NUR 5461 ADVANCED
PHARMACOLOGY FINAL EXAM
QUESTIONS AND CORRECT ANSWERS
2026/2027
1. A patient is being switched from a Monoamine Oxidase Inhibitor (MAOI) to a Selective
Serotonin Reuptake Inhibitor (SSRI). Which of the following is the most critical
pharmacokinetic consideration for the prescriber?
A. A washout period of 14 days is required to allow for the regeneration of the MAO
enzyme.
B. The patient should wait at least 5 days between stopping the MAOI and starting the SSRI.
C. The SSRI should be started at half the normal dose while tapering the MAOI.
D. MAOIs and SSRIs can be cross-tapered safely over a 48-hour period.
Answer: A
Conceptual Explanation: A 14-day washout period is necessary when switching from an
MAOI to another antidepressant because MAOIs irreversibly inhibit the enzyme
responsible for degrading serotonin; starting an SSRI too soon can lead to potentially fatal
Serotonin Syndrome.
,2. When prescribing Clozapine (Clozaril) for treatment-resistant schizophrenia, which
laboratory value must be monitored weekly for the first six months according to the REMS
program?
A. Serum Creatinine
B. Aspartate Aminotransferase (AST)
C. Absolute Neutrophil Count (ANC)
D. Hemoglobin A1c
Answer: C
Conceptual Explanation: Clozapine carries a black box warning for agranulocytosis. The
REMS program requires strict monitoring of the Absolute Neutrophil Count (ANC) to
prevent life-threatening infections.
3. A patient with a history of tonic-clonic seizures is currently taking Phenytoin. If the
patient’s serum level is 18 mcg/mL and the dose is slightly increased, the serum level rises
disproportionately to 35 mcg/mL. This phenomenon occurs because:
A. Phenytoin follows zero-order kinetics (Michaelis-Menten) where metabolic pathways
become saturated.
B. Phenytoin is a potent inducer of the CYP3A4 enzyme system.
C. The drug has a high volume of distribution leading to tissue sequestration.
D. Phenytoin is highly protein-bound and was displaced by another medication.
, Answer: A
Conceptual Explanation: Phenytoin metabolism switches from first-order to zero-order
(saturated) kinetics within the therapeutic range. Small dose increases can lead to massive
increases in serum concentration because the liver’s capacity to metabolize the drug is
maxed out.
4. Which of the following antidepressants is contraindicated in patients with a history of
bulimia nervosa or seizure disorders?
A. Sertraline
B. Venlafaxine
C. Bupropion
D. Mirtazapine
Answer: C
Conceptual Explanation: Bupropion lowers the seizure threshold and is specifically
contraindicated in patients with eating disorders due to an increased risk of seizures in this
population.
5. A patient taking Lithium Carbonate for Bipolar Disorder presents with coarse tremors,
ataxia, and a serum lithium level of 2.1 mEq/L. Which of the following is the most appropriate
next step?
A. Increase fluid intake and continue the current dose.
B. Switch the patient to Valproic Acid immediately.
PHARMACOLOGY FINAL EXAM
QUESTIONS AND CORRECT ANSWERS
2026/2027
1. A patient is being switched from a Monoamine Oxidase Inhibitor (MAOI) to a Selective
Serotonin Reuptake Inhibitor (SSRI). Which of the following is the most critical
pharmacokinetic consideration for the prescriber?
A. A washout period of 14 days is required to allow for the regeneration of the MAO
enzyme.
B. The patient should wait at least 5 days between stopping the MAOI and starting the SSRI.
C. The SSRI should be started at half the normal dose while tapering the MAOI.
D. MAOIs and SSRIs can be cross-tapered safely over a 48-hour period.
Answer: A
Conceptual Explanation: A 14-day washout period is necessary when switching from an
MAOI to another antidepressant because MAOIs irreversibly inhibit the enzyme
responsible for degrading serotonin; starting an SSRI too soon can lead to potentially fatal
Serotonin Syndrome.
,2. When prescribing Clozapine (Clozaril) for treatment-resistant schizophrenia, which
laboratory value must be monitored weekly for the first six months according to the REMS
program?
A. Serum Creatinine
B. Aspartate Aminotransferase (AST)
C. Absolute Neutrophil Count (ANC)
D. Hemoglobin A1c
Answer: C
Conceptual Explanation: Clozapine carries a black box warning for agranulocytosis. The
REMS program requires strict monitoring of the Absolute Neutrophil Count (ANC) to
prevent life-threatening infections.
3. A patient with a history of tonic-clonic seizures is currently taking Phenytoin. If the
patient’s serum level is 18 mcg/mL and the dose is slightly increased, the serum level rises
disproportionately to 35 mcg/mL. This phenomenon occurs because:
A. Phenytoin follows zero-order kinetics (Michaelis-Menten) where metabolic pathways
become saturated.
B. Phenytoin is a potent inducer of the CYP3A4 enzyme system.
C. The drug has a high volume of distribution leading to tissue sequestration.
D. Phenytoin is highly protein-bound and was displaced by another medication.
, Answer: A
Conceptual Explanation: Phenytoin metabolism switches from first-order to zero-order
(saturated) kinetics within the therapeutic range. Small dose increases can lead to massive
increases in serum concentration because the liver’s capacity to metabolize the drug is
maxed out.
4. Which of the following antidepressants is contraindicated in patients with a history of
bulimia nervosa or seizure disorders?
A. Sertraline
B. Venlafaxine
C. Bupropion
D. Mirtazapine
Answer: C
Conceptual Explanation: Bupropion lowers the seizure threshold and is specifically
contraindicated in patients with eating disorders due to an increased risk of seizures in this
population.
5. A patient taking Lithium Carbonate for Bipolar Disorder presents with coarse tremors,
ataxia, and a serum lithium level of 2.1 mEq/L. Which of the following is the most appropriate
next step?
A. Increase fluid intake and continue the current dose.
B. Switch the patient to Valproic Acid immediately.
