NR 565 ADVANCED PHARMACOLOGY
FINAL EXAM PREP QUESTIONS AND
ANSWERS
1. A patient with chronic kidney disease requires a medication that is primarily excreted by
the kidneys. How should the initial dose be adjusted?
A. Increase the loading dose to reach steady state faster
B. Switch to an oral route to delay absorption
C. Decrease the dose or lengthen the dosing interval
D. Maintain the standard dose but monitor liver enzymes
Answer: C
Conceptual Explanation: In renal impairment, the clearance of renally excreted drugs is
decreased. To prevent toxicity, the clinician must either decrease the dose or increase the
time between doses (lengthen the interval).
2. Which of the following is an example of a Phase II metabolic reaction?
A. Glucuronidation
B. Hydrolysis
,C. Oxidation
D. Reduction
Answer: A
Conceptual Explanation: Phase I reactions involve oxidation, reduction, and hydrolysis.
Phase II reactions involve conjugation, such as glucuronidation, acetylation, or sulfation, to
make the metabolite more water-soluble for excretion.
3. A patient is taking Warfarin and starts a course of Rifampin. What is the expected drug
interaction?
A. Rifampin inhibits CYP enzymes, increasing Warfarin levels and bleeding risk
B. Rifampin induces CYP enzymes, decreasing Warfarin levels and increasing clot risk
C. Warfarin competes with Rifampin for protein binding, causing Rifampin toxicity
D. There is no clinically significant interaction between these two drugs
Answer: B
Conceptual Explanation: Rifampin is a potent inducer of cytochrome P450 enzymes.
Induction leads to faster metabolism of Warfarin, resulting in sub-therapeutic levels and an
increased risk of thrombosis.
4. According to the Beer’s Criteria, which medication class should be avoided in elderly
patients due to the high risk of orthostatic hypotension and CNS effects?
A. Proton Pump Inhibitors
, B. SSRIs
C. Tricyclic Antidepressants (TCAs)
D. ACE Inhibitors
Answer: C
Conceptual Explanation: TCAs have significant anticholinergic and alpha-adrenergic
blocking effects, leading to sedation and orthostatic hypotension, making them high-risk
for falls in the elderly.
5. Which statement regarding Schedule II controlled substances is correct?
A. A written or electronic prescription is required and no refills are permitted
B. Prescriptions may be called in verbally in non-emergency situations
C. Refills are allowed up to 5 times within 6 months
D. They have the lowest potential for abuse among controlled substances
Answer: A
Conceptual Explanation: Schedule II drugs have a high potential for abuse. Federal law
prohibits refills on Schedule II prescriptions; a new prescription must be issued for each
fill.
6. A patient diagnosed with Heart Failure with Reduced Ejection Fraction (HFrEF) is prescribed
an ACE inhibitor. What is the primary monitoring parameter for safety?
A. Serum Calcium
FINAL EXAM PREP QUESTIONS AND
ANSWERS
1. A patient with chronic kidney disease requires a medication that is primarily excreted by
the kidneys. How should the initial dose be adjusted?
A. Increase the loading dose to reach steady state faster
B. Switch to an oral route to delay absorption
C. Decrease the dose or lengthen the dosing interval
D. Maintain the standard dose but monitor liver enzymes
Answer: C
Conceptual Explanation: In renal impairment, the clearance of renally excreted drugs is
decreased. To prevent toxicity, the clinician must either decrease the dose or increase the
time between doses (lengthen the interval).
2. Which of the following is an example of a Phase II metabolic reaction?
A. Glucuronidation
B. Hydrolysis
,C. Oxidation
D. Reduction
Answer: A
Conceptual Explanation: Phase I reactions involve oxidation, reduction, and hydrolysis.
Phase II reactions involve conjugation, such as glucuronidation, acetylation, or sulfation, to
make the metabolite more water-soluble for excretion.
3. A patient is taking Warfarin and starts a course of Rifampin. What is the expected drug
interaction?
A. Rifampin inhibits CYP enzymes, increasing Warfarin levels and bleeding risk
B. Rifampin induces CYP enzymes, decreasing Warfarin levels and increasing clot risk
C. Warfarin competes with Rifampin for protein binding, causing Rifampin toxicity
D. There is no clinically significant interaction between these two drugs
Answer: B
Conceptual Explanation: Rifampin is a potent inducer of cytochrome P450 enzymes.
Induction leads to faster metabolism of Warfarin, resulting in sub-therapeutic levels and an
increased risk of thrombosis.
4. According to the Beer’s Criteria, which medication class should be avoided in elderly
patients due to the high risk of orthostatic hypotension and CNS effects?
A. Proton Pump Inhibitors
, B. SSRIs
C. Tricyclic Antidepressants (TCAs)
D. ACE Inhibitors
Answer: C
Conceptual Explanation: TCAs have significant anticholinergic and alpha-adrenergic
blocking effects, leading to sedation and orthostatic hypotension, making them high-risk
for falls in the elderly.
5. Which statement regarding Schedule II controlled substances is correct?
A. A written or electronic prescription is required and no refills are permitted
B. Prescriptions may be called in verbally in non-emergency situations
C. Refills are allowed up to 5 times within 6 months
D. They have the lowest potential for abuse among controlled substances
Answer: A
Conceptual Explanation: Schedule II drugs have a high potential for abuse. Federal law
prohibits refills on Schedule II prescriptions; a new prescription must be issued for each
fill.
6. A patient diagnosed with Heart Failure with Reduced Ejection Fraction (HFrEF) is prescribed
an ACE inhibitor. What is the primary monitoring parameter for safety?
A. Serum Calcium
