NR 566 Advanced Pharmacology
Final Exam Questions and Answers| Updated| Pass Guaranteed| Chamberlain
1. Which statement best defines bioavailability?
A. The time required for plasma concentration to fall by half
B. The fraction of an administered dose that reaches the systemic circulation
unchanged
C. The volume in which a drug appears to be distributed
D. The rate at which the kidney clears a drug
Answer: B. The fraction of an administered dose that reaches the systemic
circulation unchanged
Rationale: Intravenous drugs have 100% bioavailability. Oral drugs may be
reduced by incomplete absorption and first-pass hepatic metabolism.
2. Why is nitroglycerin given sublingually rather than swallowed for acute
angina?
A. Sublingual absorption bypasses extensive first-pass hepatic metabolism
B. It is destroyed by saliva
C. It requires gastric acid for activation
D. It is a prodrug activated in the intestine
Answer: A. Sublingual absorption bypasses extensive first-pass hepatic
metabolism
Rationale: Venous drainage from the oral mucosa enters the superior vena cava
directly, so the drug reaches the circulation before reaching the liver.
Page 1
,3. Approximately how many half-lives are needed to reach steady-state
concentration with repeated dosing?
A. 1 half-life
B. 10 to 12 half-lives
C. Steady state is reached after the first dose
D. 4 to 5 half-lives
Answer: D. 4 to 5 half-lives
Rationale: After 4 to 5 half-lives, about 94 to 97% of steady state is achieved. The
same interval applies to washout after stopping a drug.
4. A patient stable on simvastatin is prescribed clarithromycin. What is the most
important concern?
A. CYP3A4 induction lowers simvastatin levels
B. Clarithromycin has no hepatic effects
C. CYP3A4 inhibition raises simvastatin levels, increasing the risk of myopathy
and rhabdomyolysis
D. Simvastatin will inhibit clarithromycin
Answer: C. CYP3A4 inhibition raises simvastatin levels, increasing the risk of
myopathy and rhabdomyolysis
Rationale: Strong CYP3A4 inhibitors (clarithromycin, ketoconazole, itraconazole,
ritonavir, grapefruit juice) are contraindicated with simvastatin. Hold the statin or
choose azithromycin.
Page 2
,5. A woman taking an oral contraceptive is prescribed rifampin. What is the
expected effect?
A. It increases hormone levels and clotting risk
B. Rifampin induces CYP enzymes and reduces contraceptive hormone levels,
increasing the risk of failure
C. No interaction occurs
D. It prolongs the half-life of ethinyl estradiol
Answer: B. Rifampin induces CYP enzymes and reduces contraceptive hormone
levels, increasing the risk of failure
Rationale: Enzyme inducers (rifampin, carbamazepine, phenytoin, St. John's wort)
lower hormone exposure. Advise a backup method or a non-hormonal option
such as a copper IUD.
6. Which group contains only narrow therapeutic index drugs?
A. Warfarin, digoxin, lithium, phenytoin
B. Amoxicillin, cephalexin, loratadine, famotidine
C. Acetaminophen, ibuprofen, montelukast, cetirizine
D. Omeprazole, amlodipine, metformin, sertraline
Answer: A. Warfarin, digoxin, lithium, phenytoin
Rationale: Small changes in dose or concentration of narrow-index drugs cause
toxicity or loss of efficacy, so drug levels or INR monitoring is required.
7. Which drug is a classic example of zero-order (saturable) kinetics at
therapeutic doses?
A. Amoxicillin
B. Lisinopril
C. Atenolol
D. Phenytoin
Page 3
, Answer: D. Phenytoin
Rationale: When metabolic enzymes saturate, a constant amount is eliminated,
so small dose increases cause disproportionate rises in plasma concentration and
toxicity.
8. Which pharmacokinetic parameter determines the loading dose, and which
determines the maintenance dose?
A. Clearance determines the loading dose; volume of distribution determines
the maintenance dose
B. Half-life determines both
C. Volume of distribution determines the loading dose; clearance determines
the maintenance dose
D. Bioavailability determines neither
Answer: C. Volume of distribution determines the loading dose; clearance
determines the maintenance dose
Rationale: Loading dose = target concentration x Vd (divided by F). Maintenance
dose rate = clearance x target concentration.
9. Why is codeine avoided in children after tonsillectomy and in ultrarapid
CYP2D6 metabolizers?
A. It is inactivated by CYP2D6
B. It is a prodrug converted to morphine, and rapid conversion can cause life-
threatening respiratory depression
C. It causes hepatic failure
D. It has no analgesic effect
Page 4
Final Exam Questions and Answers| Updated| Pass Guaranteed| Chamberlain
1. Which statement best defines bioavailability?
A. The time required for plasma concentration to fall by half
B. The fraction of an administered dose that reaches the systemic circulation
unchanged
C. The volume in which a drug appears to be distributed
D. The rate at which the kidney clears a drug
Answer: B. The fraction of an administered dose that reaches the systemic
circulation unchanged
Rationale: Intravenous drugs have 100% bioavailability. Oral drugs may be
reduced by incomplete absorption and first-pass hepatic metabolism.
2. Why is nitroglycerin given sublingually rather than swallowed for acute
angina?
A. Sublingual absorption bypasses extensive first-pass hepatic metabolism
B. It is destroyed by saliva
C. It requires gastric acid for activation
D. It is a prodrug activated in the intestine
Answer: A. Sublingual absorption bypasses extensive first-pass hepatic
metabolism
Rationale: Venous drainage from the oral mucosa enters the superior vena cava
directly, so the drug reaches the circulation before reaching the liver.
Page 1
,3. Approximately how many half-lives are needed to reach steady-state
concentration with repeated dosing?
A. 1 half-life
B. 10 to 12 half-lives
C. Steady state is reached after the first dose
D. 4 to 5 half-lives
Answer: D. 4 to 5 half-lives
Rationale: After 4 to 5 half-lives, about 94 to 97% of steady state is achieved. The
same interval applies to washout after stopping a drug.
4. A patient stable on simvastatin is prescribed clarithromycin. What is the most
important concern?
A. CYP3A4 induction lowers simvastatin levels
B. Clarithromycin has no hepatic effects
C. CYP3A4 inhibition raises simvastatin levels, increasing the risk of myopathy
and rhabdomyolysis
D. Simvastatin will inhibit clarithromycin
Answer: C. CYP3A4 inhibition raises simvastatin levels, increasing the risk of
myopathy and rhabdomyolysis
Rationale: Strong CYP3A4 inhibitors (clarithromycin, ketoconazole, itraconazole,
ritonavir, grapefruit juice) are contraindicated with simvastatin. Hold the statin or
choose azithromycin.
Page 2
,5. A woman taking an oral contraceptive is prescribed rifampin. What is the
expected effect?
A. It increases hormone levels and clotting risk
B. Rifampin induces CYP enzymes and reduces contraceptive hormone levels,
increasing the risk of failure
C. No interaction occurs
D. It prolongs the half-life of ethinyl estradiol
Answer: B. Rifampin induces CYP enzymes and reduces contraceptive hormone
levels, increasing the risk of failure
Rationale: Enzyme inducers (rifampin, carbamazepine, phenytoin, St. John's wort)
lower hormone exposure. Advise a backup method or a non-hormonal option
such as a copper IUD.
6. Which group contains only narrow therapeutic index drugs?
A. Warfarin, digoxin, lithium, phenytoin
B. Amoxicillin, cephalexin, loratadine, famotidine
C. Acetaminophen, ibuprofen, montelukast, cetirizine
D. Omeprazole, amlodipine, metformin, sertraline
Answer: A. Warfarin, digoxin, lithium, phenytoin
Rationale: Small changes in dose or concentration of narrow-index drugs cause
toxicity or loss of efficacy, so drug levels or INR monitoring is required.
7. Which drug is a classic example of zero-order (saturable) kinetics at
therapeutic doses?
A. Amoxicillin
B. Lisinopril
C. Atenolol
D. Phenytoin
Page 3
, Answer: D. Phenytoin
Rationale: When metabolic enzymes saturate, a constant amount is eliminated,
so small dose increases cause disproportionate rises in plasma concentration and
toxicity.
8. Which pharmacokinetic parameter determines the loading dose, and which
determines the maintenance dose?
A. Clearance determines the loading dose; volume of distribution determines
the maintenance dose
B. Half-life determines both
C. Volume of distribution determines the loading dose; clearance determines
the maintenance dose
D. Bioavailability determines neither
Answer: C. Volume of distribution determines the loading dose; clearance
determines the maintenance dose
Rationale: Loading dose = target concentration x Vd (divided by F). Maintenance
dose rate = clearance x target concentration.
9. Why is codeine avoided in children after tonsillectomy and in ultrarapid
CYP2D6 metabolizers?
A. It is inactivated by CYP2D6
B. It is a prodrug converted to morphine, and rapid conversion can cause life-
threatening respiratory depression
C. It causes hepatic failure
D. It has no analgesic effect
Page 4
