NR565 / NR 565 Midterm Exam Study Guide (Latest 2026
UPDATED): Advanced Pharmacology Fundamentals -
Chamberlain 2026\2027 A+ Grade
APRN prescribing role
- correct answer Prescriptive authority for nurse practitioners also regulates prescribing rights beyond
medications and controlled substances. These rights include therapeutic devices and services and are
outlined in state practice laws and regulations and include Durable Medical Equipment (DME) such as
wheelchairs, power scooters, hospital beds, portable oxygen equipment, handicap placards, etc. and
medical services such as Physical Therapy (PT), Occupational Therapy (OT), home health services, etc.
Prescriptive authority encompasses more than writing a prescription correctly. It requires adherence to
ethical guidelines to ensure that patients are safeguarded from harm. Ethical prescribing starts with
being well-informed about medications. Mechanism of action, efficacy, and safety are important
considerations, as are a patient's distinct needs and circumstances, including the number of medications
prescribed (Mitchell & Oliphant, 2
benefits of full practice authority
- correct answer 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
- correct answer 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,
Beer's Criteria
- correct answer 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
- correct answer the study of the biochemical and physiologic effects of drugs on the body and the
molecular mechanisms by which those effects are produced
Pharmacokinetics
- correct answer the study of drug movement throughout the body
Pharmacogenomics
- correct answer 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
- correct answer 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
- correct answer 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
- correct answer 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
- correct answer 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
- correct answer
Chronic Pain Management
- correct answer
, Opioid Management
- correct answer
Regulations of Controlled Substances
- correct answer 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 nu
Opioid Epidemic & Responsible Prescribing
- correct answer
Opioid Use Disorder
- correct answer a pattern of use that leads to significant impairment or distress. Typically, this disorder
is marked by unsuccessful efforts to reduce or control use resulting in the inability to fulfill work, school,
or home responsibilities. Opioid use disorder is different from drug tolerance and physical dependence,
which may also exist. Opioid use creates high levels of positive reinforcement, increasing the likelihood
of continued use. It is often a chronic lifelong disorder, leading to serious consequences such as
disability and death. Although it is similar to other substance use disorders, it has distinct features that
have fueled the current opioid epidemic. Opioids can lead to physical dependence in only 4-8 weeks.
Abruptly stopping use in chronic users leads to severe symptoms, which motivates continued use to
prevent withdrawal. The 2016 CDC guidelines for prescribing opioids recommends calculating the total
daily dose
State Prescription Drug
- correct answer Clinicians should review the patient's history of controlled substance prescriptions
using state prescription drug monitoring program (PDMP) data to determine whether the patient is
receiving opioid dosages or dangerous combinations that put him or her at high risk for overdose.
Clinicians should review PDMP data when starting opioid therapy for chronic pain and periodically
during opioid therapy for chronic pain, ranging from every prescription to every 3 months.
UPDATED): Advanced Pharmacology Fundamentals -
Chamberlain 2026\2027 A+ Grade
APRN prescribing role
- correct answer Prescriptive authority for nurse practitioners also regulates prescribing rights beyond
medications and controlled substances. These rights include therapeutic devices and services and are
outlined in state practice laws and regulations and include Durable Medical Equipment (DME) such as
wheelchairs, power scooters, hospital beds, portable oxygen equipment, handicap placards, etc. and
medical services such as Physical Therapy (PT), Occupational Therapy (OT), home health services, etc.
Prescriptive authority encompasses more than writing a prescription correctly. It requires adherence to
ethical guidelines to ensure that patients are safeguarded from harm. Ethical prescribing starts with
being well-informed about medications. Mechanism of action, efficacy, and safety are important
considerations, as are a patient's distinct needs and circumstances, including the number of medications
prescribed (Mitchell & Oliphant, 2
benefits of full practice authority
- correct answer 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
- correct answer 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,
Beer's Criteria
- correct answer 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
- correct answer the study of the biochemical and physiologic effects of drugs on the body and the
molecular mechanisms by which those effects are produced
Pharmacokinetics
- correct answer the study of drug movement throughout the body
Pharmacogenomics
- correct answer 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
- correct answer 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
- correct answer 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
- correct answer 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
- correct answer 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
- correct answer
Chronic Pain Management
- correct answer
, Opioid Management
- correct answer
Regulations of Controlled Substances
- correct answer 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 nu
Opioid Epidemic & Responsible Prescribing
- correct answer
Opioid Use Disorder
- correct answer a pattern of use that leads to significant impairment or distress. Typically, this disorder
is marked by unsuccessful efforts to reduce or control use resulting in the inability to fulfill work, school,
or home responsibilities. Opioid use disorder is different from drug tolerance and physical dependence,
which may also exist. Opioid use creates high levels of positive reinforcement, increasing the likelihood
of continued use. It is often a chronic lifelong disorder, leading to serious consequences such as
disability and death. Although it is similar to other substance use disorders, it has distinct features that
have fueled the current opioid epidemic. Opioids can lead to physical dependence in only 4-8 weeks.
Abruptly stopping use in chronic users leads to severe symptoms, which motivates continued use to
prevent withdrawal. The 2016 CDC guidelines for prescribing opioids recommends calculating the total
daily dose
State Prescription Drug
- correct answer Clinicians should review the patient's history of controlled substance prescriptions
using state prescription drug monitoring program (PDMP) data to determine whether the patient is
receiving opioid dosages or dangerous combinations that put him or her at high risk for overdose.
Clinicians should review PDMP data when starting opioid therapy for chronic pain and periodically
during opioid therapy for chronic pain, ranging from every prescription to every 3 months.
