NUR 635 Final Review —Q&A
NUR 635 FINAL Exam
Tyler / Sarhan Exam
Questions and Answers| Guaranteed Pass
Advanced Pharmacology
Page 1
, NUR 635 Final Review —Q&A
Q1. A drug in which a constant PERCENTAGE of drug is eliminated per unit time,
regardless of dose, follows what type of kinetics?
A. Zero-order kinetics
B. First-order kinetics
C. Michaelis-Menten kinetics only
D. Saturation kinetics
Answer: B. First-order kinetics
Rationale: First-order kinetics means a constant fraction (percentage) of the
drug is eliminated per unit time; most drugs at therapeutic doses follow first-
order elimination.
Q2. Phenytoin at higher/toxic doses characteristically switches to which
elimination kinetics, making toxicity more likely with small dose increases?
A. First-order kinetics
B. Zero-order kinetics
C. Second-order kinetics
D. Linear kinetics
Answer: B. Zero-order kinetics
Rationale: At therapeutic-to-toxic doses, phenytoin's metabolic enzymes
become saturated, so it shifts to zero-order kinetics — a constant AMOUNT
(not percentage) is eliminated per unit time, causing disproportionate
increases in serum levels with small dose changes.
Q3. Which route of administration is defined as having 100% bioavailability by
definition?
A. Oral
B. Intravenous
C. Subcutaneous
D. Sublingual
Answer: B. Intravenous
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, NUR 635 Final Review —Q&A
Rationale: Bioavailability compares the amount of drug reaching systemic
circulation to the administered dose; IV administration bypasses absorption
barriers entirely, so it is the reference standard at 100%.
Q4. A drug with a very large volume of distribution (Vd) is most likely to have
which characteristic?
A. High water solubility and confinement to plasma
B. High lipophilicity with extensive distribution into tissues
C. Complete renal elimination unchanged
D. Zero protein binding
Answer: B. High lipophilicity with extensive distribution into tissues
Rationale: Lipophilic drugs cross cell membranes readily and distribute
extensively into fat and tissue compartments, producing a large apparent
volume of distribution relative to plasma volume.
Q5. Warfarin is highly protein-bound to albumin. What is a clinical concern
when a second highly protein-bound drug is added to a patient's regimen?
A. Displacement of warfarin from protein binding sites, increasing free (active)
drug and bleeding risk
B. No interaction occurs because protein binding is irrelevant to drug activity
C. The second drug will always be rendered inactive
D. Protein binding interactions only affect elimination, never activity
Answer: A. Displacement of warfarin from protein binding sites, increasing
free (active) drug and bleeding risk
Rationale: When two highly protein-bound drugs compete for the same
albumin binding sites, one may be displaced, increasing the unbound
(pharmacologically active) fraction of that drug — a significant concern with
narrow-therapeutic-index drugs like warfarin.
Q6. Carbamazepine is well known for which unique pharmacokinetic property?
A. Autoinduction — it induces its own hepatic metabolism over time,
requiring dose increases
B. It has no hepatic metabolism at all
Page 3
, NUR 635 Final Review —Q&A
C. It is entirely renally eliminated unchanged
D. It has zero drug interactions
Answer: A. Autoinduction — it induces its own hepatic metabolism over
time, requiring dose increases
Rationale: Carbamazepine induces the CYP3A4 enzyme responsible for its
own metabolism (autoinduction), so its clearance increases over the first few
weeks of therapy, often requiring dose titration upward to maintain
therapeutic levels.
Q7. A CYP450 enzyme INHIBITOR (e.g., grapefruit juice, ketoconazole) added to
a patient's regimen would be expected to do what to a co-administered drug
metabolized by that enzyme?
A. Decrease the drug's serum concentration
B. Increase the drug's serum concentration, raising toxicity risk
C. Have no effect on serum concentration
D. Only affect the drug's absorption, not metabolism
Answer: B. Increase the drug's serum concentration, raising toxicity risk
Rationale: Enzyme inhibitors slow the metabolism of co-administered
substrate drugs, leading to drug accumulation, higher serum concentrations,
and increased risk of toxicity.
Q8. Approximately how many half-lives are required for a drug to reach steady-
state concentration?
A. 1-2 half-lives
B. 4-5 half-lives
C. 8-10 half-lives
D. Steady state is reached immediately
Answer: B. 4-5 half-lives
Rationale: With repeated first-order dosing, a drug reaches approximately
94-97% of steady-state concentration after 4-5 half-lives, which is the
standard clinical rule of thumb.
Page 4
NUR 635 FINAL Exam
Tyler / Sarhan Exam
Questions and Answers| Guaranteed Pass
Advanced Pharmacology
Page 1
, NUR 635 Final Review —Q&A
Q1. A drug in which a constant PERCENTAGE of drug is eliminated per unit time,
regardless of dose, follows what type of kinetics?
A. Zero-order kinetics
B. First-order kinetics
C. Michaelis-Menten kinetics only
D. Saturation kinetics
Answer: B. First-order kinetics
Rationale: First-order kinetics means a constant fraction (percentage) of the
drug is eliminated per unit time; most drugs at therapeutic doses follow first-
order elimination.
Q2. Phenytoin at higher/toxic doses characteristically switches to which
elimination kinetics, making toxicity more likely with small dose increases?
A. First-order kinetics
B. Zero-order kinetics
C. Second-order kinetics
D. Linear kinetics
Answer: B. Zero-order kinetics
Rationale: At therapeutic-to-toxic doses, phenytoin's metabolic enzymes
become saturated, so it shifts to zero-order kinetics — a constant AMOUNT
(not percentage) is eliminated per unit time, causing disproportionate
increases in serum levels with small dose changes.
Q3. Which route of administration is defined as having 100% bioavailability by
definition?
A. Oral
B. Intravenous
C. Subcutaneous
D. Sublingual
Answer: B. Intravenous
Page 2
, NUR 635 Final Review —Q&A
Rationale: Bioavailability compares the amount of drug reaching systemic
circulation to the administered dose; IV administration bypasses absorption
barriers entirely, so it is the reference standard at 100%.
Q4. A drug with a very large volume of distribution (Vd) is most likely to have
which characteristic?
A. High water solubility and confinement to plasma
B. High lipophilicity with extensive distribution into tissues
C. Complete renal elimination unchanged
D. Zero protein binding
Answer: B. High lipophilicity with extensive distribution into tissues
Rationale: Lipophilic drugs cross cell membranes readily and distribute
extensively into fat and tissue compartments, producing a large apparent
volume of distribution relative to plasma volume.
Q5. Warfarin is highly protein-bound to albumin. What is a clinical concern
when a second highly protein-bound drug is added to a patient's regimen?
A. Displacement of warfarin from protein binding sites, increasing free (active)
drug and bleeding risk
B. No interaction occurs because protein binding is irrelevant to drug activity
C. The second drug will always be rendered inactive
D. Protein binding interactions only affect elimination, never activity
Answer: A. Displacement of warfarin from protein binding sites, increasing
free (active) drug and bleeding risk
Rationale: When two highly protein-bound drugs compete for the same
albumin binding sites, one may be displaced, increasing the unbound
(pharmacologically active) fraction of that drug — a significant concern with
narrow-therapeutic-index drugs like warfarin.
Q6. Carbamazepine is well known for which unique pharmacokinetic property?
A. Autoinduction — it induces its own hepatic metabolism over time,
requiring dose increases
B. It has no hepatic metabolism at all
Page 3
, NUR 635 Final Review —Q&A
C. It is entirely renally eliminated unchanged
D. It has zero drug interactions
Answer: A. Autoinduction — it induces its own hepatic metabolism over
time, requiring dose increases
Rationale: Carbamazepine induces the CYP3A4 enzyme responsible for its
own metabolism (autoinduction), so its clearance increases over the first few
weeks of therapy, often requiring dose titration upward to maintain
therapeutic levels.
Q7. A CYP450 enzyme INHIBITOR (e.g., grapefruit juice, ketoconazole) added to
a patient's regimen would be expected to do what to a co-administered drug
metabolized by that enzyme?
A. Decrease the drug's serum concentration
B. Increase the drug's serum concentration, raising toxicity risk
C. Have no effect on serum concentration
D. Only affect the drug's absorption, not metabolism
Answer: B. Increase the drug's serum concentration, raising toxicity risk
Rationale: Enzyme inhibitors slow the metabolism of co-administered
substrate drugs, leading to drug accumulation, higher serum concentrations,
and increased risk of toxicity.
Q8. Approximately how many half-lives are required for a drug to reach steady-
state concentration?
A. 1-2 half-lives
B. 4-5 half-lives
C. 8-10 half-lives
D. Steady state is reached immediately
Answer: B. 4-5 half-lives
Rationale: With repeated first-order dosing, a drug reaches approximately
94-97% of steady-state concentration after 4-5 half-lives, which is the
standard clinical rule of thumb.
Page 4
