1|Page
NUR 635 Final Exam — Advanced
Pharmacology & Pathophysiology
Questions with verified solutions and
Rationales
1. A patient is prescribed a drug that is highly protein-bound. The patient has
cirrhosis with low serum albumin. What is the most likely effect?
A. Decreased drug effect due to reduced absorption
B. Increased free drug concentration and risk of toxicity
C. No change in drug effect
D. Increased renal clearance
Correct Answer: B
Rationale: Highly protein-bound drugs rely on albumin for transport. In cirrhosis
with hypoalbuminemia, less albumin is available for binding, increasing the free
(active) drug concentration and risk of toxicity .
2. Which of the following statements about zero-order kinetics is correct?
A. The rate of elimination is proportional to drug concentration
B. A constant amount of drug is eliminated per unit of time regardless of
,2|Page
concentration
C. Most drugs follow zero-order kinetics
D. Half-life is constant regardless of dose
Correct Answer: B
Rationale: Zero-order kinetics (saturation kinetics) eliminates a constant amount
of drug per unit time regardless of concentration. Alcohol, phenytoin, and high-
dose aspirin are examples. Most drugs follow first-order kinetics .
3. Approximately how many half-lives are required to reach steady-state
concentration?
A. 1-2
B. 2-3
C. 4-5
D. 10-12
Correct Answer: C
Rationale: Steady state is achieved after approximately 4-5 half-lives, when the
rate of drug administration equals the rate of elimination .
,3|Page
4. A drug has a narrow therapeutic index. Which monitoring approach is most
appropriate?
A. No monitoring needed
B. Routine monitoring of serum drug levels
C. Monitoring only if symptoms develop
D. Monitoring once yearly
Correct Answer: B
Rationale: Narrow therapeutic index drugs (e.g., warfarin, digoxin, lithium,
phenytoin) require routine serum level monitoring because small changes can
lead to toxicity or therapeutic failure .
5. Which cytochrome P450 enzyme is involved in the metabolism of most drugs?
A. CYP1A2
B. CYP2D6
C. CYP3A4
D. CYP2C9
Correct Answer: C
Rationale: CYP3A4 is responsible for metabolizing approximately 50% of all drugs.
It is the most abundant CYP enzyme in the liver and intestine .
, 4|Page
6. A patient taking warfarin is prescribed rifampin. What is the expected drug
interaction?
A. Increased warfarin effect
B. Decreased warfarin effect
C. No interaction
D. Increased bleeding risk
Correct Answer: B
Rationale: Rifampin is a potent CYP450 inducer. It increases the metabolism of
warfarin, decreasing its anticoagulant effect and increasing the risk of clotting .
7. Which statement about first-order elimination is correct?
A. A constant amount of drug is eliminated per unit time
B. The rate of elimination is proportional to drug concentration
C. Half-life increases with dose
D. Clearance decreases as concentration increases
Correct Answer: B
Rationale: In first-order kinetics, the rate of elimination is directly proportional to
drug concentration. A constant fraction (not amount) is eliminated per unit time .
NUR 635 Final Exam — Advanced
Pharmacology & Pathophysiology
Questions with verified solutions and
Rationales
1. A patient is prescribed a drug that is highly protein-bound. The patient has
cirrhosis with low serum albumin. What is the most likely effect?
A. Decreased drug effect due to reduced absorption
B. Increased free drug concentration and risk of toxicity
C. No change in drug effect
D. Increased renal clearance
Correct Answer: B
Rationale: Highly protein-bound drugs rely on albumin for transport. In cirrhosis
with hypoalbuminemia, less albumin is available for binding, increasing the free
(active) drug concentration and risk of toxicity .
2. Which of the following statements about zero-order kinetics is correct?
A. The rate of elimination is proportional to drug concentration
B. A constant amount of drug is eliminated per unit of time regardless of
,2|Page
concentration
C. Most drugs follow zero-order kinetics
D. Half-life is constant regardless of dose
Correct Answer: B
Rationale: Zero-order kinetics (saturation kinetics) eliminates a constant amount
of drug per unit time regardless of concentration. Alcohol, phenytoin, and high-
dose aspirin are examples. Most drugs follow first-order kinetics .
3. Approximately how many half-lives are required to reach steady-state
concentration?
A. 1-2
B. 2-3
C. 4-5
D. 10-12
Correct Answer: C
Rationale: Steady state is achieved after approximately 4-5 half-lives, when the
rate of drug administration equals the rate of elimination .
,3|Page
4. A drug has a narrow therapeutic index. Which monitoring approach is most
appropriate?
A. No monitoring needed
B. Routine monitoring of serum drug levels
C. Monitoring only if symptoms develop
D. Monitoring once yearly
Correct Answer: B
Rationale: Narrow therapeutic index drugs (e.g., warfarin, digoxin, lithium,
phenytoin) require routine serum level monitoring because small changes can
lead to toxicity or therapeutic failure .
5. Which cytochrome P450 enzyme is involved in the metabolism of most drugs?
A. CYP1A2
B. CYP2D6
C. CYP3A4
D. CYP2C9
Correct Answer: C
Rationale: CYP3A4 is responsible for metabolizing approximately 50% of all drugs.
It is the most abundant CYP enzyme in the liver and intestine .
, 4|Page
6. A patient taking warfarin is prescribed rifampin. What is the expected drug
interaction?
A. Increased warfarin effect
B. Decreased warfarin effect
C. No interaction
D. Increased bleeding risk
Correct Answer: B
Rationale: Rifampin is a potent CYP450 inducer. It increases the metabolism of
warfarin, decreasing its anticoagulant effect and increasing the risk of clotting .
7. Which statement about first-order elimination is correct?
A. A constant amount of drug is eliminated per unit time
B. The rate of elimination is proportional to drug concentration
C. Half-life increases with dose
D. Clearance decreases as concentration increases
Correct Answer: B
Rationale: In first-order kinetics, the rate of elimination is directly proportional to
drug concentration. A constant fraction (not amount) is eliminated per unit time .
