NR 508 ADVANCED PHARMACOLOGY
MIDTERM AND FINAL EXAM
QUESTION AND ANSWERS
1. A patient with a history of asthma is diagnosed with hypertension. Which of the following
beta-blockers should be avoided due to the risk of bronchospasm?
A. Metoprolol
B. Propranolol
C. Atenolol
D. Bisoprolol
Answer: B
Conceptual Explanation: Propranolol is a non-selective beta-blocker that antagonizes
both beta-1 and beta-2 receptors. Blocking beta-2 receptors in the lungs can lead to
bronchoconstriction, which is dangerous for patients with asthma.
2. When prescribing Metformin for a patient with Type 2 Diabetes, the clinician must monitor
which lab value closely due to the risk of lactic acidosis?
A. Serum Potassium
,B. Hemoglobin A1c
C. Alanine Aminotransferase (ALT)
D. Glomerular Filtration Rate (eGFR)
Answer: D
Conceptual Explanation: Metformin is renally excreted. A decrease in eGFR (specifically
below 30 mL/min/1.73m²) significantly increases the risk of metformin-associated lactic
acidosis.
3. Which of the following describes the ‘First-Pass Effect’ in pharmacology?
A. The rapid excretion of a drug by the kidneys
B. The metabolism of an oral drug in the liver before it reaches systemic circulation
C. The distribution of a drug to the brain via the blood-brain barrier
D. The binding of a drug to plasma proteins
Answer: B
Conceptual Explanation: The first-pass effect occurs when an orally administered drug is
absorbed from the GI tract and enters the portal circulation, where it is metabolized by the
liver before reaching the rest of the body.
4. An elderly patient is prescribed a new medication that is highly protein-bound. What is the
primary concern for this patient compared to a younger adult?
A. Lower serum albumin levels resulting in more free, active drug
, B. Increased serum albumin levels leading to drug toxicity
C. Faster renal clearance of the drug
D. Increased gastric acid production reducing absorption
Answer: A
Conceptual Explanation: Elderly patients often have decreased serum albumin levels. For
drugs that are highly protein-bound, fewer binding sites mean more ‘free’ drug is
circulating, which can lead to increased pharmacological effects or toxicity.
5. Which antibiotic class is most strongly associated with the risk of tendon rupture,
especially in older adults or those taking corticosteroids?
A. Macrolides
B. Penicillins
C. Cephalosporins
D. Fluoroquinolones
Answer: D
Conceptual Explanation: Fluoroquinolones (like Ciprofloxacin and Levofloxacin) carry a
Black Box Warning for increased risk of tendinitis and tendon rupture.
6. A patient taking Warfarin (Coumadin) is started on Amiodarone for atrial fibrillation. What
adjustment is typically required for the Warfarin dose?
A. Decrease the Warfarin dose by 25% to 50%
MIDTERM AND FINAL EXAM
QUESTION AND ANSWERS
1. A patient with a history of asthma is diagnosed with hypertension. Which of the following
beta-blockers should be avoided due to the risk of bronchospasm?
A. Metoprolol
B. Propranolol
C. Atenolol
D. Bisoprolol
Answer: B
Conceptual Explanation: Propranolol is a non-selective beta-blocker that antagonizes
both beta-1 and beta-2 receptors. Blocking beta-2 receptors in the lungs can lead to
bronchoconstriction, which is dangerous for patients with asthma.
2. When prescribing Metformin for a patient with Type 2 Diabetes, the clinician must monitor
which lab value closely due to the risk of lactic acidosis?
A. Serum Potassium
,B. Hemoglobin A1c
C. Alanine Aminotransferase (ALT)
D. Glomerular Filtration Rate (eGFR)
Answer: D
Conceptual Explanation: Metformin is renally excreted. A decrease in eGFR (specifically
below 30 mL/min/1.73m²) significantly increases the risk of metformin-associated lactic
acidosis.
3. Which of the following describes the ‘First-Pass Effect’ in pharmacology?
A. The rapid excretion of a drug by the kidneys
B. The metabolism of an oral drug in the liver before it reaches systemic circulation
C. The distribution of a drug to the brain via the blood-brain barrier
D. The binding of a drug to plasma proteins
Answer: B
Conceptual Explanation: The first-pass effect occurs when an orally administered drug is
absorbed from the GI tract and enters the portal circulation, where it is metabolized by the
liver before reaching the rest of the body.
4. An elderly patient is prescribed a new medication that is highly protein-bound. What is the
primary concern for this patient compared to a younger adult?
A. Lower serum albumin levels resulting in more free, active drug
, B. Increased serum albumin levels leading to drug toxicity
C. Faster renal clearance of the drug
D. Increased gastric acid production reducing absorption
Answer: A
Conceptual Explanation: Elderly patients often have decreased serum albumin levels. For
drugs that are highly protein-bound, fewer binding sites mean more ‘free’ drug is
circulating, which can lead to increased pharmacological effects or toxicity.
5. Which antibiotic class is most strongly associated with the risk of tendon rupture,
especially in older adults or those taking corticosteroids?
A. Macrolides
B. Penicillins
C. Cephalosporins
D. Fluoroquinolones
Answer: D
Conceptual Explanation: Fluoroquinolones (like Ciprofloxacin and Levofloxacin) carry a
Black Box Warning for increased risk of tendinitis and tendon rupture.
6. A patient taking Warfarin (Coumadin) is started on Amiodarone for atrial fibrillation. What
adjustment is typically required for the Warfarin dose?
A. Decrease the Warfarin dose by 25% to 50%
