NR.110.332 Integrated Clinical
Pharmacology
Final Exam Review
(Questions & Solutions)
2025
1
, 1. Multiple-Choice
A 72-year-old with decompensated systolic heart failure is switched from
metoprolol tartrate to carvedilol. Which intrinsic pharmacokinetic
property chiefly justifies prescribing carvedilol twice daily rather than
once daily?
A. Prolonged elimination half-life
B. Enterohepatic recirculation
C. Extensive first-pass hepatic metabolism
D. High renal clearance
Correct ANS – C.
Rationale: Carvedilol undergoes marked first-pass metabolism that
shortens the effective plasma half-life despite a relatively long terminal
half-life. Dividing the dose maintains near-constant β-blockade without
toxic peaks or sub-therapeutic troughs.
---
2. Multiple-Choice
A patient stabilized on warfarin has her INR increase from 2.3 to 4.7
within three days of starting amiodarone. Which CYP450 interaction best
explains this finding?
A. CYP3A4 induction
B. CYP1A2 induction
C. CYP2C9 inhibition
D. CYP2C19 inhibition
Correct ANS – C.
Rationale: The S-enantiomer of warfarin, responsible for most
anticoagulant effect, is cleared primarily by CYP2C9; amiodarone is a
potent inhibitor of that isoenzyme, so warfarin accumulates and INR rises
sharply.
2
, ---
3. Multiple-Choice
A 58-year-old with stage 4 chronic kidney disease is receiving morphine
for cancer pain. Which metabolite is most likely to accumulate and cause
neurotoxicity?
A. Normorphine
B. Morphine-3-sulfate
C. Morphine-6-glucuronide
D. Hydromorphone-3-glucuronide
Correct ANS – C.
Rationale: Morphine-6-glucuronide is an active, renally cleared
metabolite whose buildup in renal failure produces prolonged sedation
and respiratory depression.
---
4. Multiple-Choice
During aminoglycoside therapy the nurse practitioner orders once-daily
(“extended-interval”) gentamicin. The clinical rationale for this schedule
rests on which pharmacodynamic principle?
A. Post-antibiotic effect
B. Time-dependent killing
C. Saturable renal reabsorption
D. High protein binding
Correct ANS – A.
Rationale: Gentamicin exhibits concentration-dependent killing plus a
prolonged post-antibiotic effect, so one high peak each day maximizes
bacterial eradication while limiting nephrotoxicity.
---
5. Multiple-Choice
3
Pharmacology
Final Exam Review
(Questions & Solutions)
2025
1
, 1. Multiple-Choice
A 72-year-old with decompensated systolic heart failure is switched from
metoprolol tartrate to carvedilol. Which intrinsic pharmacokinetic
property chiefly justifies prescribing carvedilol twice daily rather than
once daily?
A. Prolonged elimination half-life
B. Enterohepatic recirculation
C. Extensive first-pass hepatic metabolism
D. High renal clearance
Correct ANS – C.
Rationale: Carvedilol undergoes marked first-pass metabolism that
shortens the effective plasma half-life despite a relatively long terminal
half-life. Dividing the dose maintains near-constant β-blockade without
toxic peaks or sub-therapeutic troughs.
---
2. Multiple-Choice
A patient stabilized on warfarin has her INR increase from 2.3 to 4.7
within three days of starting amiodarone. Which CYP450 interaction best
explains this finding?
A. CYP3A4 induction
B. CYP1A2 induction
C. CYP2C9 inhibition
D. CYP2C19 inhibition
Correct ANS – C.
Rationale: The S-enantiomer of warfarin, responsible for most
anticoagulant effect, is cleared primarily by CYP2C9; amiodarone is a
potent inhibitor of that isoenzyme, so warfarin accumulates and INR rises
sharply.
2
, ---
3. Multiple-Choice
A 58-year-old with stage 4 chronic kidney disease is receiving morphine
for cancer pain. Which metabolite is most likely to accumulate and cause
neurotoxicity?
A. Normorphine
B. Morphine-3-sulfate
C. Morphine-6-glucuronide
D. Hydromorphone-3-glucuronide
Correct ANS – C.
Rationale: Morphine-6-glucuronide is an active, renally cleared
metabolite whose buildup in renal failure produces prolonged sedation
and respiratory depression.
---
4. Multiple-Choice
During aminoglycoside therapy the nurse practitioner orders once-daily
(“extended-interval”) gentamicin. The clinical rationale for this schedule
rests on which pharmacodynamic principle?
A. Post-antibiotic effect
B. Time-dependent killing
C. Saturable renal reabsorption
D. High protein binding
Correct ANS – A.
Rationale: Gentamicin exhibits concentration-dependent killing plus a
prolonged post-antibiotic effect, so one high peak each day maximizes
bacterial eradication while limiting nephrotoxicity.
---
5. Multiple-Choice
3
