NR565 ADVANCED PHARMACOLOGY
EXAM 1 PRACTICE QUESTIONS AND
VERIFIED ANSWERS (2026/ 2027
UPDATE)- CHAMBERLAIN
1. A patient with hypoalbuminemia is prescribed a drug that is 98% protein-bound. What is
the primary pharmacokinetic concern for this patient?
A. Decreased bioavailability of the drug.
B. Faster hepatic metabolism of the active drug.
C. Enhanced renal clearance of the drug.
D. Increased risk of drug toxicity due to higher levels of free drug.
Answer: D
Conceptual Explanation: When albumin levels are low, there are fewer binding sites for
highly protein-bound drugs. This leads to a higher concentration of the ‘free’ or active drug
in the plasma, which can cause toxicity even at standard doses.
2. Which cytochrome P450 enzyme is responsible for the metabolism of approximately 50%
of all clinically used drugs?
A. CYP2D6
B. CYP3A4
,C. CYP2C19
D. CYP1A2
Answer: B
Conceptual Explanation: CYP3A4 is the most abundant CYP enzyme in the liver and is
responsible for the metabolism of roughly half of all prescribed medications.
3. A patient is taking a drug that is a CYP3A4 inducer. If a second drug that is a CYP3A4
substrate is added, what is the most likely outcome?
A. Increased plasma levels of the substrate drug.
B. Decreased plasma levels of the substrate drug.
C. No change in drug levels, but increased side effects.
D. Decreased metabolism of the inducer drug.
Answer: B
Conceptual Explanation: Inducers increase the activity of the CYP enzyme, leading to
faster metabolism of substrate drugs, which results in lower plasma concentrations and
potentially subtherapeutic effects.
4. According to the Beers Criteria, which class of medications should be avoided in elderly
patients due to the high risk of orthostatic hypotension and CNS effects?
A. ACE inhibitors
B. Second-generation antihistamines
, C. Tricyclic antidepressants
D. Statins
Answer: C
Conceptual Explanation: Tricyclic antidepressants (TCAs) have strong anticholinergic and
alpha-blocking properties, increasing the risk of falls and confusion in the elderly.
5. Which of the following is a characteristic of a Schedule II controlled substance?
A. Refills are allowed up to 5 times in 6 months.
B. Prescriptions can be phoned in for routine use.
C. A written or electronic prescription is required with no refills permitted.
D. Low potential for abuse compared to Schedule III.
Answer: C
Conceptual Explanation: Schedule II drugs have a high potential for abuse and require a
new prescription for every fill; refills are not permitted by federal law.
6. An ultra-metabolizer of CYP2D6 would have what reaction to codeine?
A. Lack of therapeutic effect due to inability to convert to morphine.
B. Increased risk of toxicity due to rapid conversion to morphine.
C. Severe allergic reaction regardless of dose.
D. Delayed absorption in the small intestine.
EXAM 1 PRACTICE QUESTIONS AND
VERIFIED ANSWERS (2026/ 2027
UPDATE)- CHAMBERLAIN
1. A patient with hypoalbuminemia is prescribed a drug that is 98% protein-bound. What is
the primary pharmacokinetic concern for this patient?
A. Decreased bioavailability of the drug.
B. Faster hepatic metabolism of the active drug.
C. Enhanced renal clearance of the drug.
D. Increased risk of drug toxicity due to higher levels of free drug.
Answer: D
Conceptual Explanation: When albumin levels are low, there are fewer binding sites for
highly protein-bound drugs. This leads to a higher concentration of the ‘free’ or active drug
in the plasma, which can cause toxicity even at standard doses.
2. Which cytochrome P450 enzyme is responsible for the metabolism of approximately 50%
of all clinically used drugs?
A. CYP2D6
B. CYP3A4
,C. CYP2C19
D. CYP1A2
Answer: B
Conceptual Explanation: CYP3A4 is the most abundant CYP enzyme in the liver and is
responsible for the metabolism of roughly half of all prescribed medications.
3. A patient is taking a drug that is a CYP3A4 inducer. If a second drug that is a CYP3A4
substrate is added, what is the most likely outcome?
A. Increased plasma levels of the substrate drug.
B. Decreased plasma levels of the substrate drug.
C. No change in drug levels, but increased side effects.
D. Decreased metabolism of the inducer drug.
Answer: B
Conceptual Explanation: Inducers increase the activity of the CYP enzyme, leading to
faster metabolism of substrate drugs, which results in lower plasma concentrations and
potentially subtherapeutic effects.
4. According to the Beers Criteria, which class of medications should be avoided in elderly
patients due to the high risk of orthostatic hypotension and CNS effects?
A. ACE inhibitors
B. Second-generation antihistamines
, C. Tricyclic antidepressants
D. Statins
Answer: C
Conceptual Explanation: Tricyclic antidepressants (TCAs) have strong anticholinergic and
alpha-blocking properties, increasing the risk of falls and confusion in the elderly.
5. Which of the following is a characteristic of a Schedule II controlled substance?
A. Refills are allowed up to 5 times in 6 months.
B. Prescriptions can be phoned in for routine use.
C. A written or electronic prescription is required with no refills permitted.
D. Low potential for abuse compared to Schedule III.
Answer: C
Conceptual Explanation: Schedule II drugs have a high potential for abuse and require a
new prescription for every fill; refills are not permitted by federal law.
6. An ultra-metabolizer of CYP2D6 would have what reaction to codeine?
A. Lack of therapeutic effect due to inability to convert to morphine.
B. Increased risk of toxicity due to rapid conversion to morphine.
C. Severe allergic reaction regardless of dose.
D. Delayed absorption in the small intestine.
