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NR565 / NR 565 Advanced Pharmacology
Care of the Fundamentals Midterm
Exam Review (Weeks 1-4) | Chamberlain
University (2026/2027) | Verified
Questions & Answers with Rationales |
Exam Structure:
Subject: Advanced Pharmacology (NR565) – Midterm Exam Review (Weeks 1-4)
Source: NR565 / NR 565 Advanced Pharmacology Care of the Fundamentals –
Midterm Exam Review (Chamberlain)
Format: Multiple Choice & Open-Ended Q&A
1. During which trimester is a pregnant woman most at risk for
adverse drug reactions with potential long-term consequences?
Correct Answer: First trimester.
Rationale:
1. Organogenesis occurs during weeks 3-8 of gestation.
2. Teratogens cause structural birth defects during this period.
3. After the first trimester, drugs may cause growth restriction or functional
defects but not major malformations.
4. Avoid all non-essential medications in the first trimester.
2. What are the Beers Criteria?
Correct Answer: Recommendations of medications inappropriate for
elderly (65 and older). The prescriber ultimately decides.
Rationale:
1. Developed by the American Geriatrics Society.
2. Identifies potentially inappropriate medications (PIMs) for older adults.
, 2|Page
3. Includes medications to avoid, use with caution, or avoid in specific
conditions.
4. Reduces adverse drug events, falls, delirium, and hospitalizations.
3. What is the CYP450 (cytochrome P450) system?
Correct Answer: Liver enzyme system where medications are metabolized.
Can either be inducers or inhibitors and create drug-drug interactions.
Rationale:
1. CYP450 enzymes metabolize most drugs.
2. Inhibitors decrease metabolism → increased drug levels → toxicity.
3. Inducers increase metabolism → decreased drug levels → therapeutic
failure.
4. Genetic polymorphisms cause variable metabolism among individuals.
4. What do CYP450 inducers do?
Correct Answer: Speed up metabolism of drugs (drug is cleared faster).
Drug has lesser effect (decrease blood levels of drug). Elevate CYP450
enzymes.
Rationale:
1. Induction increases enzyme synthesis.
2. Leads to lower drug concentrations.
3. May require higher doses of the affected drug.
4. Example: rifampin + oral contraceptive → breakthrough bleeding.
5. What is the pneumonic for CYP450 inducers?
Correct Answer: “Bullshit Crap GPS INDUCES rage” (Barbiturates, St.
John’s Wort, Carbamazepine, Phenytoin, Sulfonylureas? – see standard list
below).
Rationale:
1. Standard inducers: Barbiturates, St. John’s Wort, Carbamazepine, Rifampin,
Phenytoin, Griseofulvin, Phenobarbital, Sulfonylureas.
2. The pneumonic helps memorize common inducers.
3. Inducers increase metabolism of co-administered drugs.
4. Monitor for reduced efficacy when inducers are added.
, 3|Page
6. What are CYP450 inducer drug names?
Correct Answer: Barbiturates, St. John’s Wort, Carbamazepine, Rifampin,
Alcohol, Phenytoin, Griseofulvin, Phenobarbital, Sulfonylureas.
Rationale:
1. Barbiturates (phenobarbital) induce CYP3A4, CYP2C9, CYP2C19.
2. Rifampin is a potent inducer of multiple CYP enzymes.
3. Carbamazepine induces its own metabolism (autoinduction).
4. St. John’s Wort induces CYP3A4 (interacts with many drugs).
7. What do CYP450 inhibitors do?
Correct Answer: Inhibit metabolism, increase blood levels of medications.
Rationale:
1. Inhibition decreases drug metabolism.
2. Leads to higher drug concentrations.
3. May cause toxicity, especially for narrow therapeutic index drugs.
4. May require dose reduction of the affected drug.
8. What is the pneumonic for CYP450 inhibitors?
Correct Answer: “VISA credit card debt INHIBITS spending on designers
like CK to look GQ” (Valproate, Isoniazid, Sulfonamides, Amiodarone,
Chloramphenicol, Ketoconazole, Grapefruit juice, Quinidine).
Rationale:
1. These drugs inhibit CYP450 enzymes, particularly CYP3A4, CYP2C9,
CYP2C19.
2. Inhibition increases levels of co-administered drugs.
3. Grapefruit juice inhibits intestinal CYP3A4.
4. Monitor for toxicity when inhibitors are added.
9. What are CYP450 inhibitor drug names?
Correct Answer: Valproate, Isoniazid, Sulfonamides, Amiodarone,
Chloramphenicol, Ketoconazole, Grapefruit juice, Quinidine.
Rationale:
1. Valproate inhibits multiple CYP enzymes.
2. Amiodarone inhibits CYP2C9, CYP2D6, CYP3A4.
3. Ketoconazole is a potent CYP3A4 inhibitor.
4. Grapefruit juice inhibits intestinal CYP3A4.
, 4|Page
10. What are the physiological changes during pregnancy that impact
pharmacodynamics and pharmacokinetic properties of drugs?
Correct Answer: Increased glomerular filtration rate leads to increased
drug excretion; increased hepatic metabolism; decreased tone and motility
of bowel; increased drug absorption.
Rationale:
1. GFR increases by 50%, accelerating renal drug elimination.
2. Hepatic metabolism changes variably (some drugs increased, some
decreased).
3. Prolonged gastric emptying delays absorption but increased intestinal
transit may affect absorption site.
4. Increased plasma volume dilutes drugs, requiring higher doses for some.
11. What are examples of medications that can be teratogenic?
Correct Answer: Antiepileptic drugs, antimicrobials such as tetracyclines
and fluoroquinolones, vitamin A in large doses, some anticoagulants, and
hormonal medications such as diethylstilbestrol (DES).
Rationale:
1. Valproate causes neural tube defects and cognitive impairment.
2. Isotretinoin (vitamin A analog) causes craniofacial, cardiac, and CNS
malformations.
3. Warfarin causes fetal warfarin syndrome (nasal hypoplasia, stippled
epiphyses).
4. Tetracyclines cause tooth discoloration; fluoroquinolones cause cartilage
damage.
12. How is absorption of intramuscular medications different in
neonates?
Correct Answer: Slow and erratic due to low blood flow to muscles in the
first few days of life.
Rationale:
1. Neonatal muscle perfusion is lower than in older infants.
2. Reduced blood flow delays absorption.
3. Erratic absorption leads to unpredictable drug levels.
4. The IM route is less reliable in neonates; IV preferred when possible.
NR565 / NR 565 Advanced Pharmacology
Care of the Fundamentals Midterm
Exam Review (Weeks 1-4) | Chamberlain
University (2026/2027) | Verified
Questions & Answers with Rationales |
Exam Structure:
Subject: Advanced Pharmacology (NR565) – Midterm Exam Review (Weeks 1-4)
Source: NR565 / NR 565 Advanced Pharmacology Care of the Fundamentals –
Midterm Exam Review (Chamberlain)
Format: Multiple Choice & Open-Ended Q&A
1. During which trimester is a pregnant woman most at risk for
adverse drug reactions with potential long-term consequences?
Correct Answer: First trimester.
Rationale:
1. Organogenesis occurs during weeks 3-8 of gestation.
2. Teratogens cause structural birth defects during this period.
3. After the first trimester, drugs may cause growth restriction or functional
defects but not major malformations.
4. Avoid all non-essential medications in the first trimester.
2. What are the Beers Criteria?
Correct Answer: Recommendations of medications inappropriate for
elderly (65 and older). The prescriber ultimately decides.
Rationale:
1. Developed by the American Geriatrics Society.
2. Identifies potentially inappropriate medications (PIMs) for older adults.
, 2|Page
3. Includes medications to avoid, use with caution, or avoid in specific
conditions.
4. Reduces adverse drug events, falls, delirium, and hospitalizations.
3. What is the CYP450 (cytochrome P450) system?
Correct Answer: Liver enzyme system where medications are metabolized.
Can either be inducers or inhibitors and create drug-drug interactions.
Rationale:
1. CYP450 enzymes metabolize most drugs.
2. Inhibitors decrease metabolism → increased drug levels → toxicity.
3. Inducers increase metabolism → decreased drug levels → therapeutic
failure.
4. Genetic polymorphisms cause variable metabolism among individuals.
4. What do CYP450 inducers do?
Correct Answer: Speed up metabolism of drugs (drug is cleared faster).
Drug has lesser effect (decrease blood levels of drug). Elevate CYP450
enzymes.
Rationale:
1. Induction increases enzyme synthesis.
2. Leads to lower drug concentrations.
3. May require higher doses of the affected drug.
4. Example: rifampin + oral contraceptive → breakthrough bleeding.
5. What is the pneumonic for CYP450 inducers?
Correct Answer: “Bullshit Crap GPS INDUCES rage” (Barbiturates, St.
John’s Wort, Carbamazepine, Phenytoin, Sulfonylureas? – see standard list
below).
Rationale:
1. Standard inducers: Barbiturates, St. John’s Wort, Carbamazepine, Rifampin,
Phenytoin, Griseofulvin, Phenobarbital, Sulfonylureas.
2. The pneumonic helps memorize common inducers.
3. Inducers increase metabolism of co-administered drugs.
4. Monitor for reduced efficacy when inducers are added.
, 3|Page
6. What are CYP450 inducer drug names?
Correct Answer: Barbiturates, St. John’s Wort, Carbamazepine, Rifampin,
Alcohol, Phenytoin, Griseofulvin, Phenobarbital, Sulfonylureas.
Rationale:
1. Barbiturates (phenobarbital) induce CYP3A4, CYP2C9, CYP2C19.
2. Rifampin is a potent inducer of multiple CYP enzymes.
3. Carbamazepine induces its own metabolism (autoinduction).
4. St. John’s Wort induces CYP3A4 (interacts with many drugs).
7. What do CYP450 inhibitors do?
Correct Answer: Inhibit metabolism, increase blood levels of medications.
Rationale:
1. Inhibition decreases drug metabolism.
2. Leads to higher drug concentrations.
3. May cause toxicity, especially for narrow therapeutic index drugs.
4. May require dose reduction of the affected drug.
8. What is the pneumonic for CYP450 inhibitors?
Correct Answer: “VISA credit card debt INHIBITS spending on designers
like CK to look GQ” (Valproate, Isoniazid, Sulfonamides, Amiodarone,
Chloramphenicol, Ketoconazole, Grapefruit juice, Quinidine).
Rationale:
1. These drugs inhibit CYP450 enzymes, particularly CYP3A4, CYP2C9,
CYP2C19.
2. Inhibition increases levels of co-administered drugs.
3. Grapefruit juice inhibits intestinal CYP3A4.
4. Monitor for toxicity when inhibitors are added.
9. What are CYP450 inhibitor drug names?
Correct Answer: Valproate, Isoniazid, Sulfonamides, Amiodarone,
Chloramphenicol, Ketoconazole, Grapefruit juice, Quinidine.
Rationale:
1. Valproate inhibits multiple CYP enzymes.
2. Amiodarone inhibits CYP2C9, CYP2D6, CYP3A4.
3. Ketoconazole is a potent CYP3A4 inhibitor.
4. Grapefruit juice inhibits intestinal CYP3A4.
, 4|Page
10. What are the physiological changes during pregnancy that impact
pharmacodynamics and pharmacokinetic properties of drugs?
Correct Answer: Increased glomerular filtration rate leads to increased
drug excretion; increased hepatic metabolism; decreased tone and motility
of bowel; increased drug absorption.
Rationale:
1. GFR increases by 50%, accelerating renal drug elimination.
2. Hepatic metabolism changes variably (some drugs increased, some
decreased).
3. Prolonged gastric emptying delays absorption but increased intestinal
transit may affect absorption site.
4. Increased plasma volume dilutes drugs, requiring higher doses for some.
11. What are examples of medications that can be teratogenic?
Correct Answer: Antiepileptic drugs, antimicrobials such as tetracyclines
and fluoroquinolones, vitamin A in large doses, some anticoagulants, and
hormonal medications such as diethylstilbestrol (DES).
Rationale:
1. Valproate causes neural tube defects and cognitive impairment.
2. Isotretinoin (vitamin A analog) causes craniofacial, cardiac, and CNS
malformations.
3. Warfarin causes fetal warfarin syndrome (nasal hypoplasia, stippled
epiphyses).
4. Tetracyclines cause tooth discoloration; fluoroquinolones cause cartilage
damage.
12. How is absorption of intramuscular medications different in
neonates?
Correct Answer: Slow and erratic due to low blood flow to muscles in the
first few days of life.
Rationale:
1. Neonatal muscle perfusion is lower than in older infants.
2. Reduced blood flow delays absorption.
3. Erratic absorption leads to unpredictable drug levels.
4. The IM route is less reliable in neonates; IV preferred when possible.
