NU 578 Advanced Pharmacology – Units
1–5 Exam Questions And Answers Plus
Rationales | Qs & Ans 2026 | Instant Pdf
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1. A patient with hepatic cirrhosis has a decreased ability to
metabolize drugs. Which phase of pharmacokinetics is most directly
affected by liver disease?
A. Absorption
B. Distribution
C. Metabolism (biotransformation)
D. Excretion
Answer: C
Rationale: The liver is the primary site of drug metabolism (Phase I and
II reactions). Cirrhosis reduces metabolic capacity, leading to drug
accumulation.
2. A drug has a half-life of 4 hours. How long will it take for the
drug to reach steady state if administered at regular intervals?
A. 8 hours
B. 12 hours
C. 20 hours
D. 24 hours
,Answer: C
Rationale: Steady state is achieved after approximately 4–5 half-lives. 4
hours × 5 = 20 hours.
3. A nurse practitioner prescribes a medication that is a weak acid
with a pKa of 4.5. Where will this drug primarily be absorbed?
A. Stomach (pH 1.5–3.5)
B. Small intestine (pH 6–7)
C. Colon
D. Rectum
Answer: A
Rationale: Weak acids are nonionized (lipid-soluble) in acidic
environments (pH lower than pKa), favoring absorption in the stomach.
4. A patient taking warfarin is started on amiodarone. The INR
increases from 2.5 to 5.5. Which type of drug interaction is this?
A. Pharmacodynamic antagonism
B. Pharmacokinetic (metabolism inhibition)
C. Additive effect
D. Physiologic antagonism
Answer: B
Rationale: Amiodarone inhibits CYP2C9 and CYP1A2, reducing warfarin
metabolism, increasing INR and bleeding risk.
5. A patient with a genetic variant of CYP2D6 is a “poor
metabolizer.” Which medication would require a lower dose or
,alternative agent?
A. Lisinopril
B. Codeine (requires conversion to morphine via CYP2D6)
C. Metformin
D. Furosemide
Answer: B
Rationale: Codeine is a prodrug converted to morphine by CYP2D6.
Poor metabolizers have inadequate analgesia; ultrarapid metabolizers
risk toxicity.
6. A drug has a volume of distribution (Vd) of 500 L in a 70 kg adult.
Which interpretation is correct?
A. The drug is confined to the plasma
B. The drug is highly protein-bound
C. The drug is extensively distributed into tissues
D. The drug is excreted unchanged in urine
Answer: C
Rationale: High Vd (>42 L) indicates extensive tissue distribution, not
confined to plasma or extracellular fluid.
7. A patient develops urticaria, angioedema, and hypotension after
receiving IV penicillin. Which type of adverse drug reaction is this?
A. Type A (augmented)
B. Type B (bizarre/hypersensitivity) – Type I IgE-mediated
, C. Type C (chronic)
D. Type D (delayed)
Answer: B
Rationale: Type B reactions are idiosyncratic or allergic. Anaphylaxis is a
Type I IgE-mediated hypersensitivity (Type B).
8. Which statement best describes the therapeutic index (TI)?
A. TI = TD50/ED50; a high TI indicates a safe drug
B. TI = ED50/TD50; a low TI indicates a safe drug
C. TI = LD50/ED50; a narrow TI requires therapeutic drug monitoring
D. TI = ED50/LD50; a narrow TI is desirable
Answer: C
Rationale: Therapeutic index = LD50/ED50 (animal) or TD50/ED50
(human). Narrow TI drugs (e.g., digoxin, warfarin, lithium) require
monitoring.
9. A patient with myasthenia gravis is taking neostigmine. Which
effect is mediated by muscarinic receptors?
A. Increased skeletal muscle strength
B. Bradycardia and salivation
C. Tachycardia
D. Mydriasis
Answer: B
Rationale: Neostigmine (acetylcholinesterase inhibitor) increases
1–5 Exam Questions And Answers Plus
Rationales | Qs & Ans 2026 | Instant Pdf
Download
1. A patient with hepatic cirrhosis has a decreased ability to
metabolize drugs. Which phase of pharmacokinetics is most directly
affected by liver disease?
A. Absorption
B. Distribution
C. Metabolism (biotransformation)
D. Excretion
Answer: C
Rationale: The liver is the primary site of drug metabolism (Phase I and
II reactions). Cirrhosis reduces metabolic capacity, leading to drug
accumulation.
2. A drug has a half-life of 4 hours. How long will it take for the
drug to reach steady state if administered at regular intervals?
A. 8 hours
B. 12 hours
C. 20 hours
D. 24 hours
,Answer: C
Rationale: Steady state is achieved after approximately 4–5 half-lives. 4
hours × 5 = 20 hours.
3. A nurse practitioner prescribes a medication that is a weak acid
with a pKa of 4.5. Where will this drug primarily be absorbed?
A. Stomach (pH 1.5–3.5)
B. Small intestine (pH 6–7)
C. Colon
D. Rectum
Answer: A
Rationale: Weak acids are nonionized (lipid-soluble) in acidic
environments (pH lower than pKa), favoring absorption in the stomach.
4. A patient taking warfarin is started on amiodarone. The INR
increases from 2.5 to 5.5. Which type of drug interaction is this?
A. Pharmacodynamic antagonism
B. Pharmacokinetic (metabolism inhibition)
C. Additive effect
D. Physiologic antagonism
Answer: B
Rationale: Amiodarone inhibits CYP2C9 and CYP1A2, reducing warfarin
metabolism, increasing INR and bleeding risk.
5. A patient with a genetic variant of CYP2D6 is a “poor
metabolizer.” Which medication would require a lower dose or
,alternative agent?
A. Lisinopril
B. Codeine (requires conversion to morphine via CYP2D6)
C. Metformin
D. Furosemide
Answer: B
Rationale: Codeine is a prodrug converted to morphine by CYP2D6.
Poor metabolizers have inadequate analgesia; ultrarapid metabolizers
risk toxicity.
6. A drug has a volume of distribution (Vd) of 500 L in a 70 kg adult.
Which interpretation is correct?
A. The drug is confined to the plasma
B. The drug is highly protein-bound
C. The drug is extensively distributed into tissues
D. The drug is excreted unchanged in urine
Answer: C
Rationale: High Vd (>42 L) indicates extensive tissue distribution, not
confined to plasma or extracellular fluid.
7. A patient develops urticaria, angioedema, and hypotension after
receiving IV penicillin. Which type of adverse drug reaction is this?
A. Type A (augmented)
B. Type B (bizarre/hypersensitivity) – Type I IgE-mediated
, C. Type C (chronic)
D. Type D (delayed)
Answer: B
Rationale: Type B reactions are idiosyncratic or allergic. Anaphylaxis is a
Type I IgE-mediated hypersensitivity (Type B).
8. Which statement best describes the therapeutic index (TI)?
A. TI = TD50/ED50; a high TI indicates a safe drug
B. TI = ED50/TD50; a low TI indicates a safe drug
C. TI = LD50/ED50; a narrow TI requires therapeutic drug monitoring
D. TI = ED50/LD50; a narrow TI is desirable
Answer: C
Rationale: Therapeutic index = LD50/ED50 (animal) or TD50/ED50
(human). Narrow TI drugs (e.g., digoxin, warfarin, lithium) require
monitoring.
9. A patient with myasthenia gravis is taking neostigmine. Which
effect is mediated by muscarinic receptors?
A. Increased skeletal muscle strength
B. Bradycardia and salivation
C. Tachycardia
D. Mydriasis
Answer: B
Rationale: Neostigmine (acetylcholinesterase inhibitor) increases
