Chamberlain NR 565 Final Exam – Advanced Pharmacology Actual Questions
and Answers (PDF
Unit 1: Pharmacokinetics & Pharmacodynamics (Questions 1-20)
1. A patient with a history of alcoholism is prescribed a medication that
undergoes extensive first-pass metabolism in the liver. Which pharmacokinetic
change is the provider most concerned about?
A) Increased protein binding leading to toxicity
B) Reduced first-pass metabolism leading to higher bioavailability
C) Decreased glomerular filtration rate
D) Increased excretion via the biliary tract
Answer: B
Rationale: Chronic liver disease or cirrhosis reduces hepatic function and blood
flow. This decreases the first-pass effect, meaning more of an orally administered
drug reaches systemic circulation, potentially leading to toxicity if standard doses
are used .
2. A drug has a half-life of 4 hours. Approximately how long will it take to reach
steady state?
A) 8 hours
,B) 12 hours
C) 20 hours
D) 48 hours
Answer: C
Rationale: Steady state is achieved after approximately 4-5 half-lives. Therefore, 4
hours x 5 half-lives = 20 hours .
3. A patient is prescribed a drug that is a weak acid with a pKa of 4.5. Where will
this drug best be absorbed in the gastrointestinal tract?
A) Stomach (pH 1.5-3.5)
B) Duodenum (pH 6-7)
C) Colon (pH 7.5-8.0)
D) Rectum (pH 7.0)
Answer: A
Rationale: Weak acids are non-ionized (lipid-soluble) in acidic environments,
allowing them to cross cell membranes easily. The stomach provides this acidic
environment, facilitating absorption .
,4. A patient is taking a highly protein-bound medication (98% bound). A second
medication with a high affinity for the same binding site is added. What effect is
expected regarding the first medication?
A) Decreased free drug concentration
B) Increased free drug concentration and risk of toxicity
C) No change in the drug's half-life
D) Decreased renal clearance
Answer: B
Rationale: Displacement from protein binding increases the free (active) fraction
of the drug. This leads to a stronger pharmacological effect and a higher risk of
adverse reactions or toxicity .
5. The prescriber decides to give a loading dose for a patient with a severe
infection. What is the primary purpose of a loading dose?
A) To reduce the frequency of dosing
B) To achieve therapeutic levels immediately
C) To minimize gastrointestinal side effects
D) To allow for once-daily dosing
, Answer: B
Rationale: A loading dose is used when rapid therapeutic effect is needed. It
quickly fills the volume of distribution to reach steady-state concentrations,
bypassing the time needed for 4-5 half-lives to pass .
6. A patient with heart failure and reduced cardiac output is given an IM injection.
How does low cardiac output affect drug absorption from the muscle?
A) Increases absorption due to increased perfusion pressure
B) Decreases absorption due to reduced blood flow to tissues
C) Has no effect on absorption
D) Increases the rate of metabolism
Answer: B
Rationale: Absorption from intramuscular sites depends on blood flow to carry
the drug into systemic circulation. Decreased cardiac output reduces peripheral
perfusion, slowing absorption .
7. A patient is a "poor metabolizer" of CYP2D6 substrates. Which medication
poses the greatest risk of toxicity at standard doses due to accumulation of the
parent drug?
A) Codeine (ineffective)
and Answers (PDF
Unit 1: Pharmacokinetics & Pharmacodynamics (Questions 1-20)
1. A patient with a history of alcoholism is prescribed a medication that
undergoes extensive first-pass metabolism in the liver. Which pharmacokinetic
change is the provider most concerned about?
A) Increased protein binding leading to toxicity
B) Reduced first-pass metabolism leading to higher bioavailability
C) Decreased glomerular filtration rate
D) Increased excretion via the biliary tract
Answer: B
Rationale: Chronic liver disease or cirrhosis reduces hepatic function and blood
flow. This decreases the first-pass effect, meaning more of an orally administered
drug reaches systemic circulation, potentially leading to toxicity if standard doses
are used .
2. A drug has a half-life of 4 hours. Approximately how long will it take to reach
steady state?
A) 8 hours
,B) 12 hours
C) 20 hours
D) 48 hours
Answer: C
Rationale: Steady state is achieved after approximately 4-5 half-lives. Therefore, 4
hours x 5 half-lives = 20 hours .
3. A patient is prescribed a drug that is a weak acid with a pKa of 4.5. Where will
this drug best be absorbed in the gastrointestinal tract?
A) Stomach (pH 1.5-3.5)
B) Duodenum (pH 6-7)
C) Colon (pH 7.5-8.0)
D) Rectum (pH 7.0)
Answer: A
Rationale: Weak acids are non-ionized (lipid-soluble) in acidic environments,
allowing them to cross cell membranes easily. The stomach provides this acidic
environment, facilitating absorption .
,4. A patient is taking a highly protein-bound medication (98% bound). A second
medication with a high affinity for the same binding site is added. What effect is
expected regarding the first medication?
A) Decreased free drug concentration
B) Increased free drug concentration and risk of toxicity
C) No change in the drug's half-life
D) Decreased renal clearance
Answer: B
Rationale: Displacement from protein binding increases the free (active) fraction
of the drug. This leads to a stronger pharmacological effect and a higher risk of
adverse reactions or toxicity .
5. The prescriber decides to give a loading dose for a patient with a severe
infection. What is the primary purpose of a loading dose?
A) To reduce the frequency of dosing
B) To achieve therapeutic levels immediately
C) To minimize gastrointestinal side effects
D) To allow for once-daily dosing
, Answer: B
Rationale: A loading dose is used when rapid therapeutic effect is needed. It
quickly fills the volume of distribution to reach steady-state concentrations,
bypassing the time needed for 4-5 half-lives to pass .
6. A patient with heart failure and reduced cardiac output is given an IM injection.
How does low cardiac output affect drug absorption from the muscle?
A) Increases absorption due to increased perfusion pressure
B) Decreases absorption due to reduced blood flow to tissues
C) Has no effect on absorption
D) Increases the rate of metabolism
Answer: B
Rationale: Absorption from intramuscular sites depends on blood flow to carry
the drug into systemic circulation. Decreased cardiac output reduces peripheral
perfusion, slowing absorption .
7. A patient is a "poor metabolizer" of CYP2D6 substrates. Which medication
poses the greatest risk of toxicity at standard doses due to accumulation of the
parent drug?
A) Codeine (ineffective)
