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FITZGERALD PHARMACOLOGY MIDTERM
EXAM
2026-2027 | COMPLETE PRACTICE
QUESTION BANK
250+ QUESTIONS WITH VERIFIED
ANSWERS & DETAILED RATIONALES
# SECTION I: PHARMACOKINETICS
## A. Absorption
**QUESTION 1**
When considering the movement of drugs throughout the body, the most common form of drug
absorption is via:
A. Active transport
B. Facilitated transfer
C. Passive diffusion
D. Creation of a pH gradient
**Correct Answer: C. Passive diffusion**
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**Rationale:** Passive diffusion is the most common mechanism of drug absorption across
biological membranes. Drugs move from an area of higher concentration (e.g., GI lumen) to
lower concentration (bloodstream) without requiring energy expenditure. This process is driven
by the concentration gradient and is influenced by the drug's lipid solubility, molecular size, and
degree of ionization. Active transport and facilitated transfer require carrier proteins and energy,
while pH gradient creation affects ionization but does not directly drive absorption.
---
**QUESTION 2**
A drug with a pKa of 4.5 is administered orally. In the stomach (pH 1.5), the drug will primarily
exist in which form?
A. Ionized form
B. Non-ionized (uncharged) form
C. Equally ionized and non-ionized
D. Precipitated form
**Correct Answer: B. Non-ionized (uncharged) form**
**Rationale:** According to the Henderson-Hasselbalch equation, for a weak acid (pKa 4.5) in
an acidic environment (pH 1.5), the drug will primarily exist in its non-ionized (uncharged) form.
The non-ionized form is more lipophilic and can readily cross lipid membranes, facilitating
absorption in the stomach. When the pH is less than the pKa, weak acids are predominantly non-
ionized. This principle is fundamental to understanding drug absorption in different parts of the
GI tract.
---
**QUESTION 3**
Which of the following factors would DECREASE oral drug absorption?
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A. Increased GI blood flow
B. Large surface area of the small intestine
C. Presence of food that slows gastric emptying
D. Administration with a high-fat meal for a lipophilic drug
**Correct Answer: C. Presence of food that slows gastric emptying**
**Rationale:** Delayed gastric emptying generally decreases the rate of drug absorption,
although it may increase the extent of absorption for some drugs. Increased GI blood flow
enhances absorption by maintaining a concentration gradient. The large surface area of the small
intestine maximizes absorption. A high-fat meal can actually enhance absorption of lipophilic
drugs by increasing bile secretion and lymphatic transport.
---
**QUESTION 4**
A patient is prescribed a medication that undergoes extensive first-pass metabolism. Which route
of administration would BEST bypass this effect?
A. Oral
B. Sublingual
C. Rectal
D. Enteric-coated oral
**Correct Answer: B. Sublingual**
**Rationale:** Sublingual administration allows the drug to be absorbed directly into the
systemic circulation through the highly vascularized sublingual mucosa, bypassing the portal
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circulation and thus avoiding first-pass metabolism by the liver. Oral and enteric-coated oral
routes both subject the drug to first-pass metabolism. Rectal administration partially bypasses
first-pass metabolism but not completely, as some blood from the lower rectum drains into the
systemic circulation while the upper rectum drains into the portal system.
---
**QUESTION 5**
Which statement about drug absorption in the elderly is CORRECT?
A. Gastric pH decreases with age, enhancing absorption of weak acids
B. Gastric emptying slows with age, potentially delaying drug absorption
C. GI blood flow increases with age, enhancing absorption
D. Intestinal surface area increases with age
**Correct Answer: B. Gastric emptying slows with age, potentially delaying drug absorption**
**Rationale:** In the elderly, gastric emptying time is prolonged, which can delay the
absorption of orally administered drugs. Gastric pH actually increases (becomes less acidic) with
age due to decreased acid secretion. GI blood flow decreases with age, and intestinal surface area
does not increase. These age-related changes contribute to altered pharmacokinetics in older
adults.
---
**QUESTION 6**
A drug that is a weak base (pKa 8.5) is administered orally. Where in the GI tract will it be
MOST extensively absorbed?
A. Stomach (pH 1.5)
FITZGERALD PHARMACOLOGY MIDTERM
EXAM
2026-2027 | COMPLETE PRACTICE
QUESTION BANK
250+ QUESTIONS WITH VERIFIED
ANSWERS & DETAILED RATIONALES
# SECTION I: PHARMACOKINETICS
## A. Absorption
**QUESTION 1**
When considering the movement of drugs throughout the body, the most common form of drug
absorption is via:
A. Active transport
B. Facilitated transfer
C. Passive diffusion
D. Creation of a pH gradient
**Correct Answer: C. Passive diffusion**
,Page 2 of 171
**Rationale:** Passive diffusion is the most common mechanism of drug absorption across
biological membranes. Drugs move from an area of higher concentration (e.g., GI lumen) to
lower concentration (bloodstream) without requiring energy expenditure. This process is driven
by the concentration gradient and is influenced by the drug's lipid solubility, molecular size, and
degree of ionization. Active transport and facilitated transfer require carrier proteins and energy,
while pH gradient creation affects ionization but does not directly drive absorption.
---
**QUESTION 2**
A drug with a pKa of 4.5 is administered orally. In the stomach (pH 1.5), the drug will primarily
exist in which form?
A. Ionized form
B. Non-ionized (uncharged) form
C. Equally ionized and non-ionized
D. Precipitated form
**Correct Answer: B. Non-ionized (uncharged) form**
**Rationale:** According to the Henderson-Hasselbalch equation, for a weak acid (pKa 4.5) in
an acidic environment (pH 1.5), the drug will primarily exist in its non-ionized (uncharged) form.
The non-ionized form is more lipophilic and can readily cross lipid membranes, facilitating
absorption in the stomach. When the pH is less than the pKa, weak acids are predominantly non-
ionized. This principle is fundamental to understanding drug absorption in different parts of the
GI tract.
---
**QUESTION 3**
Which of the following factors would DECREASE oral drug absorption?
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A. Increased GI blood flow
B. Large surface area of the small intestine
C. Presence of food that slows gastric emptying
D. Administration with a high-fat meal for a lipophilic drug
**Correct Answer: C. Presence of food that slows gastric emptying**
**Rationale:** Delayed gastric emptying generally decreases the rate of drug absorption,
although it may increase the extent of absorption for some drugs. Increased GI blood flow
enhances absorption by maintaining a concentration gradient. The large surface area of the small
intestine maximizes absorption. A high-fat meal can actually enhance absorption of lipophilic
drugs by increasing bile secretion and lymphatic transport.
---
**QUESTION 4**
A patient is prescribed a medication that undergoes extensive first-pass metabolism. Which route
of administration would BEST bypass this effect?
A. Oral
B. Sublingual
C. Rectal
D. Enteric-coated oral
**Correct Answer: B. Sublingual**
**Rationale:** Sublingual administration allows the drug to be absorbed directly into the
systemic circulation through the highly vascularized sublingual mucosa, bypassing the portal
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circulation and thus avoiding first-pass metabolism by the liver. Oral and enteric-coated oral
routes both subject the drug to first-pass metabolism. Rectal administration partially bypasses
first-pass metabolism but not completely, as some blood from the lower rectum drains into the
systemic circulation while the upper rectum drains into the portal system.
---
**QUESTION 5**
Which statement about drug absorption in the elderly is CORRECT?
A. Gastric pH decreases with age, enhancing absorption of weak acids
B. Gastric emptying slows with age, potentially delaying drug absorption
C. GI blood flow increases with age, enhancing absorption
D. Intestinal surface area increases with age
**Correct Answer: B. Gastric emptying slows with age, potentially delaying drug absorption**
**Rationale:** In the elderly, gastric emptying time is prolonged, which can delay the
absorption of orally administered drugs. Gastric pH actually increases (becomes less acidic) with
age due to decreased acid secretion. GI blood flow decreases with age, and intestinal surface area
does not increase. These age-related changes contribute to altered pharmacokinetics in older
adults.
---
**QUESTION 6**
A drug that is a weak base (pKa 8.5) is administered orally. Where in the GI tract will it be
MOST extensively absorbed?
A. Stomach (pH 1.5)
