NSG 533 - Advanced Pharmacology Exam 1 2026/2027
Practice Exam 126 -Questions with 100% Verified
Answers & Rationales
OVERVIEW
This practice exam covers Wilkes University NSG 533 Exam 1 2026. Focus: Advanced Pharmacology
principles and major drug classes. Answers in GREEN and rationales .
Subtitles / Blueprint:
1. Foundations: Pharmacokinetics (ADME, first-pass, Vd, protein binding), pharmacodynamics (receptor
theory, therapeutic index, half-life/steady state), CYP450 inducers/inhibitors, NTI drugs, Beers Criteria,
pharmacogenomics (CYP2D6/codeine).
2. Autonomic: Cholinergic vs adrenergic, alpha/beta agonists/antagonists, epinephrine in anaphylaxis,
atropine toxicity, order of blockade in pheochromocytoma.
3. Pain, Headache, Inflammation: Acetaminophen limit, NSAIDs COX-1 vs COX-2 risks, opioids
equianalgesia and naloxone, triptans contraindications, gout acute vs chronic therapy.
4. Bone & Joint: Osteoporosis bisphosphonate administration, methotrexate monitoring, TNF inhibitors
infection risk, denosumab MOA.
5. GI & Dermatology: H2 blockers vs PPIs timing and long-term risks, ondansetron QT, topical steroids
potency, isotretinoin iPledge.
6. Diabetes & Thyroid: Metformin MOA/contraindication, GLP-1 RA and SGLT2i ADRs/benefits, insulin
start, levothyroxine administration, methimazole vs PTU in pregnancy.
Use: Answer first, then check green answer and rationale for why.
BEGIN PRACTICE QUESTIONS (126)
1. A 68-year-old with atrial fibrillation starts amiodarone, which is a known inhibitor of
CYP3A4 and P-glycoprotein. Which medication would have increased levels?
A. Warfarin
B. Metformin
C. Lisinopril
D. Levothyroxine
Rationale: Amiodarone inhibits CYP3A4, 1A2, 2C9 and P-gp, increasing warfarin (2C9), digoxin, statins. INR
will rise.
2. Steady state of a drug with half-life 8 hours given every 8 hours is reached after
approximately:
A. 8 hours
B. 16 hours
C. 32-40 hours
D. 8 days
, Rationale: Steady state after 4-5 half-lives. 8h x 4-5 = 32-40h.
3. Which factor increases volume of distribution (Vd)?
A. High plasma protein binding
B. Low lipophilicity
C. High tissue binding
D. Renal failure
Rationale: Vd high when drug leaves plasma into tissues. High tissue binding and high lipophilicity increase
Vd.
4. Phase II metabolism is best described as:
A. Oxidation via CYP450
B. Conjugation to increase water solubility
C. Hydrolysis
D. Reduction
Rationale: Phase I = functionalization (CYP oxidation). Phase II = conjugation to make water soluble for
excretion.
5. Drug with narrow therapeutic index (NTI):
A. Amoxicillin
B. Lithium
C. Lisinopril
D. Metformin
Rationale: NTI: lithium, warfarin, phenytoin, digoxin, theophylline, aminoglycosides, tacrolimus. Require
TDM.
6. First-pass effect significantly reduces bioavailability of:
A. Lithium
B. Nitroglycerin oral
C. Vancomycin IV
D. Insulin IV
Rationale: High first-pass drugs: nitroglycerin, lidocaine, morphine oral, propranolol. Use SL/IV to bypass.
7. Which CYP inducer decreases efficacy of OCPs and warfarin?
A. Fluoxetine
B. Carbamazepine
C. Erythromycin
D. Cimetidine
Rationale: Inducers: Carbamazepine, Rifampin, St. John's wort, Phenytoin, Phenobarbital. They increase
metabolism.
8. Protein binding competition important for:
A. Phenytoin + valproate
B. Metformin + insulin
, C. Albuterol + ipratropium
D. Omeprazole + calcium
Rationale: Highly protein bound: phenytoin, warfarin, valproate. Displacement raises free active drug.
9. Beers Criteria warns to avoid in elderly:
A. Acetaminophen
B. Diphenhydramine
C. Fluticasone inhaler
D. Atorvastatin
Rationale: Anticholinergics (diphenhydramine), benzodiazepines, meperidine are high risk in elderly due to
confusion/falls.
10. Pharmacogenomics: Poor CYP2D6 metabolizers will have:
A. Increased codeine analgesia
B. No analgesia from codeine
C. Increased morphine clearance
D. Decreased tramadol toxicity
Rationale: Codeine is prodrug converted by CYP2D6 to morphine. Poor metabolizers get no pain relief.
11. Beta-1 selective blocker preferred in asthma/COPD?
A. Atenolol
B. Propranolol
C. Carvedilol
D. Sotalol
Rationale: Beta-1 selective: atenolol, metoprolol, esmolol, bisoprolol. Non-selective blocks beta-2
bronchoconstriction.
12. Epinephrine MOA in anaphylaxis:
A. Alpha-1, Beta-1, Beta-2 agonism
B. Alpha-1 only
C. Beta-2 only
D. Muscarinic agonist
Rationale: Epi: alpha-1 vasoconstriction, beta-1 increased CO, beta-2 bronchodilation. Give IM mid-outer
thigh.
13. Atropine toxicity includes:
A. Bronchorrhea, bradycardia, miosis
B. Dry mouth, tachycardia, urinary retention, hyperthermia
C. Diarrhea, salivation
D. Bronchospasm
Rationale: Anticholinergic toxidrome: dry, hot, red, blind, mad. Tachycardia, dry mouth, urinary retention.
14. Pheochromocytoma: correct order of blockade:
A. Alpha then beta
Practice Exam 126 -Questions with 100% Verified
Answers & Rationales
OVERVIEW
This practice exam covers Wilkes University NSG 533 Exam 1 2026. Focus: Advanced Pharmacology
principles and major drug classes. Answers in GREEN and rationales .
Subtitles / Blueprint:
1. Foundations: Pharmacokinetics (ADME, first-pass, Vd, protein binding), pharmacodynamics (receptor
theory, therapeutic index, half-life/steady state), CYP450 inducers/inhibitors, NTI drugs, Beers Criteria,
pharmacogenomics (CYP2D6/codeine).
2. Autonomic: Cholinergic vs adrenergic, alpha/beta agonists/antagonists, epinephrine in anaphylaxis,
atropine toxicity, order of blockade in pheochromocytoma.
3. Pain, Headache, Inflammation: Acetaminophen limit, NSAIDs COX-1 vs COX-2 risks, opioids
equianalgesia and naloxone, triptans contraindications, gout acute vs chronic therapy.
4. Bone & Joint: Osteoporosis bisphosphonate administration, methotrexate monitoring, TNF inhibitors
infection risk, denosumab MOA.
5. GI & Dermatology: H2 blockers vs PPIs timing and long-term risks, ondansetron QT, topical steroids
potency, isotretinoin iPledge.
6. Diabetes & Thyroid: Metformin MOA/contraindication, GLP-1 RA and SGLT2i ADRs/benefits, insulin
start, levothyroxine administration, methimazole vs PTU in pregnancy.
Use: Answer first, then check green answer and rationale for why.
BEGIN PRACTICE QUESTIONS (126)
1. A 68-year-old with atrial fibrillation starts amiodarone, which is a known inhibitor of
CYP3A4 and P-glycoprotein. Which medication would have increased levels?
A. Warfarin
B. Metformin
C. Lisinopril
D. Levothyroxine
Rationale: Amiodarone inhibits CYP3A4, 1A2, 2C9 and P-gp, increasing warfarin (2C9), digoxin, statins. INR
will rise.
2. Steady state of a drug with half-life 8 hours given every 8 hours is reached after
approximately:
A. 8 hours
B. 16 hours
C. 32-40 hours
D. 8 days
, Rationale: Steady state after 4-5 half-lives. 8h x 4-5 = 32-40h.
3. Which factor increases volume of distribution (Vd)?
A. High plasma protein binding
B. Low lipophilicity
C. High tissue binding
D. Renal failure
Rationale: Vd high when drug leaves plasma into tissues. High tissue binding and high lipophilicity increase
Vd.
4. Phase II metabolism is best described as:
A. Oxidation via CYP450
B. Conjugation to increase water solubility
C. Hydrolysis
D. Reduction
Rationale: Phase I = functionalization (CYP oxidation). Phase II = conjugation to make water soluble for
excretion.
5. Drug with narrow therapeutic index (NTI):
A. Amoxicillin
B. Lithium
C. Lisinopril
D. Metformin
Rationale: NTI: lithium, warfarin, phenytoin, digoxin, theophylline, aminoglycosides, tacrolimus. Require
TDM.
6. First-pass effect significantly reduces bioavailability of:
A. Lithium
B. Nitroglycerin oral
C. Vancomycin IV
D. Insulin IV
Rationale: High first-pass drugs: nitroglycerin, lidocaine, morphine oral, propranolol. Use SL/IV to bypass.
7. Which CYP inducer decreases efficacy of OCPs and warfarin?
A. Fluoxetine
B. Carbamazepine
C. Erythromycin
D. Cimetidine
Rationale: Inducers: Carbamazepine, Rifampin, St. John's wort, Phenytoin, Phenobarbital. They increase
metabolism.
8. Protein binding competition important for:
A. Phenytoin + valproate
B. Metformin + insulin
, C. Albuterol + ipratropium
D. Omeprazole + calcium
Rationale: Highly protein bound: phenytoin, warfarin, valproate. Displacement raises free active drug.
9. Beers Criteria warns to avoid in elderly:
A. Acetaminophen
B. Diphenhydramine
C. Fluticasone inhaler
D. Atorvastatin
Rationale: Anticholinergics (diphenhydramine), benzodiazepines, meperidine are high risk in elderly due to
confusion/falls.
10. Pharmacogenomics: Poor CYP2D6 metabolizers will have:
A. Increased codeine analgesia
B. No analgesia from codeine
C. Increased morphine clearance
D. Decreased tramadol toxicity
Rationale: Codeine is prodrug converted by CYP2D6 to morphine. Poor metabolizers get no pain relief.
11. Beta-1 selective blocker preferred in asthma/COPD?
A. Atenolol
B. Propranolol
C. Carvedilol
D. Sotalol
Rationale: Beta-1 selective: atenolol, metoprolol, esmolol, bisoprolol. Non-selective blocks beta-2
bronchoconstriction.
12. Epinephrine MOA in anaphylaxis:
A. Alpha-1, Beta-1, Beta-2 agonism
B. Alpha-1 only
C. Beta-2 only
D. Muscarinic agonist
Rationale: Epi: alpha-1 vasoconstriction, beta-1 increased CO, beta-2 bronchodilation. Give IM mid-outer
thigh.
13. Atropine toxicity includes:
A. Bronchorrhea, bradycardia, miosis
B. Dry mouth, tachycardia, urinary retention, hyperthermia
C. Diarrhea, salivation
D. Bronchospasm
Rationale: Anticholinergic toxidrome: dry, hot, red, blind, mad. Tachycardia, dry mouth, urinary retention.
14. Pheochromocytoma: correct order of blockade:
A. Alpha then beta
