Page 1 of 112
NURS 5334 Advanced Pharmacology Final EXAM QUESTIONS
AND CORRECT VERIFIED SOLUTIONS LATEST UPDATE THIS
YEAR – JUST RELEASED
NURS 5334 Advanced Pharmacology Final Exam
EXAM COVERAGE OVERVIEW (10 Key Points)
1. Pharmacokinetics & Pharmacodynamics: ADME processes determine drug
concentration at action sites. Pharmacokinetics is "what the body does to the drug";
pharmacodynamics is "what the drug does to the body" .
2. Therapeutic Index: Narrow therapeutic index drugs (warfarin, digoxin, lithium,
phenytoin) require close therapeutic drug monitoring due to small margin between
therapeutic and toxic doses .
3. Drug Metabolism & CYP450: CYP3A4 metabolizes approximately 50% of all marketed
drugs. Grapefruit juice inhibits CYP3A4, increasing levels of affected drugs (felodipine,
statins) . CYP450 inducers (rifampin, carbamazepine) increase metabolism .
4. Protein Binding & Drug Interactions: Only free (unbound) drug is pharmacologically
active. Hypoalbuminemia increases free drug concentration and toxicity risk. Two highly
protein-bound drugs compete for binding sites, potentially causing toxicity .
5. Special Populations: In pregnancy, methyldopa and labetalol are traditional
antihypertensives of choice as they have limited effects on uteroplacental and fetal
hemodynamics . Pediatric dosing is weight-based, with gastric pH reaching adult levels
by 2 years .
6. Geriatric Pharmacology: Beers List identifies potentially inappropriate medications in
older adults. Altered pharmacokinetics (increased body fat, decreased lean mass,
reduced renal clearance) increase ADR risk . Creatinine clearance is preferred over serum
creatinine due to reduced muscle mass .
7. Antibiotic Classes: Penicillinase-resistant penicillins (oxacillin, nafcillin, dicloxacillin);
broad-spectrum penicillins (ampicillin, amoxicillin); extended-spectrum (ticarcillin,
piperacillin). Beta-lactamase inhibitors: sulbactam, tazobactam, clavulanic acid .
8. Antimicrobial Stewardship: Narrow-spectrum antibiotics preferred over broad-spectrum
to reduce resistance emergence. Penicillins and cephalosporins work by weakening
bacterial cell wall .
9. Opioid & Pain Management: Hydrocodone can be combined with aspirin,
acetaminophen, or ibuprofen. Benzodiazepines and CNS depressants are contraindicated
with hydrocodone due to respiratory depression risk .
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10. Drug Interactions & Monitoring: Warfarin monitored via PT/INR. Heparin toxicity
treated with protamine sulfate. Rapid-acting insulin (lispro) onset 5-15 minutes.
Sulfonylureas stimulate pancreatic insulin release .
SECTION 1: PHARMACOKINETICS AND PHARMACODYNAMICS (Questions 1-20)
1. A drug with a high volume of distribution (Vd) is most likely to:
A) Remain mostly in the plasma
B) Require dialysis for overdose removal
C) Accumulate in tissues
D) Have a short half-life
Answer: C) Accumulate in tissues
Rationale: High Vd indicates extensive tissue binding and uptake. Drugs with large Vd (e.g.,
lipophilic drugs) are widely distributed throughout the body. Dialysis is ineffective for such drugs
because they are not confined to the vascular space. A high Vd does not necessarily correlate
with short half-life; in fact, extensive tissue distribution often prolongs elimination .
2. Which pharmacokinetic process is primarily responsible for drug bioavailability?
A) Absorption
B) Distribution
C) Metabolism
D) Excretion
Answer: A) Absorption
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Rationale: Bioavailability is the fraction of an administered dose of unchanged drug that reaches
systemic circulation. Absorption is the primary determinant of bioavailability for non-IV routes.
Factors affecting absorption include the drug's formulation, gastric emptying, and first-pass
metabolism .
3. A drug with zero-order kinetics:
A) Eliminates a constant fraction per unit time
B) Eliminates a constant amount per unit time
C) Has a constant half-life
D) Follows first-pass metabolism
Answer: B) Eliminates a constant amount per unit time
Rationale: Zero-order kinetics eliminates a fixed amount per hour regardless of concentration.
Half-life increases with dose. Examples: phenytoin (therapeutic doses), high-dose alcohol, high-
dose aspirin .
4. The half-life of Drug X is 24 hours. Approximately how long will it take to reach steady
state?
A) 24 hours
B) 48 hours
C) 5 days
D) 10 days
Answer: C) 5 days
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Rationale: Steady state is reached after approximately 4-5 half-lives of continuous dosing. At 4
half-lives, 94% of steady state is reached; at 5 half-lives, approximately 97% is reached. 24 hours
× 5 = 120 hours = 5 days .
5. The therapeutic index of a drug is a measure of:
A) Drug potency
B) Drug efficacy
C) Drug safety
D) Drug absorption
Answer: C) Drug safety
Rationale: The therapeutic index is the ratio of the toxic dose to the therapeutic dose
(TD50/ED50). A narrow therapeutic index indicates a small margin of safety and requires close
monitoring .
6. Drugs with a narrow therapeutic index include: (Select all that apply)
A) Warfarin
B) Digoxin
C) Lithium
D) Amoxicillin
Answer: A, B, C
Rationale: Warfarin, digoxin, and lithium have narrow therapeutic indices and require
therapeutic drug monitoring. Amoxicillin has a wide therapeutic index .
NURS 5334 Advanced Pharmacology Final EXAM QUESTIONS
AND CORRECT VERIFIED SOLUTIONS LATEST UPDATE THIS
YEAR – JUST RELEASED
NURS 5334 Advanced Pharmacology Final Exam
EXAM COVERAGE OVERVIEW (10 Key Points)
1. Pharmacokinetics & Pharmacodynamics: ADME processes determine drug
concentration at action sites. Pharmacokinetics is "what the body does to the drug";
pharmacodynamics is "what the drug does to the body" .
2. Therapeutic Index: Narrow therapeutic index drugs (warfarin, digoxin, lithium,
phenytoin) require close therapeutic drug monitoring due to small margin between
therapeutic and toxic doses .
3. Drug Metabolism & CYP450: CYP3A4 metabolizes approximately 50% of all marketed
drugs. Grapefruit juice inhibits CYP3A4, increasing levels of affected drugs (felodipine,
statins) . CYP450 inducers (rifampin, carbamazepine) increase metabolism .
4. Protein Binding & Drug Interactions: Only free (unbound) drug is pharmacologically
active. Hypoalbuminemia increases free drug concentration and toxicity risk. Two highly
protein-bound drugs compete for binding sites, potentially causing toxicity .
5. Special Populations: In pregnancy, methyldopa and labetalol are traditional
antihypertensives of choice as they have limited effects on uteroplacental and fetal
hemodynamics . Pediatric dosing is weight-based, with gastric pH reaching adult levels
by 2 years .
6. Geriatric Pharmacology: Beers List identifies potentially inappropriate medications in
older adults. Altered pharmacokinetics (increased body fat, decreased lean mass,
reduced renal clearance) increase ADR risk . Creatinine clearance is preferred over serum
creatinine due to reduced muscle mass .
7. Antibiotic Classes: Penicillinase-resistant penicillins (oxacillin, nafcillin, dicloxacillin);
broad-spectrum penicillins (ampicillin, amoxicillin); extended-spectrum (ticarcillin,
piperacillin). Beta-lactamase inhibitors: sulbactam, tazobactam, clavulanic acid .
8. Antimicrobial Stewardship: Narrow-spectrum antibiotics preferred over broad-spectrum
to reduce resistance emergence. Penicillins and cephalosporins work by weakening
bacterial cell wall .
9. Opioid & Pain Management: Hydrocodone can be combined with aspirin,
acetaminophen, or ibuprofen. Benzodiazepines and CNS depressants are contraindicated
with hydrocodone due to respiratory depression risk .
, Page 2 of 112
10. Drug Interactions & Monitoring: Warfarin monitored via PT/INR. Heparin toxicity
treated with protamine sulfate. Rapid-acting insulin (lispro) onset 5-15 minutes.
Sulfonylureas stimulate pancreatic insulin release .
SECTION 1: PHARMACOKINETICS AND PHARMACODYNAMICS (Questions 1-20)
1. A drug with a high volume of distribution (Vd) is most likely to:
A) Remain mostly in the plasma
B) Require dialysis for overdose removal
C) Accumulate in tissues
D) Have a short half-life
Answer: C) Accumulate in tissues
Rationale: High Vd indicates extensive tissue binding and uptake. Drugs with large Vd (e.g.,
lipophilic drugs) are widely distributed throughout the body. Dialysis is ineffective for such drugs
because they are not confined to the vascular space. A high Vd does not necessarily correlate
with short half-life; in fact, extensive tissue distribution often prolongs elimination .
2. Which pharmacokinetic process is primarily responsible for drug bioavailability?
A) Absorption
B) Distribution
C) Metabolism
D) Excretion
Answer: A) Absorption
, Page 3 of 112
Rationale: Bioavailability is the fraction of an administered dose of unchanged drug that reaches
systemic circulation. Absorption is the primary determinant of bioavailability for non-IV routes.
Factors affecting absorption include the drug's formulation, gastric emptying, and first-pass
metabolism .
3. A drug with zero-order kinetics:
A) Eliminates a constant fraction per unit time
B) Eliminates a constant amount per unit time
C) Has a constant half-life
D) Follows first-pass metabolism
Answer: B) Eliminates a constant amount per unit time
Rationale: Zero-order kinetics eliminates a fixed amount per hour regardless of concentration.
Half-life increases with dose. Examples: phenytoin (therapeutic doses), high-dose alcohol, high-
dose aspirin .
4. The half-life of Drug X is 24 hours. Approximately how long will it take to reach steady
state?
A) 24 hours
B) 48 hours
C) 5 days
D) 10 days
Answer: C) 5 days
, Page 4 of 112
Rationale: Steady state is reached after approximately 4-5 half-lives of continuous dosing. At 4
half-lives, 94% of steady state is reached; at 5 half-lives, approximately 97% is reached. 24 hours
× 5 = 120 hours = 5 days .
5. The therapeutic index of a drug is a measure of:
A) Drug potency
B) Drug efficacy
C) Drug safety
D) Drug absorption
Answer: C) Drug safety
Rationale: The therapeutic index is the ratio of the toxic dose to the therapeutic dose
(TD50/ED50). A narrow therapeutic index indicates a small margin of safety and requires close
monitoring .
6. Drugs with a narrow therapeutic index include: (Select all that apply)
A) Warfarin
B) Digoxin
C) Lithium
D) Amoxicillin
Answer: A, B, C
Rationale: Warfarin, digoxin, and lithium have narrow therapeutic indices and require
therapeutic drug monitoring. Amoxicillin has a wide therapeutic index .
