MSN571
Advanced Pharmacology
Final Exam Review
(Questions & Solutions)
2025
1
, Question 1
Case Scenario: A 7‑day‑old preterm neonate with suspected sepsis is
prescribed gentamicin. Given the neonate’s physiology, which
pharmacokinetic factor most increases the risk of toxicity in this age
group?
- A) Increased gastrointestinal motility
- B) Reduced glomerular filtration rate
- C) Enhanced protein binding
- D) Faster hepatic metabolism
Correct ANS: B
Rationale: Neonates have immature renal function, including a reduced
glomerular filtration rate, which decreases gentamicin clearance and
heightens the risk of toxicity.
---
Question 2
Case Scenario: A 4‑year‑old child is started on valproic acid for seizure
control. Compared with adults, pediatric patients often require dosing
adjustments.
Question: Which pharmacokinetic property in children generally
necessitates a higher mg/kg dosing of medications like valproic acid?
- A) Decreased metabolic clearance
- B) Lower distribution volume
- C) Increased hepatic enzyme activity relative to body weight
- D) Reduced renal excretion
Correct ANS: C
Rationale: Children often have a relatively higher metabolic rate and
increased hepatic enzyme activity per kilogram body weight, leading to
faster clearance of drugs and the need for proportionally higher dose-
per-weight regimens.
2
,---
Question 3
Case Scenario: A 30‑year‑old pregnant woman with epilepsy maintained
on lamotrigine experiences a breakthrough seizure during her second
trimester.
Question: Which pharmacokinetic change during pregnancy is most
likely responsible for the reduced plasma concentration of lamotrigine?
- A) Decreased renal clearance
- B) Increased plasma protein binding
- C) Upregulated hepatic metabolism (enzyme induction)
- D) Reduced gastrointestinal absorption
Correct ANS: C
Rationale: During pregnancy, estrogen‐mediated enzyme induction
upregulates hepatic metabolism, increasing lamotrigine clearance and
thereby lowering its plasma concentration, which may lead to
breakthrough seizures.
---
Question 4
Case Scenario: A 75‑year‑old female with insomnia is prescribed a
low‑dose, long‑acting benzodiazepine.
Question: Which age‑related physiological change most contributes to
prolonged drug half‑life in this patient?
- A) Reduced cardiac output
- B) Increased adipose tissue
- C) Increased plasma volume
- D) Enhanced first‑pass metabolism
Correct ANS: B
Rationale: With aging, an increased proportion of adipose tissue
provides a larger reservoir for lipophilic drugs (e.g., benzodiazepines),
3
, prolonging their half‑life and increasing the risk of accumulation and
adverse effects.
---
Question 5
Case Scenario: A 68‑year‑old man with chronic kidney disease is
prescribed a renally excreted antibiotic for pneumonia.
Question: Which principle should guide his medication management?
- A) Initiate drug therapy at standard doses regardless of renal function
- B) Adjust the dosage based on renal clearance measurements
- C) Use only parenteral routes to bypass hepatic metabolism
- D) Increase the dosing frequency to maintain therapeutic levels
Correct ANS: B
Rationale: In patients with reduced renal function, dose adjustments
based on measured renal clearance help avoid drug accumulation and
toxicity.
---
Question 6
Case Scenario: A 5‑year‑old child is being evaluated for an acute
infection. Compared to adults, pediatric patients demonstrate
differences in drug metabolism.
Question: Which statement best explains pediatric differences in drug
metabolism?
- A) Neonates and older children have uniformly reduced CYP enzyme
activity
- B) Infants generally have slower metabolism, but by age five,
increased liver size relative to body weight enhances drug clearance
- C) Pediatric patients eliminate drugs solely through renal pathways
- D) All drugs require the same dosing regimen across childhood and
adulthood
4
Advanced Pharmacology
Final Exam Review
(Questions & Solutions)
2025
1
, Question 1
Case Scenario: A 7‑day‑old preterm neonate with suspected sepsis is
prescribed gentamicin. Given the neonate’s physiology, which
pharmacokinetic factor most increases the risk of toxicity in this age
group?
- A) Increased gastrointestinal motility
- B) Reduced glomerular filtration rate
- C) Enhanced protein binding
- D) Faster hepatic metabolism
Correct ANS: B
Rationale: Neonates have immature renal function, including a reduced
glomerular filtration rate, which decreases gentamicin clearance and
heightens the risk of toxicity.
---
Question 2
Case Scenario: A 4‑year‑old child is started on valproic acid for seizure
control. Compared with adults, pediatric patients often require dosing
adjustments.
Question: Which pharmacokinetic property in children generally
necessitates a higher mg/kg dosing of medications like valproic acid?
- A) Decreased metabolic clearance
- B) Lower distribution volume
- C) Increased hepatic enzyme activity relative to body weight
- D) Reduced renal excretion
Correct ANS: C
Rationale: Children often have a relatively higher metabolic rate and
increased hepatic enzyme activity per kilogram body weight, leading to
faster clearance of drugs and the need for proportionally higher dose-
per-weight regimens.
2
,---
Question 3
Case Scenario: A 30‑year‑old pregnant woman with epilepsy maintained
on lamotrigine experiences a breakthrough seizure during her second
trimester.
Question: Which pharmacokinetic change during pregnancy is most
likely responsible for the reduced plasma concentration of lamotrigine?
- A) Decreased renal clearance
- B) Increased plasma protein binding
- C) Upregulated hepatic metabolism (enzyme induction)
- D) Reduced gastrointestinal absorption
Correct ANS: C
Rationale: During pregnancy, estrogen‐mediated enzyme induction
upregulates hepatic metabolism, increasing lamotrigine clearance and
thereby lowering its plasma concentration, which may lead to
breakthrough seizures.
---
Question 4
Case Scenario: A 75‑year‑old female with insomnia is prescribed a
low‑dose, long‑acting benzodiazepine.
Question: Which age‑related physiological change most contributes to
prolonged drug half‑life in this patient?
- A) Reduced cardiac output
- B) Increased adipose tissue
- C) Increased plasma volume
- D) Enhanced first‑pass metabolism
Correct ANS: B
Rationale: With aging, an increased proportion of adipose tissue
provides a larger reservoir for lipophilic drugs (e.g., benzodiazepines),
3
, prolonging their half‑life and increasing the risk of accumulation and
adverse effects.
---
Question 5
Case Scenario: A 68‑year‑old man with chronic kidney disease is
prescribed a renally excreted antibiotic for pneumonia.
Question: Which principle should guide his medication management?
- A) Initiate drug therapy at standard doses regardless of renal function
- B) Adjust the dosage based on renal clearance measurements
- C) Use only parenteral routes to bypass hepatic metabolism
- D) Increase the dosing frequency to maintain therapeutic levels
Correct ANS: B
Rationale: In patients with reduced renal function, dose adjustments
based on measured renal clearance help avoid drug accumulation and
toxicity.
---
Question 6
Case Scenario: A 5‑year‑old child is being evaluated for an acute
infection. Compared to adults, pediatric patients demonstrate
differences in drug metabolism.
Question: Which statement best explains pediatric differences in drug
metabolism?
- A) Neonates and older children have uniformly reduced CYP enzyme
activity
- B) Infants generally have slower metabolism, but by age five,
increased liver size relative to body weight enhances drug clearance
- C) Pediatric patients eliminate drugs solely through renal pathways
- D) All drugs require the same dosing regimen across childhood and
adulthood
4
