PNC Licensing Examination Pharmacology and Therapeutics Syllabus

Calculate the IV rate in mL/hr for 1000 mL to be infused over 8 hours.

1000 mL ÷ 8 hr = 125 mL/hr.

What is the standard formula for pediatric dose using body weight (mg/kg)?

Pediatric dose = prescribed dose per kg × child's weight in kg (e.g., 10 mg/kg × 20 kg = 200 mg).

Define a medication error and name the most critical first action if one occurs.

A medication error is any preventable event that may cause inappropriate medication use or patient harm. The first action is to assess the patient's condition/safety, then notify the physician and document/report via incident report.

List three key strategies to prevent medication errors.

Use the rights of administration with three label checks; avoid error-prone abbreviations and use tall-man lettering for look-alike/sound-alike drugs; use two patient identifiers and independent double-checks for high-alert drugs.

What is the mechanism and main use of beta-blockers (e.g., atenolol, metoprolol)?

They block beta-adrenergic receptors, decreasing heart rate, contractility, and blood pressure. Used for hypertension, angina, arrhythmias, and heart failure. Suffix '-olol'.

Name the mechanism of ACE inhibitors and their characteristic side effect.

ACE inhibitors (suffix '-pril', e.g., enalapril) block conversion of angiotensin I to II, causing vasodilation and lowering BP. Characteristic side effect: dry cough (and risk of hyperkalemia/angioedema).

What is the antidote for digoxin toxicity, and what electrolyte imbalance worsens it?

Antidote: digoxin immune Fab (Digibind). Hypokalemia worsens digoxin toxicity. Hold digoxin if apical pulse < 60 bpm.

Differentiate the action of nitrates (e.g., nitroglycerin) in angina.

Nitrates cause vasodilation (mainly venous), reducing preload and myocardial oxygen demand, relieving angina. Side effects: headache, hypotension, flushing.

Name two classes of bronchodilators used in asthma and an example of each.

Beta-2 agonists (e.g., salbutamol/albuterol) and anticholinergics (e.g., ipratropium); also methylxanthines (e.g., theophylline).

What is the difference between a rescue (reliever) and a controller (preventer) inhaler in asthma?

Rescue inhalers are short-acting beta-2 agonists (e.g., salbutamol) for acute symptom relief. Controllers are inhaled corticosteroids (e.g., budesonide) used regularly to prevent inflammation.

Classify benzodiazepines: mechanism, two uses, and the antidote.

Benzodiazepines (e.g., diazepam, '-pam/-lam') enhance GABA activity (CNS depressant). Uses: anxiety, seizures, sedation, muscle relaxation. Antidote: flumazenil.

What class is omeprazole, its mechanism, and use?

Omeprazole is a proton pump inhibitor (PPI, suffix '-prazole'). It blocks the gastric H+/K+ ATPase pump, reducing acid secretion. Used for GERD, peptic ulcers, and gastritis.

Compare H2-receptor antagonists and antacids.

H2 blockers (e.g., ranitidine, '-tidine') reduce acid production by blocking histamine H2 receptors. Antacids (e.g., aluminum/magnesium hydroxide) neutralize existing stomach acid for rapid, short-term relief.

What is the role of insulin and the main adverse effect to monitor?

Insulin lowers blood glucose by promoting cellular glucose uptake. Main adverse effect: hypoglycemia (monitor for sweating, tremor, confusion).

How does metformin lower blood glucose, and what serious adverse effect must be monitored?

Metformin (a biguanide) decreases hepatic glucose production and increases insulin sensitivity. Serious adverse effect: lactic acidosis (hold before contrast studies/surgery).

Differentiate non-opioid (NSAID) from opioid analgesics in mechanism.

NSAIDs (e.g., ibuprofen) inhibit cyclooxygenase (COX), reducing prostaglandins — relieving mild–moderate pain and inflammation. Opioids (e.g., morphine) bind CNS opioid receptors for moderate–severe pain; cause respiratory depression and dependence.

What is the antidote for opioid overdose and its key sign?

Antidote: naloxone (Narcan). Key sign of opioid overdose: respiratory depression with pinpoint (miotic) pupils and decreased consciousness.

What is the maximum recommended daily dose of paracetamol (acetaminophen) in adults, and the antidote for overdose?

Maximum ~4 g/day in adults. Overdose causes hepatotoxicity; antidote is N-acetylcysteine (NAC).

Differentiate general from local anesthesia.

General anesthesia produces loss of consciousness and whole-body loss of sensation. Local/regional anesthesia (e.g., lidocaine) blocks sensation in a specific area while the patient stays conscious.

Explain bactericidal versus bacteriostatic antibiotics.

Bactericidal antibiotics kill bacteria (e.g., penicillins, aminoglycosides). Bacteriostatic antibiotics inhibit bacterial growth/reproduction, letting the immune system clear them (e.g., tetracyclines, macrolides).

What is the mechanism of penicillins, and the most serious allergic reaction?

Penicillins inhibit bacterial cell wall synthesis. Most serious allergic reaction: anaphylaxis.

Name a key adverse effect of aminoglycosides (e.g., gentamicin).

Ototoxicity (hearing/balance damage) and nephrotoxicity (kidney damage); monitor serum levels and renal function.

What is antibiotic resistance and one major cause?

Antibiotic resistance is the ability of bacteria to survive drugs that once killed them. A major cause is misuse/overuse of antibiotics, including incomplete courses and unnecessary prescriptions.

Why must patients complete the full course of antibiotics?

Stopping early leaves surviving, partially resistant bacteria that can multiply and cause resistant reinfection, contributing to antibiotic resistance.

Match drug classes: aciclovir, fluconazole, metronidazole — antiviral, antifungal, or antiparasitic?

Aciclovir = antiviral (herpes); fluconazole = antifungal (suffix '-azole'); metronidazole = antiprotozoal/antiparasitic (and anti-anaerobe; avoid alcohol — disulfiram reaction).

Name the first-line antitubercular drugs (RIPE) and their classic order.

Rifampicin, Isoniazid, Pyrazinamide, Ethambutol (RIPE).

Which TB drug causes red-orange discoloration of body fluids, and which can cause peripheral neuropathy (prevented by vitamin B6)?

Rifampicin causes red-orange urine/sweat/tears. Isoniazid causes peripheral neuropathy, prevented by pyridoxine (vitamin B6).

Classify IV fluids as isotonic, hypotonic, or hypertonic, with one example each.

Isotonic: 0.9% normal saline / Ringer's lactate (stays in vessels, expands volume). Hypotonic: 0.45% saline (moves into cells). Hypertonic: 3% saline / D10W (pulls fluid out of cells into vessels).

Which IV fluid is the first choice for fluid resuscitation in hypovolemia/shock, and which is contraindicated in patients with blood?

0.9% normal saline (isotonic) is first-line for resuscitation. Ringer's lactate should not be infused in the same line as blood (calcium causes clotting); use normal saline with blood.

List the ABO/Rh compatibility: which blood type is the universal donor and which is the universal recipient (for red cells)?

O negative is the universal red cell donor; AB positive is the universal recipient.

What are the early signs of an acute hemolytic transfusion reaction and the immediate nursing action?

Signs: fever, chills, flank/back pain, hypotension, dark urine, dyspnea (often within first 15 min). Immediate action: STOP the transfusion, keep the IV line open with normal saline, and notify the physician/blood bank.

State the normal serum potassium range and the key rule for IV potassium administration.

Normal serum potassium: 3.5–5.0 mEq/L. IV potassium must always be diluted and given slowly (never IV push/bolus — can cause fatal cardiac arrest); typically ≤10–20 mEq/hr with cardiac monitoring.