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PHARMACOTHERAPEUTICS FOR ADVANCED PRACTICE 5th Edition – Ultimate
Practice Test Bank Questions with Verified Answers & Rationales
Question 1
Which of the following best describes first-pass metabolism?
A. Drug metabolism that occurs in the liver after oral
absorption, reducing the amount of active drug entering
systemic circulation
B. Drug metabolism in the kidneys
C. Drug metabolism only in the stomach
D. Drug metabolism after intravenous administration
Answer: A
Rationale: First-pass metabolism occurs primarily in the liver
after oral absorption; it reduces bioavailability before the drug
reaches systemic circulation.
Question 2
Which of the following is an example of a cytochrome P450
enzyme inhibitor?
A. Rifampin
B. Carbamazepine
C. Ketoconazole
D. St. John’s Wort
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Answer: C
Rationale: Ketoconazole inhibits CYP3A4. Rifampin,
carbamazepine, and St. John’s Wort are inducers.
Question 3
A drug with a narrow therapeutic index requires:
A. No monitoring
B. Careful dose titration and therapeutic drug monitoring
C. Once-daily dosing only
D. Avoidance in all older adults
Answer: B
Rationale: Narrow therapeutic index drugs (e.g., warfarin,
digoxin, lithium) require close monitoring to avoid toxicity or
underdosing.
Question 4
Which of the following is an example of a prodrug that requires
activation in the liver?
A. Lisinopril
B. Clopidogrel
C. Metformin
D. Amlodipine
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Answer: B
Rationale: Clopidogrel is a prodrug that must be converted by
CYP2C19 to its active metabolite.
Question 5
Which route of administration bypasses first-pass metabolism?
A. Oral
B. Sublingual
C. Rectal only
D. Both B and C can partially or fully bypass first-pass
Answer: D
Rationale: Sublingual and some rectal routes allow direct
absorption into systemic circulation, bypassing hepatic first-
pass.
Question 6
Which of the following is a common adverse effect of SSRIs?
A. Hypertensive crisis
B. Sexual dysfunction and GI upset
C. Bradycardia
D. Hyperkalemia
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Answer: B
Rationale: SSRIs commonly cause sexual dysfunction, nausea,
and headache. Hypertensive crisis is MAOI/tyramine.
Question 7
A patient on an MAOI should avoid which food?
A. Fresh vegetables
B. Aged cheese and cured meats
C. White bread
D. Rice
Answer: B
Rationale: Tyramine-rich foods (aged cheese, cured meats) can
precipitate hypertensive crisis with MAOIs.
Question 8
Which of the following is the first-line medication for
generalized anxiety disorder?
A. Benzodiazepine
B. SSRI or SNRI
C. Antipsychotic
D. Beta-blocker only
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PHARMACOTHERAPEUTICS FOR ADVANCED PRACTICE 5th Edition – Ultimate
Practice Test Bank Questions with Verified Answers & Rationales
Question 1
Which of the following best describes first-pass metabolism?
A. Drug metabolism that occurs in the liver after oral
absorption, reducing the amount of active drug entering
systemic circulation
B. Drug metabolism in the kidneys
C. Drug metabolism only in the stomach
D. Drug metabolism after intravenous administration
Answer: A
Rationale: First-pass metabolism occurs primarily in the liver
after oral absorption; it reduces bioavailability before the drug
reaches systemic circulation.
Question 2
Which of the following is an example of a cytochrome P450
enzyme inhibitor?
A. Rifampin
B. Carbamazepine
C. Ketoconazole
D. St. John’s Wort
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, Page |2
Answer: C
Rationale: Ketoconazole inhibits CYP3A4. Rifampin,
carbamazepine, and St. John’s Wort are inducers.
Question 3
A drug with a narrow therapeutic index requires:
A. No monitoring
B. Careful dose titration and therapeutic drug monitoring
C. Once-daily dosing only
D. Avoidance in all older adults
Answer: B
Rationale: Narrow therapeutic index drugs (e.g., warfarin,
digoxin, lithium) require close monitoring to avoid toxicity or
underdosing.
Question 4
Which of the following is an example of a prodrug that requires
activation in the liver?
A. Lisinopril
B. Clopidogrel
C. Metformin
D. Amlodipine
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, Page |3
Answer: B
Rationale: Clopidogrel is a prodrug that must be converted by
CYP2C19 to its active metabolite.
Question 5
Which route of administration bypasses first-pass metabolism?
A. Oral
B. Sublingual
C. Rectal only
D. Both B and C can partially or fully bypass first-pass
Answer: D
Rationale: Sublingual and some rectal routes allow direct
absorption into systemic circulation, bypassing hepatic first-
pass.
Question 6
Which of the following is a common adverse effect of SSRIs?
A. Hypertensive crisis
B. Sexual dysfunction and GI upset
C. Bradycardia
D. Hyperkalemia
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, Page |4
Answer: B
Rationale: SSRIs commonly cause sexual dysfunction, nausea,
and headache. Hypertensive crisis is MAOI/tyramine.
Question 7
A patient on an MAOI should avoid which food?
A. Fresh vegetables
B. Aged cheese and cured meats
C. White bread
D. Rice
Answer: B
Rationale: Tyramine-rich foods (aged cheese, cured meats) can
precipitate hypertensive crisis with MAOIs.
Question 8
Which of the following is the first-line medication for
generalized anxiety disorder?
A. Benzodiazepine
B. SSRI or SNRI
C. Antipsychotic
D. Beta-blocker only
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