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FNP Pharmacology for AANP Exam Latest 2025-
2026 With Correct Verified Answers
What are the safety issues caused by taking Phenytoin (Dilantin)? - correct answer>>1.) Earliest sign of toxicity: horizontal nystagmus and unsteady gait 2.) If severe, slurred speech, lethargy, confusion, and coma 3.) monitor blood levels 4.) can also cause gingival hyperplasia BEERS Criteria: Medications that should be avoided in patients over 65 years? - correct answer>>1.) 1st generation anti-histamines (diphenhydramine, doxylamine, chlorpheniramine) 2.) Anti-psychotics: Quetiapine, Clozapine, Pimavaserin (use with caution) 3.) Rivaroxaban & Dabigatran- Increased risk of bleeding 4.) Tramadol- risk of hyponatremia from syndrom of inappropriate antidiuretic hormone secretion 5.) Opioids- do not combine with BZDs or Gabapentinoids- will induce respiratory depression What safety issues can occur when taking atypical antipsychotics such as: Risperidone (Risperidal), Olanzapine (Zyprexa), and Quetiapine (Seroquel)? - correct answer>>- High risk of weight gain, metabolic syndrome, and type 2 diabetes
- monitor weight every 3 months
- higher mortality in elderly patients
- monitor TSH, Blood glucose/A1C, weight/BMI What safety issues can be caused by taking TZDs: Pioglitazone (Actos)? - correct answer>>Black box warning! - can cause or exacerbate CHF
- do not use if class III or IV, heart failure contraindications
- do not use if hx of MI, CVA, bladder ca, type 2 DM, eye or liver problems,
- do not use if causes dyspnea, wt gain, or cough (signs of heart failure) What safety issues can be caused by taking Vitamin K antagonist: Warfarin (Coumadin)?
- correct answer>>- Interacts with "G" herbs such as garlic, ginger, gingko, ginseng, and other herbs, supplements like feverfew, green tea, and fish oil
- numerous drug interactions
- discontinue at least 7 days before surgery What safety issues can be caused by PPIs: Omeprazole (Prilosec)? - correct answer>>- Increased risk of fractures (postmenopausal women)
- Pneumonia
- C.Diff infection
- hypomagnesemia
- B12 and Iron malabsorption
- atrophic gastritis
- kidney disease
- interacts with warfarin (Coumadin), diazepam (Valium), Carbamazepine (Tegretol), Phenytoin (Dilantin) and ketoconazole (Nizoral) What safety issues can be caused by H2 antagonists: Famotidine (Pepcid), Cimetidine (Tagamet), Nizatidine (Axid)? - correct answer>>- Mental status changes with kidney disease patients
- Avoid if kidney disease with creatinine clearance of <50 ml/minute Drugs with narrow therapeutic index? (6 items) - correct answer>>1.) Warfarin sodium (Coumadin)- monitor INR 2.) Digoxin (Lanoxin)- monitor Digoxin level, EKG, electrolytes (K, Mg, Ca) 3.) Theophylline- monitor blood levels 4.) Carbamazepine (Tegretol) & Phenytoin (Dilantin)- monitor blood levels 5.) Synthroid (Levothyroxine)- monitor TSH 6.) Lithium- monitor blood levels and TSH (can increased risk of hypothyroidism) What are common potent inhibitors that can slow down drug clearance (CYP system) and increase drug concentration? (causes risk of drug overdose and adverse effects) (5 items) - correct answer>>1.) Macrolides (Erythromycin, Clarithromycin, telithromycin) 2.) Anti-fungals- (Ketoconazole, fluconazole, telithromycin) 3.) Cimetidine (Tagamet) 4.) Protease Inhibitors- (Saquinavir, Indinavir, Nelfinavir) 5.) Citalopram (Celexa) 6.) Grapefruit juice * not a drug but- affects statins, erythromycin, CCBs, antivirals, amiodarone, BZDs, carbamazepine, and buspirone What drugs are affected by kidney disease? (7 items) - correct answer>>1.) NSAIDs- Reduction of renal blood flow will damage kidneys 2.) ACEIs- Higher risk of hyperkalemia 3.) Warfarin- Higher incidence of overcoagulation (INR> 4), Severe CKD and ESRD at risk of hemorrhagic complications. Needs more frequent monitoring. 4.) Lithium- increases risk of kidney injury. Monitor renal function closely
alone upon awakening with 8-oz glass water (not juice) before breakfast; do not lie down for 30 minutes afterward; do not mix with other drugs What safety issues are caused by Stains: Atorvastatin (Lipitor), Lovastatin (Mevacor), Rosuvastatin ( Crestor), Simvustatin (Zocor), Fluvastatin (Lescol), Pravastatin (Pravachol), and Pitavastatin (Livalo)? - correct answer>>-Do not mix with grapefruit juice; drug- induced hepatitis or rhabdomyolysis higher if mixed with azole antifungals
- High-dose Zocor (80 mg) has highest risk of rhabdomyolysis (muscle pain/tenderness, muscle weakness, brown or dark red urine)
- Chinese descent: Higher risk myopathy or rhabdomyolysis when taking simvastatin 40 mg/d (or higher) with niacin
- Creatine kinase level goes up What are the safety issues caused by Lincosamides: Clindamycine (Cleocin)? - correct answer>>Clostridium Difficile- associated diarrhea (CDAD) What are the safety issues caused by Inhaled corticosteroids? - correct answer>>Adrenal insufficiency possible in children (long term [>6 months]; high doses, low-BMI child); suspect and test for adrenal insufficiency if symptoms (hypoglycemia, hypotension, altered mental status, weakness, Cushingoid features), growth deceleration/failure What are the safety issues caused by systemic glucocorticoids? - correct answer>>Cataracts, osteoporosis, skin changes (telangiectasia, easy bruising), emotional lability, weight gain, high BP Cardiac Glycosides: Digoxin (Lanoxin) important facts (5) - correct answer>>1.) Cardiac Glycosides: Digoxin (Lanoxin) ■Use of digoxin has declined because of newer drugs that are more effective and safer to use. It has been replaced by ACEIs, ARBs, beta-blockers, and CCBs. ■ Digoxin is now the second- to third-line drug therapy for heart failure with reduced ejection fraction (HFrEF). ■ Digoxin has a narrow therapeutic range (0.5-2.0 ng/mL). ■ Suspect intake of poisonous plants with cardiac glycosides (foxglove, oleander, lily of the valley): Refer to ED. ■ Life-threatening effects: Severe bradycardia, heart block, ventricular tachycardia, ventricular fibrillation. Approximately 30% people with digoxin toxicity are asymptomatic.
What drugs are used to treat heart disease? - correct answer>>Cardiac Glycosides: Digoxin (Lanoxin) and Anti-coagulants What are the signs and symptoms of digoxin overdose? - correct answer>>1.) Initial symptoms are GI (nausea/vomiting), hyperkalemia, and bradydysrhythmias (atrioventricular [AV] blocks) or tachydysrhythmias (ventricular 64tachycardia/fibrillation or atrial tachycardia with 2:1 block). 2.) Others include confusion and visual changes (yellowish-green-tinged color vision). What labs are ordered for suspected digoxin toxicity? What is the treatment? Lab values? - correct answer>>■ Laboratory tests for suspected digoxin toxicity: Order a digoxin level, electrolytes (potassium, magnesium, calcium), creatinine, and serial EKGs. Treatment: Digoxin-specific antibodies are IgG antidigoxin antibodies that bind free digoxin in blood (Digibind, DigiFab). ■ Potassium values (adult to elderly): ● Critical: <2.5 or >6.5 mEq/L ● Normal: 3.5 to 5.0 mEq/L What drug class is recommended for treating, preventing, and reducing the recurrence of venous thromboembolism (VTE), which results in stroke, PE, or acute MI? - correct answer>>Anticoagulants What is the first line agent of anticoagulants for patients without valvular disease? - correct answer>>Direct oral anticoagulants (DOACs)- which do not require laboratory monitoring of INR and are not affected by Vitamin K in the diet What is the only type of chronic anticoagulant is recommended for patients with valvular disease or prosthetic heart valves? - correct answer>>Warfarin sodium (Coumadin) What drug is:
- A vitamin K antagonist (VKA)
- Considered category D drug in pregnant women with a mechanical heart valve
- Considered category X drug for all other pregnant women - correct answer>>Warfarin sodium (Coumadin) What are the indications for warfarin sodium (Coumadin)? (7 items) - correct answer>>1.) Atrial fibrillation 2.) prosthetic heart valve 3.) PE
Contraindications for Vitamin K antagonist: Warfarin (Coumadin) in treating heart disease? (4 items) - correct answer>>1.) Large esophageal varices, 2.) thrombocytopenia 3.)recent eye/brain/trauma surgery, within 72 hours of major surgery, 4.) blood dyscrasias Careful if history of GI bleeding Contraindications for ACEIs: Enalapril (Vasotec) Ramipril (Altace) Lisinopril (Zestril) Captopril (Capoten), in treating heart disease? (8 items) - correct answer>>1.) Avoid mixing with potassium supplements or potassium-sparing diuretics 2.) Avoid in pregnancy, 3.) breastfeeding, 4.) aortic stenosis, angioedema, 5.)symptomatic hypotension, 6.)severe aortic stenosis, 7.) hyperkalemia 8.) ACEI cough: New onset of dry cough (not accompanied by upper respiratory infection symptoms), switch to an ARB or another antihypertensive drug class Contraindications for ARBs Candesartan (Atacand) Valsartan (Diovan), Losartan (Cozaar), in treating heart disease? (4 items) - correct answer>>1.) Avoid mixing with potassium supplements 2.) Do not combine ACEI with ARBs 3.) Lower incidence of cough compared with ACEIs 4.) Avoid in pregnancy Contraindications for Potassium-sparing diuretics Triamterene (Dyrenium) Triamterene + hydrochlorothiazide (Dyazide) Amiloride, (Midamor) Spironolactone (Aldactone), in treating heart disease? - correct answer>>Higher risk of hyperkalemia if combined with ACEI, potassium, or ARBs and with severe renal disease Diuretics may worsen urinary incontinence
Spironolactone: Avoid combining with ACEI, ARBs, high potassium diet/supplements, salt substitutes, chronic NSAIDs (risk of hyperkalemia); gynecomastia may occur; aldosterone antagonist activity Contraindications for Beta-Blockers Propranolol (Inderal) Atenolol (Tenormin) Metoprolol (Lopressor), Pindolol (Visken), in treating heart disease? - correct answer>>Contraindicated if patient has chronic lung diseases (asthma, COPD, emphysema, chronic bronchitis) Do not discontinue beta-blockers abruptly because of severe rebound (hypertensive crisis) Contraindications for Phosphodiesterase 5 (PDE5) inhibitors Sildenafil (Viagra) Tadalafil (Cialis) Vardenafil (Levitra), in treating heart disease? - correct answer>>Do not mix with nitrates (nitroglycerine, isosorbide dinitrate) and some alpha-blockers Erection >4 hours: Refer to ED Do not give within 3-6 months of a myocardial infarction or stroke Contraindications for SSRIs Citalopram (Celexa), in treating heart disease? - correct answer>>Avoid doses > mg/d; can prolong QT interval For patients >60 years of age, the maximum dose is 20 mg per day Routine vitamin K1 (Phytonadione) supplementation is not advised- what are the dietary issues of taking Warfarin (Coumadin)? - correct answer>>Patient should avoid excess intake of kale, spinach, collards/mustards/beet greens, and broccoli raab to prevent reducing the effect of Warfarin and decreasing INR *Note- mayonnaise, canola oil, and soybean oil also have high levels of Vitamin K Why should patients avoid drinking or limit alcohol to no more than 1-2 servings occasionally when taking Warfarin (Coumadin)? - correct answer>>increases risk of bleeding even if INR is in target range What is an adverse reaction of taking Warfarin (Coumadin)? - correct answer>>Purple toes syndrome- (Rare)- skin necrosis located in subcutaneous fat, breasts, extremities, trunk (within first few days of receiving large doses of warfarin), bleeding
Atrial fibrillation is categorized based on its duration (< 1 week, < 1 year, long-term, and refractory to treatment). Triggers include caffeine, stress, alcohol, and emotion. Patients with cardiovascular disease, history of cardiac surgery, hypertension, and diabetes are also at increased risk for developing atrial fibrillation. Typical treatment and treatment goal for afib? - correct answer>>achieve rate control, generally with beta blocker medication or CCB if untreated, risks include cerebrovascular complications and HF due to blood stasis in the ventricle and inefficient pumping leading to myocardial dysfunction Signs and symptoms of afib? - correct answer>>fast, irregular heartbeat, palpitations, anxiety, fatigue, SOB, possible syncope What cardiac phenomenon involves a narrowing at any portion of the aorta, but most commonly in the region of the ductus arteriosus (juxtaductal region). Freshly oygenated blood flows from the left ventricle and into the aorta but cannot reach the lower extremities. As a result of the obstruction, left ventricular afterload increases and this can lead to hypertrophy of the left ventricle and hypertension. - correct answer>>coarctation of the aorta Note: In all neonates, coarctation of the aorta leads to either left ventricular failure or insufficient cardiac output that cannot meet metabolic demands. Ultimately, once the ductus arteriosus functionally closes, perfusion to the lower extremities decreases and the lower body develops a pale coloration. While not the most common congenital heart defect diagnosed in the neonatal period, coarctation of the aorta is considered a cyanotic heart defect and requires intensive care and cardiology involvement. Any newborn who presents to an outpatient setting with a horizontal line of demarcation and a significant difference between upper and lower extremity mean arterial blood pressure readings or pre and post-ductal pulse oximetry readings requires an urgent transfer to the nearest emergency room. Prostaglandin E1 may be necessary to maintain ductal patency in the timeframe preceding primary repair. Describe aortic regurgitation murmur and where it is heard the best? - correct answer>>a high-pitched, blowing diastolic murmur with a decrescendo pattern typically heard best with the diaphragm of the stethoscope at the left sternal border Describe a mitral regurgitation murmur and where it is heard the best? - correct answer>>a high-pitched, holosystolic murmur, heard best with the diaphragm of the stethoscope at the apex
What are the systolic murmurs? - correct answer>>MR- mitral regurgitation PM-physiologic murmur AS- aortic stenosis MVP- mitral valve prolapse What are the diastolic murmurs? - correct answer>>AR- aortic regurgitation MS-mitral stenosis What are two main concerns for initiating statin therapy? - correct answer>>1.)acute drug-induced hepatitis 2.) rhabdomyolysis Note: monitor liver function closely Liver function must be closely monitored by drawing liver function tests (D) at baseline and at 12 weeks after beginning a statin. If a patient experiences jaundice, dark urine, gastrointestinal upset, or clay-colored stools, they should be advised to call their nurse practitioner immediately so these tests can be performed. Serum aminotransferases and bilirubin may be elevated. What conditions can a D-dimer level be elevated? - correct answer>>DVT kidney disease infection malignancy Note: D-dimer is a protein that develops in the blood when a clot is dissolved and a normal value is <500mg/L. Remember, a D-dimer level does not confirm DVT- you need a doppler US What Tanner stages does pubertal growth occur in girls? - correct answer>>Stage II-III What Tanner stages does pubertal growth occur in boys? - correct answer>>Stages III-IV What is the correct order of maturation in males? (growth and development) - correct answer>>pubic, axillary, and then facial hair What is the earliest secondary sexual characteristic in girls? (growth and development) - correct answer>>the onset of breast development
Avoidance of tobacco, ETOH, others, and anabolic steroids (educate this age) - correct answer>>Growth and development: Anticipatory guidance A 12 y/o female visits the NP because she has asymmetry of her breasts. She is in Tanner Stage 3. The NP knows that this: (also for boys) - correct answer>>Will probably resolve by Tanner Stage 5 What two drugs can cause gynecomastia? - correct answer>>1. Tagamet/Cimetadine
- Marijuana *also, aldactone A 2 week old infant has white pinpoint papules on his face and cheeks. What is this? - correct answer>>Milia Which finding is abnormal in a 2 month old child? - correct answer>>A closed anterior fontanelle In most children, the primary teeth have completely erupted by: - correct answer>> 24 months Normal vision in a child is expected by: - correct answer>>6 years of age Growth and development of 2 month old - correct answer>>- infant focuses on face
- grasps rattle if placed in hand
- smiles
- coos
- able to lift head 45 degrees Growth and development of 4 month old - correct answer>>-able to hold and control head when held upright
- no head lag when pulled upright
- raises body on hands
- rolls prone to supine
- follows light 180 degrees Growth and development of 6 month old - correct answer>>-able to place object in opposite hand in mouth
- sits with support/maybe unassisted
- rolls supine to prone
- bears weight
- recognizes parents
- says "dada" or "baba"
- babbles
- smiles, squeals, laughs, imitates sounds Growth and development of 9 month old - correct answer>>-pulls to stand
- bangs, shakes, drops, and throws objects
- able to feed self with finger foods
- responds to own name and understands a few words
- stranger anxiety
- crawls, creeps, and scoots Growth and development of 12 month old - correct answer>>-pulls to stand, may take a few steps
- uses pincer grasp and able to point
- says 2-4 words
- looks for dropped or hidden objects
- responds to own name and understands a few words
- feeds self and drinks from cup
- waves and says "bye-bye", "dada", and "mama"
- imitates vocalizations Growth and development of 15 month old - correct answer>>-walks well and is able to stoop
- can point to a body part
- says 3-6 words
- stacks two blocks
- follows simple commands
- points, grunts, pulls to show what he wants
- listens to a story Growth and development of 18 month old - correct answer>>-able to walk backwards
- can throw a ball
- says 15-20 words
- imitates words, uses two word phrases
- points to multiple body parts Growth and development of 2 year old - correct answer>>-Able to walk up and down stairs one step at a time
Anticipatory guidance for one month old - correct answer>>-do not place bottle in bed with baby
- do not give solids until 4 months of age
- discuss colic and comfort measures Anticipatory guidance for two month old - correct answer>>-No solid foods, no cereal in bottle
- Do not give honey or plain water in bottle Anticipatory guidance for four month old - correct answer>>-Childproof home (small, sharp, or dangerous objects, poisons, meds, etc.)
- introduce solid foods: cereal first, then pureed veggies, fruits
- Have syrup of ipecac available Anticipatory guidance for six month old - correct answer>>-Introduce solids 2-3 times per day
- avoids foods which are choking hazards: nuts, hotdogs, whole grapes, hard candy
- Start using a cup
- Fluoride supplements if not in drinking water Anticipatory guidance for nine month old - correct answer>>-Introduce mashed foods and finger foods, start table foods
- Discuss weaning from bottle
- brush teeth Anticipatory guidance for 12 month old - correct answer>>-start on whole milk
- allow to feed self Anticipatory guidance for 18 month old - correct answer>>-allow toddler to feed self with spoon and hands
- assess child's readiness for toilet training Anticipatory guidance for 3 year old - correct answer>>-Use time-out for unacceptable behavior: 1 minute for each year of age Tanner Staging-Female (Beginning at 8 years of age) - correct answer>>-Stage 1: Prepubertal: papilla elevated above chest wall
- Stage 2: Breast bud stage (8-13 years): breast and papilla form small mound, areola increases in diameter
- Stage 3: breast and areola enlarge: no separation in contours
- Stage 4: secondary mound formed by areola and papilla about at level of breast
- Stage 5: adult breast Tanner Staging-Male (Beginning at 8 years of age) - correct answer>>-Stage 1: testes 1 cm scrotum and penis are size seen in early childhood
- Stage 2: slight enlargement of testes (2-3 cm), scrotum becomes reddened and textured (10-13.5 years)
- Stage 3: Further testicular growth (3-4 cm) slight enlargement of penis
- Stage 4: Penis increases in length and diameter, testes enlarge (4-5 cm)
- Stage 5: Adult genitalia Tanner Staging Pubic Hair (Beginning at 8 years of age) - correct answer>>-Stage 1: No pubic hair present
- Stage 2: Sparse, .lightly pigmented, straight along border or labia/base of penis
- Stage 3: hair becomes more pigmented, coarse, curled, and more abundant
- Stage 4: Pubic hair abundant but covers smaller area than found in adult
- Stage 5: Adult hair distribution, female distributed as reverse triangle
- Stage 6: Hair grows up linea alba Immunizations for Birth - correct answer>>Hepatitis B (1st dose) **Remember the B in hepatitis B vaccine to know that this is the ONLY vaccine given at birth. Immunizations for 2 months - correct answer>>Hepatitis B (2nd dose) DTaP (diphtheria, tetanus, pertussis)....1st dose Hib (haemophilus influenzae type B)....1st dose Polio...1st dose PCV (pneumococcal conjugate vaccine)....1st dose RV (rotavirus)....1st dose Immunizations for 4 months - correct answer>>DTaP (2nd dose) Hib (2nd dose) Polio (2nd dose) PCV (2nd dose) RV (2nd dose) Immunizations for 6 months - correct answer>>Hepatitis B (3rd dose) DTap (3rd dose) Hib (3rd dose) Polio (3rd dose)
months and remember Hepatitis B is not given at 4 months, you have knocked out a lot of vaccines to remember. immune thrombocytopenia - correct answer>>In children, this is most often an acute episode following a viral infection. It is seen most frequently in children ages 3 to 5. Clinical manifestations include a sudden onset of mucocutaneous bleeding, ecchymosis, and petechiae. Severity of bleeding can vary, with about 3% of affected children requiring hospitalization and blood transfusions. Lymphadenopathy, hepatomegaly, and splenomegaly are not usually observed upon exam.Laboratory tests often reveal an isolated low platelet count. Treatment is determined by severity of bleeding, platelet count, and other risk factors. Platelet transfusion and administration of intravenous immune globulin, steroids, and intravenous anti-D immune globulin can be considered depending on severity of bleeding. Close monitoring without intervention can be considered for patients with a low risk. Most children recover in 3-6 months, whether treated or not.
- age >65 years
- patients with comorbiditie
- recent (3 months) antibiotic exposure
- alcoholics
- immunosuppressed
- exposure to child in daycare - correct answer>>Drug Resistant S. Pneumoniae (Population) (Community Acquired Pneumonia)
- abrupt onset with fever
- chills
- cough
- pain in side or chest
- rust colored sputum
- older patients exhibit fewer symptoms (confusion, absence of fever) - correct answer>>Drug Resistant S. Pneumoniae (Symptoms) (Community Acquired Pneumonia) What diagnostic test is gold standard for diagnosing community acquired pneumonia (CAP)? - correct answer>>Chest x-ray
- young, otherwise healthy
- non-smoker
- community outbreak - correct answer>>Atypical Pathogens (Mycoplasma, Chlamydophila, Legionella) (Population) (Community Acquired Pneumonia)
- low grade fever
- cough
- chills,
- headache
- rash
- joint aches
- arrythmias - correct answer>>Atypical Pathogens (Mycoplasma, Chlamydophila, Legionella) (symptoms) (Community Acquired Pneumonia) Common treatment for atypical pathogen for community acquired pneumonia? - correct answer>>Macrolide or Doxycyline Treatment for Drug Resistant S. Pneumoniae? - correct answer>>Respiratory Quinolone (Moxifloxacin, Gatafloxacin, Levofloxacin)
