NR 565 Advanced Pharmacology Midterm Exam
200-Question Practice Test with Answers &
Rationales| Free Pdf Access.
Section 1: Pharmacokinetics, Pharmacodynamics & Drug
Interactions
Question 1: A patient is started on a new medication that is a substrate for CYP3A4.
Which of the following medications, if added to the regimen, would be most likely to
increase the risk of toxicity from the new drug?
A. Rifampin
B. Carbamazepine
C. Ketoconazole
D. Phenytoin
Answer: C. Ketoconazole
Rationale: Ketoconazole is a potent CYP450 inhibitor. Inhibitors slow the rate of drug
metabolism, causing an increase in active drug accumulation, which can lead to increased
adverse effects and toxicity . Rifampin, carbamazepine, and phenytoin are all CYP450
inducers, which would decrease drug levels and reduce efficacy .
Question 2: A provider is reviewing the medication list of a patient on multiple
medications. The provider notes the patient is on a medication that is a CYP450 inducer.
What is the most likely consequence of adding a CYP450 inducer to a patient's regimen?
A. Increased drug levels and increased toxicity
B. Decreased drug levels and reduced therapeutic effect
,C. No change in drug levels
D. Increased protein binding of other medications
Answer: B. Decreased drug levels and reduced therapeutic effect
Rationale: CYP450 inducers act on the liver to stimulate enzyme synthesis, a process
known as induction. By increasing the rate of drug metabolism, the amount of active drug
is decreased and plasma drug levels fall. If dosage adjustments are not made, the drug
may not achieve therapeutic levels .
Question 3: Which mnemonic is commonly used to remember CYP450 inducers?
A. CRAP GPS
B. VISA KING
C. FAST DOCS
D. DRUG SAFE
Answer: A. CRAP GPS
Rationale: The mnemonic "CRAP GPS" is used to remember CYP450 inducers:
Carbamazepine, Rifampin, Alcohol (chronic), Phenytoin, Griseofulvin, Phenobarbital, and
Sulfonylureas .
Question 4: Which of the following is a CYP450 inhibitor?
A. Valproate
B. Rifampin
C. Carbamazepine
D. Phenytoin
Answer: A. Valproate
Rationale: Valproate is a CYP450 inhibitor . Inhibitors slow metabolism, leading to
increased levels of substrate drugs and potential toxicity. Rifampin, carbamazepine, and
phenytoin are all CYP450 inducers .
,Question 5: A patient on warfarin is started on amiodarone. The nurse practitioner
should anticipate which effect?
A. Decreased INR and reduced warfarin effect
B. Increased INR and increased bleeding risk
C. No change in INR
D. Increased warfarin metabolism
Answer: B. Increased INR and increased bleeding risk
Rationale: Amiodarone is a CYP450 inhibitor. When a patient on warfarin (a substrate for
CYP2C9) is started on amiodarone, warfarin metabolism is inhibited, leading to elevated
warfarin levels, increased INR, and increased bleeding risk. This is a classic drug
interaction that requires close monitoring and dose adjustment.
Question 6: A patient has a genetic polymorphism that results in poor metabolism via
CYP2D6. Which of the following is most likely true for this patient?
A. The patient will metabolize all drugs more rapidly
B. The patient may have reduced efficacy or increased toxicity from CYP2D6 substrates
C. The patient will have no change in drug metabolism
D. The patient will have increased drug excretion
Answer: B. The patient may have reduced efficacy or increased toxicity from
CYP2D6 substrates
Rationale: Poor metabolizer phenotype occurs when CYP2D6 alleles have inactivating
mutations, leading to enzyme synthesis with impaired or no activity . These patients may
have reduced efficacy if the drug requires activation (prodrugs like codeine) or increased
toxicity if the parent drug accumulates.
Question 7: A 72-year-old patient is on multiple medications for hypertension, diabetes,
and hyperlipidemia. Which statement best reflects a concern for this patient?
, A. The elderly metabolize medications faster than younger adults
B. The elderly are at high risk for polypharmacy and adverse drug events
C. The elderly require higher doses of all medications
D. The elderly are not at risk for drug interactions
Answer: B. The elderly are at high risk for polypharmacy and adverse drug events
Rationale: The elderly population is often prescribed multiple medications
simultaneously, known as polypharmacy, which increases the risk of adverse drug
interactions, overdose, and other complications. This requires careful evaluation and
management of medication regimens to ensure safety and effectiveness .
Question 8: A provider is evaluating a medication regimen for an older adult. Which
tool would be most useful for identifying potentially inappropriate medications in this
population?
A. Beers Criteria
B. STOPP/START Criteria
C. Both A and B
D. Broselow Tape
Answer: C. Both A and B
Rationale: The Beers Criteria is a tool identifying inappropriate medication use in older
adults, cautioning against certain drugs and interactions . The STOPP/START criteria
(Screening Tool of Older Person's Prescriptions/Screening Tool to Alert to Right Treatment)
is another validated tool for identifying potentially inappropriate medications and
potential prescribing omissions in older adults. Both are useful clinical tools.
Question 9: A patient is prescribed a medication that is highly protein-bound. Which
statement about this medication is correct?
A. It has a high volume of distribution
B. It may interact with other highly protein-bound drugs, leading to increased free drug
levels
200-Question Practice Test with Answers &
Rationales| Free Pdf Access.
Section 1: Pharmacokinetics, Pharmacodynamics & Drug
Interactions
Question 1: A patient is started on a new medication that is a substrate for CYP3A4.
Which of the following medications, if added to the regimen, would be most likely to
increase the risk of toxicity from the new drug?
A. Rifampin
B. Carbamazepine
C. Ketoconazole
D. Phenytoin
Answer: C. Ketoconazole
Rationale: Ketoconazole is a potent CYP450 inhibitor. Inhibitors slow the rate of drug
metabolism, causing an increase in active drug accumulation, which can lead to increased
adverse effects and toxicity . Rifampin, carbamazepine, and phenytoin are all CYP450
inducers, which would decrease drug levels and reduce efficacy .
Question 2: A provider is reviewing the medication list of a patient on multiple
medications. The provider notes the patient is on a medication that is a CYP450 inducer.
What is the most likely consequence of adding a CYP450 inducer to a patient's regimen?
A. Increased drug levels and increased toxicity
B. Decreased drug levels and reduced therapeutic effect
,C. No change in drug levels
D. Increased protein binding of other medications
Answer: B. Decreased drug levels and reduced therapeutic effect
Rationale: CYP450 inducers act on the liver to stimulate enzyme synthesis, a process
known as induction. By increasing the rate of drug metabolism, the amount of active drug
is decreased and plasma drug levels fall. If dosage adjustments are not made, the drug
may not achieve therapeutic levels .
Question 3: Which mnemonic is commonly used to remember CYP450 inducers?
A. CRAP GPS
B. VISA KING
C. FAST DOCS
D. DRUG SAFE
Answer: A. CRAP GPS
Rationale: The mnemonic "CRAP GPS" is used to remember CYP450 inducers:
Carbamazepine, Rifampin, Alcohol (chronic), Phenytoin, Griseofulvin, Phenobarbital, and
Sulfonylureas .
Question 4: Which of the following is a CYP450 inhibitor?
A. Valproate
B. Rifampin
C. Carbamazepine
D. Phenytoin
Answer: A. Valproate
Rationale: Valproate is a CYP450 inhibitor . Inhibitors slow metabolism, leading to
increased levels of substrate drugs and potential toxicity. Rifampin, carbamazepine, and
phenytoin are all CYP450 inducers .
,Question 5: A patient on warfarin is started on amiodarone. The nurse practitioner
should anticipate which effect?
A. Decreased INR and reduced warfarin effect
B. Increased INR and increased bleeding risk
C. No change in INR
D. Increased warfarin metabolism
Answer: B. Increased INR and increased bleeding risk
Rationale: Amiodarone is a CYP450 inhibitor. When a patient on warfarin (a substrate for
CYP2C9) is started on amiodarone, warfarin metabolism is inhibited, leading to elevated
warfarin levels, increased INR, and increased bleeding risk. This is a classic drug
interaction that requires close monitoring and dose adjustment.
Question 6: A patient has a genetic polymorphism that results in poor metabolism via
CYP2D6. Which of the following is most likely true for this patient?
A. The patient will metabolize all drugs more rapidly
B. The patient may have reduced efficacy or increased toxicity from CYP2D6 substrates
C. The patient will have no change in drug metabolism
D. The patient will have increased drug excretion
Answer: B. The patient may have reduced efficacy or increased toxicity from
CYP2D6 substrates
Rationale: Poor metabolizer phenotype occurs when CYP2D6 alleles have inactivating
mutations, leading to enzyme synthesis with impaired or no activity . These patients may
have reduced efficacy if the drug requires activation (prodrugs like codeine) or increased
toxicity if the parent drug accumulates.
Question 7: A 72-year-old patient is on multiple medications for hypertension, diabetes,
and hyperlipidemia. Which statement best reflects a concern for this patient?
, A. The elderly metabolize medications faster than younger adults
B. The elderly are at high risk for polypharmacy and adverse drug events
C. The elderly require higher doses of all medications
D. The elderly are not at risk for drug interactions
Answer: B. The elderly are at high risk for polypharmacy and adverse drug events
Rationale: The elderly population is often prescribed multiple medications
simultaneously, known as polypharmacy, which increases the risk of adverse drug
interactions, overdose, and other complications. This requires careful evaluation and
management of medication regimens to ensure safety and effectiveness .
Question 8: A provider is evaluating a medication regimen for an older adult. Which
tool would be most useful for identifying potentially inappropriate medications in this
population?
A. Beers Criteria
B. STOPP/START Criteria
C. Both A and B
D. Broselow Tape
Answer: C. Both A and B
Rationale: The Beers Criteria is a tool identifying inappropriate medication use in older
adults, cautioning against certain drugs and interactions . The STOPP/START criteria
(Screening Tool of Older Person's Prescriptions/Screening Tool to Alert to Right Treatment)
is another validated tool for identifying potentially inappropriate medications and
potential prescribing omissions in older adults. Both are useful clinical tools.
Question 9: A patient is prescribed a medication that is highly protein-bound. Which
statement about this medication is correct?
A. It has a high volume of distribution
B. It may interact with other highly protein-bound drugs, leading to increased free drug
levels
