NURS 5334 Advanced Pharmacology Final
Examination 2 versions Questions and Answers |
2026 Update | 100% Correct – UTA.
Module 1: Pharmacokinetics, Pharmacodynamics, CYP Enzymes,
Pharmacogenomics & Toxicology
Q1
A patient with chronic kidney disease (eGFR $22\ \text{mL/min}$) is prescribed a
renally eliminated drug. Which pharmacokinetic parameter is primarily altered in
this patient?
A) Volume of distribution ($V_d$)
B) Bioavailability ($F$)
C) Systemic clearance ($\text{CL}$)
D) Hepatic extraction ratio
Answer: C
Explanation: Systemic clearance ($\text{CL}$) is directly affected by renal
clearance ($\text{CL}_{\text{renal}} = \text{GFR} \times f_u$). When renal function
declines, renal clearance drops proportionately, leading to drug accumulation and
prolonged half-life unless the dose or frequency is adjusted.
Q2
,A patient who is a CYP2D6 ultrarapid metabolizer is prescribed codeine for post-
surgical pain. What clinical effect should the APRN anticipate?
A) Subtherapeutic pain relief due to rapid elimination
B) Excessive analgesia and heightened risk of respiratory depression
C) Severe gastrointestinal bleeding
D) Acute hepatic necrosis
Answer: B
Explanation: Codeine is a prodrug that relies on CYP2D6 to be bioactivated
into its active metabolite, morphine. Ultrarapid metabolizers convert codeine to
morphine much faster and more extensively than normal metabolizers, resulting in
potentially toxic levels of morphine and life-threatening respiratory depression.
Q3
Which parameter measures a drug’s affinity for its receptor and is defined as the
concentration required to produce 50% of its maximal response?
A) $\text{E}_{\text{max}}$
B) $\text{EC}_{50}$
C) Therapeutic Index ($\text{TI}$)
D) Clearance ($\text{CL}$)
Answer: B
,Explanation: The $\text{EC}_{50}$ (effective concentration 50%) measures
drug potency; lower $\text{EC}_{50}$ values indicate higher potency/affinity. In
contrast, $\text{E}_{\text{max}}$ represents drug efficacy (the maximum
achievable response).
Q4
Co-administration of a potent CYP3A4 inhibitor (e.g., clarithromycin) with a
CYP3A4 substrate (e.g., simvastatin) will result in:
A) Increased plasma concentrations and potential toxicity of simvastatin
B) Decreased plasma concentrations and therapeutic failure of simvastatin
C) Rapid renal clearance of clarithromycin
D) Induction of hepatic microsomal enzymes
Answer: A
Explanation: CYP3A4 inhibitors block the enzymatic breakdown of CYP3A4
substrates, causing substrate serum concentrations to spike. For statins like
simvastatin, elevated drug levels significantly increase the risk of statin-induced
myopathy and rhabdomyolysis.
Q5
Which phase of drug biotransformation involves conjugation reactions such as
glucuronidation, sulfation, or glutathione addition to make molecules water-
soluble?
A) Phase I
, B) Phase II
C) Phase III
D) Phase 0
Answer: B
Explanation: Phase II biotransformation consists of conjugation reactions
(e.g., glucuronidation, sulfation, acetylation, glutathione conjugation) that attach
polar endogenous groups to the drug or Phase I metabolite, making it highly
water-soluble for excretion.
Q6
A non-competitive antagonist alters the agonist dose-response curve by:
A) Shifting the curve to the right without affecting maximal response
B) Reducing the maximal response ($\text{E}_{\text{max}}$) regardless of
agonist concentration
C) Shifting the curve to the left and increasing potency
D) Elevating baseline constitutive receptor activity
Answer: B
Explanation: Non-competitive (or irreversible) antagonists bind to allosteric
sites or form covalent bonds with receptors. Because they cannot be displaced by
increasing concentrations of the agonist, they decrease the maximum response
($\text{E}_{\text{max}}$).
Examination 2 versions Questions and Answers |
2026 Update | 100% Correct – UTA.
Module 1: Pharmacokinetics, Pharmacodynamics, CYP Enzymes,
Pharmacogenomics & Toxicology
Q1
A patient with chronic kidney disease (eGFR $22\ \text{mL/min}$) is prescribed a
renally eliminated drug. Which pharmacokinetic parameter is primarily altered in
this patient?
A) Volume of distribution ($V_d$)
B) Bioavailability ($F$)
C) Systemic clearance ($\text{CL}$)
D) Hepatic extraction ratio
Answer: C
Explanation: Systemic clearance ($\text{CL}$) is directly affected by renal
clearance ($\text{CL}_{\text{renal}} = \text{GFR} \times f_u$). When renal function
declines, renal clearance drops proportionately, leading to drug accumulation and
prolonged half-life unless the dose or frequency is adjusted.
Q2
,A patient who is a CYP2D6 ultrarapid metabolizer is prescribed codeine for post-
surgical pain. What clinical effect should the APRN anticipate?
A) Subtherapeutic pain relief due to rapid elimination
B) Excessive analgesia and heightened risk of respiratory depression
C) Severe gastrointestinal bleeding
D) Acute hepatic necrosis
Answer: B
Explanation: Codeine is a prodrug that relies on CYP2D6 to be bioactivated
into its active metabolite, morphine. Ultrarapid metabolizers convert codeine to
morphine much faster and more extensively than normal metabolizers, resulting in
potentially toxic levels of morphine and life-threatening respiratory depression.
Q3
Which parameter measures a drug’s affinity for its receptor and is defined as the
concentration required to produce 50% of its maximal response?
A) $\text{E}_{\text{max}}$
B) $\text{EC}_{50}$
C) Therapeutic Index ($\text{TI}$)
D) Clearance ($\text{CL}$)
Answer: B
,Explanation: The $\text{EC}_{50}$ (effective concentration 50%) measures
drug potency; lower $\text{EC}_{50}$ values indicate higher potency/affinity. In
contrast, $\text{E}_{\text{max}}$ represents drug efficacy (the maximum
achievable response).
Q4
Co-administration of a potent CYP3A4 inhibitor (e.g., clarithromycin) with a
CYP3A4 substrate (e.g., simvastatin) will result in:
A) Increased plasma concentrations and potential toxicity of simvastatin
B) Decreased plasma concentrations and therapeutic failure of simvastatin
C) Rapid renal clearance of clarithromycin
D) Induction of hepatic microsomal enzymes
Answer: A
Explanation: CYP3A4 inhibitors block the enzymatic breakdown of CYP3A4
substrates, causing substrate serum concentrations to spike. For statins like
simvastatin, elevated drug levels significantly increase the risk of statin-induced
myopathy and rhabdomyolysis.
Q5
Which phase of drug biotransformation involves conjugation reactions such as
glucuronidation, sulfation, or glutathione addition to make molecules water-
soluble?
A) Phase I
, B) Phase II
C) Phase III
D) Phase 0
Answer: B
Explanation: Phase II biotransformation consists of conjugation reactions
(e.g., glucuronidation, sulfation, acetylation, glutathione conjugation) that attach
polar endogenous groups to the drug or Phase I metabolite, making it highly
water-soluble for excretion.
Q6
A non-competitive antagonist alters the agonist dose-response curve by:
A) Shifting the curve to the right without affecting maximal response
B) Reducing the maximal response ($\text{E}_{\text{max}}$) regardless of
agonist concentration
C) Shifting the curve to the left and increasing potency
D) Elevating baseline constitutive receptor activity
Answer: B
Explanation: Non-competitive (or irreversible) antagonists bind to allosteric
sites or form covalent bonds with receptors. Because they cannot be displaced by
increasing concentrations of the agonist, they decrease the maximum response
($\text{E}_{\text{max}}$).
