NURS 6521 Advanced Pharmacology Midterm Exam
Questions and Answers| Latest Update| Guaranteed Pass
Q1. A patient with severe hypoalbuminemia is prescribed a highly protein-bound drug
such as phenytoin. What is the most likely consequence?
A. Decreased free drug concentration and reduced effect
B. Increased free drug concentration and risk of toxicity
C. No change because albumin does not affect distribution
D. Increased renal clearance of the drug
Answer: B
Rationale: Highly protein-bound drugs like phenytoin rely on albumin for transport.
With hypoalbuminemia, fewer binding sites are available, increasing the free
(unbound, pharmacologically active) fraction of the drug, which raises the risk of
toxicity even when total drug levels appear normal.
Q2. Which pharmacokinetic parameter best describes the percentage of an
administered drug dose that reaches systemic circulation unchanged?
A. Volume of distribution
B. Bioavailability
C. Clearance
D. Half-life
Answer: B
Rationale: Bioavailability (F) is the fraction of an administered dose that reaches
systemic circulation in an unchanged, active form. IV drugs have 100% bioavailability;
oral drugs are often lower due to first-pass metabolism.
Q3. A drug has a half-life of 6 hours. Approximately how long will it take to reach steady-
state concentration with regular dosing?
A. 6 hours
B. 12 hours
C. 24-30 hours
D. 48-60 hours
Answer: C
, Rationale: Steady state is reached after approximately 4-5 half-lives regardless of
dose or dosing interval. With a 6-hour half-life, 4-5 half-lives equals 24-30 hours.
Q4. Which enzyme system is primarily responsible for phase I metabolism of most drugs
in the liver?
A. Glucuronyl transferase
B. Cytochrome P450
C. Acetyltransferase
D. Monoamine oxidase
Answer: B
Rationale: The cytochrome P450 (CYP450) enzyme system, located primarily in the
liver, catalyzes phase I oxidation, reduction, and hydrolysis reactions for the majority
of clinically used drugs.
Q5. A patient taking warfarin is started on fluconazole. What is the most likely
pharmacokinetic interaction?
A. Fluconazole induces CYP2C9, decreasing warfarin effect
B. Fluconazole inhibits CYP2C9, increasing warfarin effect and bleeding risk
C. Fluconazole has no effect on warfarin metabolism
D. Fluconazole increases warfarin protein binding, decreasing free drug
Answer: B
Rationale: Fluconazole is a potent inhibitor of CYP2C9, the primary enzyme
responsible for warfarin metabolism. Inhibition slows warfarin clearance, raising INR
and increasing bleeding risk; close INR monitoring and dose adjustment are required.
Q6. Which route of administration bypasses first-pass hepatic metabolism entirely?
A. Oral
B. Sublingual
C. Rectal (lower two-thirds)
D. Both B and C
Answer: D
Rationale: Sublingual and lower rectal administration allow drug absorption into
systemic veins that bypass the portal circulation and liver, avoiding first-pass
metabolism, unlike oral administration which passes through the portal vein to the
liver first.
,Q7. A patient with end-stage renal disease is prescribed gentamicin. Which adjustment
is most appropriate?
A. Increase the dose to compensate for poor absorption
B. Extend the dosing interval and monitor peak/trough levels
C. No adjustment needed since gentamicin is hepatically cleared
D. Switch to an oral formulation
Answer: B
Rationale: Gentamicin is renally eliminated and has a narrow therapeutic index. In
renal impairment, the dosing interval should be extended (or dose reduced) with
peak/trough monitoring to prevent nephrotoxicity and ototoxicity from drug
accumulation.
Q8. What term describes the phenomenon where a drug's effect diminishes with
repeated administration, requiring higher doses to achieve the same effect?
A. Idiosyncratic reaction
B. Tolerance
C. Tachyphylaxis
D. Synergism
Answer: B
Rationale: Tolerance is a decreased response to a drug that develops over repeated
exposures, requiring dose escalation to maintain the same therapeutic effect; it is
commonly seen with opioids and benzodiazepines.
Q9. Which term describes an adverse drug reaction that is unpredictable, unrelated to
dose, and often genetically determined?
A. Idiosyncratic reaction
B. Additive effect
C. Potentiation
D. Cumulative effect
Answer: A
Rationale: An idiosyncratic reaction is an abnormal, unpredictable response to a drug
that is not dose-dependent and often results from genetic variations in drug
metabolism (pharmacogenomics), such as malignant hyperthermia with anesthetics.
Q10. A drug is described as having zero-order kinetics. What does this mean clinically?
A. A constant percentage of drug is eliminated per unit time
, B. A constant amount of drug is eliminated per unit time regardless of concentration
C. The drug is not metabolized at all
D. Elimination rate increases proportionally with dose
Answer: B
Rationale: Zero-order kinetics means a constant amount (not percentage) of drug is
eliminated per unit time because elimination pathways are saturated. Phenytoin,
alcohol, and aspirin (at high doses) exhibit zero-order kinetics, making small dose
increases risk disproportionate toxicity.
Questions and Answers| Latest Update| Guaranteed Pass
Q1. A patient with severe hypoalbuminemia is prescribed a highly protein-bound drug
such as phenytoin. What is the most likely consequence?
A. Decreased free drug concentration and reduced effect
B. Increased free drug concentration and risk of toxicity
C. No change because albumin does not affect distribution
D. Increased renal clearance of the drug
Answer: B
Rationale: Highly protein-bound drugs like phenytoin rely on albumin for transport.
With hypoalbuminemia, fewer binding sites are available, increasing the free
(unbound, pharmacologically active) fraction of the drug, which raises the risk of
toxicity even when total drug levels appear normal.
Q2. Which pharmacokinetic parameter best describes the percentage of an
administered drug dose that reaches systemic circulation unchanged?
A. Volume of distribution
B. Bioavailability
C. Clearance
D. Half-life
Answer: B
Rationale: Bioavailability (F) is the fraction of an administered dose that reaches
systemic circulation in an unchanged, active form. IV drugs have 100% bioavailability;
oral drugs are often lower due to first-pass metabolism.
Q3. A drug has a half-life of 6 hours. Approximately how long will it take to reach steady-
state concentration with regular dosing?
A. 6 hours
B. 12 hours
C. 24-30 hours
D. 48-60 hours
Answer: C
, Rationale: Steady state is reached after approximately 4-5 half-lives regardless of
dose or dosing interval. With a 6-hour half-life, 4-5 half-lives equals 24-30 hours.
Q4. Which enzyme system is primarily responsible for phase I metabolism of most drugs
in the liver?
A. Glucuronyl transferase
B. Cytochrome P450
C. Acetyltransferase
D. Monoamine oxidase
Answer: B
Rationale: The cytochrome P450 (CYP450) enzyme system, located primarily in the
liver, catalyzes phase I oxidation, reduction, and hydrolysis reactions for the majority
of clinically used drugs.
Q5. A patient taking warfarin is started on fluconazole. What is the most likely
pharmacokinetic interaction?
A. Fluconazole induces CYP2C9, decreasing warfarin effect
B. Fluconazole inhibits CYP2C9, increasing warfarin effect and bleeding risk
C. Fluconazole has no effect on warfarin metabolism
D. Fluconazole increases warfarin protein binding, decreasing free drug
Answer: B
Rationale: Fluconazole is a potent inhibitor of CYP2C9, the primary enzyme
responsible for warfarin metabolism. Inhibition slows warfarin clearance, raising INR
and increasing bleeding risk; close INR monitoring and dose adjustment are required.
Q6. Which route of administration bypasses first-pass hepatic metabolism entirely?
A. Oral
B. Sublingual
C. Rectal (lower two-thirds)
D. Both B and C
Answer: D
Rationale: Sublingual and lower rectal administration allow drug absorption into
systemic veins that bypass the portal circulation and liver, avoiding first-pass
metabolism, unlike oral administration which passes through the portal vein to the
liver first.
,Q7. A patient with end-stage renal disease is prescribed gentamicin. Which adjustment
is most appropriate?
A. Increase the dose to compensate for poor absorption
B. Extend the dosing interval and monitor peak/trough levels
C. No adjustment needed since gentamicin is hepatically cleared
D. Switch to an oral formulation
Answer: B
Rationale: Gentamicin is renally eliminated and has a narrow therapeutic index. In
renal impairment, the dosing interval should be extended (or dose reduced) with
peak/trough monitoring to prevent nephrotoxicity and ototoxicity from drug
accumulation.
Q8. What term describes the phenomenon where a drug's effect diminishes with
repeated administration, requiring higher doses to achieve the same effect?
A. Idiosyncratic reaction
B. Tolerance
C. Tachyphylaxis
D. Synergism
Answer: B
Rationale: Tolerance is a decreased response to a drug that develops over repeated
exposures, requiring dose escalation to maintain the same therapeutic effect; it is
commonly seen with opioids and benzodiazepines.
Q9. Which term describes an adverse drug reaction that is unpredictable, unrelated to
dose, and often genetically determined?
A. Idiosyncratic reaction
B. Additive effect
C. Potentiation
D. Cumulative effect
Answer: A
Rationale: An idiosyncratic reaction is an abnormal, unpredictable response to a drug
that is not dose-dependent and often results from genetic variations in drug
metabolism (pharmacogenomics), such as malignant hyperthermia with anesthetics.
Q10. A drug is described as having zero-order kinetics. What does this mean clinically?
A. A constant percentage of drug is eliminated per unit time
, B. A constant amount of drug is eliminated per unit time regardless of concentration
C. The drug is not metabolized at all
D. Elimination rate increases proportionally with dose
Answer: B
Rationale: Zero-order kinetics means a constant amount (not percentage) of drug is
eliminated per unit time because elimination pathways are saturated. Phenytoin,
alcohol, and aspirin (at high doses) exhibit zero-order kinetics, making small dose
increases risk disproportionate toxicity.
