NR 565 Advanced Pharmacology
Midterm Exam V3 (2026) Practice Questions
200 multiple-choice questions with answers and rationales
Pharmacokinetics and Pharmacodynamics
1. Bioavailability of a drug is best defined as:
A. The rate at which a drug is eliminated from the body
B. The percentage of drug bound to plasma proteins
C. The time required to reach peak plasma concentration
D. The fraction of an administered dose that reaches the systemic
circulation unchanged
Answer: D
Rationale: Bioavailability (F) is the fraction of the dose that reaches the
systemic circulation in active form. An IV dose has F = 1 (100%); oral
doses are reduced by incomplete absorption and first-pass metabolism.
2. Sublingual nitroglycerin is used for acute angina primarily because
this route:
A. Increases the drug's half-life
B. Bypasses hepatic first-pass metabolism
C. Decreases the volume of distribution
D. Increases protein binding
Answer: B
Rationale: Swallowed nitroglycerin undergoes extensive first-pass
hepatic metabolism. Sublingual absorption drains directly into the
systemic venous circulation, giving rapid onset.
NR 565 Midterm Practice Exam - Page 1
,3. A drug with a half-life of 12 hours is given at regular intervals.
About how long until steady state is reached?
A. About 12 hours
B. About 2 to 2.5 days
C. About 24 hours
D. About 7 days
Answer: B
Rationale: Steady state is reached after approximately 4 to 5 half-lives
(4-5 x 12 h = 48-60 h, or 2-2.5 days), regardless of the dose size.
4. A loading dose is determined primarily by the drug's:
A. Clearance
B. Elimination half-life
C. Rate of renal excretion
D. Volume of distribution
Answer: D
Rationale: Loading dose = (target concentration x Vd) / F. It fills the
'distribution space' quickly, so Vd is the key determinant.
5. The maintenance dose rate needed to achieve a target steady-state
concentration depends primarily on the drug's:
A. Volume of distribution
B. Time to peak concentration
C. Lipid solubility
D. Clearance
Answer: D
Rationale: Maintenance dose rate = (Css x CL) / F. Clearance
determines how fast drug is removed and therefore how much must be
replaced.
NR 565 Midterm Practice Exam - Page 2
,6. Which relationship correctly describes elimination half-life (t1/2)?
A. Directly proportional to clearance and inversely proportional to
volume of distribution
B. Independent of both clearance and volume of distribution
C. Directly proportional to bioavailability only
D. Directly proportional to volume of distribution and inversely
proportional to clearance
Answer: D
Rationale: t1/2 = 0.693 x Vd / CL. A larger Vd prolongs half-life; higher
clearance shortens it.
7. Which drug most likely follows zero-order (saturable) elimination
kinetics at therapeutic doses?
A. Amoxicillin
B. Lisinopril
C. Atenolol
D. Phenytoin
Answer: D
Rationale: Phenytoin's hepatic enzymes saturate within the therapeutic
range, so a fixed amount (not fixed fraction) is eliminated per unit time.
Ethanol and high-dose aspirin behave similarly.
NR 565 Midterm Practice Exam - Page 3
, 8. A patient's phenytoin level is subtherapeutic on 300 mg/day. Why
should dose increases be small (e.g., 30-50 mg)?
A. Saturable metabolism can cause a disproportionately large rise in
serum level with small dose increases
B. Phenytoin has a very large volume of distribution
C. Phenytoin is not protein bound
D. Phenytoin is eliminated unchanged by the kidneys
Answer: A
Rationale: With Michaelis-Menten kinetics, once enzymes approach
saturation, small dose increments produce large, nonlinear increases in
serum concentration and toxicity risk.
9. Warfarin is about 99% protein bound. What is the clinical concern
when another highly protein-bound or CYP2C9-inhibiting drug is
added?
A. Warfarin bioavailability decreases
B. Warfarin's therapeutic effect is lost
C. The free (active) warfarin fraction and INR may rise, increasing
bleeding risk
D. No monitoring is needed because only total drug matters
Answer: C
Rationale: Only unbound drug is pharmacologically active.
Displacement and/or metabolic inhibition can raise free warfarin,
increasing INR, so closer INR monitoring is required.
NR 565 Midterm Practice Exam - Page 4
Midterm Exam V3 (2026) Practice Questions
200 multiple-choice questions with answers and rationales
Pharmacokinetics and Pharmacodynamics
1. Bioavailability of a drug is best defined as:
A. The rate at which a drug is eliminated from the body
B. The percentage of drug bound to plasma proteins
C. The time required to reach peak plasma concentration
D. The fraction of an administered dose that reaches the systemic
circulation unchanged
Answer: D
Rationale: Bioavailability (F) is the fraction of the dose that reaches the
systemic circulation in active form. An IV dose has F = 1 (100%); oral
doses are reduced by incomplete absorption and first-pass metabolism.
2. Sublingual nitroglycerin is used for acute angina primarily because
this route:
A. Increases the drug's half-life
B. Bypasses hepatic first-pass metabolism
C. Decreases the volume of distribution
D. Increases protein binding
Answer: B
Rationale: Swallowed nitroglycerin undergoes extensive first-pass
hepatic metabolism. Sublingual absorption drains directly into the
systemic venous circulation, giving rapid onset.
NR 565 Midterm Practice Exam - Page 1
,3. A drug with a half-life of 12 hours is given at regular intervals.
About how long until steady state is reached?
A. About 12 hours
B. About 2 to 2.5 days
C. About 24 hours
D. About 7 days
Answer: B
Rationale: Steady state is reached after approximately 4 to 5 half-lives
(4-5 x 12 h = 48-60 h, or 2-2.5 days), regardless of the dose size.
4. A loading dose is determined primarily by the drug's:
A. Clearance
B. Elimination half-life
C. Rate of renal excretion
D. Volume of distribution
Answer: D
Rationale: Loading dose = (target concentration x Vd) / F. It fills the
'distribution space' quickly, so Vd is the key determinant.
5. The maintenance dose rate needed to achieve a target steady-state
concentration depends primarily on the drug's:
A. Volume of distribution
B. Time to peak concentration
C. Lipid solubility
D. Clearance
Answer: D
Rationale: Maintenance dose rate = (Css x CL) / F. Clearance
determines how fast drug is removed and therefore how much must be
replaced.
NR 565 Midterm Practice Exam - Page 2
,6. Which relationship correctly describes elimination half-life (t1/2)?
A. Directly proportional to clearance and inversely proportional to
volume of distribution
B. Independent of both clearance and volume of distribution
C. Directly proportional to bioavailability only
D. Directly proportional to volume of distribution and inversely
proportional to clearance
Answer: D
Rationale: t1/2 = 0.693 x Vd / CL. A larger Vd prolongs half-life; higher
clearance shortens it.
7. Which drug most likely follows zero-order (saturable) elimination
kinetics at therapeutic doses?
A. Amoxicillin
B. Lisinopril
C. Atenolol
D. Phenytoin
Answer: D
Rationale: Phenytoin's hepatic enzymes saturate within the therapeutic
range, so a fixed amount (not fixed fraction) is eliminated per unit time.
Ethanol and high-dose aspirin behave similarly.
NR 565 Midterm Practice Exam - Page 3
, 8. A patient's phenytoin level is subtherapeutic on 300 mg/day. Why
should dose increases be small (e.g., 30-50 mg)?
A. Saturable metabolism can cause a disproportionately large rise in
serum level with small dose increases
B. Phenytoin has a very large volume of distribution
C. Phenytoin is not protein bound
D. Phenytoin is eliminated unchanged by the kidneys
Answer: A
Rationale: With Michaelis-Menten kinetics, once enzymes approach
saturation, small dose increments produce large, nonlinear increases in
serum concentration and toxicity risk.
9. Warfarin is about 99% protein bound. What is the clinical concern
when another highly protein-bound or CYP2C9-inhibiting drug is
added?
A. Warfarin bioavailability decreases
B. Warfarin's therapeutic effect is lost
C. The free (active) warfarin fraction and INR may rise, increasing
bleeding risk
D. No monitoring is needed because only total drug matters
Answer: C
Rationale: Only unbound drug is pharmacologically active.
Displacement and/or metabolic inhibition can raise free warfarin,
increasing INR, so closer INR monitoring is required.
NR 565 Midterm Practice Exam - Page 4
