NR 565 ADVANCED PHARMACOLOGY
COMPREHENSIVE EXAM REVIEW
QUESTIONS AND ANSWERS
1. A 65-year-old patient with chronic kidney disease (CKD) Stage 3 is prescribed a new
medication that is primarily excreted renally. Which pharmacokinetic process is most
significantly altered in this patient?
A. Absorption
B. Distribution
C. Elimination
D. Metabolism
Answer: C
Conceptual Explanation: Elimination is the primary pharmacokinetic process affected by
kidney function. In CKD, the glomerular filtration rate (GFR) decreases, leading to reduced
clearance and potential toxicity of renally excreted drugs.
2. Which of the following describes the ‘first-pass effect’ encountered with oral medications?
A. The metabolism of a drug by the liver before it reaches systemic circulation.
,B. The rapid distribution of drug to the brain via the blood-brain barrier.
C. The excretion of drug metabolites through the biliary system.
D. The absorption of the drug through the gastric mucosa.
Answer: A
Conceptual Explanation: The first-pass effect occurs when an oral drug is absorbed from
the GI tract and transported via the portal vein to the liver, where a significant portion may
be metabolized before reaching the systemic circulation.
3. A patient is taking Phenytoin, a known CYP450 inducer. If the patient is started on
Warfarin, what is the likely clinical outcome?
A. Increased serum levels of Warfarin and increased risk of bleeding.
B. No change in Warfarin levels as Phenytoin only affects Phase II reactions.
C. Increased serum levels of Phenytoin and risk of ataxia.
D. Decreased serum levels of Warfarin and increased risk of clotting.
Answer: D
Conceptual Explanation: Phenytoin is a CYP450 inducer, which increases the metabolism
of substrate drugs like Warfarin. This leads to decreased therapeutic levels of Warfarin,
increasing the risk of subtherapeutic anticoagulation (clotting).
, 4. When monitoring a patient on Amiodarone, which organ system requires baseline and
periodic assessment due to potential toxicity?
A. Pancreas
B. Musculoskeletal system
C. Kidneys
D. Thyroid
Answer: D
Conceptual Explanation: Amiodarone contains high levels of iodine and can cause both
hypothyroidism and hyperthyroidism, as well as pulmonary toxicity and hepatotoxicity.
5. Which beta-blocker is preferred for a patient with hypertension who also has a history of
severe reactive airway disease (asthma)?
A. Propranolol
B. Nadolol
C. Timolol
D. Metoprolol
Answer: D
Conceptual Explanation: Metoprolol is a cardioselective beta-1 blocker, making it safer
for patients with asthma compared to non-selective beta-blockers like Propranolol or
Nadolol, which can cause bronchoconstriction via beta-2 blockade.
COMPREHENSIVE EXAM REVIEW
QUESTIONS AND ANSWERS
1. A 65-year-old patient with chronic kidney disease (CKD) Stage 3 is prescribed a new
medication that is primarily excreted renally. Which pharmacokinetic process is most
significantly altered in this patient?
A. Absorption
B. Distribution
C. Elimination
D. Metabolism
Answer: C
Conceptual Explanation: Elimination is the primary pharmacokinetic process affected by
kidney function. In CKD, the glomerular filtration rate (GFR) decreases, leading to reduced
clearance and potential toxicity of renally excreted drugs.
2. Which of the following describes the ‘first-pass effect’ encountered with oral medications?
A. The metabolism of a drug by the liver before it reaches systemic circulation.
,B. The rapid distribution of drug to the brain via the blood-brain barrier.
C. The excretion of drug metabolites through the biliary system.
D. The absorption of the drug through the gastric mucosa.
Answer: A
Conceptual Explanation: The first-pass effect occurs when an oral drug is absorbed from
the GI tract and transported via the portal vein to the liver, where a significant portion may
be metabolized before reaching the systemic circulation.
3. A patient is taking Phenytoin, a known CYP450 inducer. If the patient is started on
Warfarin, what is the likely clinical outcome?
A. Increased serum levels of Warfarin and increased risk of bleeding.
B. No change in Warfarin levels as Phenytoin only affects Phase II reactions.
C. Increased serum levels of Phenytoin and risk of ataxia.
D. Decreased serum levels of Warfarin and increased risk of clotting.
Answer: D
Conceptual Explanation: Phenytoin is a CYP450 inducer, which increases the metabolism
of substrate drugs like Warfarin. This leads to decreased therapeutic levels of Warfarin,
increasing the risk of subtherapeutic anticoagulation (clotting).
, 4. When monitoring a patient on Amiodarone, which organ system requires baseline and
periodic assessment due to potential toxicity?
A. Pancreas
B. Musculoskeletal system
C. Kidneys
D. Thyroid
Answer: D
Conceptual Explanation: Amiodarone contains high levels of iodine and can cause both
hypothyroidism and hyperthyroidism, as well as pulmonary toxicity and hepatotoxicity.
5. Which beta-blocker is preferred for a patient with hypertension who also has a history of
severe reactive airway disease (asthma)?
A. Propranolol
B. Nadolol
C. Timolol
D. Metoprolol
Answer: D
Conceptual Explanation: Metoprolol is a cardioselective beta-1 blocker, making it safer
for patients with asthma compared to non-selective beta-blockers like Propranolol or
Nadolol, which can cause bronchoconstriction via beta-2 blockade.
