D116 NURS 6800
Advanced Pharmacology for the Advanced
Practice Nurse
Objective Assessments
2025 Versions
(With Solutions)
Multiple Choice Questions (MCQ)
A 65-year-old patient with chronic kidney disease (stage 3) is
prescribed digoxin for atrial fibrillation. Which pharmacokinetic
alteration is most important to consider?
A) Increased hepatic metabolism
B) Decreased renal clearance
C) Increased protein binding
D) Increased volume of distribution
ANS: B) Decreased renal clearance
Rationale: Digoxin is primarily eliminated renally. Impaired kidney
function reduces clearance and increases the risk of toxicity,
requiring dose adjustment.
Which mechanism best explains why selective serotonin reuptake
inhibitors (SSRIs) require several weeks to achieve therapeutic
effects despite rapid serotonin reuptake inhibition?
A) Immediate neurotransmitter depletion
B) Downregulation of postsynaptic serotonin receptors
C) Upregulation of presynaptic autoreceptors leading to delayed
neurotransmitter release
D) Rapid desensitization of serotonin transporters
ANS: C) Upregulation of presynaptic autoreceptors leading to
delayed neurotransmitter release
Rationale: SSRIs initially increase serotonin in the synapse but also
activate 5-HT1A autoreceptors, which reduce serotonin release
temporarily until receptor desensitization occurs.
An advanced practice nurse prescribes warfarin for a patient with a
history of deep vein thrombosis. Which genetic factor most
significantly impacts warfarin dosing?
,A) CYP2C19 polymorphism
B) VKORC1 gene polymorphism
C) NAT2 acetylator status
D) CYP3A4 induction
ANS: B) VKORC1 gene polymorphism
Rationale: Variants in VKORC1 affect warfarin sensitivity by altering
vitamin K epoxide reductase activity, critically influencing dosing
requirements.
Which antibiotic class carries the highest risk of causing QT
prolongation in patients?
A) Beta-lactams
B) Macrolides
C) Tetracyclines
D) Aminoglycosides
ANS: B) Macrolides
Rationale: Macrolides, such as erythromycin, can block cardiac
potassium channels involved in repolarization, increasing QT interval
duration and risk of torsades de pointes.
In managing pain via the opioid receptor system, which receptor
subtype is primarily responsible for supraspinal analgesia and
sedation?
A) Delta (δ) receptors
B) Kappa (κ) receptors
C) Mu (μ) receptors
D) Sigma (σ) receptors
ANS: C) Mu (μ) receptors
Rationale: Mu receptors mediate analgesia, euphoria, respiratory
depression, and sedation; they are the primary target for most
opioids.
Fill-in-the-Blank Questions
The primary enzyme responsible for the metabolism of
acetaminophen to its toxic metabolite NAPQI is ____.
ANS: CYP2E1
Rationale: CYP2E1 metabolizes acetaminophen via oxidative
pathways, producing NAPQI, which in excessive amounts causes
hepatotoxicity.
The antidote used to reverse benzodiazepine overdose is ____.
ANS: Flumazenil
Rationale: Flumazenil acts as a competitive antagonist at the
benzodiazepine receptor to reverse sedative effects.
,In pharmacodynamics, the ____ of a drug refers to the concentration
required to produce 50% of its maximal effect.
ANS: EC50 (Effective concentration 50%)
Rationale: EC50 is a standard measure of a drug's potency.
When a drug exhibits a narrow therapeutic index, there is a high risk
of ____.
ANS: toxicity
Rationale: Narrow therapeutic index means the effective dose is
close to the toxic dose.
The process by which the liver chemically modifies a drug to increase
its water solubility is known as ____.
ANS: biotransformation (or metabolism)
Rationale: Biotransformation facilitates drug elimination by
converting lipophilic compounds to more hydrophilic metabolites.
True/False Questions
True or False: Grapefruit juice can inhibit CYP3A4 enzymes,
potentially increasing the plasma concentration of many
medications metabolized by this pathway.
ANS: True
Rationale: Grapefruit juice contains compounds that inhibit
intestinal CYP3A4, leading to higher systemic drug levels and risk of
toxicity.
True or False: Loop diuretics primarily act on the distal convoluted
tubule to inhibit sodium reabsorption.
ANS: False
Rationale: Loop diuretics act on the thick ascending limb of the loop
of Henle, not on the distal tubule.
True or False: Phase I reactions of drug metabolism typically involve
conjugation to increase water solubility.
ANS: False
Rationale: Phase I reactions involve oxidation, reduction, or
hydrolysis, while conjugation (Phase II) mainly increases solubility.
True or False: The volume of distribution (Vd) indicates the extent to
which a drug distributes into body tissues relative to plasma.
ANS: True
Rationale: Vd reflects how extensively a drug disperses throughout
body compartments beyond the bloodstream.
, True or False: Nonsteroidal anti-inflammatory drugs (NSAIDs)
selectively inhibit COX-2 to spare gastrointestinal mucosa.
ANS: False
Rationale: Nonselective NSAIDs inhibit both COX-1 and COX-2, with
COX-1 inhibition linked to GI toxicity; selective COX-2 inhibitors are
designed to reduce this risk.
Multiple Response Questions
Which of the following drugs are metabolized primarily by CYP450
enzymes? (Select all that apply)
A) Warfarin
B) Metformin
C) Diazepam
D) Lithium
E) Theophylline
ANS: A) Warfarin, C) Diazepam, E) Theophylline
Rationale: Warfarin, diazepam, and theophylline are metabolized by
CYP450 enzymes, unlike metformin and lithium, which are primarily
excreted renally unchanged.
Common adverse effects associated with corticosteroid therapy
include: (Select all that apply)
A) Hyperglycemia
B) Osteoporosis
C) Bradycardia
D) Immunosuppression
E) Hypotension
ANS: A) Hyperglycemia, B) Osteoporosis, D) Immunosuppression
Rationale: Corticosteroids can increase blood glucose, reduce bone
density, and suppress immune function; cardiovascular effects tend
to include hypertension rather than bradycardia or hypotension.
Which of the following drugs are classified as beta-lactam
antibiotics? (Select all that apply)
A) Amoxicillin
B) Vancomycin
C) Ceftriaxone
D) Azithromycin
E) Piperacillin
ANS: A) Amoxicillin, C) Ceftriaxone, E) Piperacillin
Rationale: Beta-lactam antibiotics include penicillins and
cephalosporins; vancomycin and azithromycin are not beta-lactams.
Advanced Pharmacology for the Advanced
Practice Nurse
Objective Assessments
2025 Versions
(With Solutions)
Multiple Choice Questions (MCQ)
A 65-year-old patient with chronic kidney disease (stage 3) is
prescribed digoxin for atrial fibrillation. Which pharmacokinetic
alteration is most important to consider?
A) Increased hepatic metabolism
B) Decreased renal clearance
C) Increased protein binding
D) Increased volume of distribution
ANS: B) Decreased renal clearance
Rationale: Digoxin is primarily eliminated renally. Impaired kidney
function reduces clearance and increases the risk of toxicity,
requiring dose adjustment.
Which mechanism best explains why selective serotonin reuptake
inhibitors (SSRIs) require several weeks to achieve therapeutic
effects despite rapid serotonin reuptake inhibition?
A) Immediate neurotransmitter depletion
B) Downregulation of postsynaptic serotonin receptors
C) Upregulation of presynaptic autoreceptors leading to delayed
neurotransmitter release
D) Rapid desensitization of serotonin transporters
ANS: C) Upregulation of presynaptic autoreceptors leading to
delayed neurotransmitter release
Rationale: SSRIs initially increase serotonin in the synapse but also
activate 5-HT1A autoreceptors, which reduce serotonin release
temporarily until receptor desensitization occurs.
An advanced practice nurse prescribes warfarin for a patient with a
history of deep vein thrombosis. Which genetic factor most
significantly impacts warfarin dosing?
,A) CYP2C19 polymorphism
B) VKORC1 gene polymorphism
C) NAT2 acetylator status
D) CYP3A4 induction
ANS: B) VKORC1 gene polymorphism
Rationale: Variants in VKORC1 affect warfarin sensitivity by altering
vitamin K epoxide reductase activity, critically influencing dosing
requirements.
Which antibiotic class carries the highest risk of causing QT
prolongation in patients?
A) Beta-lactams
B) Macrolides
C) Tetracyclines
D) Aminoglycosides
ANS: B) Macrolides
Rationale: Macrolides, such as erythromycin, can block cardiac
potassium channels involved in repolarization, increasing QT interval
duration and risk of torsades de pointes.
In managing pain via the opioid receptor system, which receptor
subtype is primarily responsible for supraspinal analgesia and
sedation?
A) Delta (δ) receptors
B) Kappa (κ) receptors
C) Mu (μ) receptors
D) Sigma (σ) receptors
ANS: C) Mu (μ) receptors
Rationale: Mu receptors mediate analgesia, euphoria, respiratory
depression, and sedation; they are the primary target for most
opioids.
Fill-in-the-Blank Questions
The primary enzyme responsible for the metabolism of
acetaminophen to its toxic metabolite NAPQI is ____.
ANS: CYP2E1
Rationale: CYP2E1 metabolizes acetaminophen via oxidative
pathways, producing NAPQI, which in excessive amounts causes
hepatotoxicity.
The antidote used to reverse benzodiazepine overdose is ____.
ANS: Flumazenil
Rationale: Flumazenil acts as a competitive antagonist at the
benzodiazepine receptor to reverse sedative effects.
,In pharmacodynamics, the ____ of a drug refers to the concentration
required to produce 50% of its maximal effect.
ANS: EC50 (Effective concentration 50%)
Rationale: EC50 is a standard measure of a drug's potency.
When a drug exhibits a narrow therapeutic index, there is a high risk
of ____.
ANS: toxicity
Rationale: Narrow therapeutic index means the effective dose is
close to the toxic dose.
The process by which the liver chemically modifies a drug to increase
its water solubility is known as ____.
ANS: biotransformation (or metabolism)
Rationale: Biotransformation facilitates drug elimination by
converting lipophilic compounds to more hydrophilic metabolites.
True/False Questions
True or False: Grapefruit juice can inhibit CYP3A4 enzymes,
potentially increasing the plasma concentration of many
medications metabolized by this pathway.
ANS: True
Rationale: Grapefruit juice contains compounds that inhibit
intestinal CYP3A4, leading to higher systemic drug levels and risk of
toxicity.
True or False: Loop diuretics primarily act on the distal convoluted
tubule to inhibit sodium reabsorption.
ANS: False
Rationale: Loop diuretics act on the thick ascending limb of the loop
of Henle, not on the distal tubule.
True or False: Phase I reactions of drug metabolism typically involve
conjugation to increase water solubility.
ANS: False
Rationale: Phase I reactions involve oxidation, reduction, or
hydrolysis, while conjugation (Phase II) mainly increases solubility.
True or False: The volume of distribution (Vd) indicates the extent to
which a drug distributes into body tissues relative to plasma.
ANS: True
Rationale: Vd reflects how extensively a drug disperses throughout
body compartments beyond the bloodstream.
, True or False: Nonsteroidal anti-inflammatory drugs (NSAIDs)
selectively inhibit COX-2 to spare gastrointestinal mucosa.
ANS: False
Rationale: Nonselective NSAIDs inhibit both COX-1 and COX-2, with
COX-1 inhibition linked to GI toxicity; selective COX-2 inhibitors are
designed to reduce this risk.
Multiple Response Questions
Which of the following drugs are metabolized primarily by CYP450
enzymes? (Select all that apply)
A) Warfarin
B) Metformin
C) Diazepam
D) Lithium
E) Theophylline
ANS: A) Warfarin, C) Diazepam, E) Theophylline
Rationale: Warfarin, diazepam, and theophylline are metabolized by
CYP450 enzymes, unlike metformin and lithium, which are primarily
excreted renally unchanged.
Common adverse effects associated with corticosteroid therapy
include: (Select all that apply)
A) Hyperglycemia
B) Osteoporosis
C) Bradycardia
D) Immunosuppression
E) Hypotension
ANS: A) Hyperglycemia, B) Osteoporosis, D) Immunosuppression
Rationale: Corticosteroids can increase blood glucose, reduce bone
density, and suppress immune function; cardiovascular effects tend
to include hypertension rather than bradycardia or hypotension.
Which of the following drugs are classified as beta-lactam
antibiotics? (Select all that apply)
A) Amoxicillin
B) Vancomycin
C) Ceftriaxone
D) Azithromycin
E) Piperacillin
ANS: A) Amoxicillin, C) Ceftriaxone, E) Piperacillin
Rationale: Beta-lactam antibiotics include penicillins and
cephalosporins; vancomycin and azithromycin are not beta-lactams.
