor cmedication-syndrome cinteractions cthat cmay cexacerbate cthe cdisease
cor csyndrome
•medications cto cbe cused ccautiously cin colder cadults
•clinically csignificant cdrug cinteractions cthat cshould cbe cavoided cin colder cadults
•medications cto cbe cavoided cor cdosage cdecreased cin cthe cpresence cof cimpaired ckidney cfunction cin colder cadults c(American
cGeriatric cSociety cBeers cCriteria cUpdate cExpert cPanel, c2019)
CYP450 c- cCORRECT cANS✔✔Many cmedications care cmetabolized cthrough cthe cliver cenzyme csystem ccalled ccytochrome cP450
c(CYP450). cMetabolization ccan cbe cinhibited cor cinduced cby cdrugs cand conce cthis chappens cdrug-drug cinteractions ccan coccur.
VISA ccredit ccard cdept cInhibits cSpending con cCK cand cGQ c- cCORRECT cANS✔✔Valproate
I-soniazid
S-ulfamids
A-miodarone
C-hloramphenical
Ketoconazole
G-rapefruit cJuice c
Q-uinidine
CYP450 cInhibitors c- cCORRECT cANS✔✔- cDecreases cthe cCYP450 cwhich ckeeps cthe cmedication cin cyour cbody clonger cwhich
ccan ccause ctoxicity
CYP450 cINDUCERS c- cCORRECT cANS✔✔Increase cCYP450 cto cwork cfaster ccauses c
Drugs cto cleave cyour cbody cfaster.
Inducers cfor cPY450 cChronic cAlcholics cSteal cPhen cPhen cand cNever cRefuse cGreasy cCarbs c- cCORRECT cANS✔✔Chronic
cAlcoholics c
St. cJohns cWort c
, Phenytoin c
Phenobarbital c
Nevirapine
cRefiampin c
Griseofalvin c
Carbamazepine
· cWhat chappens cwhen csomeone chas ca cpoor cmetabolism cphenotype? c- cCORRECT cANS✔✔Metabolizes cto cslow cor cto cfast.
How cis cabsorption cof cintramuscular cmedication cdifferent cin cneonates? c- cCORRECT cANS✔✔•Slow cand cerratic cdue cto clow
cblood cflow cin cmuscles cfirst cfew cdays cof clife
•Why cis cabsorption cof cmedication cin cthe cstomach cincreased cin cinfancy? c- cCORRECT cANS✔✔Delayed cgastric cemptying
c(adult cvalues creached cby c6-8 cmonths)
What care csome cmedications cthat cshould cbe cavoided cin cthe cpediatric cpatient? c- cCORRECT cANS✔✔glucocorticoids,
cdiscoloration cof cdeveloping cteeth cwith ctetracyclines, cand ckernicterus cwith csulfonamides
•What cshould cbe cincluded cin cmedication cadministration cpatient ceducation? c- cCORRECT cANS✔✔1. cdosage csize cand ctiming c
2. croute cand ctechnique cof cadministration c
3. cduration cof ctreatment c
4.drug cstorage
c5.nature cand ctime ccourse cof cdesired cresponses c
6. cnature cand ctime ccourse cof cadverse cresponses
•What care csome cof cthe cPhysiologic cchanges cthat coccur cin cthe cbody cwhen ca cwoman cis cpregnant cthat ccan cchange cthe
cpharmacodynamic cand cpharmacokinetic cproperties cof cmany cdrugs? c- cCORRECT cANS✔✔- cIncreased cGFR= cIncreased cdrug
cexcretion
- cIncreased chepatic cmetabolism cfor csome cdrugs.
- cDecreased ctone cand cmobility cof cbowel
- cIncreased cdrug cabsorption.
•During cwhat ctrimester cis ca cpregnant cwoman cmost cat crisk cfor cadverse cdrug creactions cwith cpotential clong-term
cconsequences? c- cCORRECT cANS✔✔1 ctrimester
•What care csome cmedications cthat cwe cknow cto cbe cteratogenic? c- cCORRECT cANS✔✔•Antiepileptic cdrugs, cantimicrobials
csuch cas ctetracyclines cand cfluoroquinolones, cvitamin cA cin clarge cdoses, csome canticoagulants, cand chormonal cmedications
csuch cas cdiethylstilbestrol c(DES).
•How ccan cwe cas chealthcare cproviders cdecrease cthe clikelihood cof ca celderly cpatient cexperiencing can cadverse cdrug creaction?
c- cCORRECT cANS✔✔•- cobtaining ca cthorough cdrug chistory cthat cincludes cover-the-counter cmedications
•considering cpharmacokinetic cand cpharmacodynamic cchanges cdue cto cage
•monitoring cthe cpatient's cclinical cresponse cand cplasma cdrug clevels
•using cthe csimplest cregimen cpossible
•monitoring cfor cdrug-drug cinteractions cand ciatrogenic cillness
•periodically creviewing cthe cneed cfor ccontinued cdrug ctherapy
•encouraging cthe cpatient cto cdispose cof cold cmedications
•taking csteps cto cpromote cadherence cand cto cavoid cdrugs con cthe cBeers clist
Why cdo cNitrates cneed cto cbe ctaken cno clater cthan c4 cpm? c- cCORRECT cANS✔✔Need cnitrate cfree cinterval cso ctolerance
cdoesn't cdevelop
•What care cthe cnine cfactors cthat cimpact cthe coutcome cof cmedication caccording cto cRosenthal c& cBurcham? c- cCORRECT
cANS✔✔•Gender cand crace
•Genetics cand cpharmacogenomics
•Variability cin cabsorption
•placebo ceffect
•Tolerance
•patho
•age
•bodyweight
•What cis cthe cdifference cbetween cNP cpractice cauthority cand cprescriptive cauthority? c- cCORRECT cANS✔✔Practice cauthority
crefers cto cthe cnurse cpractitioner's cability cto cpractice cwithout cphysician coversight, cwhereas cprescriptive cauthority crefers cto cthe
cnurse cpractitioner's cauthority cto cprescribe cmedications cindependently cand cwithout climitations.
•Who cregulates cprescription cauthority? c- cCORRECT cANS✔✔The cregulation cof cprescriptive cauthority cis cunder cthe cjurisdiction
cof ca chealth cprofessional cboard. cThis cmay cbe cthe cState cBoard cof cNursing, cthe cState cBoard cof cMedicine, cor cthe cState
cBoard cof cPharmacy, cas cdetermined cby ceach cstate. cAlthough cthe cfederal cgovernment ccontrols cdrug cregulation, cit chas cno
ccontrol cover cprescriptive cauthority.
•What cis cscope cof cpractice cdetermined cby? c- cCORRECT cANS✔✔Nurse cpractitioner cscope cof cpractice cis cdetermined cby
cstate cpractice cand clicensure claws.
