,NUR 521 Advanced Pharmacology Exam 4
| University of Alabama | 26/27
1. A patient with a history of chronic kidney disease (eGFR 25 mL/min) requires anticoagulation for
newly diagnosed atrial fibrillation. Which anticoagulant is most appropriate considering the patient's
renal function?
A) Apixaban 5 mg twice daily
B) Rivaroxaban 20 mg once daily
C) Warfarin with INR target 2-3
D) Edoxaban 60 mg once daily
Correct Answer: Apixaban 5 mg twice daily
Rationale: Apixaban is preferred in severe renal impairment (eGFR 15-29 mL/min) with dose
adjustment to 2.5 mg twice daily if criteria met; however, the standard 5 mg dose is acceptable if no
other dose-reduction criteria are present. Rivaroxaban is contraindicated if CrCl <15 mL/min and
requires caution if <30 mL/min. Edoxaban is not recommended if CrCl <15 mL/min. Warfarin is
effective but requires frequent monitoring and has many interactions.
2. An APRN is evaluating a patient with type 2 diabetes mellitus and established atherosclerotic
cardiovascular disease who is currently maintained on metformin. The patient's HbA1c remains at
8.4%. According to current ADA guidelines, which class of medication should be added to provide
proven cardiovascular and renal benefit?
A) Sulfonylurea
B) Thiazolidinedione
C) SGLT2 inhibitor
D) DPP-4 inhibitor
Correct Answer: SGLT2 inhibitor
Rationale: Current ADA guidelines recommend adding an SGLT2 inhibitor or GLP-1 receptor agonist
with proven cardiovascular benefit for patients with type 2 diabetes and established atherosclerotic
cardiovascular disease, heart failure, or chronic kidney disease. SGLT2 inhibitors have demonstrated
significant reductions in major adverse cardiovascular events and progression of diabetic kidney
disease.
,3. Which of the following drug pairs exhibits a pharmacodynamic antagonism that can lead to reduced
efficacy of one of the agents?
A) Lisinopril and spironolactone
B) Albuterol and propranolol
C) Warfarin and aspirin
D) Fluoxetine and linezolid
Correct Answer: Albuterol and propranolol
Rationale: Propranolol, a non-selective beta-blocker, antagonizes the beta-2 adrenergic effects of
albuterol, reducing its bronchodilator efficacy. This is a classic pharmacodynamic antagonism.
Lisinopril and spironolactone both affect the RAAS and can cause hyperkalemia. Warfarin and aspirin
increase bleeding risk. Fluoxetine and linezolid increase the risk of serotonin syndrome.
4. A patient with renal impairment is prescribed a medication that is primarily eliminated by the
kidneys. Which pharmacokinetic parameter would be most significantly affected?
A) Bioavailability
B) Volume of distribution
C) Half-life
D) Protein binding
Correct Answer: Half-life
Rationale: Renal impairment decreases drug clearance, leading to a prolonged half-life and drug
accumulation. The half-life is directly dependent on clearance; when clearance decreases, half-life
increases proportionally. Bioavailability, volume of distribution, and protein binding are not directly
or primarily affected by renal impairment in the same manner.
5. A drug has a volume of distribution of 42 L and a clearance of 120 mL/min. What is the approximate
elimination half-life?
A) 4 hours
B) 6 hours
C) 8 hours
, D) 10 hours
Correct Answer: 4 hours
Rationale: Using the formula t1/2 = 0.693 × Vd/CL, converting units: Vd = 42 L, CL = 0.12 L/min. t1/2 =
0.693 × .12 = 242.55 minutes, which equals approximately 4.04 hours. This calculation is
fundamental for determining dosing intervals.
6. Which of the following drug characteristics would result in the highest oral bioavailability?
A) High first-pass metabolism and low lipophilicity
B) Low first-pass metabolism and high lipophilicity
C) High first-pass metabolism and high molecular weight
D) Low aqueous solubility and high protein binding
Correct Answer: Low first-pass metabolism and high lipophilicity
Rationale: High lipophilicity enhances membrane permeability and absorption, while low first-pass
metabolism ensures more drug reaches systemic circulation. Both factors contribute to higher
bioavailability. High first-pass metabolism, high molecular weight, and low aqueous solubility all
reduce oral bioavailability.
7. A patient is receiving a drug that follows zero-order kinetics. Which statement correctly describes
the elimination of this drug?
A) The elimination half-life remains constant regardless of dose
B) A constant amount of drug is eliminated per unit time
C) The rate of elimination is proportional to drug concentration
D) The drug is typically eliminated within one to two half-lives
Correct Answer: A constant amount of drug is eliminated per unit time
Rationale: Zero-order kinetics describes a process where a constant amount of drug is eliminated per
unit time, regardless of concentration. This is characteristic of drugs like phenytoin and ethanol. First-
order kinetics describes proportional elimination, where a constant fraction is eliminated per unit
time.
| University of Alabama | 26/27
1. A patient with a history of chronic kidney disease (eGFR 25 mL/min) requires anticoagulation for
newly diagnosed atrial fibrillation. Which anticoagulant is most appropriate considering the patient's
renal function?
A) Apixaban 5 mg twice daily
B) Rivaroxaban 20 mg once daily
C) Warfarin with INR target 2-3
D) Edoxaban 60 mg once daily
Correct Answer: Apixaban 5 mg twice daily
Rationale: Apixaban is preferred in severe renal impairment (eGFR 15-29 mL/min) with dose
adjustment to 2.5 mg twice daily if criteria met; however, the standard 5 mg dose is acceptable if no
other dose-reduction criteria are present. Rivaroxaban is contraindicated if CrCl <15 mL/min and
requires caution if <30 mL/min. Edoxaban is not recommended if CrCl <15 mL/min. Warfarin is
effective but requires frequent monitoring and has many interactions.
2. An APRN is evaluating a patient with type 2 diabetes mellitus and established atherosclerotic
cardiovascular disease who is currently maintained on metformin. The patient's HbA1c remains at
8.4%. According to current ADA guidelines, which class of medication should be added to provide
proven cardiovascular and renal benefit?
A) Sulfonylurea
B) Thiazolidinedione
C) SGLT2 inhibitor
D) DPP-4 inhibitor
Correct Answer: SGLT2 inhibitor
Rationale: Current ADA guidelines recommend adding an SGLT2 inhibitor or GLP-1 receptor agonist
with proven cardiovascular benefit for patients with type 2 diabetes and established atherosclerotic
cardiovascular disease, heart failure, or chronic kidney disease. SGLT2 inhibitors have demonstrated
significant reductions in major adverse cardiovascular events and progression of diabetic kidney
disease.
,3. Which of the following drug pairs exhibits a pharmacodynamic antagonism that can lead to reduced
efficacy of one of the agents?
A) Lisinopril and spironolactone
B) Albuterol and propranolol
C) Warfarin and aspirin
D) Fluoxetine and linezolid
Correct Answer: Albuterol and propranolol
Rationale: Propranolol, a non-selective beta-blocker, antagonizes the beta-2 adrenergic effects of
albuterol, reducing its bronchodilator efficacy. This is a classic pharmacodynamic antagonism.
Lisinopril and spironolactone both affect the RAAS and can cause hyperkalemia. Warfarin and aspirin
increase bleeding risk. Fluoxetine and linezolid increase the risk of serotonin syndrome.
4. A patient with renal impairment is prescribed a medication that is primarily eliminated by the
kidneys. Which pharmacokinetic parameter would be most significantly affected?
A) Bioavailability
B) Volume of distribution
C) Half-life
D) Protein binding
Correct Answer: Half-life
Rationale: Renal impairment decreases drug clearance, leading to a prolonged half-life and drug
accumulation. The half-life is directly dependent on clearance; when clearance decreases, half-life
increases proportionally. Bioavailability, volume of distribution, and protein binding are not directly
or primarily affected by renal impairment in the same manner.
5. A drug has a volume of distribution of 42 L and a clearance of 120 mL/min. What is the approximate
elimination half-life?
A) 4 hours
B) 6 hours
C) 8 hours
, D) 10 hours
Correct Answer: 4 hours
Rationale: Using the formula t1/2 = 0.693 × Vd/CL, converting units: Vd = 42 L, CL = 0.12 L/min. t1/2 =
0.693 × .12 = 242.55 minutes, which equals approximately 4.04 hours. This calculation is
fundamental for determining dosing intervals.
6. Which of the following drug characteristics would result in the highest oral bioavailability?
A) High first-pass metabolism and low lipophilicity
B) Low first-pass metabolism and high lipophilicity
C) High first-pass metabolism and high molecular weight
D) Low aqueous solubility and high protein binding
Correct Answer: Low first-pass metabolism and high lipophilicity
Rationale: High lipophilicity enhances membrane permeability and absorption, while low first-pass
metabolism ensures more drug reaches systemic circulation. Both factors contribute to higher
bioavailability. High first-pass metabolism, high molecular weight, and low aqueous solubility all
reduce oral bioavailability.
7. A patient is receiving a drug that follows zero-order kinetics. Which statement correctly describes
the elimination of this drug?
A) The elimination half-life remains constant regardless of dose
B) A constant amount of drug is eliminated per unit time
C) The rate of elimination is proportional to drug concentration
D) The drug is typically eliminated within one to two half-lives
Correct Answer: A constant amount of drug is eliminated per unit time
Rationale: Zero-order kinetics describes a process where a constant amount of drug is eliminated per
unit time, regardless of concentration. This is characteristic of drugs like phenytoin and ethanol. First-
order kinetics describes proportional elimination, where a constant fraction is eliminated per unit
time.
