NR566 Advanced Pharmacology Care of the Family
Midterm Review Quiz bank | LATEST, 2020/2021
|Q & A| Chamberlain College
Section 1: Pharmacokinetics & Pharmacodynamics
Q1. A 45-year-old woman with chronic kidney disease stage 3 is prescribed a medication that is
90% renally excreted. The provider needs to adjust the dosing interval. Understanding the
drug's pharmacokinetic profile is essential for safe prescribing in this population.
A. Increase the loading dose to achieve therapeutic levels faster
B. Extend the dosing interval to prevent drug accumulation
C. Switch to a sublingual route to bypass first-pass metabolism
D. Add a competitive inhibitor to reduce metabolism
Rationale: In renal impairment, drugs that are primarily renally excreted will have prolonged
half-lives, leading to accumulation if the dosing interval is not extended. Extending the interval
allows more time for elimination between doses. Increasing the loading dose would raise peak
concentrations without addressing accumulation, potentially causing toxicity.
Q2. A 62-year-old man takes warfarin 5 mg daily for atrial fibrillation and is newly prescribed
fluconazole for a fungal infection. Three days later, his INR is markedly elevated. The nurse
practitioner must understand the mechanism behind this interaction to manage it properly.
A. Fluconazole induces CYP2C9, increasing warfarin metabolism
B. Fluconazole inhibits CYP2C9, reducing warfarin metabolism
C. Fluconazole displaces warfarin from albumin binding sites only
D. Fluconazole increases gastric pH, enhancing warfarin absorption
Rationale: Fluconazole is a potent inhibitor of CYP2C9, the primary enzyme responsible for
S-warfarin metabolism. Inhibition of this enzyme reduces warfarin clearance, raising plasma
levels and INR. While protein binding displacement can contribute modestly, the primary
mechanism is enzymatic inhibition, making dose reduction of warfarin necessary.
Q3. A 38-year-old woman is prescribed oral propranolol for migraine prophylaxis but reports
minimal symptom improvement after two weeks. The provider suspects poor bioavailability as a
contributing factor. Understanding first-pass metabolism is critical to addressing this therapeutic
failure.
,A. Propranolol has near-complete oral bioavailability exceeding 90%
B. Propranolol is a prodrug requiring hepatic activation to become effective
C. Propranolol undergoes extensive first-pass metabolism, reducing oral bioavailability to
about 25%
D. Propranolol is primarily excreted unchanged by the kidneys without hepatic metabolism
Rationale: Propranolol is a high-extraction-ratio drug that undergoes extensive first-pass
hepatic metabolism, resulting in oral bioavailability of approximately 25%. This means a large
fraction of each oral dose is metabolized before reaching systemic circulation. Switching to a
longer-acting formulation or adjusting the dose may overcome this limitation.
Q4. A 55-year-old man with heart failure has significant peripheral edema and is started on
furosemide. He also takes lisinopril for hypertension. The nurse practitioner must consider how
volume of distribution affects drug dosing in this clinical scenario.
A. Drugs with high lipid solubility will have reduced volume of distribution in edematous states
B. Water-soluble drugs may have an increased volume of distribution in fluid overload
C. Volume of distribution is unaffected by changes in body fluid compartments
D. Edema only affects drug absorption from the gastrointestinal tract
Rationale: In fluid overload states such as heart failure with edema, water-soluble drugs
distribute into the expanded extracellular fluid volume, increasing their volume of distribution.
This may require higher loading doses to achieve therapeutic plasma concentrations. Lipid-
soluble drugs are less affected by changes in total body water.
Q5. A 30-year-old woman who is a poor CYP2D6 metabolizer is prescribed codeine for
postoperative pain after a dental extraction. She reports no analgesic effect despite taking the
maximum recommended dose. What is the most likely pharmacogenomic explanation for the
treatment failure?
A. CYP2D6 converts codeine to its active metabolite morphine, and poor metabolizers
produce insufficient morphine for analgesia
B. CYP2D6 metabolizes codeine to a toxic metabolite causing sedation rather than analgesia
C. Poor CYP2D6 metabolizers clear codeine too rapidly for therapeutic effect
D. Codeine is a prodrug activated by CYP3A4, not CYP2D6
Rationale: Codeine is a prodrug that requires O-demethylation by CYP2D6 to form
morphine for analgesic effect. Poor CYP2D6 metabolizers cannot convert codeine to morphine
effectively, resulting in treatment failure. This is a classic example of pharmacogenomic
variability affecting drug response.
,Q6. A 68-year-old man takes simvastatin 40 mg daily for hyperlipidemia. His new provider
prescribes clarithromycin for community-acquired pneumonia. He presents three days later
with diffuse myalgias and dark-colored urine. Which pharmacokinetic interaction best 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
Rationale: Clarithromycin is a strong CYP3A4 inhibitor that reduces simvastatin metabolism,
leading to elevated statin levels and rhabdomyolysis. CYP3A4 induction would decrease statin
levels, simvastatin has low protein binding displacement potential, and simvastatin is hepatically
cleared, not renally.
Q7. The study of drug absorption, distribution, metabolism, and excretion is known as:
A. Pharmacotherapeutics
B. Pharmacokinetics
C. Pharmacodynamics
D. Posology
Rationale: Pharmacokinetics refers to what the body does to a drug, including absorption,
distribution, metabolism, and excretion (ADME). These processes determine the onset,
intensity, and duration of drug action. Pharmacodynamics, in contrast, describes what the drug
does to the body.
Q8. A situation in which a drug should not be administered is called:
A. Side effect
B. Adverse effect
C. Contraindication
D. Idiosyncrasy
Rationale: A contraindication is any condition or factor that makes the use of a drug unsafe
or inappropriate. Side effects and adverse effects refer to unwanted drug reactions, but they do
not necessarily prevent use of the drug. A drug allergy is an immune-mediated response, which
may be a reason for contraindication but is not the term itself.
Q9. An unusual or unpredictable drug reaction in a patient is called:
, A. Toxic effect
B. Antagonism
C. Idiosyncrasy
D. Side effect
Rationale: Idiosyncrasy refers to an abnormal, genetically determined reaction to a drug
that is not related to its pharmacological action. Toxic effects are dose-related and predictable.
Side effects are predictable secondary drug effects, while antagonism refers to drug interactions
where one drug reduces the effect of another.
Q10. The time from drug administration to the first observable effect is called:
A. Duration of action
B. Onset of action
C. Ceiling effect
D. Maximal response
Rationale: Onset of action refers to the time taken for a drug to produce its initial
therapeutic effect after administration. Duration of action is how long the effect lasts. Ceiling
effect refers to the maximum response a drug can produce, while maximal response refers to
the greatest effect achievable.
Q11. A drug regulated due to potential for abuse is classified as a:
A. Prescription drug
B. OTC drug
C. Controlled substance
D. Generic drug
Rationale: Controlled substances are drugs regulated by law due to their potential for abuse
and dependence. They are classified into schedules based on risk. OTC drugs are safe without
prescription, while prescription drugs require authorization but are not necessarily controlled
substances.
Q12. The term that refers to determining drug dosage for therapeutic effect is:
A. Posology
B. Toxicology
C. Pharmacodynamics
D. Pharmacotherapeutics
Midterm Review Quiz bank | LATEST, 2020/2021
|Q & A| Chamberlain College
Section 1: Pharmacokinetics & Pharmacodynamics
Q1. A 45-year-old woman with chronic kidney disease stage 3 is prescribed a medication that is
90% renally excreted. The provider needs to adjust the dosing interval. Understanding the
drug's pharmacokinetic profile is essential for safe prescribing in this population.
A. Increase the loading dose to achieve therapeutic levels faster
B. Extend the dosing interval to prevent drug accumulation
C. Switch to a sublingual route to bypass first-pass metabolism
D. Add a competitive inhibitor to reduce metabolism
Rationale: In renal impairment, drugs that are primarily renally excreted will have prolonged
half-lives, leading to accumulation if the dosing interval is not extended. Extending the interval
allows more time for elimination between doses. Increasing the loading dose would raise peak
concentrations without addressing accumulation, potentially causing toxicity.
Q2. A 62-year-old man takes warfarin 5 mg daily for atrial fibrillation and is newly prescribed
fluconazole for a fungal infection. Three days later, his INR is markedly elevated. The nurse
practitioner must understand the mechanism behind this interaction to manage it properly.
A. Fluconazole induces CYP2C9, increasing warfarin metabolism
B. Fluconazole inhibits CYP2C9, reducing warfarin metabolism
C. Fluconazole displaces warfarin from albumin binding sites only
D. Fluconazole increases gastric pH, enhancing warfarin absorption
Rationale: Fluconazole is a potent inhibitor of CYP2C9, the primary enzyme responsible for
S-warfarin metabolism. Inhibition of this enzyme reduces warfarin clearance, raising plasma
levels and INR. While protein binding displacement can contribute modestly, the primary
mechanism is enzymatic inhibition, making dose reduction of warfarin necessary.
Q3. A 38-year-old woman is prescribed oral propranolol for migraine prophylaxis but reports
minimal symptom improvement after two weeks. The provider suspects poor bioavailability as a
contributing factor. Understanding first-pass metabolism is critical to addressing this therapeutic
failure.
,A. Propranolol has near-complete oral bioavailability exceeding 90%
B. Propranolol is a prodrug requiring hepatic activation to become effective
C. Propranolol undergoes extensive first-pass metabolism, reducing oral bioavailability to
about 25%
D. Propranolol is primarily excreted unchanged by the kidneys without hepatic metabolism
Rationale: Propranolol is a high-extraction-ratio drug that undergoes extensive first-pass
hepatic metabolism, resulting in oral bioavailability of approximately 25%. This means a large
fraction of each oral dose is metabolized before reaching systemic circulation. Switching to a
longer-acting formulation or adjusting the dose may overcome this limitation.
Q4. A 55-year-old man with heart failure has significant peripheral edema and is started on
furosemide. He also takes lisinopril for hypertension. The nurse practitioner must consider how
volume of distribution affects drug dosing in this clinical scenario.
A. Drugs with high lipid solubility will have reduced volume of distribution in edematous states
B. Water-soluble drugs may have an increased volume of distribution in fluid overload
C. Volume of distribution is unaffected by changes in body fluid compartments
D. Edema only affects drug absorption from the gastrointestinal tract
Rationale: In fluid overload states such as heart failure with edema, water-soluble drugs
distribute into the expanded extracellular fluid volume, increasing their volume of distribution.
This may require higher loading doses to achieve therapeutic plasma concentrations. Lipid-
soluble drugs are less affected by changes in total body water.
Q5. A 30-year-old woman who is a poor CYP2D6 metabolizer is prescribed codeine for
postoperative pain after a dental extraction. She reports no analgesic effect despite taking the
maximum recommended dose. What is the most likely pharmacogenomic explanation for the
treatment failure?
A. CYP2D6 converts codeine to its active metabolite morphine, and poor metabolizers
produce insufficient morphine for analgesia
B. CYP2D6 metabolizes codeine to a toxic metabolite causing sedation rather than analgesia
C. Poor CYP2D6 metabolizers clear codeine too rapidly for therapeutic effect
D. Codeine is a prodrug activated by CYP3A4, not CYP2D6
Rationale: Codeine is a prodrug that requires O-demethylation by CYP2D6 to form
morphine for analgesic effect. Poor CYP2D6 metabolizers cannot convert codeine to morphine
effectively, resulting in treatment failure. This is a classic example of pharmacogenomic
variability affecting drug response.
,Q6. A 68-year-old man takes simvastatin 40 mg daily for hyperlipidemia. His new provider
prescribes clarithromycin for community-acquired pneumonia. He presents three days later
with diffuse myalgias and dark-colored urine. Which pharmacokinetic interaction best 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
Rationale: Clarithromycin is a strong CYP3A4 inhibitor that reduces simvastatin metabolism,
leading to elevated statin levels and rhabdomyolysis. CYP3A4 induction would decrease statin
levels, simvastatin has low protein binding displacement potential, and simvastatin is hepatically
cleared, not renally.
Q7. The study of drug absorption, distribution, metabolism, and excretion is known as:
A. Pharmacotherapeutics
B. Pharmacokinetics
C. Pharmacodynamics
D. Posology
Rationale: Pharmacokinetics refers to what the body does to a drug, including absorption,
distribution, metabolism, and excretion (ADME). These processes determine the onset,
intensity, and duration of drug action. Pharmacodynamics, in contrast, describes what the drug
does to the body.
Q8. A situation in which a drug should not be administered is called:
A. Side effect
B. Adverse effect
C. Contraindication
D. Idiosyncrasy
Rationale: A contraindication is any condition or factor that makes the use of a drug unsafe
or inappropriate. Side effects and adverse effects refer to unwanted drug reactions, but they do
not necessarily prevent use of the drug. A drug allergy is an immune-mediated response, which
may be a reason for contraindication but is not the term itself.
Q9. An unusual or unpredictable drug reaction in a patient is called:
, A. Toxic effect
B. Antagonism
C. Idiosyncrasy
D. Side effect
Rationale: Idiosyncrasy refers to an abnormal, genetically determined reaction to a drug
that is not related to its pharmacological action. Toxic effects are dose-related and predictable.
Side effects are predictable secondary drug effects, while antagonism refers to drug interactions
where one drug reduces the effect of another.
Q10. The time from drug administration to the first observable effect is called:
A. Duration of action
B. Onset of action
C. Ceiling effect
D. Maximal response
Rationale: Onset of action refers to the time taken for a drug to produce its initial
therapeutic effect after administration. Duration of action is how long the effect lasts. Ceiling
effect refers to the maximum response a drug can produce, while maximal response refers to
the greatest effect achievable.
Q11. A drug regulated due to potential for abuse is classified as a:
A. Prescription drug
B. OTC drug
C. Controlled substance
D. Generic drug
Rationale: Controlled substances are drugs regulated by law due to their potential for abuse
and dependence. They are classified into schedules based on risk. OTC drugs are safe without
prescription, while prescription drugs require authorization but are not necessarily controlled
substances.
Q12. The term that refers to determining drug dosage for therapeutic effect is:
A. Posology
B. Toxicology
C. Pharmacodynamics
D. Pharmacotherapeutics
