ADVANCED PRACTICE
PHARMACOTHERAPEUTICS 2026 STUDY GUIDE
FULL CHAPTER LEARNING OUTLINE &
PRACTICE REVIEW | LATEST COURSE VERSION
Below are 100 exam-style questions and answers covering:
Clinical decision-making, pharmacokinetics, pharmacodynamics, drug classes, advanced
prescriptive reasoning, special populations, safety, guidelines, and therapeutic management
across systems.
Each question is short, targeted, and aligned with graduate-level NP/APRN pharmacology
expectations.
100 QUESTIONS & ANSWERS
(Correct Answer Marked With )
1–10: Pharmacokinetics & Pharmacodynamics
1. Which factor most directly influences the bioavailability of an oral medication?
A. Renal perfusion
B. Hepatic first-pass metabolism
C. Protein binding
D. Drug half-life
2. A drug with high protein binding will have which characteristic?
A. Increased free active drug
B. Increased risk of drug displacement interactions
C. Shorter duration of action
D. Minimal effect on dosing
3. What does the volume of distribution (Vd) primarily indicate?
A. Rate of renal clearance
,B. Extent to which a drug distributes into tissues
C. Drug receptor affinity
D. First-pass metabolism
4. Which route avoids first-pass metabolism entirely?
A. Oral
B. Sublingual
C. Enteric-coated
D. Rectal
5. Steady-state concentration is typically achieved after how many half-lives?
A. 1–2
B. 2–3
C. 4–5
D. 8–12
6. What is the primary determinant of drug clearance?
A. GI pH
B. Hepatic and renal function
C. Volume of distribution
D. Blood pressure
7. What is the therapeutic index?
A. Drug cost ratio
B. Safety ratio between toxic and therapeutic dose
C. Ratio of bound to unbound drug
D. Absorption rate
8. Tachyphylaxis describes what phenomenon?
A. First-dose hypersensitivity
B. Rapid drug tolerance with repeated dosing
C. Drug accumulation
D. Idiosyncratic reactions
9. A competitive antagonist works by:
A. Irreversibly altering receptors
B. Binding to receptor sites and blocking agonists
C. Enhancing neurotransmitter release
D. Lowering therapeutic index
, 10. Which factor slows GI drug absorption?
A. Rapid peristalsis
B. High gastric acidity
C. High drug lipid solubility
D. Food delay elimination
11–20: Prescriptive Authority & Safety
11. What should be assessed before prescribing a high-risk medication?
A. Insurance coverage
B. Patient literacy
C. Baseline labs and organ function
D. Pharmacy availability
12. Which schedule drug has the highest abuse potential?
A. Schedule IV
B. Schedule V
C. Schedule III
D. Schedule II
13. Black box warnings indicate:
A. Mild adverse effects
B. Off-label usage
C. Potential for severe or life-threatening effects
D. Drug interactions only
14. When prescribing opioids, the NP must first:
A. Select long-acting agents
B. Review substance-use history
C. Avoid all NSAIDs
D. Prescribe naloxone automatically
15. Which population requires lowest starting doses?
A. Middle-aged adults
B. Adolescents
C. Older adults
D. Pregnant adults
PHARMACOTHERAPEUTICS 2026 STUDY GUIDE
FULL CHAPTER LEARNING OUTLINE &
PRACTICE REVIEW | LATEST COURSE VERSION
Below are 100 exam-style questions and answers covering:
Clinical decision-making, pharmacokinetics, pharmacodynamics, drug classes, advanced
prescriptive reasoning, special populations, safety, guidelines, and therapeutic management
across systems.
Each question is short, targeted, and aligned with graduate-level NP/APRN pharmacology
expectations.
100 QUESTIONS & ANSWERS
(Correct Answer Marked With )
1–10: Pharmacokinetics & Pharmacodynamics
1. Which factor most directly influences the bioavailability of an oral medication?
A. Renal perfusion
B. Hepatic first-pass metabolism
C. Protein binding
D. Drug half-life
2. A drug with high protein binding will have which characteristic?
A. Increased free active drug
B. Increased risk of drug displacement interactions
C. Shorter duration of action
D. Minimal effect on dosing
3. What does the volume of distribution (Vd) primarily indicate?
A. Rate of renal clearance
,B. Extent to which a drug distributes into tissues
C. Drug receptor affinity
D. First-pass metabolism
4. Which route avoids first-pass metabolism entirely?
A. Oral
B. Sublingual
C. Enteric-coated
D. Rectal
5. Steady-state concentration is typically achieved after how many half-lives?
A. 1–2
B. 2–3
C. 4–5
D. 8–12
6. What is the primary determinant of drug clearance?
A. GI pH
B. Hepatic and renal function
C. Volume of distribution
D. Blood pressure
7. What is the therapeutic index?
A. Drug cost ratio
B. Safety ratio between toxic and therapeutic dose
C. Ratio of bound to unbound drug
D. Absorption rate
8. Tachyphylaxis describes what phenomenon?
A. First-dose hypersensitivity
B. Rapid drug tolerance with repeated dosing
C. Drug accumulation
D. Idiosyncratic reactions
9. A competitive antagonist works by:
A. Irreversibly altering receptors
B. Binding to receptor sites and blocking agonists
C. Enhancing neurotransmitter release
D. Lowering therapeutic index
, 10. Which factor slows GI drug absorption?
A. Rapid peristalsis
B. High gastric acidity
C. High drug lipid solubility
D. Food delay elimination
11–20: Prescriptive Authority & Safety
11. What should be assessed before prescribing a high-risk medication?
A. Insurance coverage
B. Patient literacy
C. Baseline labs and organ function
D. Pharmacy availability
12. Which schedule drug has the highest abuse potential?
A. Schedule IV
B. Schedule V
C. Schedule III
D. Schedule II
13. Black box warnings indicate:
A. Mild adverse effects
B. Off-label usage
C. Potential for severe or life-threatening effects
D. Drug interactions only
14. When prescribing opioids, the NP must first:
A. Select long-acting agents
B. Review substance-use history
C. Avoid all NSAIDs
D. Prescribe naloxone automatically
15. Which population requires lowest starting doses?
A. Middle-aged adults
B. Adolescents
C. Older adults
D. Pregnant adults
