Advanced Pharmacotherapeutics Review
200 Practice Questions & Answers for Advanced Practice Nursing / PA Pharmacology Review
Original review questions covering core pharmacotherapeutics topics for advanced practice study.
PHARMACOKINETICS & PHARMACODYNAMICS
1. What are the four processes of pharmacokinetics?
Answer: Absorption, distribution, metabolism, and excretion (ADME).
2. What does bioavailability refer to?
Answer: The fraction of an administered drug dose that reaches systemic circulation unchanged.
3. Which route of administration has 100% bioavailability by definition?
Answer: Intravenous (IV) administration.
4. What is the first-pass effect?
Answer: Extensive hepatic metabolism of an orally absorbed drug before it reaches systemic circulation, reducing
bioavailability.
5. What is the primary organ responsible for drug metabolism?
Answer: The liver, via the cytochrome P450 enzyme system.
6. What is a drug's half-life (t1/2)?
Answer: The time required for the plasma concentration of a drug to decrease by 50%.
7. What is the therapeutic index?
Answer: A ratio comparing the toxic dose to the effective dose of a drug (TD50/ED50); a narrow index means a small margin
of safety.
8. What is the difference between agonist and antagonist drugs?
Answer: Agonists bind to a receptor and produce a biologic response; antagonists bind to a receptor and block or reduce the
response of an agonist.
9. What does the term 'protein binding' affect in pharmacokinetics?
Answer: The amount of free (active) drug available to exert effects; only unbound drug can cross membranes and act at
receptors.
10. What is zero-order kinetics?
Answer: Elimination of a constant amount of drug per unit time, regardless of concentration (e.g., alcohol, phenytoin at high
doses).
AUTONOMIC NERVOUS SYSTEM DRUGS
11. What are the primary effects of alpha-1 adrenergic agonists?
Answer: Vasoconstriction, increased blood pressure, and mydriasis.
12. Name a selective beta-1 adrenergic blocker.
Answer: Metoprolol (also atenolol).
13. What is the mechanism of action of albuterol?
Answer: Beta-2 adrenergic agonist that causes bronchodilation via smooth muscle relaxation.
14. What is the primary use of atropine?
Answer: An anticholinergic (muscarinic antagonist) used to treat bradycardia and as an antidote for cholinergic
toxicity/organophosphate poisoning.
15. What are common side effects of anticholinergic drugs?
Answer: Dry mouth, blurred vision, urinary retention, constipation, and tachycardia (remembered as 'can't see, can't pee,
can't spit, can't sh*t').
, 16. What is the mechanism of action of phenylephrine?
Answer: Selective alpha-1 adrenergic agonist causing vasoconstriction, used as a decongestant and to treat hypotension.
17. What condition is a relative contraindication for nonselective beta blockers?
Answer: Asthma/reactive airway disease, due to risk of bronchospasm from beta-2 blockade.
18. What is the mechanism of clonidine?
Answer: Central alpha-2 adrenergic agonist that decreases sympathetic outflow, lowering blood pressure.
19. What is myasthenia gravis treated with, pharmacologically?
Answer: Cholinesterase inhibitors such as pyridostigmine, which increase acetylcholine availability at the neuromuscular
junction.
20. What is a major risk of abruptly stopping beta blockers?
Answer: Rebound hypertension and tachycardia (or angina/MI in patients with coronary artery disease).
CNS: ANXIOLYTICS & SEDATIVE-HYPNOTICS
21. What is the mechanism of action of benzodiazepines?
Answer: They enhance the effect of GABA at the GABA-A receptor, increasing chloride influx and neuronal inhibition.
22. What is the antidote for benzodiazepine overdose?
Answer: Flumazenil.
23. Why should benzodiazepines be used cautiously in older adults?
Answer: Increased risk of falls, sedation, cognitive impairment, and paradoxical agitation.
24. What is buspirone used for, and what is notable about its onset?
Answer: An anxiolytic that does not act on GABA receptors; it has a delayed onset of action (1-2 weeks) and low abuse
potential.
25. What is a key risk of combining benzodiazepines with opioids?
Answer: Additive CNS and respiratory depression, increasing risk of fatal overdose.
26. What class of drug is zolpidem, and what is it used for?
Answer: A non-benzodiazepine hypnotic ('Z-drug') used for short-term treatment of insomnia.
27. What is a major concern with long-term benzodiazepine use?
Answer: Physical dependence and withdrawal symptoms (including seizure risk) upon abrupt discontinuation.
28. What monitoring is important before starting a patient on a sedative-hypnotic?
Answer: History of substance use disorder, hepatic function, and fall risk.
29. Which benzodiazepine is commonly used for alcohol withdrawal due to its long half-life?
Answer: Chlordiazepoxide (or diazepam).
30. What should patients be counseled about when starting benzodiazepines?
Answer: Avoid alcohol, avoid driving/operating machinery until effects are known, and do not stop abruptly.
CNS: ANTIDEPRESSANTS
31. What is the mechanism of SSRIs?
Answer: Selective inhibition of serotonin reuptake at the presynaptic neuron, increasing serotonin availability in the synapse.
32. What is serotonin syndrome, and what are its hallmark signs?
Answer: A potentially life-threatening condition from excess serotonergic activity, marked by agitation, hyperthermia,
tremor, clonus, and autonomic instability.
33. What black box warning applies to antidepressants in children/adolescents?
Answer: Increased risk of suicidal thinking and behavior.
34. What dietary restriction is required with MAOIs?
200 Practice Questions & Answers for Advanced Practice Nursing / PA Pharmacology Review
Original review questions covering core pharmacotherapeutics topics for advanced practice study.
PHARMACOKINETICS & PHARMACODYNAMICS
1. What are the four processes of pharmacokinetics?
Answer: Absorption, distribution, metabolism, and excretion (ADME).
2. What does bioavailability refer to?
Answer: The fraction of an administered drug dose that reaches systemic circulation unchanged.
3. Which route of administration has 100% bioavailability by definition?
Answer: Intravenous (IV) administration.
4. What is the first-pass effect?
Answer: Extensive hepatic metabolism of an orally absorbed drug before it reaches systemic circulation, reducing
bioavailability.
5. What is the primary organ responsible for drug metabolism?
Answer: The liver, via the cytochrome P450 enzyme system.
6. What is a drug's half-life (t1/2)?
Answer: The time required for the plasma concentration of a drug to decrease by 50%.
7. What is the therapeutic index?
Answer: A ratio comparing the toxic dose to the effective dose of a drug (TD50/ED50); a narrow index means a small margin
of safety.
8. What is the difference between agonist and antagonist drugs?
Answer: Agonists bind to a receptor and produce a biologic response; antagonists bind to a receptor and block or reduce the
response of an agonist.
9. What does the term 'protein binding' affect in pharmacokinetics?
Answer: The amount of free (active) drug available to exert effects; only unbound drug can cross membranes and act at
receptors.
10. What is zero-order kinetics?
Answer: Elimination of a constant amount of drug per unit time, regardless of concentration (e.g., alcohol, phenytoin at high
doses).
AUTONOMIC NERVOUS SYSTEM DRUGS
11. What are the primary effects of alpha-1 adrenergic agonists?
Answer: Vasoconstriction, increased blood pressure, and mydriasis.
12. Name a selective beta-1 adrenergic blocker.
Answer: Metoprolol (also atenolol).
13. What is the mechanism of action of albuterol?
Answer: Beta-2 adrenergic agonist that causes bronchodilation via smooth muscle relaxation.
14. What is the primary use of atropine?
Answer: An anticholinergic (muscarinic antagonist) used to treat bradycardia and as an antidote for cholinergic
toxicity/organophosphate poisoning.
15. What are common side effects of anticholinergic drugs?
Answer: Dry mouth, blurred vision, urinary retention, constipation, and tachycardia (remembered as 'can't see, can't pee,
can't spit, can't sh*t').
, 16. What is the mechanism of action of phenylephrine?
Answer: Selective alpha-1 adrenergic agonist causing vasoconstriction, used as a decongestant and to treat hypotension.
17. What condition is a relative contraindication for nonselective beta blockers?
Answer: Asthma/reactive airway disease, due to risk of bronchospasm from beta-2 blockade.
18. What is the mechanism of clonidine?
Answer: Central alpha-2 adrenergic agonist that decreases sympathetic outflow, lowering blood pressure.
19. What is myasthenia gravis treated with, pharmacologically?
Answer: Cholinesterase inhibitors such as pyridostigmine, which increase acetylcholine availability at the neuromuscular
junction.
20. What is a major risk of abruptly stopping beta blockers?
Answer: Rebound hypertension and tachycardia (or angina/MI in patients with coronary artery disease).
CNS: ANXIOLYTICS & SEDATIVE-HYPNOTICS
21. What is the mechanism of action of benzodiazepines?
Answer: They enhance the effect of GABA at the GABA-A receptor, increasing chloride influx and neuronal inhibition.
22. What is the antidote for benzodiazepine overdose?
Answer: Flumazenil.
23. Why should benzodiazepines be used cautiously in older adults?
Answer: Increased risk of falls, sedation, cognitive impairment, and paradoxical agitation.
24. What is buspirone used for, and what is notable about its onset?
Answer: An anxiolytic that does not act on GABA receptors; it has a delayed onset of action (1-2 weeks) and low abuse
potential.
25. What is a key risk of combining benzodiazepines with opioids?
Answer: Additive CNS and respiratory depression, increasing risk of fatal overdose.
26. What class of drug is zolpidem, and what is it used for?
Answer: A non-benzodiazepine hypnotic ('Z-drug') used for short-term treatment of insomnia.
27. What is a major concern with long-term benzodiazepine use?
Answer: Physical dependence and withdrawal symptoms (including seizure risk) upon abrupt discontinuation.
28. What monitoring is important before starting a patient on a sedative-hypnotic?
Answer: History of substance use disorder, hepatic function, and fall risk.
29. Which benzodiazepine is commonly used for alcohol withdrawal due to its long half-life?
Answer: Chlordiazepoxide (or diazepam).
30. What should patients be counseled about when starting benzodiazepines?
Answer: Avoid alcohol, avoid driving/operating machinery until effects are known, and do not stop abruptly.
CNS: ANTIDEPRESSANTS
31. What is the mechanism of SSRIs?
Answer: Selective inhibition of serotonin reuptake at the presynaptic neuron, increasing serotonin availability in the synapse.
32. What is serotonin syndrome, and what are its hallmark signs?
Answer: A potentially life-threatening condition from excess serotonergic activity, marked by agitation, hyperthermia,
tremor, clonus, and autonomic instability.
33. What black box warning applies to antidepressants in children/adolescents?
Answer: Increased risk of suicidal thinking and behavior.
34. What dietary restriction is required with MAOIs?
