NSG 5240 Advanced Pharmacology Final
Practice Exam 2026 | South College
SECTION 1: PHARMACOKINETICS & PHARMACODYNAMICS (Questions 1-15)
Q1. A patient with liver cirrhosis has reduced metabolism of a drug that normally undergoes
extensive first-pass effect. How will this affect the oral dose of the drug?
- A) Increased first-pass metabolism
- B) Decreased bioavailability
- C) Significantly increased bioavailability
- D) No change in drug levels
Answer: C – First-pass effect occurs in the liver. If liver function is impaired, less drug is
metabolized before reaching systemic circulation, leading to higher bioavailability and risk of
toxicity .
Q2. A drug has a half-life of 12 hours. Approximately how many hours will it take to reach
steady state?
- A) 24 hours
- B) 36 hours
- C) 48 hours
- D) 60 hours
Answer: D – Steady state is achieved after approximately 4-5 half-lives. 5 × 12 hours = 60 hours
.
Q3. Which route of administration bypasses the first-pass effect?
- A) Oral
- B) Sublingual
- C) Rectal
- D) Both B and C
Answer: D – Sublingual and rectal (partially) routes allow drug absorption directly into systemic
circulation, avoiding portal circulation and hepatic first-pass metabolism .
Q4. An agonist drug is best defined as a substance that:
- A) Binds to a receptor and blocks its action
- B) Binds to a receptor and activates it, producing a maximal response
,- C) Binds to a receptor and produces a partial response
- D) Inactivates enzymes
Answer: B – A full agonist binds to and activates a receptor, producing the maximal tissue
response .
Q5. A drug with a high volume of distribution (Vd) primarily indicates:
- A) The drug is highly protein-bound
- B) The drug is confined to the vascular space
- C) The drug extensively distributes into tissues
- D) The drug has a short half-life
Answer: C – A high Vd suggests the drug has left the plasma and entered tissues, often due to
lipophilicity or tissue binding .
Q6. The therapeutic index (TI) of a drug is calculated as:
- A) ED50/TD50
- B) TD50/ED50
- C) LD50/ED50
- D) ED50/LD50
Answer: B – TI = TD50 (toxic dose in 50%) / ED50 (effective dose in 50%). A low TI indicates a
narrow safety margin .
Q7. Which cytochrome P450 enzyme is most commonly involved in drug-drug interactions?
- A) CYP1A2
- B) CYP2D6
- C) CYP3A4
- D) CYP2C9
Answer: C – CYP3A4 metabolizes over 50% of all drugs and is inhibited or induced by many
agents (e.g., grapefruit juice, rifampin, ketoconazole) .
Q8. Bioavailability of an IV drug is:
- A) 0%
- B) Less than 50%
- C) 100%
- D) Variable based on lipophilicity
Answer: C – IV administration bypasses absorption barriers, delivering 100% of the dose into
systemic circulation .
Q9. A drug with zero-order kinetics is characterized by:
- A) Constant percentage eliminated per unit time
, - B) Exponential decline in plasma concentration
- C) Constant amount of drug eliminated per unit time
- D) Increased clearance with higher doses
Answer: C – Zero-order kinetics (e.g., phenytoin, alcohol) means a fixed amount of drug is
eliminated per hour, not a fixed percentage .
Q10. What is the effect of a competitive antagonist on the dose-response curve of an agonist?
- A) Reduced maximal response
- B) Rightward shift of the curve (higher EC50)
- C) Leftward shift of the curve
- D) No change
Answer: B – A competitive antagonist increases the dose needed for the same effect, shifting
the curve rightward; maximal response remains achievable with enough agonist .
Q11. A patient with chronic kidney disease has reduced GFR. Which drug property would most
likely require dose adjustment?
- A) High lipid solubility
- B) Extensive hepatic metabolism
- C) High renal excretion (unchanged drug)
- D) High protein binding
Answer: C – Drugs primarily excreted unchanged by the kidneys (e.g., aminoglycosides,
digoxin) accumulate in renal impairment and require dose adjustment .
Q12. Which statement about prodrugs is correct?
- A) They are active upon administration
- B) They require biotransformation to become active
- C) They always have longer half-lives
- D) They cannot be given orally
Answer: B – Prodrugs (e.g., enalapril, levodopa, codeine) are inactive until metabolized to the
active compound .
Q13. Enterohepatic recirculation tends to:
- A) Shorten drug half-life
- B) Prolong drug action and half-life
- C) Decrease bioavailability
- D) Increase first-pass metabolism
Answer: B – Drug excreted in bile is reabsorbed in the intestines, returning to the liver and
systemic circulation, prolonging presence in the body .
Practice Exam 2026 | South College
SECTION 1: PHARMACOKINETICS & PHARMACODYNAMICS (Questions 1-15)
Q1. A patient with liver cirrhosis has reduced metabolism of a drug that normally undergoes
extensive first-pass effect. How will this affect the oral dose of the drug?
- A) Increased first-pass metabolism
- B) Decreased bioavailability
- C) Significantly increased bioavailability
- D) No change in drug levels
Answer: C – First-pass effect occurs in the liver. If liver function is impaired, less drug is
metabolized before reaching systemic circulation, leading to higher bioavailability and risk of
toxicity .
Q2. A drug has a half-life of 12 hours. Approximately how many hours will it take to reach
steady state?
- A) 24 hours
- B) 36 hours
- C) 48 hours
- D) 60 hours
Answer: D – Steady state is achieved after approximately 4-5 half-lives. 5 × 12 hours = 60 hours
.
Q3. Which route of administration bypasses the first-pass effect?
- A) Oral
- B) Sublingual
- C) Rectal
- D) Both B and C
Answer: D – Sublingual and rectal (partially) routes allow drug absorption directly into systemic
circulation, avoiding portal circulation and hepatic first-pass metabolism .
Q4. An agonist drug is best defined as a substance that:
- A) Binds to a receptor and blocks its action
- B) Binds to a receptor and activates it, producing a maximal response
,- C) Binds to a receptor and produces a partial response
- D) Inactivates enzymes
Answer: B – A full agonist binds to and activates a receptor, producing the maximal tissue
response .
Q5. A drug with a high volume of distribution (Vd) primarily indicates:
- A) The drug is highly protein-bound
- B) The drug is confined to the vascular space
- C) The drug extensively distributes into tissues
- D) The drug has a short half-life
Answer: C – A high Vd suggests the drug has left the plasma and entered tissues, often due to
lipophilicity or tissue binding .
Q6. The therapeutic index (TI) of a drug is calculated as:
- A) ED50/TD50
- B) TD50/ED50
- C) LD50/ED50
- D) ED50/LD50
Answer: B – TI = TD50 (toxic dose in 50%) / ED50 (effective dose in 50%). A low TI indicates a
narrow safety margin .
Q7. Which cytochrome P450 enzyme is most commonly involved in drug-drug interactions?
- A) CYP1A2
- B) CYP2D6
- C) CYP3A4
- D) CYP2C9
Answer: C – CYP3A4 metabolizes over 50% of all drugs and is inhibited or induced by many
agents (e.g., grapefruit juice, rifampin, ketoconazole) .
Q8. Bioavailability of an IV drug is:
- A) 0%
- B) Less than 50%
- C) 100%
- D) Variable based on lipophilicity
Answer: C – IV administration bypasses absorption barriers, delivering 100% of the dose into
systemic circulation .
Q9. A drug with zero-order kinetics is characterized by:
- A) Constant percentage eliminated per unit time
, - B) Exponential decline in plasma concentration
- C) Constant amount of drug eliminated per unit time
- D) Increased clearance with higher doses
Answer: C – Zero-order kinetics (e.g., phenytoin, alcohol) means a fixed amount of drug is
eliminated per hour, not a fixed percentage .
Q10. What is the effect of a competitive antagonist on the dose-response curve of an agonist?
- A) Reduced maximal response
- B) Rightward shift of the curve (higher EC50)
- C) Leftward shift of the curve
- D) No change
Answer: B – A competitive antagonist increases the dose needed for the same effect, shifting
the curve rightward; maximal response remains achievable with enough agonist .
Q11. A patient with chronic kidney disease has reduced GFR. Which drug property would most
likely require dose adjustment?
- A) High lipid solubility
- B) Extensive hepatic metabolism
- C) High renal excretion (unchanged drug)
- D) High protein binding
Answer: C – Drugs primarily excreted unchanged by the kidneys (e.g., aminoglycosides,
digoxin) accumulate in renal impairment and require dose adjustment .
Q12. Which statement about prodrugs is correct?
- A) They are active upon administration
- B) They require biotransformation to become active
- C) They always have longer half-lives
- D) They cannot be given orally
Answer: B – Prodrugs (e.g., enalapril, levodopa, codeine) are inactive until metabolized to the
active compound .
Q13. Enterohepatic recirculation tends to:
- A) Shorten drug half-life
- B) Prolong drug action and half-life
- C) Decrease bioavailability
- D) Increase first-pass metabolism
Answer: B – Drug excreted in bile is reabsorbed in the intestines, returning to the liver and
systemic circulation, prolonging presence in the body .
