BIO290 Pharmacology Exam 1 Complete
Study Guide | ADME, Drug Development,
Dosage Concepts, Adverse Effects & Herbal
Supplements | Joyce University | 2026
Update
Practice Question Bank & Answer Rationale
THIS PACK CONTAINS
147 exam-style multiple-choice questions. Each question includes the correct answer and a complete
rationale for focused revision.
COVERAGE
This exam covers foundational pharmacology including pharmacokinetics (ADME), pharmacodynamics, drug
development phases, dosage calculations, adverse drug effects, and herbal supplement interactions. It
emphasizes clinical application and safety across diverse patient populations.
STUDY GUIDE
Recommended duration: 3 hours. Passing target: 70%.
HIGHP - Page 1 of 47
,1. A patient with a history of opioid use disorder is prescribed buprenorphine/naloxone.
Which pharmacokinetic property of buprenorphine allows for once-daily dosing?
[ ] A. High first-pass metabolism
[ ] B. Long elimination half-life
[ ] C. Rapid renal excretion
[ ] D. Extensive tissue binding
CORRECT: B. Long elimination half-life
Buprenorphine has a long elimination half-life (24-42 hours) due to its slow dissociation from mu-opioid
receptors, enabling once-daily dosing. High first-pass metabolism would reduce oral bioavailability, not
prolong dosing. Rapid renal excretion and extensive tissue binding do not primarily determine dosing
frequency.
2. During which phase of clinical trials is the primary objective to assess the safety and
tolerability of a new drug in a small number of healthy volunteers?
[ ] A. Phase I
[ ] B. Phase II
[ ] C. Phase III
[ ] D. Phase IV
CORRECT: A. Phase I
Phase I trials focus on safety, tolerability, and pharmacokinetics in a small group (20-80) of healthy volunteers
or sometimes patients. Phase II evaluates efficacy and side effects in patients, Phase III confirms efficacy
and monitors adverse reactions in larger populations, and Phase IV occurs after marketing.
3. A physician orders 0.5 mg of digoxin IV for a patient with heart failure. The available vial
contains 0.25 mg/mL. How many mL should the nurse administer?
[ ] A. 0.5 mL
[ ] B. 1 mL
[ ] C. 2 mL
[ ] D. 4 mL
CORRECT: C. 2 mL
Using the formula: Volume (mL) = Dose ordered / Concentration = 0.5 mg / 0.25 mg/mL = 2 mL. Therefore, 2
mL is correct. Other options would result in under- or over-dosing.
4. Which adverse drug reaction is most commonly associated with long-term
corticosteroid therapy?
[ ] A. Hypoglycemia
[ ] B. Osteoporosis
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, [ ] C. Bradycardia
[ ] D. Hypokalemia
CORRECT: B. Osteoporosis
Long-term corticosteroid use leads to decreased bone formation and increased resorption, causing
osteoporosis. Hyperglycemia, not hypoglycemia, is common. Bradycardia and hypokalemia are not typical;
hypokalemia can occur with diuretics, not steroids.
5. A patient taking warfarin wants to start St. John's wort for mild depression. Which
potential interaction should the nurse anticipate?
[ ] A. Increased warfarin effect and bleeding risk
[ ] B. Decreased warfarin effect and clot risk
[ ] C. No significant interaction
[ ] D. Increased risk of serotonin syndrome
CORRECT: B. Decreased warfarin effect and clot risk
St. John's wort induces CYP3A4 and CYP2C9, which increases warfarin metabolism, reducing its
anticoagulant effect and increasing clot risk. It does not increase warfarin effect. Serotonin syndrome risk is
with serotonergic drugs, not warfarin.
6. Which statement accurately describes the 'first-pass effect'?
[ ] A. Drugs are metabolized in the liver before reaching systemic circulation.
[ ] B. Drugs are excreted unchanged in the urine.
[ ] C. Drugs bypass the liver and enter systemic circulation directly.
[ ] D. Drugs are absorbed in the stomach and inactivated by acid.
CORRECT: A. Drugs are metabolized in the liver before reaching systemic circulation.
First-pass effect refers to the metabolism of a drug in the liver and gut wall before it reaches systemic
circulation, reducing bioavailability. Option B describes renal excretion, C describes bypassing first-pass (e.g.,
IV), and D describes acid degradation, not first-pass.
7. A patient with renal impairment is prescribed a drug that is primarily excreted
unchanged by the kidneys. What adjustment is most appropriate?
[ ] A. Increase the dose
[ ] B. Decrease the dose
[ ] C. Administer with food
[ ] D. Monitor serum drug levels only
CORRECT: B. Decrease the dose
For drugs excreted unchanged by the kidneys, renal impairment reduces clearance, increasing risk of
HIGHP - Page 3 of 47
, toxicity; thus, dose reduction is necessary. Increasing dose would worsen toxicity. Food and monitoring alone
do not address accumulation.
8. Which herbal supplement is known to increase the risk of bleeding when taken with
anticoagulants?
[ ] A. Ginkgo biloba
[ ] B. Echinacea
[ ] C. Valerian root
[ ] D. Milk thistle
CORRECT: A. Ginkgo biloba
Ginkgo biloba inhibits platelet aggregation and can potentiate bleeding risk with anticoagulants. Echinacea,
valerian, and milk thistle do not have significant antiplatelet effects.
9. A nurse is reviewing a medication order for a drug with a narrow therapeutic index.
Which action is most important?
[ ] A. Administer the drug with grapefruit juice
[ ] B. Monitor serum drug levels regularly
[ ] C. Use a fixed-dose regimen
[ ] D. Avoid generic substitution
CORRECT: B. Monitor serum drug levels regularly
Narrow therapeutic index drugs require close monitoring of serum levels to avoid toxicity or subtherapeutic
effects. Grapefruit juice can interact, fixed dosing may not be safe, and generic substitution is usually
acceptable if bioequivalent.
10. Which phase of pharmacokinetics involves the movement of a drug from the site of
administration into the bloodstream?
[ ] A. Absorption
[ ] B. Distribution
[ ] C. Metabolism
[ ] D. Excretion
CORRECT: A. Absorption
Absorption is the process by which a drug moves from the site of administration into the bloodstream.
Distribution is movement to tissues, metabolism is biotransformation, and excretion is elimination.
HIGHP - Page 4 of 47
Study Guide | ADME, Drug Development,
Dosage Concepts, Adverse Effects & Herbal
Supplements | Joyce University | 2026
Update
Practice Question Bank & Answer Rationale
THIS PACK CONTAINS
147 exam-style multiple-choice questions. Each question includes the correct answer and a complete
rationale for focused revision.
COVERAGE
This exam covers foundational pharmacology including pharmacokinetics (ADME), pharmacodynamics, drug
development phases, dosage calculations, adverse drug effects, and herbal supplement interactions. It
emphasizes clinical application and safety across diverse patient populations.
STUDY GUIDE
Recommended duration: 3 hours. Passing target: 70%.
HIGHP - Page 1 of 47
,1. A patient with a history of opioid use disorder is prescribed buprenorphine/naloxone.
Which pharmacokinetic property of buprenorphine allows for once-daily dosing?
[ ] A. High first-pass metabolism
[ ] B. Long elimination half-life
[ ] C. Rapid renal excretion
[ ] D. Extensive tissue binding
CORRECT: B. Long elimination half-life
Buprenorphine has a long elimination half-life (24-42 hours) due to its slow dissociation from mu-opioid
receptors, enabling once-daily dosing. High first-pass metabolism would reduce oral bioavailability, not
prolong dosing. Rapid renal excretion and extensive tissue binding do not primarily determine dosing
frequency.
2. During which phase of clinical trials is the primary objective to assess the safety and
tolerability of a new drug in a small number of healthy volunteers?
[ ] A. Phase I
[ ] B. Phase II
[ ] C. Phase III
[ ] D. Phase IV
CORRECT: A. Phase I
Phase I trials focus on safety, tolerability, and pharmacokinetics in a small group (20-80) of healthy volunteers
or sometimes patients. Phase II evaluates efficacy and side effects in patients, Phase III confirms efficacy
and monitors adverse reactions in larger populations, and Phase IV occurs after marketing.
3. A physician orders 0.5 mg of digoxin IV for a patient with heart failure. The available vial
contains 0.25 mg/mL. How many mL should the nurse administer?
[ ] A. 0.5 mL
[ ] B. 1 mL
[ ] C. 2 mL
[ ] D. 4 mL
CORRECT: C. 2 mL
Using the formula: Volume (mL) = Dose ordered / Concentration = 0.5 mg / 0.25 mg/mL = 2 mL. Therefore, 2
mL is correct. Other options would result in under- or over-dosing.
4. Which adverse drug reaction is most commonly associated with long-term
corticosteroid therapy?
[ ] A. Hypoglycemia
[ ] B. Osteoporosis
HIGHP - Page 2 of 47
, [ ] C. Bradycardia
[ ] D. Hypokalemia
CORRECT: B. Osteoporosis
Long-term corticosteroid use leads to decreased bone formation and increased resorption, causing
osteoporosis. Hyperglycemia, not hypoglycemia, is common. Bradycardia and hypokalemia are not typical;
hypokalemia can occur with diuretics, not steroids.
5. A patient taking warfarin wants to start St. John's wort for mild depression. Which
potential interaction should the nurse anticipate?
[ ] A. Increased warfarin effect and bleeding risk
[ ] B. Decreased warfarin effect and clot risk
[ ] C. No significant interaction
[ ] D. Increased risk of serotonin syndrome
CORRECT: B. Decreased warfarin effect and clot risk
St. John's wort induces CYP3A4 and CYP2C9, which increases warfarin metabolism, reducing its
anticoagulant effect and increasing clot risk. It does not increase warfarin effect. Serotonin syndrome risk is
with serotonergic drugs, not warfarin.
6. Which statement accurately describes the 'first-pass effect'?
[ ] A. Drugs are metabolized in the liver before reaching systemic circulation.
[ ] B. Drugs are excreted unchanged in the urine.
[ ] C. Drugs bypass the liver and enter systemic circulation directly.
[ ] D. Drugs are absorbed in the stomach and inactivated by acid.
CORRECT: A. Drugs are metabolized in the liver before reaching systemic circulation.
First-pass effect refers to the metabolism of a drug in the liver and gut wall before it reaches systemic
circulation, reducing bioavailability. Option B describes renal excretion, C describes bypassing first-pass (e.g.,
IV), and D describes acid degradation, not first-pass.
7. A patient with renal impairment is prescribed a drug that is primarily excreted
unchanged by the kidneys. What adjustment is most appropriate?
[ ] A. Increase the dose
[ ] B. Decrease the dose
[ ] C. Administer with food
[ ] D. Monitor serum drug levels only
CORRECT: B. Decrease the dose
For drugs excreted unchanged by the kidneys, renal impairment reduces clearance, increasing risk of
HIGHP - Page 3 of 47
, toxicity; thus, dose reduction is necessary. Increasing dose would worsen toxicity. Food and monitoring alone
do not address accumulation.
8. Which herbal supplement is known to increase the risk of bleeding when taken with
anticoagulants?
[ ] A. Ginkgo biloba
[ ] B. Echinacea
[ ] C. Valerian root
[ ] D. Milk thistle
CORRECT: A. Ginkgo biloba
Ginkgo biloba inhibits platelet aggregation and can potentiate bleeding risk with anticoagulants. Echinacea,
valerian, and milk thistle do not have significant antiplatelet effects.
9. A nurse is reviewing a medication order for a drug with a narrow therapeutic index.
Which action is most important?
[ ] A. Administer the drug with grapefruit juice
[ ] B. Monitor serum drug levels regularly
[ ] C. Use a fixed-dose regimen
[ ] D. Avoid generic substitution
CORRECT: B. Monitor serum drug levels regularly
Narrow therapeutic index drugs require close monitoring of serum levels to avoid toxicity or subtherapeutic
effects. Grapefruit juice can interact, fixed dosing may not be safe, and generic substitution is usually
acceptable if bioequivalent.
10. Which phase of pharmacokinetics involves the movement of a drug from the site of
administration into the bloodstream?
[ ] A. Absorption
[ ] B. Distribution
[ ] C. Metabolism
[ ] D. Excretion
CORRECT: A. Absorption
Absorption is the process by which a drug moves from the site of administration into the bloodstream.
Distribution is movement to tissues, metabolism is biotransformation, and excretion is elimination.
HIGHP - Page 4 of 47
