Final Exam: NR 568/ NR568 (New 2024/ 2025
Update) Advanced Pharmacology for the
AGPCNP- Guide with Verified Answers -
100% Correct- A Grade - Chamberlain
QUESTION
IQuestionI1
CleoIisIaI65-year-
oldImaleIdiagnosedIwithImildIcognitiveIchangesIrelatedItoIAlzheimer'sIdisease.IHeIalsoIhasI
anxiety,ICOPD,IandIsmokesIcigarettes.IWhichIofItheIfollowingImedicationsIisIappropriateIforI
Cleo?
donepezilIIII(CorrectIanswer)
rivastigmineIgalantamine
Rationale:IIIIDonepezilIisIappropriateIforICleo.IItIisIapprovedIbyItheIFDAIforItheItreatmentIof
ImildIdementiaIandIisInotIaffectedIbyInicotine.IDonepezilIalsoItreatsIpsychologicalIsymptomsI
ofIADIsuchIasIanxiety,Idepression,Iapathy,Idelusions,IandIpacingI(Stahl,I2015).IRivastigmineIa
ndIgalantamineIareInotIappropriateIchoicesIforICleo.IRivastigmineIshouldIbeIavoidedIinIclient
sIwithICOPD.INicotineIcanIalsoIincreaseIclearanceIofItheImedication.IGalantamine
isIalsoIFDAIindicatedIforImildItoImoderateIdementiaIbutIwillInotIaddressIhisIanxiety.
Answer:
IdementiaIquestions
QUESTION
IQuestionI2
AIpatientIdiagnosedIwithIAlzheimer'sIdiseaseIhasIdecidedItoIstopItreatment.ITheINPIhasI
educatedItheIclientIthatImedicationIdiscontinuationIwillIresult
inItheIreturnIofIcognitiveIsymptomsIandItheImedicationImayInotIworkIasIwellIifIrestarted.IThe
IclientIwouldIstillIlikeItoIstopItheImedicationIdueIto
theIgastrointestinalIsideIeffects.IWhichIofItheIfollowingImedicationsIrequiresItapering?
donepezilIIII(CorrectIanswer)
rivastigmineIgalantamine
Rationale:IDonepezilIrequiresItapering.IRivastigmineIandIGalantamineIdoInotIrequireItapering.
,Answer:
IdementiaIquestions
QUESTION
IRiskIvs.IBenefitsIofITreatment
Answer:
IThisIdebilitatingIincurableIillnessIcanItugIatIyourIheartIasIyouIwatchItheIprogressionIinIyourI
patients.IAsIanINPIanyItreatmentIyouIprovideIisIforItemporaryIsymptomaticIreliefIandItheIrisk
IandIbenefitsImustIbeIconsideredIwhenIprescribing.
Alzheimer'sIDiseaseI(AD)IisIaIprogressiveIirreversibleIdisease.IAtIthisItimeIthereIareInoImedic
ationsIwhichIcanIstopItheIprogressionIorIreverseItheIdisease.
TheIavailableIADImedicationsIcanIprovideIsomeIsymptomaticIimprovement,IbutItheIimprove
mentsIwillIfadeIasItheIdiseaseIprogresses.
IfIanIADImedicationIisIdiscontinued,ItheImedicationImayInotIbeIasIeffectiveIifIrestarted.
I
TheIcurrentIgoldIstandardIofItreatmentIforIcognitiveIsymptomsIincludesIpharmaco-
IlogicImanagementIwithIaIcholinesteraseI(ChE)IinhibitorIandIanINMDAIantagonist.
QUESTION
ISeizuresIareItypicallyIaIresultIofIaIdysfunctionIofItheIcentralInervousIsystem,IaItreatableIsyst
emicIprocess,IorIanIunderlyingIbrainIpathology,Iin-Icluding
Answer:
IBrainIlesionsIorIdisorders
Migraines
TIAs
MetabolicIderangement
Encephalitis
HeadIinjury
Drug/alcoholIwithdrawal
SyncopeIInfectionsIFever
QUESTION
IHYDANTOINS
,Answer:
IExamples
EthotoinI(Peganone);IOnlyIavailableIinI250Img
FosphenytoinI(Cerebyx)INOTIforIprimaryIcare
AvailableIonlyIinIintramuscularI(IM)IorIintravenousI(IV)Idosing
GivenIonlyIforIaboutI5Idays
PhenytoinI(Dilantin)
AvailableIinIchewable,Isuspension,IIVIandIextended-releaseIcaps
First-lineItreatmentIforItonic-clonicIandIpartialIcomplexIseizures.IPharmacodynam-Iics
WorksIbyIstabilizingIneuronalImembranesIandIdecreasingIseizureIactivityIbyIin-
IcreasingIeffluxIorIdecreasingIeffluxIofIsodiumIionsIacrossIcellImembranesIinItheImotorIcorte
x.IOnsetIandIdurationIvariesIforIeachIclassIofIdrugs,IPharmacokinetics
MetabolizedIinItheIliver:IstrongICYPI2C9Ieffects.ILevelsIwillIincreaseIwithIcimetidine,Idiazep
am,IacuteIalcoholIintake,IvalproicIacid,Iallopurinol.IDecreasesIeffectsIwithIbarbiturates,Iantaci
ds,Icalcium,IchronicIalcoholIuse.
RationalIdrugIselection
NurseIpractitionerIrole:IworkingIwithIneurologistIwhoIhasImadeIdiagnosis
UsedIforIgrandImalIandIpsychomotorIseizures.IMonitoring
BaselineIlabsIandIplasmaIlevels,IalongIwithIthyroidIstimulatingIhormoneI(TSH)INeedItoIasses
sIOTCIdrugs:Iibuprofen,Iantacids
PatientIeducation
DiscussIriskIfactorsIforIseizures
ReportIADRs
I
AvoidIdrivingIifInotIseizureIfreeIforImoreIthanI1Iyear
OralIhygiene
QUESTION
IIMINOSTILBENES
Answer:
IExamplesICarbazepineI(Tegretol,ITegretolIXR,ICarbatrol)IOxcarbazepineI(Trileptal)
ValproicIacidI(Depakote,IDepakene)IPharmacodynamics
WorksIbyIdepressingIneuronItransmissionIinItheInucleusIventralisIanteriorIofItheIthalamus.ITh
eseImedicationsIhaveIaIBlackIBoxIwarningIforIcausingIBloodIDyscrasias.ITheyIhaveItheIabilit
yItoIinduceIitsIownImetabolism.IConsiderIgeneticItestingIofIAsians
Pharmacokinetics
AbsorbedIthroughItheIstomach,ImetabolizedIinItheIliver;IInducesImetabolismIofImanyICYPI45
0Isubstrates
, Drug-drugIinteractions
WatchIoutIforIgrapefruitIjuice!
DrugIlevelsIincreaseIwithIconcurrentIuseIofIpropoxypheneI(Darvocet),Icimetidine,Ierythromyci
n,Iclarithromycin,Iverapamil,Ihydantoins
DecreasesIplasmaIlevelsIofIseveralIdrugs:IbetaIblockers,Iwarfarin,Idoxycycline,Isuccinimides,I
haloperidol
AdverseIDrugIReactions
DepressionIofIboneImarrow
LiverIdamage,IimpairsIthyroidIfunction
Drowsiness,Idizziness,IblurredIvision,In/v,IdryImouth,Idiplopia,IheadacheI(HA)IMonitoring
BaselineIlabs:IcompleteIbloodIcount,IchemicalIpanel,IhepaticIpanel,ITSHIlevelIPatientIeducati
on:ITeachIsymptomsIofIboneImarrowIdepression,ICAREFULIuseIofImedications,ItherapeuticId
osing,IKINDLING.
QUESTION
ISUCCINIMIDES
Answer:
IUsedIinItheIadjunctiveItreatmentIofIprimaryIgeneralizedIton-Iic-
clonicIseizuresIandIpartialIseizuresIinIadultsIandIchildrenIolderIthanI2Iyears.INOTIforIuseIwit
hIvalproicIacidIorIenzymeIinducers.IAlsoIusedIforIbipolar.
Example
LamotrigineI(Lamictal)IPharmacodynamics
LevelsIdecreasedIbyIbarbiturates,Iestrogens,Iphenytoin,IMefloquine
LevelsIincreasedIbyIalcohol,Icarbamazepine,ICNSIdepressants,IvalproicIacid
Pharmacokinetics
LamotriginesIareImetabolizedIinItheIliverIandItheIkidneys.IAdverseIDrugIReactions
I
GII-ImostlyIn/v,Iconstipation
CardiovascularI-IchestIpain,IperipheralIedema
CNSI-Isomnolence,Ifatigue,Idizziness,IanxietyIinsomnia,Iheadache,Iamblyopia,Inystagmus
DermatologicalI-Irashes
PatientIeducation
Adherence,IavoidIalcohol,IavoidIOTCImeds,IadequateIhydration,IreportIanyInewIdrugs,IreportI
ADRs
DiscussionIofIriskIfactorsIthatIcontributeItoIseizures
Driving
