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NSG 533 – Advanced Pharmacology Exam 2 |
Wilkes University | 2025/2026 | Verified Study
Guide
NSG 533 – Advanced Pharmacology Exam 2
Wilkes University – Graduate Nursing Program
2025/2026 Academic Year
Verified Study Guide
Section 1: Pharmacokinetics & Pharmacodynamics (Questions 1–15)
1. A patient with hepatic cirrhosis has a reduced ability to metabolize drugs. Which pharmacokinetic
process is most directly affected?
A) Absorption
B) Distribution
C) Metabolism
D) Excretion
✔✔ Answer ✔✔ C
Explanation: The liver is the primary site of drug metabolism (biotransformation). Cirrhosis impairs
phase I (oxidation, reduction, hydrolysis) and phase II (conjugation) reactions, leading to drug
accumulation and toxicity. Excretion is primarily renal.
2. A drug has a half-life of 24 hours. How many hours will it take to reach steady state if the patient
takes the drug once daily?
A) 24 hours
B) 48 hours
C) 96 hours
D) 120 hours
✔✔ Answer ✔✔ D
Explanation: Steady state is achieved after approximately 4–5 half-lives. With a 24-hour half-life, steady
state occurs at 4–5 days (96–120 hours). Once-daily dosing means steady state is reached after 4–5
doses, i.e., 96–120 hours.
,2
3. Which of the following drug properties results in a large volume of distribution (Vd)?
A) High water solubility
B) High protein binding
C) High lipophilicity
D) Large molecular weight
✔✔ Answer ✔✔ C
Explanation: Lipophilic drugs cross cell membranes easily and distribute into tissues, resulting in a large
Vd (>0.6 L/kg). Water-soluble drugs remain in the vascular space (low Vd). High protein binding can limit
distribution initially.
4. A medication that acts as an antagonist at the mu-opioid receptor will have which effect?
A) Analgesia
B) Respiratory depression
C) Blockade of opioid effects
D) Euphoria
✔✔ Answer ✔✔ C
Explanation: An antagonist binds to a receptor but does not activate it; it blocks the action of agonists.
Naloxone is a mu-opioid antagonist used to reverse opioid overdose. Agonists produce analgesia,
respiratory depression, and euphoria.
5. A drug with zero-order kinetics:
A) Has a constant half-life regardless of dose
B) Eliminates a constant amount per unit time
C) Follows first-order elimination at high doses
D) Is never clinically relevant
✔✔ Answer ✔✔ B
Explanation: Zero-order kinetics means a constant amount of drug is eliminated per unit time (e.g.,
ethanol, phenytoin at therapeutic doses). Half-life is not constant and increases with dose. First-order
kinetics eliminates a constant fraction per time.
6. A patient is taking two drugs that are both highly protein-bound (warfarin and sulfamethoxazole).
What is the potential interaction?
A) Decreased free fraction of warfarin
B) Increased free fraction of warfarin, leading to bleeding
C) No significant interaction
D) Decreased metabolism of sulfamethoxazole
, 3
✔✔ Answer ✔✔ B
Explanation: Displacement from protein binding sites increases the free (active) concentration of
warfarin, enhancing anticoagulant effect and bleeding risk. This is a classic drug-drug interaction.
7. The CYP450 isoenzyme responsible for metabolizing warfarin, phenytoin, and many statins is:
A) CYP1A2
B) CYP2C9
C) CYP2D6
D) CYP3A4
✔✔ Answer ✔✔ B
Explanation: CYP2C9 metabolizes warfarin, phenytoin, and some NSAIDs. CYP3A4 metabolizes many
drugs (statins, calcium channel blockers). CYP2D6 metabolizes codeine, antidepressants. CYP1A2
metabolizes caffeine, theophylline.
8. A patient who is a poor metabolizer of CYP2D6 is prescribed codeine for pain. What is the expected
outcome?
A) Increased analgesic effect
B) Decreased analgesic effect because codeine is not converted to morphine
C) Increased risk of serotonin syndrome
D) No difference in effect
✔✔ Answer ✔✔ B
Explanation: Codeine is a prodrug that requires CYP2D6-mediated conversion to morphine for analgesia.
Poor metabolizers have little to no pain relief. Ultrarapid metabolizers are at risk for toxicity.
9. A drug with a narrow therapeutic index requires monitoring of:
A) Blood pressure only
B) Serum drug levels
C) Renal function only
D) Liver enzymes only
✔✔ Answer ✔✔ B
Explanation: Narrow therapeutic index drugs (warfarin, digoxin, phenytoin, lithium, theophylline) have a
small margin between therapeutic and toxic doses. Serum drug levels are monitored to avoid toxicity
and ensure efficacy.
10. The term “biotransformation” refers to:
A) Movement of drug from gut to bloodstream
NSG 533 – Advanced Pharmacology Exam 2 |
Wilkes University | 2025/2026 | Verified Study
Guide
NSG 533 – Advanced Pharmacology Exam 2
Wilkes University – Graduate Nursing Program
2025/2026 Academic Year
Verified Study Guide
Section 1: Pharmacokinetics & Pharmacodynamics (Questions 1–15)
1. A patient with hepatic cirrhosis has a reduced ability to metabolize drugs. Which pharmacokinetic
process is most directly affected?
A) Absorption
B) Distribution
C) Metabolism
D) Excretion
✔✔ Answer ✔✔ C
Explanation: The liver is the primary site of drug metabolism (biotransformation). Cirrhosis impairs
phase I (oxidation, reduction, hydrolysis) and phase II (conjugation) reactions, leading to drug
accumulation and toxicity. Excretion is primarily renal.
2. A drug has a half-life of 24 hours. How many hours will it take to reach steady state if the patient
takes the drug once daily?
A) 24 hours
B) 48 hours
C) 96 hours
D) 120 hours
✔✔ Answer ✔✔ D
Explanation: Steady state is achieved after approximately 4–5 half-lives. With a 24-hour half-life, steady
state occurs at 4–5 days (96–120 hours). Once-daily dosing means steady state is reached after 4–5
doses, i.e., 96–120 hours.
,2
3. Which of the following drug properties results in a large volume of distribution (Vd)?
A) High water solubility
B) High protein binding
C) High lipophilicity
D) Large molecular weight
✔✔ Answer ✔✔ C
Explanation: Lipophilic drugs cross cell membranes easily and distribute into tissues, resulting in a large
Vd (>0.6 L/kg). Water-soluble drugs remain in the vascular space (low Vd). High protein binding can limit
distribution initially.
4. A medication that acts as an antagonist at the mu-opioid receptor will have which effect?
A) Analgesia
B) Respiratory depression
C) Blockade of opioid effects
D) Euphoria
✔✔ Answer ✔✔ C
Explanation: An antagonist binds to a receptor but does not activate it; it blocks the action of agonists.
Naloxone is a mu-opioid antagonist used to reverse opioid overdose. Agonists produce analgesia,
respiratory depression, and euphoria.
5. A drug with zero-order kinetics:
A) Has a constant half-life regardless of dose
B) Eliminates a constant amount per unit time
C) Follows first-order elimination at high doses
D) Is never clinically relevant
✔✔ Answer ✔✔ B
Explanation: Zero-order kinetics means a constant amount of drug is eliminated per unit time (e.g.,
ethanol, phenytoin at therapeutic doses). Half-life is not constant and increases with dose. First-order
kinetics eliminates a constant fraction per time.
6. A patient is taking two drugs that are both highly protein-bound (warfarin and sulfamethoxazole).
What is the potential interaction?
A) Decreased free fraction of warfarin
B) Increased free fraction of warfarin, leading to bleeding
C) No significant interaction
D) Decreased metabolism of sulfamethoxazole
, 3
✔✔ Answer ✔✔ B
Explanation: Displacement from protein binding sites increases the free (active) concentration of
warfarin, enhancing anticoagulant effect and bleeding risk. This is a classic drug-drug interaction.
7. The CYP450 isoenzyme responsible for metabolizing warfarin, phenytoin, and many statins is:
A) CYP1A2
B) CYP2C9
C) CYP2D6
D) CYP3A4
✔✔ Answer ✔✔ B
Explanation: CYP2C9 metabolizes warfarin, phenytoin, and some NSAIDs. CYP3A4 metabolizes many
drugs (statins, calcium channel blockers). CYP2D6 metabolizes codeine, antidepressants. CYP1A2
metabolizes caffeine, theophylline.
8. A patient who is a poor metabolizer of CYP2D6 is prescribed codeine for pain. What is the expected
outcome?
A) Increased analgesic effect
B) Decreased analgesic effect because codeine is not converted to morphine
C) Increased risk of serotonin syndrome
D) No difference in effect
✔✔ Answer ✔✔ B
Explanation: Codeine is a prodrug that requires CYP2D6-mediated conversion to morphine for analgesia.
Poor metabolizers have little to no pain relief. Ultrarapid metabolizers are at risk for toxicity.
9. A drug with a narrow therapeutic index requires monitoring of:
A) Blood pressure only
B) Serum drug levels
C) Renal function only
D) Liver enzymes only
✔✔ Answer ✔✔ B
Explanation: Narrow therapeutic index drugs (warfarin, digoxin, phenytoin, lithium, theophylline) have a
small margin between therapeutic and toxic doses. Serum drug levels are monitored to avoid toxicity
and ensure efficacy.
10. The term “biotransformation” refers to:
A) Movement of drug from gut to bloodstream
