Chamberlain NR565 / NR 565 Midterm Exam
Study Guide Advanced Pharmacology
Fundamentals (Latest 2026 UPDATED):
glucose BUN & creatinine/kidney function electrolytes - sodium, potassium,
calcium, magnesium cardiac glycosides (Digoxin) - ANSWER//increase the
output force of the heart and increase its rate of contractions by acting on the
cellular sodium-potassium ATPase pump Positive Inotropic action can
increase myocardial contractile force. Increase cardiac output. Positive impact
on neurohormonal systems. Quinidine and digoxin - what happens when they
are combined - ANSWER//Quinidine can cause plasma levels of digoxin to
rise by 1) displacing digoxin from tissue binding sites and 2) reducing renal
excretion of digoxin. By elevating free levels of digoxin, quinidine can promote
digoxin toxicity. The combo should be avoided Atherosclerotic Cardiovascular
Disease (ASCVD) Risk Score What is it? - ANSWER//ASCVD risk
assessment is directed at determining the patient's absolute risk of developing
clinical coronary disease over the next 10 years. Defines high risk as 7.5% or
greater. a calculation of your 10-year risk of having a cardiovascular problem,
such as a heart attack or stroke. When is it used - ASCVD Risk Score -
ANSWER//In children a screening should be done between ages 9 and 11
and then again at ages 19 and 21. For adults every 5 years after the age of 20.
Some people are at greater risk like those with diabetes and a risk score
greater than 7.5% and should be screened more often ezetimibe- when can it
be used? - ANSWER//pregnancy/breastfeeding can be use in monotherapy or
as adjunct therapy with a statin or a fibrate What is ezetimibe? -
ANSWER//Cholesterol Absorption Inhibitor- lowers cholesterol levels by
decreasing the amount of cholesterol that is absorbed from the small intestine,
so that there is less intestinal cholesterol delivered to the liver. Does not affect
triglycerides lifestyle changes for high cholesterol - ANSWER//Lifestyle
changes are non drug measures used to lower LDL. Four main issues are diet,
exercise, weight control, and smoking cessation If a patient wanted to
minimize side effects, which drug classification is a good choice? -
ANSWER//Non-statins- fibrates, Ezetimibe, Bile acid sequestrants. Statins are
generally well tolerated and side effects are uncommon. Some patients
develop headache, flatulence, constipation, or GI disturbances, but these
effects are usually mild and transient Therapeutic action of organic nitrates
(nitroglycerin) - ANSWER//direct relaxant effect on vascular smooth muscles,
and the dilation of coronary vessels improves oxygen supply to the
myocardium. The dilation of peripheral veins, and in higher doses peripheral
arteries, reduces preload and afterload, and thereby lowers myocardial
oxygen consumption. promote vasodilation Contraindications for ranolazine -
ANSWER//Agents that inhibit CYP3A4 can increase the levels of ranolazine
and thereby increase the risk of torsades de pointes. These things include:
grapefruit juice, HIV protease inhibitors, macrolide antibiotics, azole antifungal
drugs, and some CCB. Most CCB but not amlodipine can increase levels of
ranolazine. Drugs that prolong the QT interval can increase the risk of
torsades de pointes. (quinidine, sotalol). At what age can statins be
prescribed? - ANSWER//avoid statin use in children under the age of 10 CCB
role with variant angina - ANSWER//promote relaxation of coronary artery
,spasm, increasing cardiac oxygen supply what medication can be added for
patients with worsening symptoms of HF? - ANSWER//aldosterone
antagonist- promotes myocardial remodeling and fibrosis, help with symptoms
CCB stable angina - ANSWER//promote relaxation of peripheral arterioles,
decreasing afterload and reducing cardiac oxygen demand A 41 year old
patient comes into the clinic complaining of increased heart rate after starting
nitro patches for stable angina. What would an appropriate response be? 1.
lets lower the dose and frequency of use 2. I will prescribe a BB to help with
this 3. Next time this happens, lie down and practice deep breathing, this will
bring your heart rate down - ANSWER//2- I will prescribe a BB to help with
this What do CYP450 inhibitors and reducers do when not used correctly/what
would patient experience? - ANSWER//increased side effects, adverse
reactions and toxicity A 55 year old male comes into the clinic with a gouty
arthritis. He states that he has one flareup a year. Your response is: 1. I will
prescribe you glucocorticoids to help with inflammation 2. Lets start you on
prophylactic therapy colchicine. 3. It will be helpful to take an NSAID to start
with to help relive some inflammation. I'll prescribe naproxen. - ANSWER//3-
in patients with infrequent flareups, being less than three per year, treatment
of symptoms is all thats needed. NSAIDS are the first line agent for relieving
pain of an acute gout attack. A patient comes in stating that he tried NSAIDS
to relieve a gouty attack but it hasnt helped. He asks, "what are my options?"
He further states that he has attacks every few years but when he does
NSAIDS do not help. Your response is: 1. I can prescribe a glucocorticoid
(prednisone) and that will bring down the inflammation and pain. 2. Have your
tried increasing your dosage of NSAIDS and drink plenty of water? 3. Lets
start by making some changes in your diet, can you tell me what you eat
regularly? - ANSWER//1 3- can also be correct but BEST answer Colchicine
is considered for long term treatment if a person has how many gouty attacks
per year? - ANSWER//three or more Colchicine should not be taken with what
medications? - ANSWER//statins, CYP3A4 inhibitors adverse effects of
colchicine - ANSWER//nausea, vomiting, diarrhea, myelosuppression,
myopathy, rhabdomyolysis what condition can develop with long term
allopurinol - ANSWER//SCAR (severe cutaneous adverse reaction - rash,
fever, eosinophilia, liver and kidney function) What should be co-administered
with febuxostat? - ANSWER//NSAIDS or colchicine Complications of
untreated gout - ANSWER//Erosion and irreversible joint damage, renal
damage, tophi (stone deposits in joints and tissues) Alendronate patient
education - ANSWER//minimize risk of esophagitis by swallowing the pill
whole with a full glass of water, then sit up for at least 30 min but 60 min
preferred. intake of food prevents absorption, take this med 30 min prior to
other intake Which dietary supplement interferes with Ibandronate absorption?
- ANSWER//calcium, magnesium, iron 1st line treatment of osteoporosis -
ANSWER//alendronate Is allopurinol safe to use in a patient with renal
dysfunction? - ANSWER//yes - drug of choice for patients with renal
dysfunction or who over produce uric acid Baseline diagnostics for DMARDS -
ANSWER//CBC with WBC differential s/s of infection (TB and hepatitis)
malignancies rule out pregnancy ALT, AST, serum creatinine comprehensive
history and physical exam assess risk for immunocompetence and liver and
renal status Baseline data for Methotrexate (DMARD) - ANSWER//chest x-ray,
emphasis on pulm and GI status which DMARD needs ophthalmologic and
, cardiac exam? - ANSWER//hydroxychloroquine black box warning for
Raloxifene - ANSWER//risk for venous thromboembolic events (DVT, PE,
stroke) Behaviors that should predict controlled substance addiction -
ANSWER//reinforcing properties of drugs - pleasurable (euphoria) or reduce
unpleasant experience (reduce anxiety and stress physical dependence
physiological dependence (well-being depends on drug) social factors (peer
pressure) drug availability (Drugs in hospitals - reason for nurses or
pharmacist abuse) vulnerability of individual impulsive low tolerance for
frustration rebellious against social norms depressive, anxiety, and anti-social
personality disorders abuse other drugs Treatment of chronic pain with
pregabalin - ANSWER//adjuvant analgesic for neuropathic pain Effective in
diabetic neuropathy, seizures, central neuropathy, postherpetic neuralgia, and
fibromyalgia adverse effects of pregabalin - ANSWER//Sedation/drowsy,
dizziness, and ataxia, blurred vision, difficulty thinking GI bleeding is linked to
- ANSWER//COX-2 inhibitors and NSAID patient education with colchicine -
ANSWER//only when needed to relieve an attack: Start taking this medicine at
the first sign of the attack for best results. Stop taking this medicine as soon
as the pain is relieved or at the first sign of nausea, vomiting, stomach pain, or
diarrhea. longer you wait to start with attack, less effective it might be Which
drugs are high risk in pregnancy with RA? - ANSWER//methotrexate
leflunomide biologics: anti-TNF agents, rituximab and abatacept (end in -mab)
Which drugs are safe for pregnancy with RA ? - ANSWER//NSAIDs,
APRN prescribing role - 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, 2016). Most patients receiving a prescription are taking other
medications, whether prescription or over-the-counter. Appropriate selection,
dosing, and duration of pharmaceutical agents are key to maximizing
outcomes and minimizing adverse effects benefits of full practice authority -
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 -
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
Study Guide Advanced Pharmacology
Fundamentals (Latest 2026 UPDATED):
glucose BUN & creatinine/kidney function electrolytes - sodium, potassium,
calcium, magnesium cardiac glycosides (Digoxin) - ANSWER//increase the
output force of the heart and increase its rate of contractions by acting on the
cellular sodium-potassium ATPase pump Positive Inotropic action can
increase myocardial contractile force. Increase cardiac output. Positive impact
on neurohormonal systems. Quinidine and digoxin - what happens when they
are combined - ANSWER//Quinidine can cause plasma levels of digoxin to
rise by 1) displacing digoxin from tissue binding sites and 2) reducing renal
excretion of digoxin. By elevating free levels of digoxin, quinidine can promote
digoxin toxicity. The combo should be avoided Atherosclerotic Cardiovascular
Disease (ASCVD) Risk Score What is it? - ANSWER//ASCVD risk
assessment is directed at determining the patient's absolute risk of developing
clinical coronary disease over the next 10 years. Defines high risk as 7.5% or
greater. a calculation of your 10-year risk of having a cardiovascular problem,
such as a heart attack or stroke. When is it used - ASCVD Risk Score -
ANSWER//In children a screening should be done between ages 9 and 11
and then again at ages 19 and 21. For adults every 5 years after the age of 20.
Some people are at greater risk like those with diabetes and a risk score
greater than 7.5% and should be screened more often ezetimibe- when can it
be used? - ANSWER//pregnancy/breastfeeding can be use in monotherapy or
as adjunct therapy with a statin or a fibrate What is ezetimibe? -
ANSWER//Cholesterol Absorption Inhibitor- lowers cholesterol levels by
decreasing the amount of cholesterol that is absorbed from the small intestine,
so that there is less intestinal cholesterol delivered to the liver. Does not affect
triglycerides lifestyle changes for high cholesterol - ANSWER//Lifestyle
changes are non drug measures used to lower LDL. Four main issues are diet,
exercise, weight control, and smoking cessation If a patient wanted to
minimize side effects, which drug classification is a good choice? -
ANSWER//Non-statins- fibrates, Ezetimibe, Bile acid sequestrants. Statins are
generally well tolerated and side effects are uncommon. Some patients
develop headache, flatulence, constipation, or GI disturbances, but these
effects are usually mild and transient Therapeutic action of organic nitrates
(nitroglycerin) - ANSWER//direct relaxant effect on vascular smooth muscles,
and the dilation of coronary vessels improves oxygen supply to the
myocardium. The dilation of peripheral veins, and in higher doses peripheral
arteries, reduces preload and afterload, and thereby lowers myocardial
oxygen consumption. promote vasodilation Contraindications for ranolazine -
ANSWER//Agents that inhibit CYP3A4 can increase the levels of ranolazine
and thereby increase the risk of torsades de pointes. These things include:
grapefruit juice, HIV protease inhibitors, macrolide antibiotics, azole antifungal
drugs, and some CCB. Most CCB but not amlodipine can increase levels of
ranolazine. Drugs that prolong the QT interval can increase the risk of
torsades de pointes. (quinidine, sotalol). At what age can statins be
prescribed? - ANSWER//avoid statin use in children under the age of 10 CCB
role with variant angina - ANSWER//promote relaxation of coronary artery
,spasm, increasing cardiac oxygen supply what medication can be added for
patients with worsening symptoms of HF? - ANSWER//aldosterone
antagonist- promotes myocardial remodeling and fibrosis, help with symptoms
CCB stable angina - ANSWER//promote relaxation of peripheral arterioles,
decreasing afterload and reducing cardiac oxygen demand A 41 year old
patient comes into the clinic complaining of increased heart rate after starting
nitro patches for stable angina. What would an appropriate response be? 1.
lets lower the dose and frequency of use 2. I will prescribe a BB to help with
this 3. Next time this happens, lie down and practice deep breathing, this will
bring your heart rate down - ANSWER//2- I will prescribe a BB to help with
this What do CYP450 inhibitors and reducers do when not used correctly/what
would patient experience? - ANSWER//increased side effects, adverse
reactions and toxicity A 55 year old male comes into the clinic with a gouty
arthritis. He states that he has one flareup a year. Your response is: 1. I will
prescribe you glucocorticoids to help with inflammation 2. Lets start you on
prophylactic therapy colchicine. 3. It will be helpful to take an NSAID to start
with to help relive some inflammation. I'll prescribe naproxen. - ANSWER//3-
in patients with infrequent flareups, being less than three per year, treatment
of symptoms is all thats needed. NSAIDS are the first line agent for relieving
pain of an acute gout attack. A patient comes in stating that he tried NSAIDS
to relieve a gouty attack but it hasnt helped. He asks, "what are my options?"
He further states that he has attacks every few years but when he does
NSAIDS do not help. Your response is: 1. I can prescribe a glucocorticoid
(prednisone) and that will bring down the inflammation and pain. 2. Have your
tried increasing your dosage of NSAIDS and drink plenty of water? 3. Lets
start by making some changes in your diet, can you tell me what you eat
regularly? - ANSWER//1 3- can also be correct but BEST answer Colchicine
is considered for long term treatment if a person has how many gouty attacks
per year? - ANSWER//three or more Colchicine should not be taken with what
medications? - ANSWER//statins, CYP3A4 inhibitors adverse effects of
colchicine - ANSWER//nausea, vomiting, diarrhea, myelosuppression,
myopathy, rhabdomyolysis what condition can develop with long term
allopurinol - ANSWER//SCAR (severe cutaneous adverse reaction - rash,
fever, eosinophilia, liver and kidney function) What should be co-administered
with febuxostat? - ANSWER//NSAIDS or colchicine Complications of
untreated gout - ANSWER//Erosion and irreversible joint damage, renal
damage, tophi (stone deposits in joints and tissues) Alendronate patient
education - ANSWER//minimize risk of esophagitis by swallowing the pill
whole with a full glass of water, then sit up for at least 30 min but 60 min
preferred. intake of food prevents absorption, take this med 30 min prior to
other intake Which dietary supplement interferes with Ibandronate absorption?
- ANSWER//calcium, magnesium, iron 1st line treatment of osteoporosis -
ANSWER//alendronate Is allopurinol safe to use in a patient with renal
dysfunction? - ANSWER//yes - drug of choice for patients with renal
dysfunction or who over produce uric acid Baseline diagnostics for DMARDS -
ANSWER//CBC with WBC differential s/s of infection (TB and hepatitis)
malignancies rule out pregnancy ALT, AST, serum creatinine comprehensive
history and physical exam assess risk for immunocompetence and liver and
renal status Baseline data for Methotrexate (DMARD) - ANSWER//chest x-ray,
emphasis on pulm and GI status which DMARD needs ophthalmologic and
, cardiac exam? - ANSWER//hydroxychloroquine black box warning for
Raloxifene - ANSWER//risk for venous thromboembolic events (DVT, PE,
stroke) Behaviors that should predict controlled substance addiction -
ANSWER//reinforcing properties of drugs - pleasurable (euphoria) or reduce
unpleasant experience (reduce anxiety and stress physical dependence
physiological dependence (well-being depends on drug) social factors (peer
pressure) drug availability (Drugs in hospitals - reason for nurses or
pharmacist abuse) vulnerability of individual impulsive low tolerance for
frustration rebellious against social norms depressive, anxiety, and anti-social
personality disorders abuse other drugs Treatment of chronic pain with
pregabalin - ANSWER//adjuvant analgesic for neuropathic pain Effective in
diabetic neuropathy, seizures, central neuropathy, postherpetic neuralgia, and
fibromyalgia adverse effects of pregabalin - ANSWER//Sedation/drowsy,
dizziness, and ataxia, blurred vision, difficulty thinking GI bleeding is linked to
- ANSWER//COX-2 inhibitors and NSAID patient education with colchicine -
ANSWER//only when needed to relieve an attack: Start taking this medicine at
the first sign of the attack for best results. Stop taking this medicine as soon
as the pain is relieved or at the first sign of nausea, vomiting, stomach pain, or
diarrhea. longer you wait to start with attack, less effective it might be Which
drugs are high risk in pregnancy with RA? - ANSWER//methotrexate
leflunomide biologics: anti-TNF agents, rituximab and abatacept (end in -mab)
Which drugs are safe for pregnancy with RA ? - ANSWER//NSAIDs,
APRN prescribing role - 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, 2016). Most patients receiving a prescription are taking other
medications, whether prescription or over-the-counter. Appropriate selection,
dosing, and duration of pharmaceutical agents are key to maximizing
outcomes and minimizing adverse effects benefits of full practice authority -
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 -
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
