NR565 / NR 565 Midterm Exam
Study Guide (Latest 2026/2027
UPDATED): Advanced
Pharmacology Fundamentals -
Chamberlain
- ANSWER//MAOI (hyperpyrexia coma) coma, resp depression, pinpoint
pupuls How does strength of fentanyl compare to morphine - ANSWER//high
milligram potency (about 100 times that of morphine) through what system is
fentanyl metabolized? - ANSWER//CYP34A (isoenzyme of CYP450), levels of
fentanyl can be increased by CYP34A inhibitors What is methadone used to
treat? - ANSWER//relieve pain and treat opioid addiction For what level of
pain is codeine prescribed? - ANSWER//mild to moderate What does 10% of
codeine convert to/black box warning - ANSWER//10% of each dose of
codeine undergoes conversion to morphine, the active form of codeine (led to
death in children and toxicity in infants through breast milk) Black box warning
for hydrocodone - ANSWER//products that contain Tylenol are associated
with hepatotoxicity Black box warning opioids, fentanyl, oxycodone,
hydromorphone, oxymorphone - ANSWER//respiratory depression black box
warning for methadone - ANSWER//prolong QT interval, fatal dysrhythmias
Do opioid agonist-antagonist have high or low potential for abuse? -
ANSWER//low - when compared with opioid agonists If you switch a patient
from oxycodone to buprenorphine quickly what may we expect to see? -
ANSWER//If given to a patient who is physically dependent on a pure agonist,
there drugs can precipitate withdrawal What level of pain is tramadol
approved for - ANSWER//moderate to moderately severe What schedule is
tramadol classified as? - ANSWER//schedule IV What population should
tramadol be AVOIDED in? - ANSWER//pt's with epilepsy, neurologic disorders,
elderly What drugs should be avoided for patients taking tramadol? -
ANSWER//CNS depressants (benzo, alcohol), MAOI, SSRI, serotonin and
norepinephrine reuptake inhibitors, tricyclic antidepressants, triptans What
government branch declared the opioid crisis a public health emergency? -
ANSWER//Health and Human Services (HHS) what are the top 5 priorities of
HHS? - ANSWER//Improving access to treatment and recovery services
Promoting use of overdose-reversing drugs Strengthening our understanding
of the epidemic through better public health surveillance Providing support for
cutting edge research on pain and addiction Advancing better practices for
pain management What were provisions made to the guidelines for
prescribing opioids to non-cancer patients? - ANSWER//Using opioids only
after non-opioid analgesics or more conservative methods have failed
Discussing the benefits and risks for long term opioids with patient When
possible, one prescriber, one pharmacy Ensuring comprehensive follow up to
assess efficacy and side effects of treatment and monitor for signs of opioid
abuse Stopping opioids after an attempt at opioid rotation had produced
inadequate benefits Fully documenting the entire process When prescribing
,opioids should patient be initially started on IR or ER? - ANSWER//IR- lowest
dose for shortest amount of time How are patients initially exposed to opioids?
- ANSWER//either recreationally (illicitly) or in context of pain management in
medical setting Which group of professionals are at greater risk for abusing? -
ANSWER//health care providers, nurses, pharmacists What are some effects
of opioid use that DON'T change with long term use and tolerance? -
ANSWER//constipation and miosis (pupil constriction) tolerance does develop?
- ANSWER//euphoria, respiratory depression, and nausea Is opioid
withdrawal life threatening? - ANSWER//unpleasant but rarely dangerous
Methadone can be used for which two therapies? - ANSWER//maintenance-
transferring addict from abuse opioid to oral methadone suppressive- prevent
the reinforcing effects of opioid induced euphoria Methadone half life? -
ANSWER//long, prescribed only by providers with special training in pain
management Does methadone or buprenorphine have a ceiling (drugs that
impact on body plateus) to respiratory depression? -
ANSWER//buprenorphine - makes it safer What are the therapeutic uses for
morphine? - ANSWER//pain management, sedation, euphoria, respiratory
depression, cough suppression, reduces anxiety, a sense of well-being,
suppress GI motility (help with severe diarrhea) Therapeutic uses of fentanyl?
- ANSWER//Chronic or acute severe pain, cancer pain Risk factors for opioid
use disorder - ANSWER//chronic pain, family history, other substance abuse,
prescribed for long term use Drugs not safe to take with opioids -
ANSWER//opioids, benzos, alcohol, CNS depressants, anti-histamines,
general anesthetics Buprenorzhine and Naloxone - ANSWER//agonist-
antagonist Buprenorzhine and Naloxone benefit of combination -
ANSWER//Naloxone is added to buprenorphine to decrease the likelihood of
diversion and misuse of the combination drug product Treatment of chronic
pain- Example: How should something like osteoarthritis be treated? -
ANSWER//Non Opioid medications - NSAIDs, cox-2 inhibitors
Nonpharmacologic tx - heat/cold, yoga, physical therapy, exercise, healthy
weight When prescribing medication we must understand that liver function
declines with age due to what cause? a. enlarged liver b. decreased blood
flow to liver c. increased activity of the hepatic enzymes -
ANSWER//decreased blood flow to liver a. decreased liver mass c. decrease
in enzyme activity What is the most important cause of adverse drug reactions?
(older age) a. high drug dosages b. lack of monitoring medications c.
decreased renal excretion d. overprescribing/polypharmacy -
ANSWER//decreased renal excretion Distribution of medication can be
affected in the elderly in what ways? SATA 1. decreased hormones 2.
increased body fat 3. decreased lean mass 4. decreased albumin -
ANSWER//2, 3, 4 changes in body composition associated with age due to an
increase in body fat percentage and decrease in lean muscle mass. There is
also a decrease in total body water. Distribution can also be impacted by
decreased total body water and decreased cardiac output. Absorption can be
impacted by increase gastric pH, decreased absorption surface area
decreased G.I. motility and decrease gastric emptying. Metabolism can be
impacted by de Cristo paddock blood flow, paddock mask, and activity of
hepatic enzymes. Excretion can be impacted by decreased renal blood flow,
decrease GFR, decrees to both secretion, and decrease number of nephrons
An 82 year old male visits the clinic complaining that his pain medications
, "take forever" to work after he takes his pill. What are possible reasons you
can explain to him? 1.Perhaps we need to increase your dosage.
2.Sometimes as you get older, absorption may be slower resulting in a
delayed response. 3.As we get older the gastric acid decreases and may slow
absorption. - ANSWER//2&3 Order of HTN medications typically prescribed -
ANSWER//Thiazide diuretics Ace Inhibitors ARBS CCB BB Which is best
HTN medication for someone with diabetes - ANSWER//ACE inhibitor and
ARB Which medication to avoid in a patient who is pregnant or breastfeeding?
- ANSWER//Avoid ACE and ARBs in patients who are pregnant or may
become pregnant. Especially ARBs in the second and third trimester.
Medications best for HTN for patient who is pregnant? - ANSWER//labetalol,
methyldopa, nifedipine For general population which HTN class is appropriate?
- ANSWER//thiazide diuretics For African Americans which class of HTN
medications is appropriate? - ANSWER//thiazide, CCB, BB For a chronic
kidney disease, what is the best HTN medication class? - ANSWER//ACE
Inhibitors or ARBS What class of medications to avoid in African Americans? -
ANSWER//ACE inhibitors and ARBS Thiazide diuretics MOA -
ANSWER//blockade of sodium and chloride reabsorption increases renal
excretion of sodium, chloride, potassium, and water (hyponatremia,
hypochloremia, hypokalemia) ACE inhibitors MOA - ANSWER//Angiotensin
Converting Enzyme Inhibitors (ACE-I) prevent the conversion of angiotensin I
to angiotensin II, which disrupts the renin-angiotensin-aldosterone system
(RAAS). 1. reduce levels of angiotensin II (through inhibition of ACE) 2.
increasing levels of bradykinin (through inhibition of kinase 11) End in -pril
ARBS MOA - ANSWER//Block angiotensin II receptors on blood vessels in
heart and adrenals. Increases renal excretion of sodium and water. Cause
dilation of arterioles and veins. End in -sartan CCB MOA - ANSWER//They
work by preventing calcium from entering the cells of the heart and arteries.
Calcium causes the heart and arteries to squeeze (contract) more strongly. By
blocking calcium, calcium channel blockers allow blood vessels to relax and
open. blockade of peripheral arterioles cause dilation and reduces arterial
pressure, arterioles of the heart increases coronary perfusion, blockade of the
SA node reduces heart rate, decreases AV node conduction, myocardium
decreases force of contraction Prescribing considerations when
carbamazepine is prescribed with warfarin - ANSWER//Carbamazepine
lowers the effectiveness of Warfarin. This is because of the induction of drug-
metabolizing enzymes. There needs to be close monitoring for the Warfarin
dose by checking the prothrombin and INR. The dose may need to be
adjusted to counterbalance the effect of adding or removing the inducing
agent A patient with HF develops fibrotic changes, what should the provider
do next? - ANSWER//ensure that a patient is on an ARB (valsartan) as this
inhibits fibrosis (aldosterone antagonist) Adverse effects of lasix (flurosemide)
- ANSWER//ototoxicity What medication causes ototoxicity as well and should
not be prescribed with lasix? - ANSWER//aminoglycoside antibiotics, end in -
cin What medication might we consider prescribing with a loop diuretic to
prevent an electrolyte imbalance? - ANSWER//potassium sparing diuretic
(spironolactone) black box warning for spironolactone - ANSWER//endocrine
effects - gynecomastia, menstrual irregularities, hirsutism, deepening of voice
HYPERKALEMIA What is the action of aldosterone? - ANSWER//acts on
distal tubules of the kidney to cause retention of sodium and excretion of
Study Guide (Latest 2026/2027
UPDATED): Advanced
Pharmacology Fundamentals -
Chamberlain
- ANSWER//MAOI (hyperpyrexia coma) coma, resp depression, pinpoint
pupuls How does strength of fentanyl compare to morphine - ANSWER//high
milligram potency (about 100 times that of morphine) through what system is
fentanyl metabolized? - ANSWER//CYP34A (isoenzyme of CYP450), levels of
fentanyl can be increased by CYP34A inhibitors What is methadone used to
treat? - ANSWER//relieve pain and treat opioid addiction For what level of
pain is codeine prescribed? - ANSWER//mild to moderate What does 10% of
codeine convert to/black box warning - ANSWER//10% of each dose of
codeine undergoes conversion to morphine, the active form of codeine (led to
death in children and toxicity in infants through breast milk) Black box warning
for hydrocodone - ANSWER//products that contain Tylenol are associated
with hepatotoxicity Black box warning opioids, fentanyl, oxycodone,
hydromorphone, oxymorphone - ANSWER//respiratory depression black box
warning for methadone - ANSWER//prolong QT interval, fatal dysrhythmias
Do opioid agonist-antagonist have high or low potential for abuse? -
ANSWER//low - when compared with opioid agonists If you switch a patient
from oxycodone to buprenorphine quickly what may we expect to see? -
ANSWER//If given to a patient who is physically dependent on a pure agonist,
there drugs can precipitate withdrawal What level of pain is tramadol
approved for - ANSWER//moderate to moderately severe What schedule is
tramadol classified as? - ANSWER//schedule IV What population should
tramadol be AVOIDED in? - ANSWER//pt's with epilepsy, neurologic disorders,
elderly What drugs should be avoided for patients taking tramadol? -
ANSWER//CNS depressants (benzo, alcohol), MAOI, SSRI, serotonin and
norepinephrine reuptake inhibitors, tricyclic antidepressants, triptans What
government branch declared the opioid crisis a public health emergency? -
ANSWER//Health and Human Services (HHS) what are the top 5 priorities of
HHS? - ANSWER//Improving access to treatment and recovery services
Promoting use of overdose-reversing drugs Strengthening our understanding
of the epidemic through better public health surveillance Providing support for
cutting edge research on pain and addiction Advancing better practices for
pain management What were provisions made to the guidelines for
prescribing opioids to non-cancer patients? - ANSWER//Using opioids only
after non-opioid analgesics or more conservative methods have failed
Discussing the benefits and risks for long term opioids with patient When
possible, one prescriber, one pharmacy Ensuring comprehensive follow up to
assess efficacy and side effects of treatment and monitor for signs of opioid
abuse Stopping opioids after an attempt at opioid rotation had produced
inadequate benefits Fully documenting the entire process When prescribing
,opioids should patient be initially started on IR or ER? - ANSWER//IR- lowest
dose for shortest amount of time How are patients initially exposed to opioids?
- ANSWER//either recreationally (illicitly) or in context of pain management in
medical setting Which group of professionals are at greater risk for abusing? -
ANSWER//health care providers, nurses, pharmacists What are some effects
of opioid use that DON'T change with long term use and tolerance? -
ANSWER//constipation and miosis (pupil constriction) tolerance does develop?
- ANSWER//euphoria, respiratory depression, and nausea Is opioid
withdrawal life threatening? - ANSWER//unpleasant but rarely dangerous
Methadone can be used for which two therapies? - ANSWER//maintenance-
transferring addict from abuse opioid to oral methadone suppressive- prevent
the reinforcing effects of opioid induced euphoria Methadone half life? -
ANSWER//long, prescribed only by providers with special training in pain
management Does methadone or buprenorphine have a ceiling (drugs that
impact on body plateus) to respiratory depression? -
ANSWER//buprenorphine - makes it safer What are the therapeutic uses for
morphine? - ANSWER//pain management, sedation, euphoria, respiratory
depression, cough suppression, reduces anxiety, a sense of well-being,
suppress GI motility (help with severe diarrhea) Therapeutic uses of fentanyl?
- ANSWER//Chronic or acute severe pain, cancer pain Risk factors for opioid
use disorder - ANSWER//chronic pain, family history, other substance abuse,
prescribed for long term use Drugs not safe to take with opioids -
ANSWER//opioids, benzos, alcohol, CNS depressants, anti-histamines,
general anesthetics Buprenorzhine and Naloxone - ANSWER//agonist-
antagonist Buprenorzhine and Naloxone benefit of combination -
ANSWER//Naloxone is added to buprenorphine to decrease the likelihood of
diversion and misuse of the combination drug product Treatment of chronic
pain- Example: How should something like osteoarthritis be treated? -
ANSWER//Non Opioid medications - NSAIDs, cox-2 inhibitors
Nonpharmacologic tx - heat/cold, yoga, physical therapy, exercise, healthy
weight When prescribing medication we must understand that liver function
declines with age due to what cause? a. enlarged liver b. decreased blood
flow to liver c. increased activity of the hepatic enzymes -
ANSWER//decreased blood flow to liver a. decreased liver mass c. decrease
in enzyme activity What is the most important cause of adverse drug reactions?
(older age) a. high drug dosages b. lack of monitoring medications c.
decreased renal excretion d. overprescribing/polypharmacy -
ANSWER//decreased renal excretion Distribution of medication can be
affected in the elderly in what ways? SATA 1. decreased hormones 2.
increased body fat 3. decreased lean mass 4. decreased albumin -
ANSWER//2, 3, 4 changes in body composition associated with age due to an
increase in body fat percentage and decrease in lean muscle mass. There is
also a decrease in total body water. Distribution can also be impacted by
decreased total body water and decreased cardiac output. Absorption can be
impacted by increase gastric pH, decreased absorption surface area
decreased G.I. motility and decrease gastric emptying. Metabolism can be
impacted by de Cristo paddock blood flow, paddock mask, and activity of
hepatic enzymes. Excretion can be impacted by decreased renal blood flow,
decrease GFR, decrees to both secretion, and decrease number of nephrons
An 82 year old male visits the clinic complaining that his pain medications
, "take forever" to work after he takes his pill. What are possible reasons you
can explain to him? 1.Perhaps we need to increase your dosage.
2.Sometimes as you get older, absorption may be slower resulting in a
delayed response. 3.As we get older the gastric acid decreases and may slow
absorption. - ANSWER//2&3 Order of HTN medications typically prescribed -
ANSWER//Thiazide diuretics Ace Inhibitors ARBS CCB BB Which is best
HTN medication for someone with diabetes - ANSWER//ACE inhibitor and
ARB Which medication to avoid in a patient who is pregnant or breastfeeding?
- ANSWER//Avoid ACE and ARBs in patients who are pregnant or may
become pregnant. Especially ARBs in the second and third trimester.
Medications best for HTN for patient who is pregnant? - ANSWER//labetalol,
methyldopa, nifedipine For general population which HTN class is appropriate?
- ANSWER//thiazide diuretics For African Americans which class of HTN
medications is appropriate? - ANSWER//thiazide, CCB, BB For a chronic
kidney disease, what is the best HTN medication class? - ANSWER//ACE
Inhibitors or ARBS What class of medications to avoid in African Americans? -
ANSWER//ACE inhibitors and ARBS Thiazide diuretics MOA -
ANSWER//blockade of sodium and chloride reabsorption increases renal
excretion of sodium, chloride, potassium, and water (hyponatremia,
hypochloremia, hypokalemia) ACE inhibitors MOA - ANSWER//Angiotensin
Converting Enzyme Inhibitors (ACE-I) prevent the conversion of angiotensin I
to angiotensin II, which disrupts the renin-angiotensin-aldosterone system
(RAAS). 1. reduce levels of angiotensin II (through inhibition of ACE) 2.
increasing levels of bradykinin (through inhibition of kinase 11) End in -pril
ARBS MOA - ANSWER//Block angiotensin II receptors on blood vessels in
heart and adrenals. Increases renal excretion of sodium and water. Cause
dilation of arterioles and veins. End in -sartan CCB MOA - ANSWER//They
work by preventing calcium from entering the cells of the heart and arteries.
Calcium causes the heart and arteries to squeeze (contract) more strongly. By
blocking calcium, calcium channel blockers allow blood vessels to relax and
open. blockade of peripheral arterioles cause dilation and reduces arterial
pressure, arterioles of the heart increases coronary perfusion, blockade of the
SA node reduces heart rate, decreases AV node conduction, myocardium
decreases force of contraction Prescribing considerations when
carbamazepine is prescribed with warfarin - ANSWER//Carbamazepine
lowers the effectiveness of Warfarin. This is because of the induction of drug-
metabolizing enzymes. There needs to be close monitoring for the Warfarin
dose by checking the prothrombin and INR. The dose may need to be
adjusted to counterbalance the effect of adding or removing the inducing
agent A patient with HF develops fibrotic changes, what should the provider
do next? - ANSWER//ensure that a patient is on an ARB (valsartan) as this
inhibits fibrosis (aldosterone antagonist) Adverse effects of lasix (flurosemide)
- ANSWER//ototoxicity What medication causes ototoxicity as well and should
not be prescribed with lasix? - ANSWER//aminoglycoside antibiotics, end in -
cin What medication might we consider prescribing with a loop diuretic to
prevent an electrolyte imbalance? - ANSWER//potassium sparing diuretic
(spironolactone) black box warning for spironolactone - ANSWER//endocrine
effects - gynecomastia, menstrual irregularities, hirsutism, deepening of voice
HYPERKALEMIA What is the action of aldosterone? - ANSWER//acts on
distal tubules of the kidney to cause retention of sodium and excretion of
