NR565 Final Exam Study Guide
This study guide covers content for the question bank for this course. There are 100 questions on the exam
and more content in the exam study bank than will be seen on any given exam. Therefore, you may note more
than 100 topic items noted in this study guide. However, there may also be more than one question for a topic
listed so you should know each one well. Some items listed are more specific than others. If the item listed
seems vague, if it’s a more general question and to be more specific would be to risk the integrity of the
question itself.
Number of Questions on Exam: 100
Point Value of Each Question: 2
Styles of Questions of Exam: Multiple Choice Only
Knowledge Levels: Various (remember, understand, apply)
Time Limit: 150 minutes
Number of Attempts: 1
Use of Support Materials: Not Allowed
Platform Used for Exam: ExamSoft/Examplify
Exam Expectations: Review Exam Expectations in Course
Announcements
Tips on Using this Study Guide
1. Review the topics each week to take notes as you move through the course and focus your reading and
content review in the course.
2. You can make notes directly on each tab for the respective week or print out and hand write your notes.
3. If you choose to print, you will want to adjust the size of columns so the table width will fit on a printed
page.
4. Re-write your notes if you type them to connect the content to your memory more readily as the activity
of writing and saying it again as you write it creates repetition that helps commit the content to memory.
5. Create your own practice questions that are clinical scenario based to move the content from a
memorization (Remember) level of learning to an application type of learning. Much of your exam will be
at the application level so it's not enough to memorize your notes.
6. Review your study guide and notes as often as you can. Read them out loud so you hear the words
externally as well as internally. The more senses you can engage while studying, the more likely you are
to remember it.
, Week 1
Medication Administration
▪ Educate pt on the routine of administration (e.g., PO w/ or w/out food), administration needs (e.g., suspensions
should be shaken or rolled), demonstrate how to use devices & have pt repeat demonstration (e.g., teaching pt to
use an inhaler)
Blood Flow Impact on Distribution
▪ The rate at which drugs are delivered to a particular tissue is determined by blood flow to that tissue
> Abscesses & tumors are 2 conditions in which low regional blood flow can affect drug therapy
Lipid Solubility and Absorption
▪ Highly lipid-soluble drugs are absorbed more rapidly than drugs whose lipid solubility is low (bc lipid-soluble
drugs can readily cross the membranes that separate them from the blood, whereas drugs of low lipid solubility
cannot)
Blood-Brain Barrier Impact
▪ To leave the blood and reach sites of action within the brain, a drug must be able to pass through cells of the
capillary wall; only drugs that are lipid soluble or have a transport system can cross the BBB
Placental Drug Transfer
▪ The membranes of the placenta do NOT constitute an absolute barrier to the passage of drugs
▪ Lipid-soluble, nonionized compounds readily pass from the maternal bloodstream into the blood of the fetus
▪ Ionized, highly polar, or protein bound are prevented from reaching the fetal blood
First-Pass Effect
▪ First-pass effect refers to the rapid hepatic inactivation of certain oral drugs
▪ If the capacity of the liver to metabolize a drug is extremely high, that drug can be completely inactivated on its
first pass through the liver; resulting in no therapeutic effect
> To temporarily bypass the liver, drugs are administered parenterally
Week 2
ACE Inhibitors
▪ Used for treating HTN, HF, diabetic nephropathy, & MI
▪ Adverse effects → cough, angioedema, first-dose hypotension, & hyperkalemia
ACE Inhibitors Advantages
▪ ACE inhibitors do not interfere w/ cardiovascular reflexes (exercise capacity is not impaired, & orthostatic
hypotension is minimal after the initial dose), can be used safely in pts w/ bronchial asthma (a condition that
precludes the use of β2-adrenergic antagonists), do not promote hypokalemia, hyperuricemia, or hyperglycemia
(side effects seen w/ thiazide diuretics), & reduce the risk for cardiovascular mortality caused by hypertension
Loop Diuretics MOA
▪ Acts in the thick segment of the ascending limb of the loop of Henle to block reabsorption of sodium & chloride;
interference w/ reabsorption here can produce profound diuresis
Spironolactone: MOA
▪ Blocks the actions of aldosterone in the distal nephron; inhibition of aldosterone promotes retention of potassium
& excretion of sodium
, > Diuresis caused by spironolactone is scanty bc most of the filtered sodium load has already been
reabsorbed by the time the filtrate reaches the distal nephron
Regulation of Arterial Pressure
▪ Arterial pressure is the driving force that moves blood through the arterial side of the systemic circulation
> AP= PR (peripheral resistance) x CO (cardiac output)
> PR & CO = AP ; PR & CO = AP
Week 3
Adverse Psychological Effects of High-Dose Marijuana
▪ High-dose marijuana can cause hallucinations, delusions, & paranoia, euphoria may be displaced by intense
anxiety, & a dissociative state may occur in which the user feels “outside of himself or herself”, and toxic
psychosis
Codeine and Analgesic Efficacy
▪ For analgesic use, codeine is formulated alone & in combination w/ nonopioid analgesics (either aspirin or
acetaminophen) bc they relieve pain by different mechanisms, the combinations can produce greater pain relief
than either agent alone
Fentanyl Transmucosal Use
▪ Approved only for breakthrough cancer pain in pts at least 18 yrs old who are already taking opioids around-the-
clock & have developed some degree of tolerance, defined as needing, for 1 week or longer, at least: 60 mg of
oral morphine a day, or 30 mg of oral oxycodone a day, or 25 mg of oral oxymorphone a day, or 8 mg of oral
hydromorphone a day, or 25 mcg of fentanyl per hour, or an equianalgesic dose of another opioid
> Must not be used for acute pain, postoperative pain, headache, or athletic injuries
Opioid Withdrawal
▪ Agonist-antagonists opioids given to a pt who is physically dependent on a pure opioid agonist, these drugs can
precipitate withdrawal
▪ Abrupt withdrawal of opioids will precipitate an abstinence syndrome
> Opioids should be withdrawn slowly, tapering the dosage over 3 days. If dependence is high, dosage
should be tapered over 7 to 10 days
Opioids in Pregnancy
▪ Taking opioids in early pregnancy can the risk for congenital heart defects, spina bifida, & gastroschisis
▪ Regular use of opioids during pregnancy can cause physical dependence in the fetus, resulting in withdrawal after
delivery
Week 4
Alendronate
▪ Used for the prevention & treatment of osteoporosis in postmenopausal women, in whom benefits derive from
bone resorption by osteoclasts
> 1st line treatment for glucocorticoid induced osteoporosis & Paget disease
▪ Adverse effects → esophagitis (from prolong use if alendronate fails to pass completely through the esophagus),
musculoskeletal pain, afib, hyperparthyroidism (causes blood levels of calcium to fall resulting in PTH
secretion), atypical femur fractures (suppression of bone turnover reduces bone remodeling), osteonecrosis of the
jaw (ONJ), ocular problems (e.g., conjunctivitis, scleritis, blurred vision, & eye pain)
This study guide covers content for the question bank for this course. There are 100 questions on the exam
and more content in the exam study bank than will be seen on any given exam. Therefore, you may note more
than 100 topic items noted in this study guide. However, there may also be more than one question for a topic
listed so you should know each one well. Some items listed are more specific than others. If the item listed
seems vague, if it’s a more general question and to be more specific would be to risk the integrity of the
question itself.
Number of Questions on Exam: 100
Point Value of Each Question: 2
Styles of Questions of Exam: Multiple Choice Only
Knowledge Levels: Various (remember, understand, apply)
Time Limit: 150 minutes
Number of Attempts: 1
Use of Support Materials: Not Allowed
Platform Used for Exam: ExamSoft/Examplify
Exam Expectations: Review Exam Expectations in Course
Announcements
Tips on Using this Study Guide
1. Review the topics each week to take notes as you move through the course and focus your reading and
content review in the course.
2. You can make notes directly on each tab for the respective week or print out and hand write your notes.
3. If you choose to print, you will want to adjust the size of columns so the table width will fit on a printed
page.
4. Re-write your notes if you type them to connect the content to your memory more readily as the activity
of writing and saying it again as you write it creates repetition that helps commit the content to memory.
5. Create your own practice questions that are clinical scenario based to move the content from a
memorization (Remember) level of learning to an application type of learning. Much of your exam will be
at the application level so it's not enough to memorize your notes.
6. Review your study guide and notes as often as you can. Read them out loud so you hear the words
externally as well as internally. The more senses you can engage while studying, the more likely you are
to remember it.
, Week 1
Medication Administration
▪ Educate pt on the routine of administration (e.g., PO w/ or w/out food), administration needs (e.g., suspensions
should be shaken or rolled), demonstrate how to use devices & have pt repeat demonstration (e.g., teaching pt to
use an inhaler)
Blood Flow Impact on Distribution
▪ The rate at which drugs are delivered to a particular tissue is determined by blood flow to that tissue
> Abscesses & tumors are 2 conditions in which low regional blood flow can affect drug therapy
Lipid Solubility and Absorption
▪ Highly lipid-soluble drugs are absorbed more rapidly than drugs whose lipid solubility is low (bc lipid-soluble
drugs can readily cross the membranes that separate them from the blood, whereas drugs of low lipid solubility
cannot)
Blood-Brain Barrier Impact
▪ To leave the blood and reach sites of action within the brain, a drug must be able to pass through cells of the
capillary wall; only drugs that are lipid soluble or have a transport system can cross the BBB
Placental Drug Transfer
▪ The membranes of the placenta do NOT constitute an absolute barrier to the passage of drugs
▪ Lipid-soluble, nonionized compounds readily pass from the maternal bloodstream into the blood of the fetus
▪ Ionized, highly polar, or protein bound are prevented from reaching the fetal blood
First-Pass Effect
▪ First-pass effect refers to the rapid hepatic inactivation of certain oral drugs
▪ If the capacity of the liver to metabolize a drug is extremely high, that drug can be completely inactivated on its
first pass through the liver; resulting in no therapeutic effect
> To temporarily bypass the liver, drugs are administered parenterally
Week 2
ACE Inhibitors
▪ Used for treating HTN, HF, diabetic nephropathy, & MI
▪ Adverse effects → cough, angioedema, first-dose hypotension, & hyperkalemia
ACE Inhibitors Advantages
▪ ACE inhibitors do not interfere w/ cardiovascular reflexes (exercise capacity is not impaired, & orthostatic
hypotension is minimal after the initial dose), can be used safely in pts w/ bronchial asthma (a condition that
precludes the use of β2-adrenergic antagonists), do not promote hypokalemia, hyperuricemia, or hyperglycemia
(side effects seen w/ thiazide diuretics), & reduce the risk for cardiovascular mortality caused by hypertension
Loop Diuretics MOA
▪ Acts in the thick segment of the ascending limb of the loop of Henle to block reabsorption of sodium & chloride;
interference w/ reabsorption here can produce profound diuresis
Spironolactone: MOA
▪ Blocks the actions of aldosterone in the distal nephron; inhibition of aldosterone promotes retention of potassium
& excretion of sodium
, > Diuresis caused by spironolactone is scanty bc most of the filtered sodium load has already been
reabsorbed by the time the filtrate reaches the distal nephron
Regulation of Arterial Pressure
▪ Arterial pressure is the driving force that moves blood through the arterial side of the systemic circulation
> AP= PR (peripheral resistance) x CO (cardiac output)
> PR & CO = AP ; PR & CO = AP
Week 3
Adverse Psychological Effects of High-Dose Marijuana
▪ High-dose marijuana can cause hallucinations, delusions, & paranoia, euphoria may be displaced by intense
anxiety, & a dissociative state may occur in which the user feels “outside of himself or herself”, and toxic
psychosis
Codeine and Analgesic Efficacy
▪ For analgesic use, codeine is formulated alone & in combination w/ nonopioid analgesics (either aspirin or
acetaminophen) bc they relieve pain by different mechanisms, the combinations can produce greater pain relief
than either agent alone
Fentanyl Transmucosal Use
▪ Approved only for breakthrough cancer pain in pts at least 18 yrs old who are already taking opioids around-the-
clock & have developed some degree of tolerance, defined as needing, for 1 week or longer, at least: 60 mg of
oral morphine a day, or 30 mg of oral oxycodone a day, or 25 mg of oral oxymorphone a day, or 8 mg of oral
hydromorphone a day, or 25 mcg of fentanyl per hour, or an equianalgesic dose of another opioid
> Must not be used for acute pain, postoperative pain, headache, or athletic injuries
Opioid Withdrawal
▪ Agonist-antagonists opioids given to a pt who is physically dependent on a pure opioid agonist, these drugs can
precipitate withdrawal
▪ Abrupt withdrawal of opioids will precipitate an abstinence syndrome
> Opioids should be withdrawn slowly, tapering the dosage over 3 days. If dependence is high, dosage
should be tapered over 7 to 10 days
Opioids in Pregnancy
▪ Taking opioids in early pregnancy can the risk for congenital heart defects, spina bifida, & gastroschisis
▪ Regular use of opioids during pregnancy can cause physical dependence in the fetus, resulting in withdrawal after
delivery
Week 4
Alendronate
▪ Used for the prevention & treatment of osteoporosis in postmenopausal women, in whom benefits derive from
bone resorption by osteoclasts
> 1st line treatment for glucocorticoid induced osteoporosis & Paget disease
▪ Adverse effects → esophagitis (from prolong use if alendronate fails to pass completely through the esophagus),
musculoskeletal pain, afib, hyperparthyroidism (causes blood levels of calcium to fall resulting in PTH
secretion), atypical femur fractures (suppression of bone turnover reduces bone remodeling), osteonecrosis of the
jaw (ONJ), ocular problems (e.g., conjunctivitis, scleritis, blurred vision, & eye pain)
