NUR100
Pharmacology
Latest Midterm Exam Review
2025
Multiple Choice Questions (MCQ)
A patient with a history of chronic kidney disease is prescribed digoxin. Which pharmacokinetic change is most likely to
affect dosing?
a) Increased hepatic metabolism
b) Decreased renal clearance
c) Increased plasma protein binding
d) Decreased intestinal absorption
Answer: b
Rationale: Digoxin is primarily eliminated renally; reduced kidney function decreases clearance, increasing toxicity risk.
A 65-year-old patient taking warfarin is started on trimethoprim-sulfamethoxazole. What is the primary concern?
a) Induction of CYP3A4 enzymes leading to decreased warfarin levels
b) Trimethoprim potentiates warfarin anticoagulant effect by inhibiting CYP2C9
c) Reduced absorption of warfarin due to competition for transport
d) No significant interaction
Answer: b
Rationale: Trimethoprim inhibits CYP2C9, reducing warfarin metabolism and increasing bleeding risk.
Which receptor subtype mediates the therapeutic bronchodilation effect of beta-2 agonists?
a) Beta-1 adrenergic receptors
b) Beta-2 adrenergic receptors
c) Alpha-1 adrenergic receptors
d) Muscarinic M3 receptors
Answer: b
Rationale: Beta-2 receptors on bronchial smooth muscle cause relaxation when stimulated.
Which phase of drug metabolism is responsible for adding polar groups to a molecule?
a) Phase 0
b) Phase 1
c) Phase 2
d) Phase 3
Answer: b
Rationale: Phase 1 metabolism (e.g. oxidation) introduces polar groups to enhance drug solubility.
A nurse administering a catecholamine notices extravasation at the IV site. Which antidote should be prepared?
a) Phentolamine
b) Naloxone
c) Atropine
,d) Flumazenil
Answer: a
Rationale: Phentolamine, an alpha-blocker, reverses vasoconstriction caused by norepinephrine extravasation.
True/False Questions (T/F)
Activation of the parasympathetic nervous system typically results in increased heart rate.
Answer: False
Rationale: Parasympathetic activation via vagus nerve decreases heart rate.
The volume of distribution directly correlates with plasma drug concentration.
Answer: False
Rationale: Volume of distribution inversely relates to plasma concentration; higher Vd means more drug in tissues, less in
plasma.
CYP450 enzymes are primarily located in the smooth endoplasmic reticulum of hepatocytes.
Answer: True
Rationale: CYP450 enzymes reside in smooth ER responsible for Phase 1 metabolism.
A prodrug requires metabolic activation to become pharmacologically active.
Answer: True
Rationale: Prodrugs are inactive until converted by metabolism, often by liver enzymes.
NSAIDs primarily inhibit the COX-2 enzyme to reduce inflammation and pain.
Answer: False
Rationale: Traditional NSAIDs inhibit both COX-1 and COX-2; COX-1 inhibition causes side effects like GI bleeding.
Short Answer Questions (SA)
Describe the mechanism of action of selective serotonin reuptake inhibitors (SSRIs).
Answer: SSRIs block the serotonin transporter (SERT), preventing reuptake of serotonin into presynaptic neurons, thereby
increasing serotonin concentration in the synaptic cleft.
Rationale: This enhanced serotonin signaling improves mood regulation.
List two pharmacodynamic factors that can alter drug response in elderly patients.
Answer: Reduced receptor sensitivity and altered homeostatic mechanisms.
Rationale: Age-related changes can lead to exaggerated or diminished drug effects.
What is the primary reason for monitoring plasma levels of aminoglycosides?
Answer: To avoid nephrotoxicity and ototoxicity by maintaining therapeutic but non-toxic concentrations.
Rationale: Aminoglycosides have a narrow therapeutic window.
Explain how first-pass metabolism affects oral bioavailability.
Answer: Drugs absorbed from the gut travel through the portal vein to the liver, where enzymes metabolize part of the dose
before reaching systemic circulation, reducing bioavailability.
Rationale: This can significantly reduce the active drug amount entering circulation.
Name one example of a drug that exhibits zero-order kinetics.
Answer: Phenytoin or ethanol.
Rationale: In zero-order kinetics, the rate of elimination is constant regardless of concentration.
Matching Questions (M)
,Match the drug class to their primary adverse effect.
16-20:
a) ACE inhibitors
b) Beta-blockers
c) Loop diuretics
d) Statins
e) Anticholinergics
Adverse effects:
Bradycardia
Dry cough
Muscle pain (myopathy)
Hypokalemia
Urinary retention
Answers:
16 - b - 1
17 - a - 2
18 - d - 3
19 - c - 4
20 - e - 5
Rationale: Each drug class has known characteristic side effects crucial for nursing consideration.
Fill in the Blank (FIB)
The _____________ receptor is the primary target of benzodiazepines to exert their anxiolytic and sedative effects.
Answer: GABA-A
Rationale: Benzodiazepines enhance GABA-A receptor function increasing inhibitory neurotransmission.
The antidote for acetaminophen overdose is _____________.
Answer: N-acetylcysteine
Rationale: It replenishes glutathione to detoxify toxic metabolites.
Bioavailability is defined as the fraction of the administered dose that reaches the __________ in an active form.
Answer: systemic circulation
Rationale: This measurement indicates how much active drug reaches systemic circulation.
A drug’s half-life is the time required for its plasma concentration to decrease by ________ percent.
Answer: 50
Rationale: Half-life is the time to reduce concentration to half.
The primary site of drug absorption in the gastrointestinal tract is the __________.
Answer: small intestine
Rationale: Large surface area and rich blood supply make it the main absorption site.
More Multiple Choice (MCQ)
Which of the following is an example of a pharmacodynamic drug interaction?
a) Competition for plasma protein binding sites
b) Enzyme induction altering drug metabolism
, c) Potentiation of anticoagulant effect by aspirin and warfarin
d) Reduced absorption of tetracycline with dairy products
Answer: c
Rationale: Pharmacodynamic interactions involve additive or antagonistic effects at the receptor or physiological level.
The primary effect of H1 histamine receptor antagonists is to:
a) Reduce gastric acid secretion
b) Relieve allergic symptoms
c) Induce sedation via H2 receptor blockade
d) Promote bronchoconstriction
Answer: b
Rationale: H1 antagonists block histamine-mediated allergic responses.
Which electrolyte imbalance is most commonly associated with thiazide diuretics?
a) Hyperkalemia
b) Hyponatremia
c) Hypercalcemia
d) Hypomagnesemia
Answer: b
Rationale: Thiazides promote sodium and water loss, causing hyponatremia.
A patient receiving morphine develops respiratory depression. Which receptor mediates this adverse effect?
a) Kappa opioid receptor
b) Mu opioid receptor
c) Delta opioid receptor
d) NMDA receptor
Answer: b
Rationale: Mu receptors mediate analgesia and respiratory depression.
Which parameter best reflects the drug’s ability to cross the blood-brain barrier?
a) Molecular size
b) Water solubility
c) Lipid solubility
d) Plasma protein binding
Answer: c
Rationale: Lipophilic drugs cross BBB more readily.
True/False (T/F)
Drugs with high intrinsic activity produce maximal receptor activation even at low receptor occupancy.
Answer: True
Rationale: Intrinsic activity relates to the efficacy of receptor activation.
An agonist with competitive antagonism can be overcome by increasing the agonist concentration.
Answer: True
Rationale: Competitive antagonists bind reversibly and can be outcompeted.
The clearance of a drug is unaffected by changes in liver blood flow when metabolism is capacity-limited.
Answer: True
Rationale: Capacity-limited metabolism depends on enzyme levels, not blood flow.
Pharmacology
Latest Midterm Exam Review
2025
Multiple Choice Questions (MCQ)
A patient with a history of chronic kidney disease is prescribed digoxin. Which pharmacokinetic change is most likely to
affect dosing?
a) Increased hepatic metabolism
b) Decreased renal clearance
c) Increased plasma protein binding
d) Decreased intestinal absorption
Answer: b
Rationale: Digoxin is primarily eliminated renally; reduced kidney function decreases clearance, increasing toxicity risk.
A 65-year-old patient taking warfarin is started on trimethoprim-sulfamethoxazole. What is the primary concern?
a) Induction of CYP3A4 enzymes leading to decreased warfarin levels
b) Trimethoprim potentiates warfarin anticoagulant effect by inhibiting CYP2C9
c) Reduced absorption of warfarin due to competition for transport
d) No significant interaction
Answer: b
Rationale: Trimethoprim inhibits CYP2C9, reducing warfarin metabolism and increasing bleeding risk.
Which receptor subtype mediates the therapeutic bronchodilation effect of beta-2 agonists?
a) Beta-1 adrenergic receptors
b) Beta-2 adrenergic receptors
c) Alpha-1 adrenergic receptors
d) Muscarinic M3 receptors
Answer: b
Rationale: Beta-2 receptors on bronchial smooth muscle cause relaxation when stimulated.
Which phase of drug metabolism is responsible for adding polar groups to a molecule?
a) Phase 0
b) Phase 1
c) Phase 2
d) Phase 3
Answer: b
Rationale: Phase 1 metabolism (e.g. oxidation) introduces polar groups to enhance drug solubility.
A nurse administering a catecholamine notices extravasation at the IV site. Which antidote should be prepared?
a) Phentolamine
b) Naloxone
c) Atropine
,d) Flumazenil
Answer: a
Rationale: Phentolamine, an alpha-blocker, reverses vasoconstriction caused by norepinephrine extravasation.
True/False Questions (T/F)
Activation of the parasympathetic nervous system typically results in increased heart rate.
Answer: False
Rationale: Parasympathetic activation via vagus nerve decreases heart rate.
The volume of distribution directly correlates with plasma drug concentration.
Answer: False
Rationale: Volume of distribution inversely relates to plasma concentration; higher Vd means more drug in tissues, less in
plasma.
CYP450 enzymes are primarily located in the smooth endoplasmic reticulum of hepatocytes.
Answer: True
Rationale: CYP450 enzymes reside in smooth ER responsible for Phase 1 metabolism.
A prodrug requires metabolic activation to become pharmacologically active.
Answer: True
Rationale: Prodrugs are inactive until converted by metabolism, often by liver enzymes.
NSAIDs primarily inhibit the COX-2 enzyme to reduce inflammation and pain.
Answer: False
Rationale: Traditional NSAIDs inhibit both COX-1 and COX-2; COX-1 inhibition causes side effects like GI bleeding.
Short Answer Questions (SA)
Describe the mechanism of action of selective serotonin reuptake inhibitors (SSRIs).
Answer: SSRIs block the serotonin transporter (SERT), preventing reuptake of serotonin into presynaptic neurons, thereby
increasing serotonin concentration in the synaptic cleft.
Rationale: This enhanced serotonin signaling improves mood regulation.
List two pharmacodynamic factors that can alter drug response in elderly patients.
Answer: Reduced receptor sensitivity and altered homeostatic mechanisms.
Rationale: Age-related changes can lead to exaggerated or diminished drug effects.
What is the primary reason for monitoring plasma levels of aminoglycosides?
Answer: To avoid nephrotoxicity and ototoxicity by maintaining therapeutic but non-toxic concentrations.
Rationale: Aminoglycosides have a narrow therapeutic window.
Explain how first-pass metabolism affects oral bioavailability.
Answer: Drugs absorbed from the gut travel through the portal vein to the liver, where enzymes metabolize part of the dose
before reaching systemic circulation, reducing bioavailability.
Rationale: This can significantly reduce the active drug amount entering circulation.
Name one example of a drug that exhibits zero-order kinetics.
Answer: Phenytoin or ethanol.
Rationale: In zero-order kinetics, the rate of elimination is constant regardless of concentration.
Matching Questions (M)
,Match the drug class to their primary adverse effect.
16-20:
a) ACE inhibitors
b) Beta-blockers
c) Loop diuretics
d) Statins
e) Anticholinergics
Adverse effects:
Bradycardia
Dry cough
Muscle pain (myopathy)
Hypokalemia
Urinary retention
Answers:
16 - b - 1
17 - a - 2
18 - d - 3
19 - c - 4
20 - e - 5
Rationale: Each drug class has known characteristic side effects crucial for nursing consideration.
Fill in the Blank (FIB)
The _____________ receptor is the primary target of benzodiazepines to exert their anxiolytic and sedative effects.
Answer: GABA-A
Rationale: Benzodiazepines enhance GABA-A receptor function increasing inhibitory neurotransmission.
The antidote for acetaminophen overdose is _____________.
Answer: N-acetylcysteine
Rationale: It replenishes glutathione to detoxify toxic metabolites.
Bioavailability is defined as the fraction of the administered dose that reaches the __________ in an active form.
Answer: systemic circulation
Rationale: This measurement indicates how much active drug reaches systemic circulation.
A drug’s half-life is the time required for its plasma concentration to decrease by ________ percent.
Answer: 50
Rationale: Half-life is the time to reduce concentration to half.
The primary site of drug absorption in the gastrointestinal tract is the __________.
Answer: small intestine
Rationale: Large surface area and rich blood supply make it the main absorption site.
More Multiple Choice (MCQ)
Which of the following is an example of a pharmacodynamic drug interaction?
a) Competition for plasma protein binding sites
b) Enzyme induction altering drug metabolism
, c) Potentiation of anticoagulant effect by aspirin and warfarin
d) Reduced absorption of tetracycline with dairy products
Answer: c
Rationale: Pharmacodynamic interactions involve additive or antagonistic effects at the receptor or physiological level.
The primary effect of H1 histamine receptor antagonists is to:
a) Reduce gastric acid secretion
b) Relieve allergic symptoms
c) Induce sedation via H2 receptor blockade
d) Promote bronchoconstriction
Answer: b
Rationale: H1 antagonists block histamine-mediated allergic responses.
Which electrolyte imbalance is most commonly associated with thiazide diuretics?
a) Hyperkalemia
b) Hyponatremia
c) Hypercalcemia
d) Hypomagnesemia
Answer: b
Rationale: Thiazides promote sodium and water loss, causing hyponatremia.
A patient receiving morphine develops respiratory depression. Which receptor mediates this adverse effect?
a) Kappa opioid receptor
b) Mu opioid receptor
c) Delta opioid receptor
d) NMDA receptor
Answer: b
Rationale: Mu receptors mediate analgesia and respiratory depression.
Which parameter best reflects the drug’s ability to cross the blood-brain barrier?
a) Molecular size
b) Water solubility
c) Lipid solubility
d) Plasma protein binding
Answer: c
Rationale: Lipophilic drugs cross BBB more readily.
True/False (T/F)
Drugs with high intrinsic activity produce maximal receptor activation even at low receptor occupancy.
Answer: True
Rationale: Intrinsic activity relates to the efficacy of receptor activation.
An agonist with competitive antagonism can be overcome by increasing the agonist concentration.
Answer: True
Rationale: Competitive antagonists bind reversibly and can be outcompeted.
The clearance of a drug is unaffected by changes in liver blood flow when metabolism is capacity-limited.
Answer: True
Rationale: Capacity-limited metabolism depends on enzyme levels, not blood flow.
