NUR 2407 Pharmacology Final Exam Study Guide | Rasmussen | 150+ Q&A with Rationales | 4 Options Each

This NUR 2407 Pharmacology Final Exam Study Guide for provides over 150 genuine exam-style questions with verified answers and detailed rationales in a 4-option multiple-choice format – exactly like the actual Rasmussen final exam. Designed for nursing students taking NUR 2407 (or equivalent pharmacology courses), this high-yield resource covers all major drug categories and pharmacokinetic principles tested on the final. Organized by exam blueprint with question distribution: Pharmacokinetics & Pharmacodynamics (22 Qs) Half-life & steady state calculation (4-5 half-lives) Absorption, distribution, metabolism, excretion (ADME) First-pass effect (reduced bioavailability) Protein binding & drug displacement Weak acids (non-ionized in acidic stomach) Agonists vs antagonists (naloxone example) Lipid solubility & onset of action Tolerance (decreased receptor responsiveness) Liver metabolism (CYP450 enzymes) Codeine ultra-rapid metabolizer risk (toxicity) Pharmacodynamics vs pharmacokinetics Synergistic vs additive effects IV fastest onset Narrow therapeutic index drugs (digoxin, warfarin, phenytoin) Older adult dosing (decreased liver/kidney function) Volume of distribution (high Vd = tissue distribution) CYP450 drug interactions Prodrugs (codeine → morphine, levodopa → dopamine) Factors increasing GI absorption (blood flow) Protein-binding displacement (increased free drug) Serum creatinine for renally excreted drugs Dosing interval determined by half-life Medication Safety & Dosage Calculation (15 Qs) Right dose (weight-based calculation) Dopamine mcg/min calculation (70 kg × 5 mcg = 350 mcg/min) High-alert medications (heparin, insulin drips – independent double-check) Reconstitution calculations (cefazolin 500 mg from 1g vial) Furosemide mL calculation (40 mg ÷ 10 mg/mL = 4 mL) Most overlooked right – documentation Medication error (IV push too rapidly → hypotension/bradycardia) Two patient identifiers required Morphine mL calculation (4 mg ÷ 2 mg/mL = 2 mL) Insulin drip double-check requirement IV flow rate calculation (gtt/min formula) Look-alike/sound-alike: Celebrex vs Celexa Patient refusal – document first Heparin subcutaneous calculation (5000 units ÷ 10,000 units/mL = 0.5 mL) Independent double-check for high-alert meds Cardiovascular & Hematologic Drugs (30 Qs) Lisinopril – dry cough (bradykinin accumulation) Heparin antidote – protamine sulfate Warfarin INR 5.5 with no bleeding – hold warfarin + vitamin K Digoxin toxicity – nausea, vomiting, yellow halos → check digoxin level Furosemide – hypokalemia (potassium wasting) Clopidogrel – antiplatelet (P2Y12 inhibitor) Metoprolol – beta-1 blocker (HR 60 → hold dose) Atorvastatin – monitor LFTs (hepatotoxicity) Statin muscle pain – rhabdomyolysis → notify provider immediately ACE inhibitors – black box warning: angioedema, fetal toxicity Amlodipine – peripheral edema (dihydropyridine CCB) Nitroglycerin SL – onset 1-3 minutes Sildenafil (Viagra) + nitroglycerin – severe hypotension (contraindicated) Spironolactone – hyperkalemia (potassium-sparing) Unfractionated heparin – monitor aPTT (goal 1.5-2.5× normal) Warfarin INR 1.2 – subtherapeutic (clot risk) Garlic, ginger, ginkgo, ginseng – increase bleeding risk with warfarin Digoxin therapeutic effect – improved exercise tolerance, decreased edema Furosemide IV – rapid reduction of pulmonary edema Furosemide ototoxicity – high doses or rapid IV push Enalapril therapeutic effect – BP control (128/78) Argatroban – direct thrombin inhibitor for HIT Hydralazine – reflex tachycardia Diltiazem – non-dihydropyridine CCB (slows HR) Amiodarone – monitor thyroid and pulmonary function (fibrosis) Enoxaparin (LMWH) – no routine aPTT/INR monitoring required Enoxaparin bruising – apply pressure Digoxin – check potassium before administration (hypokalemia ↑ toxicity) Carvedilol – non-selective beta-blocker + alpha-1 blockade (vasodilation) Endocrine Drugs (22 Qs) Glucagon – stimulates liver to release stored glucose (severe hypoglycemia) Metformin teaching – avoid heavy alcohol (lactic acidosis risk) Insulin Lispro (Humalog) – give immediately before meals (0-15 min) Levothyroxine – take on empty stomach 30-60 min before breakfast Hypoglycemia signs – diaphoresis, confusion, tachycardia HbA1c 9.5% – poor glycemic control (target 7%) Prednisone – hyperglycemia (monitor blood glucose) Methimazole – agranulocytosis (sore throat/fever → stop, get CBC) Regular insulin – only insulin given IV (DKA) Prednisone withdrawal – adrenal crisis (taper required) Pioglitazone (Actos) – bladder cancer risk Sick day rules – increase fluids, check glucose q4h, never stop insulin Liraglutide (Victoza) – GLP-1 agonist (weight loss, slows gastric emptying) Metformin lactic acidosis – severe diarrhea, muscle cramps Empagliflozin (Jardiance) – genital yeast infections (SGLT2 inhibitor) Levothyroxine in pregnancy – first-line, safe (methimazole teratogenic) Propylthiouracil (PTU) – hepatotoxicity (black box warning) Mixing insulin – Regular (clear) first, then NPH (cloudy) Levothyroxine overdose – palpitations, weight loss (thyrotoxicosis) Glipizide (sulfonylurea) – weight gain + hypoglycemia risk DKA insulin drip goal – lower glucose 50-75 mg/dL per hour Insulin Glargine (Lantus) – peakless basal insulin (do not mix) Neurological & Psychiatric Drugs (22 Qs) Morphine – constipation (prevent with stool softeners) Methadone – opioid use disorder maintenance SSRI + MAOI – serotonin syndrome (agitation, fever, rigidity, myoclonus) Phenytoin (Dilantin) – therapeutic range 10-20 mcg/mL Lithium toxicity – nausea, vomiting, tremors, confusion → hold dose, check level Flumazenil – benzodiazepine reversal agent Haloperidol acute dystonia – treat with benztropine (anticholinergic) MAOI (Phenelzine) + tyramine-rich foods – hypertensive crisis Valproic acid – monitor LFTs, CBC, ammonia (hepatotoxicity, thrombocytopenia) Donepezil (Aricept) – cholinesterase inhibitor (slows Alzheimer's symptoms) Diazepam (Valium) – long half-life for alcohol withdrawal Carbamazepine – hyponatremia (SIADH) and agranulocytosis SSRI sexual side effects – common, reportable to provider Phenytoin – gingival hyperplasia + therapeutic drug monitoring Quetiapine (Seroquel) – metabolic syndrome (hyperglycemia, dyslipidemia, weight gain) Naloxone – reverses respiratory depression (↑ RR) Levodopa/Carbidopa – long-term dyskinesias Benztropine (Cogentin) – acute dystonia from antipsychotics Lithium – consistent sodium/fluid intake (levels fluctuate) Zolpidem (Ambien) – non-benzodiazepine hypnotic (Z-drug) Lamotrigine (Lamictal) – Stevens-Johnson syndrome (stop at first rash) Bupropion (Wellbutrin) – contraindicated in seizure disorder Respiratory & GI Drugs (15 Qs) Albuterol (rescue) first, then Fluticasone (controller) – bronchodilator first Inhaled corticosteroid – rinse mouth after use (prevents oral thrush) Omeprazole (Prilosec) – PPI (proton pump inhibitor) Albuterol – rescue inhaler for acute bronchospasm Theophylline toxicity – nausea, vomiting, tachycardia (narrow therapeutic index) Ondansetron (Zofran) – QT prolongation risk Methylnaltrexone (Relistor) – opioid-induced constipation (peripherally-acting) Pantoprazole – reduces gastric acid by inhibiting proton pump Tiotropium (Spiriva) – LAMA (long-acting muscarinic antagonist) for COPD H. pylori treatment – triple therapy (PPI + amoxicillin + clarithromycin) Sucralfate (Carafate) – take on empty stomach, 1 hour before meals Metoclopramide (Reglan) – tardive dyskinesia (lip smacking, tongue protrusion) Acetylcysteine (Mucomyst) – mucolytic for COPD (also acetaminophen overdose) Famotidine (Pepcid) – H2 receptor antagonist Loperamide (Imodium) – contraindicated in fever/bloody stools (infectious diarrhea) Antimicrobials & Anti-infectives (15 Qs) Penicillin anaphylaxis – epinephrine IM Tetracycline – avoid dairy products (calcium chelation) Vancomycin – red man syndrome (infuse over ≥60 minutes) Isoniazid (INH) – peripheral neuropathy (prevent with vitamin B6) Ciprofloxacin – tendonitis/tendon rupture (stop immediately) Tetracycline – contraindicated in children 8 years (tooth discoloration) Clindamycin – C. difficile infection (watery diarrhea after antibiotics) Cefepime – 4th generation cephalosporin (broadest spectrum) Sulfa allergy – avoid Bactrim (trimethoprim-sulfamethoxazole) Gentamicin (aminoglycoside) – ototoxicity and nephrotoxicity Acyclovir – suppresses viral replication (does not kill virus) Hydroxychloroquine (Plaquenil) – RA and lupus (immunomodulatory) Metronidazole (Flagyl) – avoid alcohol (disulfiram-like reaction) Tenofovir – nephrotoxicity (monitor creatinine) Oseltamivir (Tamiflu) – neuraminidase inhibitor for influenza MSK, Herbal, Immunizations, Miscellaneous (9 Qs) Alendronate (Fosamax) – full glass water, upright 30 min (esophageal irritation) St. John's Wort – interacts with SSRIs (serotonin syndrome risk) Ginkgo biloba + warfarin – increased bleeding risk MMR vaccine – live, contraindicated in immunocompromised Allopurinol – prevents uric acid production (prophylaxis, not for acute attacks) Colchicine – diarrhea (dose-dependent GI toxicity) Sumatriptan (Imitrex) – triptan for migraine (contraindicated in CAD) Naltrexone – reduces alcohol craving (disulfiram causes aversive reaction) Acetaminophen – maximum daily dose 4000 mg (hepatotoxicity risk)