NR 566 Midterm Exam Study Guide (Latest 2022 /
2023): Advanced Pharmacology for Care of the
Family - Chamberlain College
SECTION 1: PHARMACOKINETICS & PHARMACODYNAMICS
Questions 1–30
1. A 72-year-old patient with chronic kidney disease has an estimated glomerular filtration rate
(eGFR) of 28 mL/min. The prescriber is considering a medication that is 85% renally cleared.
What is the most appropriate prescribing strategy?
A. Maintain the standard adult dose regardless of renal function
B. Increase the dosing frequency to ensure therapeutic effect
C. Reduce the dose or extend the dosing interval based on renal function
D. Add a second agent to enhance renal excretion of the drug
Correct Answer: C
Rationale: Renal impairment decreases drug clearance, leading to accumulation and
increased risk of toxicity. For medications primarily eliminated by the kidneys, dose reduction or
interval extension based on eGFR is the standard approach. Increasing frequency would worsen
accumulation, and maintaining standard doses can cause toxicity.
2. A 68-year-old man takes simvastatin 40 mg daily. He is prescribed clarithromycin for
community-acquired pneumonia. Three days later, he presents with diffuse myalgias and dark-
colored urine. Which pharmacokinetic interaction explains these findings?
A. Clarithromycin inhibits CYP3A4, raising simvastatin to toxic levels
B. Clarithromycin induces CYP3A4, increasing simvastatin activation
C. Clarithromycin displaces simvastatin from plasma protein binding sites
D. Clarithromycin reduces renal clearance of simvastatin metabolites
Correct Answer: A
, Rationale: Clarithromycin is a strong CYP3A4 inhibitor that reduces simvastatin metabolism,
leading to elevated statin levels and risk of rhabdomyolysis. CYP3A4 induction would decrease
statin levels, and simvastatin has low protein binding displacement potential.
3. A patient with a serum albumin level of 2.1 g/dL is prescribed a highly protein-bound drug
(98% bound). What is the primary concern?
A. Rapid renal excretion of the drug
B. Decreased therapeutic effect due to reduced free drug
C. Increased risk of drug toxicity due to elevated free drug
D. Reduced gastrointestinal absorption
Correct Answer: C
Rationale: Low albumin means fewer protein binding sites, resulting in more free (active)
drug in the bloodstream. This increases the risk of toxicity. The free drug fraction is
pharmacologically active, so hypoalbuminemia effectively increases drug exposure.
4. Which statement best describes pharmacodynamics?
A. What the body does to the drug
B. How the drug is absorbed and distributed
C. What the drug does to the body
D. How the kidney eliminates the drug
Correct Answer: C
Rationale: Pharmacodynamics concerns drug effects and mechanisms of action, including
receptor interactions, dose-response relationships, and therapeutic versus adverse effects.
Pharmacokinetics instead describes absorption, distribution, metabolism, and excretion.
5. A medication with a narrow therapeutic index requires particular attention to which
principle?
A. Minimal monitoring is necessary
B. Small changes in concentration may cause toxicity or treatment failure
C. The medication can be given at any dose without concern
D. Therapeutic drug monitoring is rarely useful
, Correct Answer: B
Rationale: A narrow therapeutic index means the effective concentration is close to the
toxic concentration. Drugs in this category (e.g., warfarin, digoxin, lithium, phenytoin) require
serum-level monitoring, careful dose adjustment, and assessment for drug interactions.
6. An agonist generally produces its pharmacologic effect by:
A. Blocking receptor activation
B. Activating a receptor to produce a biologic response
C. Increasing renal filtration rate
D. Preventing drug absorption from the GI tract
Correct Answer: B
Rationale: An agonist binds to a receptor and produces a biologic response. A full agonist
produces maximal receptor-mediated activity, whereas a partial agonist produces a submaximal
response even at full receptor occupancy.
7. How many half-lives does it typically take for a drug to reach steady-state concentration?
A. 1 to 2
B. 2 to 3
C. 4 to 5
D. 7 to 10
Correct Answer: C
Rationale: It generally takes 4 to 5 half-lives for a drug to reach steady-state concentration
in plasma. This principle guides dosing interval decisions and timing of therapeutic drug
monitoring.
8. Which of the following describes the first-pass effect?
A. Rapid renal clearance of a drug after the first dose
B. The binding of a drug to plasma proteins
C. Metabolism of an oral drug in the liver before reaching systemic circulation
D. The time it takes for a drug to reach steady state
, Correct Answer: C
Rationale: Oral drugs are absorbed in the GI tract and pass through the liver via the portal
vein, where they may be extensively metabolized before entering systemic circulation. This
reduces bioavailability for drugs like propranolol, morphine, and nitroglycerin.
9. A 30-year-old woman who is a poor CYP2D6 metabolizer is prescribed codeine for
postoperative pain. She reports no analgesic effect. What is the most likely pharmacogenomic
explanation?
A. CYP2D6 converts codeine to morphine, and poor metabolizers produce insufficient morphine
B. CYP2D6 metabolizes codeine to a toxic metabolite causing sedation
C. Poor CYP2D6 metabolizers clear codeine too rapidly
D. Codeine is activated by CYP3A4, not CYP2D6
Correct Answer: A
Rationale: Codeine is a prodrug requiring O-demethylation by CYP2D6 to form morphine for
analgesic effect. Poor CYP2D6 metabolizers cannot convert codeine to morphine effectively,
resulting in treatment failure. The FDA has warnings against codeine use in poor metabolizers.
10. Which organ is primarily responsible for metabolism of most medications?
A. Liver
B. Spleen
C. Pancreas
D. Kidneys
Correct Answer: A
Rationale: The liver contains cytochrome P450 enzymes and other metabolic systems that
transform most medications into metabolites. Hepatic impairment can alter drug exposure and
may require dose or medication selection adjustments.
11. A competitive antagonist generally:
A. Permanently destroys receptors
B. Competes with an agonist for receptor binding
C. Produces the same effect as an agonist
2023): Advanced Pharmacology for Care of the
Family - Chamberlain College
SECTION 1: PHARMACOKINETICS & PHARMACODYNAMICS
Questions 1–30
1. A 72-year-old patient with chronic kidney disease has an estimated glomerular filtration rate
(eGFR) of 28 mL/min. The prescriber is considering a medication that is 85% renally cleared.
What is the most appropriate prescribing strategy?
A. Maintain the standard adult dose regardless of renal function
B. Increase the dosing frequency to ensure therapeutic effect
C. Reduce the dose or extend the dosing interval based on renal function
D. Add a second agent to enhance renal excretion of the drug
Correct Answer: C
Rationale: Renal impairment decreases drug clearance, leading to accumulation and
increased risk of toxicity. For medications primarily eliminated by the kidneys, dose reduction or
interval extension based on eGFR is the standard approach. Increasing frequency would worsen
accumulation, and maintaining standard doses can cause toxicity.
2. A 68-year-old man takes simvastatin 40 mg daily. He is prescribed clarithromycin for
community-acquired pneumonia. Three days later, he presents with diffuse myalgias and dark-
colored urine. Which pharmacokinetic interaction explains these findings?
A. Clarithromycin inhibits CYP3A4, raising simvastatin to toxic levels
B. Clarithromycin induces CYP3A4, increasing simvastatin activation
C. Clarithromycin displaces simvastatin from plasma protein binding sites
D. Clarithromycin reduces renal clearance of simvastatin metabolites
Correct Answer: A
, Rationale: Clarithromycin is a strong CYP3A4 inhibitor that reduces simvastatin metabolism,
leading to elevated statin levels and risk of rhabdomyolysis. CYP3A4 induction would decrease
statin levels, and simvastatin has low protein binding displacement potential.
3. A patient with a serum albumin level of 2.1 g/dL is prescribed a highly protein-bound drug
(98% bound). What is the primary concern?
A. Rapid renal excretion of the drug
B. Decreased therapeutic effect due to reduced free drug
C. Increased risk of drug toxicity due to elevated free drug
D. Reduced gastrointestinal absorption
Correct Answer: C
Rationale: Low albumin means fewer protein binding sites, resulting in more free (active)
drug in the bloodstream. This increases the risk of toxicity. The free drug fraction is
pharmacologically active, so hypoalbuminemia effectively increases drug exposure.
4. Which statement best describes pharmacodynamics?
A. What the body does to the drug
B. How the drug is absorbed and distributed
C. What the drug does to the body
D. How the kidney eliminates the drug
Correct Answer: C
Rationale: Pharmacodynamics concerns drug effects and mechanisms of action, including
receptor interactions, dose-response relationships, and therapeutic versus adverse effects.
Pharmacokinetics instead describes absorption, distribution, metabolism, and excretion.
5. A medication with a narrow therapeutic index requires particular attention to which
principle?
A. Minimal monitoring is necessary
B. Small changes in concentration may cause toxicity or treatment failure
C. The medication can be given at any dose without concern
D. Therapeutic drug monitoring is rarely useful
, Correct Answer: B
Rationale: A narrow therapeutic index means the effective concentration is close to the
toxic concentration. Drugs in this category (e.g., warfarin, digoxin, lithium, phenytoin) require
serum-level monitoring, careful dose adjustment, and assessment for drug interactions.
6. An agonist generally produces its pharmacologic effect by:
A. Blocking receptor activation
B. Activating a receptor to produce a biologic response
C. Increasing renal filtration rate
D. Preventing drug absorption from the GI tract
Correct Answer: B
Rationale: An agonist binds to a receptor and produces a biologic response. A full agonist
produces maximal receptor-mediated activity, whereas a partial agonist produces a submaximal
response even at full receptor occupancy.
7. How many half-lives does it typically take for a drug to reach steady-state concentration?
A. 1 to 2
B. 2 to 3
C. 4 to 5
D. 7 to 10
Correct Answer: C
Rationale: It generally takes 4 to 5 half-lives for a drug to reach steady-state concentration
in plasma. This principle guides dosing interval decisions and timing of therapeutic drug
monitoring.
8. Which of the following describes the first-pass effect?
A. Rapid renal clearance of a drug after the first dose
B. The binding of a drug to plasma proteins
C. Metabolism of an oral drug in the liver before reaching systemic circulation
D. The time it takes for a drug to reach steady state
, Correct Answer: C
Rationale: Oral drugs are absorbed in the GI tract and pass through the liver via the portal
vein, where they may be extensively metabolized before entering systemic circulation. This
reduces bioavailability for drugs like propranolol, morphine, and nitroglycerin.
9. A 30-year-old woman who is a poor CYP2D6 metabolizer is prescribed codeine for
postoperative pain. She reports no analgesic effect. What is the most likely pharmacogenomic
explanation?
A. CYP2D6 converts codeine to morphine, and poor metabolizers produce insufficient morphine
B. CYP2D6 metabolizes codeine to a toxic metabolite causing sedation
C. Poor CYP2D6 metabolizers clear codeine too rapidly
D. Codeine is activated by CYP3A4, not CYP2D6
Correct Answer: A
Rationale: Codeine is a prodrug requiring O-demethylation by CYP2D6 to form morphine for
analgesic effect. Poor CYP2D6 metabolizers cannot convert codeine to morphine effectively,
resulting in treatment failure. The FDA has warnings against codeine use in poor metabolizers.
10. Which organ is primarily responsible for metabolism of most medications?
A. Liver
B. Spleen
C. Pancreas
D. Kidneys
Correct Answer: A
Rationale: The liver contains cytochrome P450 enzymes and other metabolic systems that
transform most medications into metabolites. Hepatic impairment can alter drug exposure and
may require dose or medication selection adjustments.
11. A competitive antagonist generally:
A. Permanently destroys receptors
B. Competes with an agonist for receptor binding
C. Produces the same effect as an agonist
