NSG 5240 Final Exam Updated Review Adv
Pharmacology South College NSG 5240
Advanced Pharmacology Exam Question And
Answers / NSG 5140 Midterm And Final
Exams/NSG 5240 Advanced Pharmacology
At South college.
SECTION 1: PHARMACOKINETICS & PHARMACODYNAMICS
1. A drug with a high volume of distribution (Vd) primarily indicates:
A. The drug is highly protein-bound
B. The drug is confined to the vascular space
C. The drug extensively distributes into tissues
D. The drug has a short half-life
Correct Answer: C
A high Vd suggests the drug has left the plasma and entered tissues, often due to
lipophilicity or tissue binding. High protein binding usually decreases Vd by keeping drug
in the vascular space. Drugs with high Vd are not easily removed by dialysis.
2. A patient with hepatic cirrhosis is prescribed a prodrug. The nurse practitioner
anticipates:
A. Enhanced therapeutic effect
B. Reduced conversion to active metabolite
C. Increased first-pass metabolism
D. No change in drug activity
Correct Answer: B
Cirrhosis impairs liver function, reducing the conversion of prodrugs to their active form,
potentially leading to therapeutic failure.
,3. Which cytochrome P450 enzyme is most commonly involved in drug-drug
interactions?
A. CYP1A2
B. CYP2D6
C. CYP3A4
D. CYP2C9
Correct Answer: C
CYP3A4 metabolizes over 50% of all drugs and is inhibited or induced by many agents
(e.g., grapefruit juice, rifampin, ketoconazole).
4. A drug's half-life is 12 hours. Approximately how many hours will it take to
reach steady state?
A. 24 hours
B. 36 hours
C. 48 hours
D. 60 hours
Correct Answer: D
Steady state is achieved after approximately 4-5 half-lives. 5 × 12 hours = 60 hours.
5. Which route of administration completely bypasses first-pass metabolism?
A. Oral
B. Sublingual
C. Intravenous
D. Subcutaneous
Correct Answer: C
IV administration delivers medication directly into the bloodstream, providing 100%
bioavailability and completely bypassing first-pass metabolism.
6. A drug with a narrow therapeutic index requires:
A. Less frequent monitoring
B. More frequent monitoring
C. No special precautions
D. Only baseline lab work
,Correct Answer: B
There is a small margin between the effective and toxic dose for drugs like warfarin,
digoxin, and phenytoin, requiring careful monitoring.
7. Phase II metabolism typically involves:
A. Oxidation via CYP450
B. Reduction reactions
C. Conjugation (e.g., glucuronidation)
D. Hydrolysis
Correct Answer: C
Phase II reactions add polar groups (glucuronide, sulfate, glutathione) to increase water
solubility and excretion.
8. Grapefruit juice increases levels of certain drugs by:
A. Inducing CYP3A4
B. Inhibiting intestinal CYP3A4
C. Increasing gastric emptying
D. Enhancing renal reabsorption
Correct Answer: B
Grapefruit juice irreversibly inhibits intestinal CYP3A4, reducing first-pass metabolism and
increasing bioavailability.
9. A patient with renal failure (CrCl 20 mL/min) requires dosing adjustment for a
drug primarily eliminated by the kidneys. The general principle is to:
A. Increase the dose and frequency
B. Decrease the dose and/or extend the dosing interval
C. No adjustment needed
D. Switch to the IV route only
Correct Answer: B
Reduced renal elimination increases drug half-life and risk of accumulation. Dose
reduction or extended dosing intervals prevent toxicity.
10. A drug that is a weak acid (pKa 4.4) will be mostly ionized in:
A. Gastric fluid (pH 1.5)
B. Urine pH 8.0
, C. Blood pH 7.4
D. Small intestine pH 6.0
Correct Answer: B
Weak acids are ionized in alkaline pH (pH > pKa). Ionized form is less lipid-soluble,
trapped in urine (ion trapping).
SECTION 2: AUTONOMIC & CARDIOVASCULAR PHARMACOLOGY
11. A patient with a history of asthma is prescribed propranolol for migraine
prophylaxis. What is the primary concern with this therapy?
A. Orthostatic hypotension
B. Bronchospasm
C. Tachycardia
D. Hepatotoxicity
Correct Answer: B
Propranolol is a non-selective beta-blocker that antagonizes beta-2 receptors in bronchial
smooth muscle. In patients with asthma, beta-2 blockade can cause bronchoconstriction
and should be avoided.
12. Which beta-blocker also possesses alpha-1 adrenergic receptor blocking
properties, making it useful in patients with hypertension and benign prostatic
hyperplasia?
A. Metoprolol
B. Atenolol
C. Carvedilol
D. Bisoprolol
Correct Answer: C
Carvedilol is a non-selective beta-blocker with additional alpha-1 blocking activity,
leading to vasodilation. It can be beneficial in patients with BPH.
13. Which adverse effect is most common with ACE inhibitors?
A. Hypokalemia
B. Dry cough
Pharmacology South College NSG 5240
Advanced Pharmacology Exam Question And
Answers / NSG 5140 Midterm And Final
Exams/NSG 5240 Advanced Pharmacology
At South college.
SECTION 1: PHARMACOKINETICS & PHARMACODYNAMICS
1. A drug with a high volume of distribution (Vd) primarily indicates:
A. The drug is highly protein-bound
B. The drug is confined to the vascular space
C. The drug extensively distributes into tissues
D. The drug has a short half-life
Correct Answer: C
A high Vd suggests the drug has left the plasma and entered tissues, often due to
lipophilicity or tissue binding. High protein binding usually decreases Vd by keeping drug
in the vascular space. Drugs with high Vd are not easily removed by dialysis.
2. A patient with hepatic cirrhosis is prescribed a prodrug. The nurse practitioner
anticipates:
A. Enhanced therapeutic effect
B. Reduced conversion to active metabolite
C. Increased first-pass metabolism
D. No change in drug activity
Correct Answer: B
Cirrhosis impairs liver function, reducing the conversion of prodrugs to their active form,
potentially leading to therapeutic failure.
,3. Which cytochrome P450 enzyme is most commonly involved in drug-drug
interactions?
A. CYP1A2
B. CYP2D6
C. CYP3A4
D. CYP2C9
Correct Answer: C
CYP3A4 metabolizes over 50% of all drugs and is inhibited or induced by many agents
(e.g., grapefruit juice, rifampin, ketoconazole).
4. A drug's half-life is 12 hours. Approximately how many hours will it take to
reach steady state?
A. 24 hours
B. 36 hours
C. 48 hours
D. 60 hours
Correct Answer: D
Steady state is achieved after approximately 4-5 half-lives. 5 × 12 hours = 60 hours.
5. Which route of administration completely bypasses first-pass metabolism?
A. Oral
B. Sublingual
C. Intravenous
D. Subcutaneous
Correct Answer: C
IV administration delivers medication directly into the bloodstream, providing 100%
bioavailability and completely bypassing first-pass metabolism.
6. A drug with a narrow therapeutic index requires:
A. Less frequent monitoring
B. More frequent monitoring
C. No special precautions
D. Only baseline lab work
,Correct Answer: B
There is a small margin between the effective and toxic dose for drugs like warfarin,
digoxin, and phenytoin, requiring careful monitoring.
7. Phase II metabolism typically involves:
A. Oxidation via CYP450
B. Reduction reactions
C. Conjugation (e.g., glucuronidation)
D. Hydrolysis
Correct Answer: C
Phase II reactions add polar groups (glucuronide, sulfate, glutathione) to increase water
solubility and excretion.
8. Grapefruit juice increases levels of certain drugs by:
A. Inducing CYP3A4
B. Inhibiting intestinal CYP3A4
C. Increasing gastric emptying
D. Enhancing renal reabsorption
Correct Answer: B
Grapefruit juice irreversibly inhibits intestinal CYP3A4, reducing first-pass metabolism and
increasing bioavailability.
9. A patient with renal failure (CrCl 20 mL/min) requires dosing adjustment for a
drug primarily eliminated by the kidneys. The general principle is to:
A. Increase the dose and frequency
B. Decrease the dose and/or extend the dosing interval
C. No adjustment needed
D. Switch to the IV route only
Correct Answer: B
Reduced renal elimination increases drug half-life and risk of accumulation. Dose
reduction or extended dosing intervals prevent toxicity.
10. A drug that is a weak acid (pKa 4.4) will be mostly ionized in:
A. Gastric fluid (pH 1.5)
B. Urine pH 8.0
, C. Blood pH 7.4
D. Small intestine pH 6.0
Correct Answer: B
Weak acids are ionized in alkaline pH (pH > pKa). Ionized form is less lipid-soluble,
trapped in urine (ion trapping).
SECTION 2: AUTONOMIC & CARDIOVASCULAR PHARMACOLOGY
11. A patient with a history of asthma is prescribed propranolol for migraine
prophylaxis. What is the primary concern with this therapy?
A. Orthostatic hypotension
B. Bronchospasm
C. Tachycardia
D. Hepatotoxicity
Correct Answer: B
Propranolol is a non-selective beta-blocker that antagonizes beta-2 receptors in bronchial
smooth muscle. In patients with asthma, beta-2 blockade can cause bronchoconstriction
and should be avoided.
12. Which beta-blocker also possesses alpha-1 adrenergic receptor blocking
properties, making it useful in patients with hypertension and benign prostatic
hyperplasia?
A. Metoprolol
B. Atenolol
C. Carvedilol
D. Bisoprolol
Correct Answer: C
Carvedilol is a non-selective beta-blocker with additional alpha-1 blocking activity,
leading to vasodilation. It can be beneficial in patients with BPH.
13. Which adverse effect is most common with ACE inhibitors?
A. Hypokalemia
B. Dry cough
