Family Nurse Practitioner Certification Intensive Review
Exam Questions & Answers.
The study of the interaction between the body and drugs - Correct Answer
Pharmacology
The movement of drugs through the body (absorption, bioavailability, distribution,
metabolism, and excretion). - Correct Answer Pharmacokinetics
The study of the physiologic and biochemical effects of the drug - Correct Answer
Pharmacodynamics
The study of how a person's genes affect response to medications.
FDA recently recommended genotyping all asians for HLA-B*1502 before starting
carbamazepine therapy. (This allele is highly associated with fatal carbamazepine
therapy induced Steven-Johnson Syndrome and toxic epidermal necrolysis). - Correct
Answer Pharmacogenomics
The amount of time in which drug concentration decreases by 50% - Correct Answer
Half-life
The average amount of drug in the blood after a dose is given. It is a measure of the
bioavailability of a drug that is administered. - Correct Answer Area under the curve
(AUC)
The lowest concentration of an antibiotic that will inhibit the growth of organisms (after
overnight incubation). - Correct Answer Minimum Inhibitory Concentration (MIC)
The highest concentration of a drug after a dose. - Correct Answer Maximum
Concentration
the lowest dose of a drug after a dose - Correct Answer Trough (Minimum
concentration)
all oral drugs (except SL) must go through the first pass metabolism before they can be
released in the body.
Swallow pill > esophagus > stomach > small intestine > portal circulation > liver > (in
liver, CYP450 system is responsible for metabolism) > when completed, released in it's
active form into the body.
A few are also broken down in the small intestine by bacteria (for example: oral
contraceptives) in addition to being metabolized in the liver.
,Clinical Pearl: Some drugs cannot be given by oral route simply because there is not
enough of the active drug left after metabolism (I.E Insulin). - Correct Answer First pass
effect
Main Organ: Liver
The CYP450 system is the most active. It can either be induced (increase metabolism)
or inhibited (decrease metabolism). Ex: Carbamazepine increases metabolism-
resulting in numerous drug interactions. Other organs are involved in metabolism such
as the kidneys, GI tract, lungs, plasma, and skin. - Correct Answer Drug metabolism
Renal filtration accounts for most drug excretion. Renal drug excretion is deceased
because of physiologic decline in GFR. - Correct Answer Drug excretion
NSAIDS> Decrease renal blood flow will damage kidneys.
ACEI > Increase risk for hyperkalemia
Warfarin > increase risk of over coagulation, hemorrhagic complications.
Lithium > increase risk for kidney injury
Contrast dyes > can injure kidneys
Potassium-sparing diuretics > increase risk for hyperkalemia
Sodium-phosphate > may cause sudden loss of kidney function as well as blood mineral
disturbances. - Correct Answer Drugs affected by Kidney Disease
These drugs are responsible for a large number of drug-drug interactions. Drugs that
act as inhibitors slow down drug clearance which increases risk of drug overdose and
ASE.
- Macrolides (erythromycin, clarithyromycin)
- Antifungals (ketoconazole, fluconazole)
-Cimetidine (Tagamet)
-Celexa
-Protease inhibitors (saquinarvir, indinavir)
-Grapefruit juice - Correct Answer Potent Inhibitors CYP450 system
Warfarin > Monitor INR
Digoxin > Monitor Digoxin level, EKG, electrolytes
Theophylline > Monitor blood levels
Carbamazepine and Phenytoin > Monitor blood levels
Levothyroxine > Monitor TSH
Lithium > Monitor blood levels and TSH (Risk of hypothyroid). - Correct Answer Narrow
Therapeutic index drugs
,ex: famotidine, cimetidine, nizatidine
Mental status changes with kidney disease. Avoid kidney disease with creatinine
clearance of < 50 ml/min. - Correct Answer H2 antagonist safety issues
ex: omeprazole
Increase risk of fractures (post-menopausal women), pneumonia, c-diff, decreased
mag, B12 and iron Mal-absorption, atrophic gastritis, and kidney disease.
Interacts with warfarin, diazepam, carbamazepine, phenytoin, and ketoconazole. -
Correct Answer Proton-pump inhibitors safety issues
Ex: warfarin
interacts with "G" herbs such as garlic, ginger, gingko, and ginseng. other
herbs/supplements: feverfew, green tea, and fish oil.
Numerous drug interactions.
Discontinue 7 days before surgery. - Correct Answer Vitamin K antagonist safety issues
ex: Pioglitazore (DM/TZD's)
Black box warning: cause or exacerbate CHF in some patients. do not use in class III or
IV.
Contraindications: history of mI, stroke, bladder cancer, T2DM, eye or liver problems.
Stop if causes dyspnea, weight gain, cough (HF). - Correct Answer Thiazides safety
issues
ex: Risperiodone, olanzapine, quetiapine
increase risk of weight gain, metabolic syndrome, T2DM, monitor weight gain every 3
months.
Black box warning: increase mortality in elderly patients. Monitor TSH, lipids, A1C,
WT/BMI. - Correct Answer Atypical antipsychotic safety issues
Ex: Alendronate, risedronate
erosive esophagitis (chest pain while eating, odonophagia, dysphagia, heartburn). Stop
immediately if these symptoms occur.
, Take alone upon awakening with 8 ounces of water before breakfast. Do not lie down
for 30 mins afterward, do not mix with other drugs.
Contraindications: active GI disease (GERD, PUD, CKD.) - Correct Answer
Biphosphonate safety issues
ex: Atorvastatin, lovastatin, simvastatin
do not mix with grapefruit juice, drug-induced hepatitis or rhabdo increased if mixed with
azalea antifungals.
increased dose of Oscar (80mg) has increased risk of rhabdo
Chinese descent: increase risk of myopathy or rhabdo when taking simvastatin 40mg
with niacin.
creatinine kinase level goes up - Correct Answer Statin safety issues
increase risk of CDAD - Correct Answer Lincosamides safety issues
adrenal insufficiency possible in children (long term use > 6 months), increased doses
low BMI child, suspect and test for adrenal insufficiency if symptoms (hypoglycemia,
hypotension, AMS, weakness, cushingoid features), growth deceleration/failure. -
Correct Answer Inhaled corticosteroids safety issues
earliest sign of toxicity (horizontal nystagmus, unsteady gait). If severe, slurred speech,
lethargy, confusion, coma, check blood level.
Can cause gingival hyperplasia. - Correct Answer Phenytoin safety issues
cataracts, osteoporosis, skin changes (telangiectasia, easy bruising), emotional lability,
weight gain, increased BP. - Correct Answer Systemic glucocorticoids safety issues
provides guidance regarding medications that should be avoided in adults over 65. The
guidelines list medications by organ system, therapeutic category, etc.
- first-generation antihistamines (ie Benadryl)
-antipsychotics (quetiapine, clozapine)
- rivaroxaban and dabigatan
-tramadol (hyponatremia)
-opioids (do not combine with Benzos or gabapentoinoids) - Correct Answer Beers
criteria
-use of digoxin has declined because of newer drugs that are more effective and safer
to use. It has been replaced by ACEI's, ARB's, BB, and CCB's.
- digoxin is now 2nd or 3rd line drug therapy for HF with REF
-narrow therapeutic range: 0.5-2.0 ng.ml
