AGACNP NU 636 Advanced Pharmacology
Midterms Exam (Qns & Ans)
2025
Multiple Choice Questions (MCQ)
A 65-year-old patient with chronic kidney disease (CKD) stage 4
requires dosing adjustment of digoxin. Which pharmacokinetic
property primarily influences digoxin dosing in this patient?
A) Hepatic metabolism
B) Renal clearance
C) Protein binding
D) First-pass metabolism
©2025
,Correct ANS: B
Rationale: Digoxin is primarily excreted by the kidneys;
therefore, impaired renal clearance significantly impacts its
dosing and risk for toxicity in CKD.
A patient on a CYP3A4 substrate develops toxicity after starting a
new medication known to inhibit CYP3A4. Which medication
class is most likely responsible?
A) Beta blockers
B) Macrolide antibiotics
C) Loop diuretics
D) Thiazide diuretics
Correct ANS: B
Rationale: Macrolides (e.g., erythromycin) are potent CYP3A4
inhibitors, which can increase blood levels of substrates
metabolized by this enzyme.
For a patient receiving warfarin, which of the following vitamin
K-dependent coagulation factors is first affected by
anticoagulation?
A) Factor II
B) Factor VII
©2025
,C) Factor IX
D) Factor X
Correct ANS: B
Rationale: Factor VII has the shortest half-life among vitamin K-
dependent clotting factors, so it is affected first by warfarin
therapy.
Which antibiotic utilizes time-dependent killing and thus requires
maintenance of serum concentration above the MIC (Minimum
Inhibitory Concentration) for effective treatment?
A) Aminoglycosides
B) Fluoroquinolones
C) Beta-lactams
D) Metronidazole
Correct ANS: C
Rationale: Beta-lactams exhibit time-dependent killing;
therapeutic effectiveness depends on the duration serum
concentration exceeds MIC.
An elderly patient has decreased activity of CYP2D6. Which drug
among the following would likely require dose adjustment?
©2025
, A) Morphine
B) Codeine
C) Acetaminophen
D) Ibuprofen
Correct ANS: B
Rationale: Codeine is a prodrug activated by CYP2D6; reduced
enzyme activity results in diminished analgesic effect,
necessitating dose reevaluation.
Fill-in-the-Blank Questions
The process by which a drug is chemically modified in the liver
via the cytochrome P450 system is called ___________.
ANS: Metabolism
Rationale: Metabolism transforms drugs into more water-soluble
compounds for elimination, commonly via hepatic CYP450
enzymes.
____________ is the pharmacokinetic parameter that describes
the time taken for the plasma concentration of a drug to reduce by
half.
ANS: Half-life (t½)
©2025
Midterms Exam (Qns & Ans)
2025
Multiple Choice Questions (MCQ)
A 65-year-old patient with chronic kidney disease (CKD) stage 4
requires dosing adjustment of digoxin. Which pharmacokinetic
property primarily influences digoxin dosing in this patient?
A) Hepatic metabolism
B) Renal clearance
C) Protein binding
D) First-pass metabolism
©2025
,Correct ANS: B
Rationale: Digoxin is primarily excreted by the kidneys;
therefore, impaired renal clearance significantly impacts its
dosing and risk for toxicity in CKD.
A patient on a CYP3A4 substrate develops toxicity after starting a
new medication known to inhibit CYP3A4. Which medication
class is most likely responsible?
A) Beta blockers
B) Macrolide antibiotics
C) Loop diuretics
D) Thiazide diuretics
Correct ANS: B
Rationale: Macrolides (e.g., erythromycin) are potent CYP3A4
inhibitors, which can increase blood levels of substrates
metabolized by this enzyme.
For a patient receiving warfarin, which of the following vitamin
K-dependent coagulation factors is first affected by
anticoagulation?
A) Factor II
B) Factor VII
©2025
,C) Factor IX
D) Factor X
Correct ANS: B
Rationale: Factor VII has the shortest half-life among vitamin K-
dependent clotting factors, so it is affected first by warfarin
therapy.
Which antibiotic utilizes time-dependent killing and thus requires
maintenance of serum concentration above the MIC (Minimum
Inhibitory Concentration) for effective treatment?
A) Aminoglycosides
B) Fluoroquinolones
C) Beta-lactams
D) Metronidazole
Correct ANS: C
Rationale: Beta-lactams exhibit time-dependent killing;
therapeutic effectiveness depends on the duration serum
concentration exceeds MIC.
An elderly patient has decreased activity of CYP2D6. Which drug
among the following would likely require dose adjustment?
©2025
, A) Morphine
B) Codeine
C) Acetaminophen
D) Ibuprofen
Correct ANS: B
Rationale: Codeine is a prodrug activated by CYP2D6; reduced
enzyme activity results in diminished analgesic effect,
necessitating dose reevaluation.
Fill-in-the-Blank Questions
The process by which a drug is chemically modified in the liver
via the cytochrome P450 system is called ___________.
ANS: Metabolism
Rationale: Metabolism transforms drugs into more water-soluble
compounds for elimination, commonly via hepatic CYP450
enzymes.
____________ is the pharmacokinetic parameter that describes
the time taken for the plasma concentration of a drug to reduce by
half.
ANS: Half-life (t½)
©2025
