Advanced Pharmacology Exam 1 Questions with Complete Solutions 2024/2025 Once you graduate from an NP program, in order to prescribe you'll need: - Correct Answer -Advanced nurse prescriber license
-DEA #
What is the purpose of a DEA #? - Correct Answer Needed to prescribed scheduled drugs Rules for prescribing Schedule II drugs: - Correct Answer -Written script needed -1 month supply only -No refills What is the PDMP? - Correct Answer Prescription Drug Monitoring Program Used to effectively track patient's controlled substance uses across different health facilities (in the same state) What are clinical practice guidelines? - Correct Answer Recommendations that are intended to optimize patient care that are informed by a systematic review of the evidence and an assessment of the benefits/harms of alternative care practices
Ex: sepsis, CAP
Common causes of medication errors: - Correct Answer -Illegible writing
-Drug names that sound alike -Medications that look alike -Administering a drug with the wrong route What is pharmacokinetics? What are its 4 categories? - Correct Answer What the body does to the drug 1 / 4
- Absorption
- Metabolism
- Distribution
- Excretion
Quickest route of absorption? Slowest? - Correct Answer IV = quickest IM = slowest What is the most common way drugs pass through cell membranes? - Correct Answer Passive diffusion What characteristics of a drug allow it to pass most quickly through cell membranes (usually through passive diffusion)? - Correct Answer Small, uncharged (unionized), lipid soluble--pass through membrane without any energy What does it mean when a drug is ionized? - Correct Answer It means that the drug is stuck in the compartment it was ionized in and has to be moved to the next compartment (cannot be absorbed into the bloodstream) Where do weak acids absorb? - Correct Answer Stomach Where do weak bases absorb? - Correct Answer Small intestine
pH of stomach: - Correct Answer 2-4
pH of small intestine: - Correct Answer 6-7
pH of large intestine: - Correct Answer 6-7
pH of bloodstream: - Correct Answer 7.35-7.45 2 / 4
pH of bladder: - Correct Answer 5-8
pH of breastmilk: - Correct Answer 7.1
Where will a drug absorb if it is a weak base that ionizes at a pH of 4 and lower? - Correct Answer In the small intestine (since the stomach has a pH of 2-4, so the drug will become ionized and move to the small intestine where it will be able to absorb into the bloodstream) How can we manipulate the urine pH in cases of overdose? - Correct Answer Drugs that are weak acids (aspirin) can be trapped and excreted through the urine.We raise pH of the urine (with sodium bicarb) to force the drug to ionize and allow it to be excreted, not reabsorbed through the bloodstream.What is distribution? - Correct Answer How a drug will be transported to the tissues it needs to go to in order for it to exert its effects
Drug factors related to distribution: - Correct Answer -Lipid solubility
-Molecular size -Degree of ionization -Duration of action -Cellular binding -Therapeutic effects -Toxic effects (lipid soluble, small, and non-ionized drugs will distribute more quickly) Body factors related to distribution: - Correct Answer -Vascularity (poor perfusion, disruption of blood flow due to trauma--difficulty distributing) -Blood barriers (blood-brain-barrier can be problematic if we need to get drugs to the brain--will need very high dosing since only a small amount of the drug will get through) 3 / 4
-Transport mechanisms -Plasma binding proteins -Disease states -Volume of distribution -Drug interactions What is the key plasma protein involved with protein binding for medications? - Correct Answer Albumin Why do we monitor albumin? - Correct Answer Indicative of nutritional status and how well protein- bound drugs will be transported to their target locations What happens to the therapeutic effect of a drug when the patient is elderly and has very low levels of albumin? - Correct Answer The drug does not bind to the protein (albumin) as much as expected, so there is a lot of free drug floating in the plasma; high risk for drug toxicity Protein bound means: - Correct Answer Inactive form of the drug; does not have any therapeutic effect when bound to a protein Free drug means: - Correct Answer Active form of the drug (available for therapeutic effect) What happens when a patient is on two drugs that are competing for the same protein binding site on the albumin? - Correct Answer Some drug interactions can occur. Drugs fight for binding position, but both drugs do not get enough as the usually would. Leads to higher free drug levels, decreased overall albumin binding, and potential toxicity for both drugs.**Unpredictable** What is the 1st pass effect? - Correct Answer PO drug goes through GI tract and absorbs in the stomach or intestines into local circulation that reaches the liver. The liver inactivates portions of the drug before it goes into systemic circulation. Some drugs with a very high 1st pass effect may have to be given IV (goes directly into systemic circulation) or in higher PO doses (watch for side effects)
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