NR 565 ADVANCED PHARMACOLOGY
COMPREHENSIVE EXAM QUESTIONS
AND ANSWERS
1. A patient with a history of heart failure is prescribed a drug that is a P-glycoprotein (P-gp)
inducer. What effect will this have on other P-gp substrate drugs the patient is taking?
A. Increased plasma levels of the substrate drugs.
B. Decreased absorption of the substrate drugs in the intestine.
C. Reduced plasma levels of the substrate drugs.
D. Decreased excretion of the substrate drugs in the kidneys.
Answer: C
Conceptual Explanation: P-glycoprotein is an efflux pump. Inducers increase the
expression of this pump, leading to increased export of substrate drugs out of cells (like the
gut lumen or into bile/urine), which reduces their overall plasma concentration.
2. When evaluating the steady-state concentration of a drug with a half-life of 12 hours, how
long will it take for the drug to reach approximately 94% of its steady-state level?
A. 12 hours
,B. 24 hours
C. 72 hours
D. 48 hours
Answer: D
Conceptual Explanation: It takes approximately four to five half-lives to reach steady
state. 12 hours multiplied by 4 is 48 hours.
3. Which of the following describes the ‘First-Pass Effect’ in pharmacology?
A. The initial distribution of drug to high-flow organs like the brain.
B. The rapid hepatic inactivation of certain oral drugs before they reach systemic
circulation.
C. The movement of drug from the site of administration into the blood.
D. The binding of drugs to plasma albumin during the first circulation.
Answer: B
Conceptual Explanation: The first-pass effect refers to the metabolism of a drug by the
liver (or sometimes the gut wall) following oral administration, significantly reducing the
amount of active drug that enters the systemic circulation.
4. A patient is known to be a ‘poor metabolizer’ of CYP2D6. Which clinical outcome is most
likely when they are prescribed Codeine for pain?
A. Increased risk of respiratory depression.
, B. Rapid onset of action.
C. Subtherapeutic pain relief.
D. Toxicity due to high morphine levels.
Answer: C
Conceptual Explanation: Codeine is a prodrug that must be converted to morphine by
CYP2D6 to be effective. Poor metabolizers cannot convert it efficiently, resulting in lack of
therapeutic effect.
5. According to the Beers Criteria, which class of medication should generally be avoided in
geriatric patients due to the high risk of orthostatic hypotension and sedation?
A. Tricyclic antidepressants
B. Proton pump inhibitors
C. ACE inhibitors
D. Biguanides
Answer: A
Conceptual Explanation: Tricyclic antidepressants (TCAs) have strong anticholinergic and
alpha-adrenergic blocking properties, leading to sedation and orthostatic hypotension in
the elderly.
COMPREHENSIVE EXAM QUESTIONS
AND ANSWERS
1. A patient with a history of heart failure is prescribed a drug that is a P-glycoprotein (P-gp)
inducer. What effect will this have on other P-gp substrate drugs the patient is taking?
A. Increased plasma levels of the substrate drugs.
B. Decreased absorption of the substrate drugs in the intestine.
C. Reduced plasma levels of the substrate drugs.
D. Decreased excretion of the substrate drugs in the kidneys.
Answer: C
Conceptual Explanation: P-glycoprotein is an efflux pump. Inducers increase the
expression of this pump, leading to increased export of substrate drugs out of cells (like the
gut lumen or into bile/urine), which reduces their overall plasma concentration.
2. When evaluating the steady-state concentration of a drug with a half-life of 12 hours, how
long will it take for the drug to reach approximately 94% of its steady-state level?
A. 12 hours
,B. 24 hours
C. 72 hours
D. 48 hours
Answer: D
Conceptual Explanation: It takes approximately four to five half-lives to reach steady
state. 12 hours multiplied by 4 is 48 hours.
3. Which of the following describes the ‘First-Pass Effect’ in pharmacology?
A. The initial distribution of drug to high-flow organs like the brain.
B. The rapid hepatic inactivation of certain oral drugs before they reach systemic
circulation.
C. The movement of drug from the site of administration into the blood.
D. The binding of drugs to plasma albumin during the first circulation.
Answer: B
Conceptual Explanation: The first-pass effect refers to the metabolism of a drug by the
liver (or sometimes the gut wall) following oral administration, significantly reducing the
amount of active drug that enters the systemic circulation.
4. A patient is known to be a ‘poor metabolizer’ of CYP2D6. Which clinical outcome is most
likely when they are prescribed Codeine for pain?
A. Increased risk of respiratory depression.
, B. Rapid onset of action.
C. Subtherapeutic pain relief.
D. Toxicity due to high morphine levels.
Answer: C
Conceptual Explanation: Codeine is a prodrug that must be converted to morphine by
CYP2D6 to be effective. Poor metabolizers cannot convert it efficiently, resulting in lack of
therapeutic effect.
5. According to the Beers Criteria, which class of medication should generally be avoided in
geriatric patients due to the high risk of orthostatic hypotension and sedation?
A. Tricyclic antidepressants
B. Proton pump inhibitors
C. ACE inhibitors
D. Biguanides
Answer: A
Conceptual Explanation: Tricyclic antidepressants (TCAs) have strong anticholinergic and
alpha-adrenergic blocking properties, leading to sedation and orthostatic hypotension in
the elderly.
