NUR 600 Clinical Pharmacology Final
Exam Prep Test Bank with a Review of
230 Quiz Questions and Correct Answers
(ST Thomas University)
SECTION 1: CORE PRINCIPLES – PHARMACOKINETICS, PHARMACODYNAMICS & PRESCRIBING
Question 1:
A patient with hepatic cirrhosis is prescribed a drug with a high first-pass metabolism. Which
pharmacokinetic change is most likely to occur?
A) Decreased oral bioavailability
B) Increased oral bioavailability
C) Decreased volume of distribution
D) Increased renal clearance
Answer: B) Increased oral bioavailability
Rationale: In hepatic cirrhosis, liver function is impaired, reducing first-pass metabolism. Drugs
that normally undergo extensive hepatic metabolism will have less degradation during their first
pass through the liver, resulting in increased systemic availability when taken orally. This
increased bioavailability can lead to toxicity if doses are not adjusted .
Question 2:
A drug that is highly protein-bound is administered to a patient with severe hypoalbuminemia.
What is the most likely pharmacokinetic consequence?
A) Decreased free drug concentration
B) Increased free drug concentration
C) Decreased elimination half-life
D) Reduced drug efficacy
Answer: B) Increased free drug concentration
Rationale: Low albumin levels reduce available binding sites for drugs. This increases the
fraction of unbound (active) drug in plasma, which can enhance pharmacologic effects and
,increase the risk of toxicity. The total drug level may appear normal, but the free fraction is
elevated. Monitoring free drug levels may be necessary .
Question 3:
A drug has a half-life of 8 hours. Approximately how many hours until steady state is reached?
A) 8 hours
B) 16 hours
C) 24 hours
D) 40 hours
Answer: D) 40 hours
Rationale: Steady state is typically reached after about 4–5 half-lives. For a drug with an 8-hour
half-life, this equates to approximately 32–40 hours, making 40 hours the best answer. This
principle is essential for understanding when therapeutic effects will be fully established after
starting or changing dosing .
Question 4:
A drug that is a weak acid (pKa 4.4) is administered orally. In the stomach (pH 1.4), the drug will
be mostly:
A) Non-ionized and readily absorbed
B) Ionized and poorly absorbed
C) Trapped in the stomach
D) Bound to albumin
Answer: A) Non-ionized and readily absorbed
Rationale: Weak acids are non-ionized at low pH (pH < pKa). The non-ionized form is lipid-
soluble and can readily cross cell membranes. In the acidic stomach environment, the drug will
be non-ionized and absorbed across the gastric mucosa. This follows the principle that "acidic
drugs are absorbed in acidic environments" .
Question 5:
A patient is given a drug that acts as a partial agonist at a receptor. Which outcome is most likely
when this drug is administered alongside a full agonist?
,A) It produces a greater maximal response than the full agonist
B) It reduces the effect of the full agonist
C) It has no effect on the full agonist's activity
D) It irreversibly binds to the receptor
Answer: B) It reduces the effect of the full agonist
Rationale: Partial agonists have lower intrinsic activity compared to full agonists. When both
compete for the same receptor, the partial agonist occupies receptors but produces a weaker
response, thereby diminishing the overall effect of the full agonist. This is similar to competitive
antagonism but with some intrinsic activity .
Question 6:
A patient's nutritional intake and lab work reflects hypoalbuminemia. This is critical to
prescribing because:
A) Distribution of drugs to target tissue may be affected
B) The solubility of the drug will not match the site of absorption
C) There will be less free drug available to generate an effect
D) Drugs bound to albumin are readily excreted by the kidney
Answer: A) Distribution of drugs to target tissue may be affected
Rationale: Albumin is a major binding protein for many drugs. Hypoalbuminemia leads to a
higher proportion of free (unbound) drug, which can increase drug effects and toxicity, and alter
distribution to target tissues. Monitoring free drug levels is important in these patients .
Question 7:
Drugs that have a significant first-pass effect:
A) Must be given by the enteral (oral) route only
B) Bypass the hepatic circulation
C) Are rapidly metabolized by the liver and may have little if any desired action
D) Are converted by the liver to more active and fat-soluble forms
Answer: C) Are rapidly metabolized by the liver and may have little if any desired action
Rationale: The first-pass effect refers to the metabolism of an oral drug by the liver before it
reaches systemic circulation. Drugs with high first-pass metabolism may have low oral
, bioavailability, sometimes requiring higher oral doses or alternative routes of administration
(e.g., sublingual, IV) .
Question 8:
The route of excretion of a volatile drug will likely be:
A) The kidneys
B) The lungs
C) The bile and feces
D) The skin
Answer: B) The lungs
Rationale: Volatile drugs (e.g., anesthetic gases, alcohol) are primarily excreted unchanged via
exhalation through the lungs. This is an important consideration for drugs administered via
inhalation and for assessing patients receiving volatile anesthetics .
Question 9:
Medroxyprogesterone (Depo Provera) is prescribed IM to create a storage reservoir of the drug.
Storage reservoirs:
A) Assure that the drug will reach its intended target tissue
B) Are the reason for giving loading doses
C) Increase the length of time a drug is available and active
D) Are most common in collagen tissues
Answer: C) Increase the length of time a drug is available and active
Rationale: Storage reservoirs (e.g., fat tissue, muscle, or protein binding sites) prolong the
duration of drug availability by slowly releasing the drug into circulation. This is the principle
behind depot formulations like Depo-Provera .
Question 10:
Azithromycin dosing requires the first day's dose be twice those of the other 4 days of the
prescription. This is considered a loading dose. A loading dose:
A) Rapidly achieves drug levels in the therapeutic range
B) Requires four to five half-lives to attain
Exam Prep Test Bank with a Review of
230 Quiz Questions and Correct Answers
(ST Thomas University)
SECTION 1: CORE PRINCIPLES – PHARMACOKINETICS, PHARMACODYNAMICS & PRESCRIBING
Question 1:
A patient with hepatic cirrhosis is prescribed a drug with a high first-pass metabolism. Which
pharmacokinetic change is most likely to occur?
A) Decreased oral bioavailability
B) Increased oral bioavailability
C) Decreased volume of distribution
D) Increased renal clearance
Answer: B) Increased oral bioavailability
Rationale: In hepatic cirrhosis, liver function is impaired, reducing first-pass metabolism. Drugs
that normally undergo extensive hepatic metabolism will have less degradation during their first
pass through the liver, resulting in increased systemic availability when taken orally. This
increased bioavailability can lead to toxicity if doses are not adjusted .
Question 2:
A drug that is highly protein-bound is administered to a patient with severe hypoalbuminemia.
What is the most likely pharmacokinetic consequence?
A) Decreased free drug concentration
B) Increased free drug concentration
C) Decreased elimination half-life
D) Reduced drug efficacy
Answer: B) Increased free drug concentration
Rationale: Low albumin levels reduce available binding sites for drugs. This increases the
fraction of unbound (active) drug in plasma, which can enhance pharmacologic effects and
,increase the risk of toxicity. The total drug level may appear normal, but the free fraction is
elevated. Monitoring free drug levels may be necessary .
Question 3:
A drug has a half-life of 8 hours. Approximately how many hours until steady state is reached?
A) 8 hours
B) 16 hours
C) 24 hours
D) 40 hours
Answer: D) 40 hours
Rationale: Steady state is typically reached after about 4–5 half-lives. For a drug with an 8-hour
half-life, this equates to approximately 32–40 hours, making 40 hours the best answer. This
principle is essential for understanding when therapeutic effects will be fully established after
starting or changing dosing .
Question 4:
A drug that is a weak acid (pKa 4.4) is administered orally. In the stomach (pH 1.4), the drug will
be mostly:
A) Non-ionized and readily absorbed
B) Ionized and poorly absorbed
C) Trapped in the stomach
D) Bound to albumin
Answer: A) Non-ionized and readily absorbed
Rationale: Weak acids are non-ionized at low pH (pH < pKa). The non-ionized form is lipid-
soluble and can readily cross cell membranes. In the acidic stomach environment, the drug will
be non-ionized and absorbed across the gastric mucosa. This follows the principle that "acidic
drugs are absorbed in acidic environments" .
Question 5:
A patient is given a drug that acts as a partial agonist at a receptor. Which outcome is most likely
when this drug is administered alongside a full agonist?
,A) It produces a greater maximal response than the full agonist
B) It reduces the effect of the full agonist
C) It has no effect on the full agonist's activity
D) It irreversibly binds to the receptor
Answer: B) It reduces the effect of the full agonist
Rationale: Partial agonists have lower intrinsic activity compared to full agonists. When both
compete for the same receptor, the partial agonist occupies receptors but produces a weaker
response, thereby diminishing the overall effect of the full agonist. This is similar to competitive
antagonism but with some intrinsic activity .
Question 6:
A patient's nutritional intake and lab work reflects hypoalbuminemia. This is critical to
prescribing because:
A) Distribution of drugs to target tissue may be affected
B) The solubility of the drug will not match the site of absorption
C) There will be less free drug available to generate an effect
D) Drugs bound to albumin are readily excreted by the kidney
Answer: A) Distribution of drugs to target tissue may be affected
Rationale: Albumin is a major binding protein for many drugs. Hypoalbuminemia leads to a
higher proportion of free (unbound) drug, which can increase drug effects and toxicity, and alter
distribution to target tissues. Monitoring free drug levels is important in these patients .
Question 7:
Drugs that have a significant first-pass effect:
A) Must be given by the enteral (oral) route only
B) Bypass the hepatic circulation
C) Are rapidly metabolized by the liver and may have little if any desired action
D) Are converted by the liver to more active and fat-soluble forms
Answer: C) Are rapidly metabolized by the liver and may have little if any desired action
Rationale: The first-pass effect refers to the metabolism of an oral drug by the liver before it
reaches systemic circulation. Drugs with high first-pass metabolism may have low oral
, bioavailability, sometimes requiring higher oral doses or alternative routes of administration
(e.g., sublingual, IV) .
Question 8:
The route of excretion of a volatile drug will likely be:
A) The kidneys
B) The lungs
C) The bile and feces
D) The skin
Answer: B) The lungs
Rationale: Volatile drugs (e.g., anesthetic gases, alcohol) are primarily excreted unchanged via
exhalation through the lungs. This is an important consideration for drugs administered via
inhalation and for assessing patients receiving volatile anesthetics .
Question 9:
Medroxyprogesterone (Depo Provera) is prescribed IM to create a storage reservoir of the drug.
Storage reservoirs:
A) Assure that the drug will reach its intended target tissue
B) Are the reason for giving loading doses
C) Increase the length of time a drug is available and active
D) Are most common in collagen tissues
Answer: C) Increase the length of time a drug is available and active
Rationale: Storage reservoirs (e.g., fat tissue, muscle, or protein binding sites) prolong the
duration of drug availability by slowly releasing the drug into circulation. This is the principle
behind depot formulations like Depo-Provera .
Question 10:
Azithromycin dosing requires the first day's dose be twice those of the other 4 days of the
prescription. This is considered a loading dose. A loading dose:
A) Rapidly achieves drug levels in the therapeutic range
B) Requires four to five half-lives to attain
