NR568 Week 4 Midterm Exam | Advanced Pharmacology for AGPCNP |
Complete Questions & Answers 2026
Questions 1–100
1. A 70-year-old patient with heart failure is started on digoxin.
Which age-related change in pharmacokinetics most increases the
risk of toxicity?
A) Decreased hepatic first-pass metabolism
B) Increased volume of distribution for water-soluble drugs
C) Decreased renal clearance of digoxin
D) Enhanced glomerular filtration rate
Answer C: Decreased renal clearance of digoxin
Rationale: Renal clearance declines with age, reducing digoxin
elimination. Dose adjustment based on renal function and monitoring of
levels is essential in older adults.
,2. A patient with a genetic polymorphism resulting in CYP2D6 poor
metabolizer phenotype is prescribed codeine for pain. What is the
most likely outcome?
A) Little to no analgesic effect due to inability to convert codeine to
morphine
B) Increased risk of respiratory depression from rapid conversion to
morphine
C) Prolonged half-life of codeine but normal analgesia
D) Increased risk of serotonin syndrome
Answer A: Little to no analgesic effect due to inability to convert
codeine to morphine
Rationale: Codeine is a prodrug requiring CYP2D6 to convert to active
morphine. Poor metabolizers have reduced analgesia.
3. A patient is receiving a drug that is a weak base (pKa 8.5). Which of
the following would increase its renal excretion?
A) Alkalinizing the urine (increasing pH)
B) Acidifying the urine (decreasing pH)
C) Increasing urine flow rate only
D) Decreasing urine flow rate
Answer B: Acidifying the urine (decreasing pH)
,Rationale: Weak bases are ionized (and less reabsorbed) in acidic urine.
Acidification traps the drug in urine, enhancing excretion.
4. A patient with hepatic cirrhosis has a reduced ability to metabolize
drugs via phase I reactions. Which drug would be most affected?
A) Lorazepam (primarily phase II glucuronidation)
B) Phenytoin (primarily phase I oxidation)
C) Digoxin (primarily renal excretion)
D) Acetaminophen (phase II conjugation)
Answer B: Phenytoin (primarily phase I oxidation)
Rationale: Phase I reactions (oxidation) are more affected by cirrhosis
than phase II. Phenytoin metabolism would be significantly impaired.
5. A patient is prescribed a drug that is a P-glycoprotein (P-gp)
substrate. Which co-administered drug would increase its oral
bioavailability?
A) Rifampin (P-gp inducer)
B) Ketoconazole (P-gp inhibitor)
C) Phenytoin (P-gp inducer)
D) St. John's wort (P-gp inducer)
Answer B: Ketoconazole (P-gp inhibitor)
, Rationale: P-gp inhibitors decrease drug efflux from intestinal cells,
increasing absorption and oral bioavailability.
6. A patient with low serum albumin is prescribed warfarin. What
effect should the NP anticipate?
A) Increased free drug levels and increased anticoagulant effect
B) Decreased free drug levels and reduced effect
C) No change because albumin binding is irrelevant
D) Increased binding to alpha-1 acid glycoprotein
Answer A: Increased free drug levels and increased anticoagulant
effect
Rationale: Low albumin increases free fraction of highly bound drugs like
warfarin. This increases effect and risk of toxicity.
7. A patient is prescribed a drug that is a high extraction ratio drug.
Which statement about its oral bioavailability is correct?
A) It is highly dependent on hepatic blood flow
B) It is independent of hepatic blood flow
C) It is primarily determined by protein binding
D) It is always 100% regardless of liver function
Answer A: It is highly dependent on hepatic blood flow
Complete Questions & Answers 2026
Questions 1–100
1. A 70-year-old patient with heart failure is started on digoxin.
Which age-related change in pharmacokinetics most increases the
risk of toxicity?
A) Decreased hepatic first-pass metabolism
B) Increased volume of distribution for water-soluble drugs
C) Decreased renal clearance of digoxin
D) Enhanced glomerular filtration rate
Answer C: Decreased renal clearance of digoxin
Rationale: Renal clearance declines with age, reducing digoxin
elimination. Dose adjustment based on renal function and monitoring of
levels is essential in older adults.
,2. A patient with a genetic polymorphism resulting in CYP2D6 poor
metabolizer phenotype is prescribed codeine for pain. What is the
most likely outcome?
A) Little to no analgesic effect due to inability to convert codeine to
morphine
B) Increased risk of respiratory depression from rapid conversion to
morphine
C) Prolonged half-life of codeine but normal analgesia
D) Increased risk of serotonin syndrome
Answer A: Little to no analgesic effect due to inability to convert
codeine to morphine
Rationale: Codeine is a prodrug requiring CYP2D6 to convert to active
morphine. Poor metabolizers have reduced analgesia.
3. A patient is receiving a drug that is a weak base (pKa 8.5). Which of
the following would increase its renal excretion?
A) Alkalinizing the urine (increasing pH)
B) Acidifying the urine (decreasing pH)
C) Increasing urine flow rate only
D) Decreasing urine flow rate
Answer B: Acidifying the urine (decreasing pH)
,Rationale: Weak bases are ionized (and less reabsorbed) in acidic urine.
Acidification traps the drug in urine, enhancing excretion.
4. A patient with hepatic cirrhosis has a reduced ability to metabolize
drugs via phase I reactions. Which drug would be most affected?
A) Lorazepam (primarily phase II glucuronidation)
B) Phenytoin (primarily phase I oxidation)
C) Digoxin (primarily renal excretion)
D) Acetaminophen (phase II conjugation)
Answer B: Phenytoin (primarily phase I oxidation)
Rationale: Phase I reactions (oxidation) are more affected by cirrhosis
than phase II. Phenytoin metabolism would be significantly impaired.
5. A patient is prescribed a drug that is a P-glycoprotein (P-gp)
substrate. Which co-administered drug would increase its oral
bioavailability?
A) Rifampin (P-gp inducer)
B) Ketoconazole (P-gp inhibitor)
C) Phenytoin (P-gp inducer)
D) St. John's wort (P-gp inducer)
Answer B: Ketoconazole (P-gp inhibitor)
, Rationale: P-gp inhibitors decrease drug efflux from intestinal cells,
increasing absorption and oral bioavailability.
6. A patient with low serum albumin is prescribed warfarin. What
effect should the NP anticipate?
A) Increased free drug levels and increased anticoagulant effect
B) Decreased free drug levels and reduced effect
C) No change because albumin binding is irrelevant
D) Increased binding to alpha-1 acid glycoprotein
Answer A: Increased free drug levels and increased anticoagulant
effect
Rationale: Low albumin increases free fraction of highly bound drugs like
warfarin. This increases effect and risk of toxicity.
7. A patient is prescribed a drug that is a high extraction ratio drug.
Which statement about its oral bioavailability is correct?
A) It is highly dependent on hepatic blood flow
B) It is independent of hepatic blood flow
C) It is primarily determined by protein binding
D) It is always 100% regardless of liver function
Answer A: It is highly dependent on hepatic blood flow
