NR 566 MIDTERM/NR566 ADVANCED PHARMACOLOGY FOR
CARE OF THE FAMILY PRACTICE EXAMINATION — STUDY
GUIDE | LATEST UPDATE 2026/2027 | ACTUAL EXAM |
PRACTICE QUESTIONS AND ANSWERS | EXAM REVIEW |
100% CORRECT ANSWERS | VERIFIED SOLUTIONS
1.
Which pharmacokinetic parameter is most significantly affected by
decreased gastric acid production in older adults?
A) Absorption of weakly acidic drugs
B) Absorption of weakly basic drugs
C) Hepatic first-pass metabolism
D) Renal tubular secretion
Correct Answer: B
Decreased gastric acid raises gastric pH, which reduces the ionization of
weakly basic drugs and can decrease their dissolution and absorption.
Weakly acidic drugs may actually dissolve more readily at higher pH.
Hepatic first-pass and renal secretion are not directly affected by gastric
acid.
2.
Rifampin is known to induce which cytochrome P450 enzyme most
significantly, leading to multiple drug interactions?
A) CYP2D6
B) CYP3A4
,C) CYP1A2
D) CYP2C9
Correct Answer: B
Rifampin is a potent inducer of CYP3A4, a major enzyme responsible for
metabolizing many drugs, including oral contraceptives, warfarin, and
antiretrovirals. Induction reduces plasma concentrations and efficacy.
Options A, C, and D are less affected by rifampin.
3.
A patient with severe liver cirrhosis is prescribed a drug with high first-
pass metabolism. What is the expected effect on oral bioavailability?
A) Decreased bioavailability
B) Increased bioavailability
C) No change in bioavailability
D) Faster elimination
Correct Answer: B
High first-pass metabolism normally removes a large fraction of an oral
drug before it reaches systemic circulation. In cirrhosis, hepatic
extraction is reduced, so more parent drug reaches circulation,
increasing bioavailability. Options A, C, and D are incorrect.
4.
Which of the following drugs is most likely to have an increased volume
of distribution and prolonged half-life in an obese patient?
A) Gentamicin
B) Lithium
C) Diazepam
D) Vancomycin
,Correct Answer: C
Lipophilic drugs like diazepam distribute extensively into adipose tissue,
increasing volume of distribution and prolonging half-life in obesity.
Gentamicin, lithium, and vancomycin are hydrophilic and distribute
primarily in lean body water.
5.
A patient with type 2 diabetes has an estimated creatinine clearance of
25 mL/min. Which medication should be avoided due to risk of lactic
acidosis?
A) Glipizide
B) Metformin
C) Pioglitazone
D) Sitagliptin
Correct Answer: B
Metformin is contraindicated when eGFR is below 30 mL/min/1.73 m²
due to increased risk of lactic acidosis. Glipizide, pioglitazone, and
sitagliptin may require dose adjustment but are not absolutely
contraindicated at this CrCl.
6.
Which drug requires therapeutic drug monitoring of trough levels to
minimize nephrotoxicity and ototoxicity?
A) Amoxicillin
B) Vancomycin
C) Azithromycin
D) Ciprofloxacin
, Correct Answer: B
Vancomycin requires trough monitoring, especially for serious MRSA
infections, to ensure efficacy and avoid nephrotoxicity and ototoxicity.
Amoxicillin and azithromycin have wide therapeutic indices;
ciprofloxacin does not routinely require trough monitoring.
7.
A patient with atrial fibrillation is to receive a loading dose of digoxin.
The desired plasma concentration is 1.5 ng/mL and the volume of
distribution is 7 L/kg. The patient weighs 70 kg. What is the
approximate loading dose?
A) 0.525 mg
B) 0.735 mg
C) 1.05 mg
D) 1.5 mg
Correct Answer: B
Loading dose = Vd × target concentration = (7 L/kg × 70 kg) × 1.5 ng/mL
= 490 L × 1.5 µg/L = 735 µg = 0.735 mg. Options A, C, and D use
incorrect volume or unit conversions.
8.
Which of the following drugs has the narrowest therapeutic index and
requires serum level monitoring?
A) Sertraline
B) Warfarin
C) Phenytoin
D) Metoprolol
CARE OF THE FAMILY PRACTICE EXAMINATION — STUDY
GUIDE | LATEST UPDATE 2026/2027 | ACTUAL EXAM |
PRACTICE QUESTIONS AND ANSWERS | EXAM REVIEW |
100% CORRECT ANSWERS | VERIFIED SOLUTIONS
1.
Which pharmacokinetic parameter is most significantly affected by
decreased gastric acid production in older adults?
A) Absorption of weakly acidic drugs
B) Absorption of weakly basic drugs
C) Hepatic first-pass metabolism
D) Renal tubular secretion
Correct Answer: B
Decreased gastric acid raises gastric pH, which reduces the ionization of
weakly basic drugs and can decrease their dissolution and absorption.
Weakly acidic drugs may actually dissolve more readily at higher pH.
Hepatic first-pass and renal secretion are not directly affected by gastric
acid.
2.
Rifampin is known to induce which cytochrome P450 enzyme most
significantly, leading to multiple drug interactions?
A) CYP2D6
B) CYP3A4
,C) CYP1A2
D) CYP2C9
Correct Answer: B
Rifampin is a potent inducer of CYP3A4, a major enzyme responsible for
metabolizing many drugs, including oral contraceptives, warfarin, and
antiretrovirals. Induction reduces plasma concentrations and efficacy.
Options A, C, and D are less affected by rifampin.
3.
A patient with severe liver cirrhosis is prescribed a drug with high first-
pass metabolism. What is the expected effect on oral bioavailability?
A) Decreased bioavailability
B) Increased bioavailability
C) No change in bioavailability
D) Faster elimination
Correct Answer: B
High first-pass metabolism normally removes a large fraction of an oral
drug before it reaches systemic circulation. In cirrhosis, hepatic
extraction is reduced, so more parent drug reaches circulation,
increasing bioavailability. Options A, C, and D are incorrect.
4.
Which of the following drugs is most likely to have an increased volume
of distribution and prolonged half-life in an obese patient?
A) Gentamicin
B) Lithium
C) Diazepam
D) Vancomycin
,Correct Answer: C
Lipophilic drugs like diazepam distribute extensively into adipose tissue,
increasing volume of distribution and prolonging half-life in obesity.
Gentamicin, lithium, and vancomycin are hydrophilic and distribute
primarily in lean body water.
5.
A patient with type 2 diabetes has an estimated creatinine clearance of
25 mL/min. Which medication should be avoided due to risk of lactic
acidosis?
A) Glipizide
B) Metformin
C) Pioglitazone
D) Sitagliptin
Correct Answer: B
Metformin is contraindicated when eGFR is below 30 mL/min/1.73 m²
due to increased risk of lactic acidosis. Glipizide, pioglitazone, and
sitagliptin may require dose adjustment but are not absolutely
contraindicated at this CrCl.
6.
Which drug requires therapeutic drug monitoring of trough levels to
minimize nephrotoxicity and ototoxicity?
A) Amoxicillin
B) Vancomycin
C) Azithromycin
D) Ciprofloxacin
, Correct Answer: B
Vancomycin requires trough monitoring, especially for serious MRSA
infections, to ensure efficacy and avoid nephrotoxicity and ototoxicity.
Amoxicillin and azithromycin have wide therapeutic indices;
ciprofloxacin does not routinely require trough monitoring.
7.
A patient with atrial fibrillation is to receive a loading dose of digoxin.
The desired plasma concentration is 1.5 ng/mL and the volume of
distribution is 7 L/kg. The patient weighs 70 kg. What is the
approximate loading dose?
A) 0.525 mg
B) 0.735 mg
C) 1.05 mg
D) 1.5 mg
Correct Answer: B
Loading dose = Vd × target concentration = (7 L/kg × 70 kg) × 1.5 ng/mL
= 490 L × 1.5 µg/L = 735 µg = 0.735 mg. Options A, C, and D use
incorrect volume or unit conversions.
8.
Which of the following drugs has the narrowest therapeutic index and
requires serum level monitoring?
A) Sertraline
B) Warfarin
C) Phenytoin
D) Metoprolol
