NR 566 Advanced Pharmacology for Care of the Family — Final Exam Study Guide Chamberlain University | 2026/2027 Verified Answers
NR 566 Final Exam Study Guide
Advanced Pharmacology for Care of the Family
Questions & Answers with Verified Rationales
150 Questions · 9 Competency Sections · 75% Scenario-Based · 2026/2027 Latest Update
Exam Overview: This study guide is organized into nine competency-aligned sections covering the NR 566
final exam blueprint: (1) Pharmacokinetics and Pharmacodynamics Across the Lifespan; (2) Pharmacogenomics
and Individualized Prescribing; (3) Cardiovascular Pharmacology; (4) Endocrine Pharmacology; (5) Respiratory
and Allergy Pharmacology; (6) Anti-Infective Pharmacology; (7) Psychopharmacology Across the Lifespan; (8)
Pain Management and Anti-Inflammatory Agents; and (9) Special Populations and Prescribing Considerations.
Each question is multiple choice with four options (A-D) and exactly one correct answer. Cognitive demand is
distributed approximately 30% recall, 50% application, and 20% analysis. Rationales double as study guide
content, identifying the correct option and contrasting common misconceptions represented in distractors.
Section Map: Q1-15 Pharmacokinetics & Pharmacodynamics · Q16-28 Pharmacogenomics · Q29-48
Cardiovascular Pharmacology · Q49-66 Endocrine Pharmacology · Q67-80 Respiratory & Allergy Pharmacology
· Q81-98 Anti-Infective Pharmacology · Q99-114 Psychopharmacology · Q115-130 Pain Management &
Anti-Inflammatory Agents · Q131-150 Special Populations & Prescribing Considerations.
Verified Answer Note: Each rationale embeds confirmation against current ADA, AHA/ACC, GOLD, GINA,
IDSA/ATS, ACOG, Beers Criteria, and FDA labeling. Commonly confused concept pairs (e.g., warfarin/DOAC
reversal; HFrEF vs HFpEF GDMT; glyburide vs glipizide in elderly; first- vs second-generation antihistamines;
CYP2D6 poor vs ultra-rapid metabolizers; aspirin-ibuprofen interaction; opioid-naïve vs opioid-tolerant dosing)
are explicitly addressed in distractor explanations.
Section 1: Pharmacokinetics and Pharmacodynamics Across the Lifespan
(Absorption, Distribution, Metabolism, Excretion, Receptors, & Therapeutic Index)
Q1. [Recall] Which statement best describes first-pass metabolism and its clinical implication for oral drug
therapy?
A. First-pass metabolism refers to hepatic (and intestinal) metabolism of a drug before it reaches systemic
circulation, reducing oral bioavailability relative to parenteral administration—clinically relevant for drugs
such as propranolol, morphine, and lidocaine, which require dose adjustment when given orally.
[CORRECT]
B. First-pass metabolism increases the bioavailability of oral drugs by activating prodrugs in the gut lumen.
C. First-pass metabolism applies only to intravenous administration.
D. First-pass metabolism bypasses portal circulation entirely.
Correct Answer: A
Rationale: First-pass (pre-systemic) metabolism occurs in the gut wall and liver via the portal circulation before
drug reaches systemic blood; it lowers oral bioavailability compared with IV/IM routes. Propranolol, morphine,
lidocaine, and nitroglycerin exhibit marked first-pass effects. NR 566 Module 1 frames first-pass metabolism as a
foundational pharmacokinetic concept with direct dosing implications.
Page 1
,NR 566 Advanced Pharmacology for Care of the Family — Final Exam Study Guide Chamberlain University | 2026/2027 Verified Answers
Q2. [Application] A 4-week-old neonate requires phenobarbital for seizures. The prescriber must account for
which age-related pharmacokinetic difference compared with adults?
A. Neonates have mature hepatic glucuronidation, requiring dose increases.
B. Neonatal renal clearance exceeds that of adults.
C. Neonates have immature hepatic metabolism (reduced CYP450 activity and glucuronidation until ~3
months), reduced plasma protein binding, and increased total body water—leading to prolonged half-lives
and the need for lower mg/kg dosing intervals that extend or doses that are reduced relative to older
infants. [CORRECT]
D. Neonates absorb drugs faster via gastric transit.
Correct Answer: C
Rationale: Neonates demonstrate reduced CYP450 and glucuronidation activity (maturing by ~3 months), lower
plasma protein binding (lower albumin), and higher total body water—prolonging half-lives (e.g., phenobarbital,
morphine, diazepam) and increasing volume of distribution for water-soluble drugs. NR 566 Module 1 emphasizes
developmental PK across the lifespan.
Q3. [Recall] Volume of distribution (Vd) is best defined as:
A. The volume of blood cleared of drug per unit time.
B. The actual plasma volume circulating through the body.
C. A theoretical volume that relates the dose administered to the resulting plasma concentration (Vd =
Dose/Cp), used to estimate the dose required to reach a target plasma concentration and to assess tissue
distribution; high Vd implies extensive tissue distribution. [CORRECT]
D. The fraction of drug reaching systemic circulation unchanged.
Correct Answer: C
Rationale: Vd = Dose / Plasma Concentration; it is a theoretical (apparent) volume, not a real anatomic space. A
high Vd (e.g., digoxin) implies extensive tissue distribution; a low Vd (e.g., warfarin) implies confinement to
plasma. NR 566 Module 1 frames Vd as foundational for dose calculation and dialysis considerations.
Q4. [Application] An elderly patient with heart failure has reduced renal function and is started on digoxin.
Which pharmacokinetic change is most important for dose adjustment?
A. Increased Vd, requiring higher loading dose.
B. Increased plasma protein binding reducing free fraction.
C. Reduced renal clearance (digoxin is ~70-80% renally cleared) prolonged half-life, and increased risk of
toxicity—requiring lower maintenance dosing and serum concentration monitoring. [CORRECT]
D. Enhanced hepatic metabolism requiring dose increases.
Correct Answer: C
Rationale: Digoxin is primarily renally cleared (70-80%); declining GFR in elderly or heart failure patients
prolongs half-life and elevates serum levels. Dose reduction and therapeutic drug monitoring (target 0.5-0.9 ng/mL
in HFrEF) are mandatory. NR 566 Module 3 lists digoxin among drugs requiring renal dose adjustment and TDM.
Q5. [Analysis] A drug has a half-life of 12 hours. Approximately how long will it take to reach steady-state
plasma concentration with continuous dosing, and how many half-lives does this require?
A. 12 hours; 1 half-life.
B. 168 hours; 14 half-lives.
C. 24 hours; 2 half-lives.
D. Approximately 60 hours (5 half-lives), because steady state is achieved after 4-5 half-lives of
continuous dosing—so a drug with t1/2 = 12 h reaches ~94-97% of steady state in 48-60 hours.
[CORRECT]
Correct Answer: D
Page 2
,NR 566 Advanced Pharmacology for Care of the Family — Final Exam Study Guide Chamberlain University | 2026/2027 Verified Answers
Rationale: Steady state is achieved after approximately 4-5 half-lives of regular dosing; for t1/2 = 12 hours, that is
48-60 hours. The same principle applies to elimination: 4-5 half-lives to ~94-97% clearance after the last dose. NR
566 Module 1 emphasizes this rule for dose titration and tapering.
Q6. [Recall] Which pharmacodynamic concept describes a drug that binds to a receptor and produces a
submaximal (less than full) response even at full receptor occupancy?
A. Inverse agonist.
B. Full agonist.
C. Competitive antagonist.
D. Partial agonist—a drug with affinity and intrinsic activity less than 1, producing a submaximal response
even at full receptor occupancy; buprenorphine and pindolol are classic examples. [CORRECT]
Correct Answer: D
Rationale: A partial agonist has affinity but lower intrinsic activity than a full agonist; it produces a submaximal
response and can act as a competitive antagonist in the presence of a full agonist (e.g., buprenorphine vs.
morphine). NR 566 Module 2 emphasizes receptor pharmacodynamics including agonists, antagonists, partial
agonists, and inverse agonists.
Q7. [Application] A patient taking warfarin requires co-prescription of amiodarone. Within 1-2 weeks, the INR
rises significantly. The mechanism is best described as:
A. Amiodarone induces warfarin metabolism.
B. Amiodarone reduces warfarin plasma protein binding only.
C. Additive anticoagulant effects only.
D. Amiodarone inhibits CYP2C9, the primary metabolizer of S-warfarin (the more potent enantiomer),
decreasing warfarin clearance and increasing INR; warfarin dose should be preemptively reduced by
25-50% and INR monitored closely. [CORRECT]
Correct Answer: D
Rationale: Amiodarone inhibits CYP2C9 (and CYP3A4), substantially reducing S-warfarin clearance and
elevating INR within 2-3 weeks. Warfarin dose should be empirically reduced and INR monitored intensively
during co-administration. NR 566 Module 2 lists warfarin-amiodarone as a high-impact CYP2C9 interaction.
Q8. [Recall] The therapeutic index (TI) of a drug is calculated as:
A. LD50 + ED50.
B. ED50 / TD50, where ED50 is the dose effective in 50% of the population and TD50 is the dose toxic in
50%; a low TI indicates a narrow safety margin (e.g., digoxin, warfarin, lithium, aminoglycosides).
[CORRECT]
C. Maximal effect divided by minimum dose.
D. Plasma concentration divided by half-life.
Correct Answer: B
Rationale: TI = TD50 / ED50 (or LD50 / ED50); a low TI (close to 1) indicates a narrow therapeutic window
requiring TDM. Examples include digoxin, lithium, warfarin, phenytoin, aminoglycosides, and vancomycin. NR
566 Module 2 emphasizes TI for selecting drugs that require monitoring.
Q9. [Application] A 6-year-old, 22 kg child requires oral amoxicillin for acute otitis media. The dosing is 90
mg/kg/day divided BID. What is the correct dose per administration?
A. 495 mg BID.
B. 220 mg BID.
C. 990 mg every 12 hours = (22 kg × 90 mg/kg/day) / 2 doses/day = 990 mg per dose; many clinicians use
1000 mg BID rounding for suspension concentration convenience. [CORRECT]
D. 990 mg BID.
Page 3
, NR 566 Advanced Pharmacology for Care of the Family — Final Exam Study Guide Chamberlain University | 2026/2027 Verified Answers
Correct Answer: C
Rationale: Pediatric dosing uses mg/kg/day divided by the dosing frequency. 22 kg × 90 mg/kg/day = 1980
mg/day, divided BID = 990 mg per dose. NR 566 Module 1 emphasizes weight-based pediatric dosing calculations;
verification with the pharmacy and caregiver-friendly suspension concentration is essential.
Q10. [Analysis] An 82-year-old with multiple comorbidities is on 12 medications. Which age-related
pharmacokinetic change is most clinically relevant for predicting drug accumulation and adverse effects?
A. Reduced hepatic mass and phase I (CYP450) metabolism, reduced renal clearance (GFR declines ~1
mL/min/year after age 40), reduced total body water and lean body mass, and increased fat
proportion—producing prolonged half-lives of lipophilic drugs and risk of accumulation. [CORRECT]
B. Increased gastric acid production increasing absorption of weak bases.
C. Higher plasma albumin increasing free drug fraction of protein-bound drugs.
D. Increased hepatic blood flow increasing first-pass metabolism.
Correct Answer: A
Rationale: Aging reduces phase I metabolism, hepatic blood flow, GFR, total body water, and lean mass while
increasing body fat—prolonging half-lives of lipophilic drugs (benzodiazepines, opioids) and increasing
accumulation of renally cleared drugs (digoxin, gabapentin, metformin). Albumin often decreases, increasing free
fraction of acidic drugs. NR 566 Module 1 frames geriatric PK as the foundation for Beers Criteria and
deprescribing.
Q11. [Recall] Which statement correctly differentiates a competitive antagonist from a noncompetitive
antagonist?
A. A competitive antagonist binds the same site as the agonist and can be overcome by increasing agonist
concentration (rightward shift of dose-response curve with preserved Emax); a noncompetitive antagonist
binds an allosteric or irreversible site, reducing Emax without the ability to be overcome by increasing
agonist. [CORRECT]
B. Both reduce efficacy irreversibly.
C. Both reversibly bind the same site as the agonist.
D. Competitive antagonists reduce Emax; noncompetitive antagonists only shift the curve.
Correct Answer: A
Rationale: A competitive antagonist shifts the dose-response curve rightward (higher dose needed for same effect,
Emax preserved) and can be overcome with more agonist; noncompetitive antagonists reduce Emax and cannot be
overcome. NR 566 Module 2 uses naloxone (competitive) vs. phenoxybenzamine (irreversible) as classic examples.
Q12. [Application] A pregnant patient at 28 weeks requires pharmacologic therapy for chronic hypertension.
Which pharmacokinetic and pharmacodynamic consideration is most relevant?
A. Pregnancy increases plasma volume, GFR, and cardiac output (~50% by third trimester), increases Vd
for water-soluble drugs, accelerates hepatic metabolism, and may require increased dose or dosing
frequency for drugs such as labetalol, nifedipine, and methyldopa. [CORRECT]
B. Pregnancy decreases glomerular filtration, prolonging drug half-lives.
C. Pregnancy has no effect on drug dosing.
D. Pregnancy increases plasma protein binding.
Correct Answer: A
Rationale: Pregnancy physiologically increases plasma volume, GFR, and cardiac output, decreases plasma
albumin, and accelerates CYP3A4 activity—increasing Vd and clearance for many drugs (labetalol, digoxin, certain
antiepileptics), often requiring increased dosing. NR 566 Module 1 frames pregnancy PK and Module 8 covers
pregnancy safety categories.
Page 4
NR 566 Final Exam Study Guide
Advanced Pharmacology for Care of the Family
Questions & Answers with Verified Rationales
150 Questions · 9 Competency Sections · 75% Scenario-Based · 2026/2027 Latest Update
Exam Overview: This study guide is organized into nine competency-aligned sections covering the NR 566
final exam blueprint: (1) Pharmacokinetics and Pharmacodynamics Across the Lifespan; (2) Pharmacogenomics
and Individualized Prescribing; (3) Cardiovascular Pharmacology; (4) Endocrine Pharmacology; (5) Respiratory
and Allergy Pharmacology; (6) Anti-Infective Pharmacology; (7) Psychopharmacology Across the Lifespan; (8)
Pain Management and Anti-Inflammatory Agents; and (9) Special Populations and Prescribing Considerations.
Each question is multiple choice with four options (A-D) and exactly one correct answer. Cognitive demand is
distributed approximately 30% recall, 50% application, and 20% analysis. Rationales double as study guide
content, identifying the correct option and contrasting common misconceptions represented in distractors.
Section Map: Q1-15 Pharmacokinetics & Pharmacodynamics · Q16-28 Pharmacogenomics · Q29-48
Cardiovascular Pharmacology · Q49-66 Endocrine Pharmacology · Q67-80 Respiratory & Allergy Pharmacology
· Q81-98 Anti-Infective Pharmacology · Q99-114 Psychopharmacology · Q115-130 Pain Management &
Anti-Inflammatory Agents · Q131-150 Special Populations & Prescribing Considerations.
Verified Answer Note: Each rationale embeds confirmation against current ADA, AHA/ACC, GOLD, GINA,
IDSA/ATS, ACOG, Beers Criteria, and FDA labeling. Commonly confused concept pairs (e.g., warfarin/DOAC
reversal; HFrEF vs HFpEF GDMT; glyburide vs glipizide in elderly; first- vs second-generation antihistamines;
CYP2D6 poor vs ultra-rapid metabolizers; aspirin-ibuprofen interaction; opioid-naïve vs opioid-tolerant dosing)
are explicitly addressed in distractor explanations.
Section 1: Pharmacokinetics and Pharmacodynamics Across the Lifespan
(Absorption, Distribution, Metabolism, Excretion, Receptors, & Therapeutic Index)
Q1. [Recall] Which statement best describes first-pass metabolism and its clinical implication for oral drug
therapy?
A. First-pass metabolism refers to hepatic (and intestinal) metabolism of a drug before it reaches systemic
circulation, reducing oral bioavailability relative to parenteral administration—clinically relevant for drugs
such as propranolol, morphine, and lidocaine, which require dose adjustment when given orally.
[CORRECT]
B. First-pass metabolism increases the bioavailability of oral drugs by activating prodrugs in the gut lumen.
C. First-pass metabolism applies only to intravenous administration.
D. First-pass metabolism bypasses portal circulation entirely.
Correct Answer: A
Rationale: First-pass (pre-systemic) metabolism occurs in the gut wall and liver via the portal circulation before
drug reaches systemic blood; it lowers oral bioavailability compared with IV/IM routes. Propranolol, morphine,
lidocaine, and nitroglycerin exhibit marked first-pass effects. NR 566 Module 1 frames first-pass metabolism as a
foundational pharmacokinetic concept with direct dosing implications.
Page 1
,NR 566 Advanced Pharmacology for Care of the Family — Final Exam Study Guide Chamberlain University | 2026/2027 Verified Answers
Q2. [Application] A 4-week-old neonate requires phenobarbital for seizures. The prescriber must account for
which age-related pharmacokinetic difference compared with adults?
A. Neonates have mature hepatic glucuronidation, requiring dose increases.
B. Neonatal renal clearance exceeds that of adults.
C. Neonates have immature hepatic metabolism (reduced CYP450 activity and glucuronidation until ~3
months), reduced plasma protein binding, and increased total body water—leading to prolonged half-lives
and the need for lower mg/kg dosing intervals that extend or doses that are reduced relative to older
infants. [CORRECT]
D. Neonates absorb drugs faster via gastric transit.
Correct Answer: C
Rationale: Neonates demonstrate reduced CYP450 and glucuronidation activity (maturing by ~3 months), lower
plasma protein binding (lower albumin), and higher total body water—prolonging half-lives (e.g., phenobarbital,
morphine, diazepam) and increasing volume of distribution for water-soluble drugs. NR 566 Module 1 emphasizes
developmental PK across the lifespan.
Q3. [Recall] Volume of distribution (Vd) is best defined as:
A. The volume of blood cleared of drug per unit time.
B. The actual plasma volume circulating through the body.
C. A theoretical volume that relates the dose administered to the resulting plasma concentration (Vd =
Dose/Cp), used to estimate the dose required to reach a target plasma concentration and to assess tissue
distribution; high Vd implies extensive tissue distribution. [CORRECT]
D. The fraction of drug reaching systemic circulation unchanged.
Correct Answer: C
Rationale: Vd = Dose / Plasma Concentration; it is a theoretical (apparent) volume, not a real anatomic space. A
high Vd (e.g., digoxin) implies extensive tissue distribution; a low Vd (e.g., warfarin) implies confinement to
plasma. NR 566 Module 1 frames Vd as foundational for dose calculation and dialysis considerations.
Q4. [Application] An elderly patient with heart failure has reduced renal function and is started on digoxin.
Which pharmacokinetic change is most important for dose adjustment?
A. Increased Vd, requiring higher loading dose.
B. Increased plasma protein binding reducing free fraction.
C. Reduced renal clearance (digoxin is ~70-80% renally cleared) prolonged half-life, and increased risk of
toxicity—requiring lower maintenance dosing and serum concentration monitoring. [CORRECT]
D. Enhanced hepatic metabolism requiring dose increases.
Correct Answer: C
Rationale: Digoxin is primarily renally cleared (70-80%); declining GFR in elderly or heart failure patients
prolongs half-life and elevates serum levels. Dose reduction and therapeutic drug monitoring (target 0.5-0.9 ng/mL
in HFrEF) are mandatory. NR 566 Module 3 lists digoxin among drugs requiring renal dose adjustment and TDM.
Q5. [Analysis] A drug has a half-life of 12 hours. Approximately how long will it take to reach steady-state
plasma concentration with continuous dosing, and how many half-lives does this require?
A. 12 hours; 1 half-life.
B. 168 hours; 14 half-lives.
C. 24 hours; 2 half-lives.
D. Approximately 60 hours (5 half-lives), because steady state is achieved after 4-5 half-lives of
continuous dosing—so a drug with t1/2 = 12 h reaches ~94-97% of steady state in 48-60 hours.
[CORRECT]
Correct Answer: D
Page 2
,NR 566 Advanced Pharmacology for Care of the Family — Final Exam Study Guide Chamberlain University | 2026/2027 Verified Answers
Rationale: Steady state is achieved after approximately 4-5 half-lives of regular dosing; for t1/2 = 12 hours, that is
48-60 hours. The same principle applies to elimination: 4-5 half-lives to ~94-97% clearance after the last dose. NR
566 Module 1 emphasizes this rule for dose titration and tapering.
Q6. [Recall] Which pharmacodynamic concept describes a drug that binds to a receptor and produces a
submaximal (less than full) response even at full receptor occupancy?
A. Inverse agonist.
B. Full agonist.
C. Competitive antagonist.
D. Partial agonist—a drug with affinity and intrinsic activity less than 1, producing a submaximal response
even at full receptor occupancy; buprenorphine and pindolol are classic examples. [CORRECT]
Correct Answer: D
Rationale: A partial agonist has affinity but lower intrinsic activity than a full agonist; it produces a submaximal
response and can act as a competitive antagonist in the presence of a full agonist (e.g., buprenorphine vs.
morphine). NR 566 Module 2 emphasizes receptor pharmacodynamics including agonists, antagonists, partial
agonists, and inverse agonists.
Q7. [Application] A patient taking warfarin requires co-prescription of amiodarone. Within 1-2 weeks, the INR
rises significantly. The mechanism is best described as:
A. Amiodarone induces warfarin metabolism.
B. Amiodarone reduces warfarin plasma protein binding only.
C. Additive anticoagulant effects only.
D. Amiodarone inhibits CYP2C9, the primary metabolizer of S-warfarin (the more potent enantiomer),
decreasing warfarin clearance and increasing INR; warfarin dose should be preemptively reduced by
25-50% and INR monitored closely. [CORRECT]
Correct Answer: D
Rationale: Amiodarone inhibits CYP2C9 (and CYP3A4), substantially reducing S-warfarin clearance and
elevating INR within 2-3 weeks. Warfarin dose should be empirically reduced and INR monitored intensively
during co-administration. NR 566 Module 2 lists warfarin-amiodarone as a high-impact CYP2C9 interaction.
Q8. [Recall] The therapeutic index (TI) of a drug is calculated as:
A. LD50 + ED50.
B. ED50 / TD50, where ED50 is the dose effective in 50% of the population and TD50 is the dose toxic in
50%; a low TI indicates a narrow safety margin (e.g., digoxin, warfarin, lithium, aminoglycosides).
[CORRECT]
C. Maximal effect divided by minimum dose.
D. Plasma concentration divided by half-life.
Correct Answer: B
Rationale: TI = TD50 / ED50 (or LD50 / ED50); a low TI (close to 1) indicates a narrow therapeutic window
requiring TDM. Examples include digoxin, lithium, warfarin, phenytoin, aminoglycosides, and vancomycin. NR
566 Module 2 emphasizes TI for selecting drugs that require monitoring.
Q9. [Application] A 6-year-old, 22 kg child requires oral amoxicillin for acute otitis media. The dosing is 90
mg/kg/day divided BID. What is the correct dose per administration?
A. 495 mg BID.
B. 220 mg BID.
C. 990 mg every 12 hours = (22 kg × 90 mg/kg/day) / 2 doses/day = 990 mg per dose; many clinicians use
1000 mg BID rounding for suspension concentration convenience. [CORRECT]
D. 990 mg BID.
Page 3
, NR 566 Advanced Pharmacology for Care of the Family — Final Exam Study Guide Chamberlain University | 2026/2027 Verified Answers
Correct Answer: C
Rationale: Pediatric dosing uses mg/kg/day divided by the dosing frequency. 22 kg × 90 mg/kg/day = 1980
mg/day, divided BID = 990 mg per dose. NR 566 Module 1 emphasizes weight-based pediatric dosing calculations;
verification with the pharmacy and caregiver-friendly suspension concentration is essential.
Q10. [Analysis] An 82-year-old with multiple comorbidities is on 12 medications. Which age-related
pharmacokinetic change is most clinically relevant for predicting drug accumulation and adverse effects?
A. Reduced hepatic mass and phase I (CYP450) metabolism, reduced renal clearance (GFR declines ~1
mL/min/year after age 40), reduced total body water and lean body mass, and increased fat
proportion—producing prolonged half-lives of lipophilic drugs and risk of accumulation. [CORRECT]
B. Increased gastric acid production increasing absorption of weak bases.
C. Higher plasma albumin increasing free drug fraction of protein-bound drugs.
D. Increased hepatic blood flow increasing first-pass metabolism.
Correct Answer: A
Rationale: Aging reduces phase I metabolism, hepatic blood flow, GFR, total body water, and lean mass while
increasing body fat—prolonging half-lives of lipophilic drugs (benzodiazepines, opioids) and increasing
accumulation of renally cleared drugs (digoxin, gabapentin, metformin). Albumin often decreases, increasing free
fraction of acidic drugs. NR 566 Module 1 frames geriatric PK as the foundation for Beers Criteria and
deprescribing.
Q11. [Recall] Which statement correctly differentiates a competitive antagonist from a noncompetitive
antagonist?
A. A competitive antagonist binds the same site as the agonist and can be overcome by increasing agonist
concentration (rightward shift of dose-response curve with preserved Emax); a noncompetitive antagonist
binds an allosteric or irreversible site, reducing Emax without the ability to be overcome by increasing
agonist. [CORRECT]
B. Both reduce efficacy irreversibly.
C. Both reversibly bind the same site as the agonist.
D. Competitive antagonists reduce Emax; noncompetitive antagonists only shift the curve.
Correct Answer: A
Rationale: A competitive antagonist shifts the dose-response curve rightward (higher dose needed for same effect,
Emax preserved) and can be overcome with more agonist; noncompetitive antagonists reduce Emax and cannot be
overcome. NR 566 Module 2 uses naloxone (competitive) vs. phenoxybenzamine (irreversible) as classic examples.
Q12. [Application] A pregnant patient at 28 weeks requires pharmacologic therapy for chronic hypertension.
Which pharmacokinetic and pharmacodynamic consideration is most relevant?
A. Pregnancy increases plasma volume, GFR, and cardiac output (~50% by third trimester), increases Vd
for water-soluble drugs, accelerates hepatic metabolism, and may require increased dose or dosing
frequency for drugs such as labetalol, nifedipine, and methyldopa. [CORRECT]
B. Pregnancy decreases glomerular filtration, prolonging drug half-lives.
C. Pregnancy has no effect on drug dosing.
D. Pregnancy increases plasma protein binding.
Correct Answer: A
Rationale: Pregnancy physiologically increases plasma volume, GFR, and cardiac output, decreases plasma
albumin, and accelerates CYP3A4 activity—increasing Vd and clearance for many drugs (labetalol, digoxin, certain
antiepileptics), often requiring increased dosing. NR 566 Module 1 frames pregnancy PK and Module 8 covers
pregnancy safety categories.
Page 4
