NSG 527 ADVANCED PHARMACOLOGY
COMPREHENSIVE EXAM PREP
QUESTIONS AND ANSWERS
1. A patient with a creatinine clearance of 30 mL/min is prescribed a drug primarily
eliminated by the kidneys. How should the initial dosing be adjusted?
A. Decrease the dose or increase the dosing interval.
B. Increase the dose to compensate for slower filtration.
C. Maintain standard dosing but monitor peak levels only.
D. Switch to a drug with high protein binding.
Answer: A
Conceptual Explanation: Renal impairment reduces the rate of drug excretion, leading to
potential toxicity if standard doses are used. Adjustments involve lowering the dose or
extending the time between doses.
2. Which pharmacokinetic process is most affected by the ‘first-pass effect’ when a drug is
administered orally?
A. Distribution
,B. Metabolism
C. Excretion
D. Absorption
Answer: B
Conceptual Explanation: The first-pass effect refers to the rapid hepatic metabolism of a
drug absorbed from the GI tract before it reaches the systemic circulation.
3. A patient taking Warfarin is started on Amiodarone. What is the expected interaction
regarding the INR?
A. INR will increase due to inhibition of CYP2C9.
B. INR will remain stable because they affect different pathways.
C. INR will decrease due to induction of CYP450.
D. Warfarin absorption will be delayed.
Answer: A
Conceptual Explanation: Amiodarone inhibits CYP2C9, the primary enzyme responsible
for metabolizing S-warfarin, leading to increased warfarin levels and elevated INR.
4. Which of the following describes the mechanism of action of ACE inhibitors in treating
hypertension?
A. Increasing the breakdown of bradykinin.
B. Directly blocking the Angiotensin II receptor type 1.
, C. Inhibiting the release of renin from the kidneys.
D. Blocking the conversion of Angiotensin I to Angiotensin II.
Answer: D
Conceptual Explanation: ACE inhibitors prevent the Angiotensin-Converting Enzyme
from converting Angiotensin I to the potent vasoconstrictor Angiotensin II.
5. A 55-year-old male with Type 2 Diabetes is started on Metformin. Which lab value is a
contraindication for this therapy?
A. eGFR of 25 mL/min/1.73m²
B. HbA1c of 9.0%
C. ALT of 45 U/L
D. LDL of 160 mg/dL
Answer: A
Conceptual Explanation: Metformin is contraindicated in patients with an eGFR below 30
mL/min/1.73m² due to the increased risk of lactic acidosis.
6. What is the primary reason for adding Carbidopa to Levodopa in Parkinson’s disease
treatment?
A. To reduce peripheral conversion of Levodopa to Dopamine.
B. To increase the permeability of the blood-brain barrier.
C. To stimulate dopamine receptors directly.
COMPREHENSIVE EXAM PREP
QUESTIONS AND ANSWERS
1. A patient with a creatinine clearance of 30 mL/min is prescribed a drug primarily
eliminated by the kidneys. How should the initial dosing be adjusted?
A. Decrease the dose or increase the dosing interval.
B. Increase the dose to compensate for slower filtration.
C. Maintain standard dosing but monitor peak levels only.
D. Switch to a drug with high protein binding.
Answer: A
Conceptual Explanation: Renal impairment reduces the rate of drug excretion, leading to
potential toxicity if standard doses are used. Adjustments involve lowering the dose or
extending the time between doses.
2. Which pharmacokinetic process is most affected by the ‘first-pass effect’ when a drug is
administered orally?
A. Distribution
,B. Metabolism
C. Excretion
D. Absorption
Answer: B
Conceptual Explanation: The first-pass effect refers to the rapid hepatic metabolism of a
drug absorbed from the GI tract before it reaches the systemic circulation.
3. A patient taking Warfarin is started on Amiodarone. What is the expected interaction
regarding the INR?
A. INR will increase due to inhibition of CYP2C9.
B. INR will remain stable because they affect different pathways.
C. INR will decrease due to induction of CYP450.
D. Warfarin absorption will be delayed.
Answer: A
Conceptual Explanation: Amiodarone inhibits CYP2C9, the primary enzyme responsible
for metabolizing S-warfarin, leading to increased warfarin levels and elevated INR.
4. Which of the following describes the mechanism of action of ACE inhibitors in treating
hypertension?
A. Increasing the breakdown of bradykinin.
B. Directly blocking the Angiotensin II receptor type 1.
, C. Inhibiting the release of renin from the kidneys.
D. Blocking the conversion of Angiotensin I to Angiotensin II.
Answer: D
Conceptual Explanation: ACE inhibitors prevent the Angiotensin-Converting Enzyme
from converting Angiotensin I to the potent vasoconstrictor Angiotensin II.
5. A 55-year-old male with Type 2 Diabetes is started on Metformin. Which lab value is a
contraindication for this therapy?
A. eGFR of 25 mL/min/1.73m²
B. HbA1c of 9.0%
C. ALT of 45 U/L
D. LDL of 160 mg/dL
Answer: A
Conceptual Explanation: Metformin is contraindicated in patients with an eGFR below 30
mL/min/1.73m² due to the increased risk of lactic acidosis.
6. What is the primary reason for adding Carbidopa to Levodopa in Parkinson’s disease
treatment?
A. To reduce peripheral conversion of Levodopa to Dopamine.
B. To increase the permeability of the blood-brain barrier.
C. To stimulate dopamine receptors directly.
