CEA NR568 / NR 568 CEA/ NR 568
Advanced Pharmacology Clinical
Evaluation and Assessment CEA Exam
Prep Test Bank
SECTION 1: PHARMACOKINETICS & PHARMACODYNAMICS
1. A 70-year-old patient with heart failure is started on digoxin. Which age-related change in
pharmacokinetics most increases the risk of toxicity?
• A) Decreased renal clearance of digoxin
• B) Increased hepatic first-pass metabolism
• C) Increased volume of distribution for water-soluble drugs
• D) Enhanced glomerular filtration rate
Answer: A) Decreased renal clearance of digoxin
Rationale: Renal clearance declines with age, reducing digoxin elimination. Dose adjustment
based on renal function and monitoring of levels is essential .
2. A patient with a genetic polymorphism resulting in CYP2D6 poor metabolizer phenotype is
prescribed codeine for pain. What is the most likely outcome?
• A) Little to no analgesic effect due to inability to convert codeine to morphine
• B) Increased risk of respiratory depression from rapid conversion to morphine
• C) Prolonged half-life of codeine but normal analgesia
• D) Increased risk of serotonin syndrome
Answer: A) Little to no analgesic effect due to inability to convert codeine to morphine
Rationale: Codeine is a prodrug requiring CYP2D6 to convert to active morphine. Poor
metabolizers have reduced analgesia .
,3. A patient is receiving a drug that undergoes zero-order kinetics (e.g., phenytoin at high
doses). Which statement is correct?
• A) A constant amount of drug is eliminated per unit time, independent of
concentration
• B) A constant fraction of drug is eliminated per unit time
• C) Half-life remains constant regardless of dose
• D) Drug accumulation does not occur
Answer: A) A constant amount of drug is eliminated per unit time, independent of
concentration
Rationale: Zero-order kinetics means elimination rate is constant (e.g., phenytoin, ethanol),
leading to concentration-dependent half-life .
4. A patient with a large amount of adipose tissue is started on a lipophilic drug (e.g.,
diazepam). Compared to a lean patient, this patient will likely have:
• A) A larger volume of distribution and prolonged half-life
• B) A smaller volume of distribution and shorter half-life
• C) No difference in distribution
• D) Faster elimination due to increased metabolism
Answer: A) A larger volume of distribution and prolonged half-life
Rationale: Lipophilic drugs accumulate in adipose tissue, increasing Vd and prolonging
elimination half-life .
5. A patient is prescribed a drug that is a weak acid (pKa 4.5). In the acidic environment of the
stomach (pH 1.5), the drug will be:
• A) Mostly nonionized and absorbed rapidly
• B) Mostly ionized and not absorbed
• C) Completely ionized and excreted
• D) Precipitated as an insoluble salt
,Answer: A) Mostly nonionized and absorbed rapidly
Rationale: Weak acids are nonionized (lipid-soluble) in acidic pH, favoring gastric absorption .
6. A patient has been on a drug with a half-life of 24 hours. Approximately how long will it
take to reach steady state?
• A) 5 days (120 hours)
• B) 24 hours
• C) 12 hours
• D) 10 days
Answer: A) 5 days (120 hours)
Rationale: Steady state is reached after 4-5 half-lives. With a 24-hour half-life, this equals 4-5
days (96-120 hours) .
7. A patient receiving a drug that follows one-compartment pharmacokinetics is given
intravenously. The elimination rate constant (k) is 0.1 hr⁻¹. What is the half-life?
• A) 6.93 hours
• B) 6.93 hours
• C) 1 hour
• D) 10 hours
Answer: B) 6.93 hours
Rationale: t½ = 0.693 / k = 0..1 = 6.93 hours .
8. A patient with cirrhosis and ascites has an increased volume of distribution for hydrophilic
drugs. Which drug would require a higher loading dose?
• A) Gentamicin (hydrophilic)
• B) Diazepam (lipophilic)
• C) Fentanyl (lipophilic)
• D) Warfarin (highly protein-bound)
, Answer: A) Gentamicin (hydrophilic)
Rationale: Ascites increases total body water, increasing Vd for hydrophilic drugs; loading dose
may need adjustment .
9. A patient is receiving a drug that is a CYP1A2 substrate (e.g., theophylline) and is a heavy
smoker. The expected effect is:
• A) Decreased theophylline levels due to CYP1A2 induction
• B) Increased theophylline levels due to CYP1A2 inhibition
• C) No change because smoking does not affect CYP enzymes
• D) Increased half-life and toxicity
Answer: A) Decreased theophylline levels due to CYP1A2 induction
Rationale: Smoking induces CYP1A2, increasing theophylline metabolism and requiring higher
doses .
10. A patient is taking a drug that is a P-glycoprotein (P-gp) substrate and is also a CYP3A4
substrate. Co-administration of a P-gp inhibitor and CYP3A4 inhibitor will most likely:
• A) Significantly increase oral bioavailability and plasma levels
• B) Decrease absorption and increase metabolism
• C) Have no net effect
• D) Cause the drug to be eliminated faster
Answer: A) Significantly increase oral bioavailability and plasma levels
Rationale: P-gp pumps drugs back into the intestinal lumen; inhibiting P-gp increases absorption
and bioavailability. CYP3A4 inhibition further reduces metabolism .
11. A patient with hypoalbuminemia is started on a highly protein-bound drug (e.g.,
phenytoin, warfarin). The expected effect is:
• A) Decreased free drug levels and reduced effect
• B) Increased free drug levels and enhanced effect/toxicity
• C) No change because albumin binding is irrelevant
Advanced Pharmacology Clinical
Evaluation and Assessment CEA Exam
Prep Test Bank
SECTION 1: PHARMACOKINETICS & PHARMACODYNAMICS
1. A 70-year-old patient with heart failure is started on digoxin. Which age-related change in
pharmacokinetics most increases the risk of toxicity?
• A) Decreased renal clearance of digoxin
• B) Increased hepatic first-pass metabolism
• C) Increased volume of distribution for water-soluble drugs
• D) Enhanced glomerular filtration rate
Answer: A) Decreased renal clearance of digoxin
Rationale: Renal clearance declines with age, reducing digoxin elimination. Dose adjustment
based on renal function and monitoring of levels is essential .
2. A patient with a genetic polymorphism resulting in CYP2D6 poor metabolizer phenotype is
prescribed codeine for pain. What is the most likely outcome?
• A) Little to no analgesic effect due to inability to convert codeine to morphine
• B) Increased risk of respiratory depression from rapid conversion to morphine
• C) Prolonged half-life of codeine but normal analgesia
• D) Increased risk of serotonin syndrome
Answer: A) Little to no analgesic effect due to inability to convert codeine to morphine
Rationale: Codeine is a prodrug requiring CYP2D6 to convert to active morphine. Poor
metabolizers have reduced analgesia .
,3. A patient is receiving a drug that undergoes zero-order kinetics (e.g., phenytoin at high
doses). Which statement is correct?
• A) A constant amount of drug is eliminated per unit time, independent of
concentration
• B) A constant fraction of drug is eliminated per unit time
• C) Half-life remains constant regardless of dose
• D) Drug accumulation does not occur
Answer: A) A constant amount of drug is eliminated per unit time, independent of
concentration
Rationale: Zero-order kinetics means elimination rate is constant (e.g., phenytoin, ethanol),
leading to concentration-dependent half-life .
4. A patient with a large amount of adipose tissue is started on a lipophilic drug (e.g.,
diazepam). Compared to a lean patient, this patient will likely have:
• A) A larger volume of distribution and prolonged half-life
• B) A smaller volume of distribution and shorter half-life
• C) No difference in distribution
• D) Faster elimination due to increased metabolism
Answer: A) A larger volume of distribution and prolonged half-life
Rationale: Lipophilic drugs accumulate in adipose tissue, increasing Vd and prolonging
elimination half-life .
5. A patient is prescribed a drug that is a weak acid (pKa 4.5). In the acidic environment of the
stomach (pH 1.5), the drug will be:
• A) Mostly nonionized and absorbed rapidly
• B) Mostly ionized and not absorbed
• C) Completely ionized and excreted
• D) Precipitated as an insoluble salt
,Answer: A) Mostly nonionized and absorbed rapidly
Rationale: Weak acids are nonionized (lipid-soluble) in acidic pH, favoring gastric absorption .
6. A patient has been on a drug with a half-life of 24 hours. Approximately how long will it
take to reach steady state?
• A) 5 days (120 hours)
• B) 24 hours
• C) 12 hours
• D) 10 days
Answer: A) 5 days (120 hours)
Rationale: Steady state is reached after 4-5 half-lives. With a 24-hour half-life, this equals 4-5
days (96-120 hours) .
7. A patient receiving a drug that follows one-compartment pharmacokinetics is given
intravenously. The elimination rate constant (k) is 0.1 hr⁻¹. What is the half-life?
• A) 6.93 hours
• B) 6.93 hours
• C) 1 hour
• D) 10 hours
Answer: B) 6.93 hours
Rationale: t½ = 0.693 / k = 0..1 = 6.93 hours .
8. A patient with cirrhosis and ascites has an increased volume of distribution for hydrophilic
drugs. Which drug would require a higher loading dose?
• A) Gentamicin (hydrophilic)
• B) Diazepam (lipophilic)
• C) Fentanyl (lipophilic)
• D) Warfarin (highly protein-bound)
, Answer: A) Gentamicin (hydrophilic)
Rationale: Ascites increases total body water, increasing Vd for hydrophilic drugs; loading dose
may need adjustment .
9. A patient is receiving a drug that is a CYP1A2 substrate (e.g., theophylline) and is a heavy
smoker. The expected effect is:
• A) Decreased theophylline levels due to CYP1A2 induction
• B) Increased theophylline levels due to CYP1A2 inhibition
• C) No change because smoking does not affect CYP enzymes
• D) Increased half-life and toxicity
Answer: A) Decreased theophylline levels due to CYP1A2 induction
Rationale: Smoking induces CYP1A2, increasing theophylline metabolism and requiring higher
doses .
10. A patient is taking a drug that is a P-glycoprotein (P-gp) substrate and is also a CYP3A4
substrate. Co-administration of a P-gp inhibitor and CYP3A4 inhibitor will most likely:
• A) Significantly increase oral bioavailability and plasma levels
• B) Decrease absorption and increase metabolism
• C) Have no net effect
• D) Cause the drug to be eliminated faster
Answer: A) Significantly increase oral bioavailability and plasma levels
Rationale: P-gp pumps drugs back into the intestinal lumen; inhibiting P-gp increases absorption
and bioavailability. CYP3A4 inhibition further reduces metabolism .
11. A patient with hypoalbuminemia is started on a highly protein-bound drug (e.g.,
phenytoin, warfarin). The expected effect is:
• A) Decreased free drug levels and reduced effect
• B) Increased free drug levels and enhanced effect/toxicity
• C) No change because albumin binding is irrelevant
