NR565 / NR 565 ADVANCED PHARMACOLOGY
FUNDAMENTALS
(2025/2026) Final Exam
Question 1:
A 65-year-old female patient with osteoarthritis presents to your clinic complaining of persistent
joint pain. She has been taking oral ibuprofen 400 mg three times daily for the past month, but
she reports minimal relief. Her medical history includes chronic kidney disease stage 3 and
gastroesophageal reflux disease (GERD). She asks whether switching to a liquid formulation of
ibuprofen would improve her pain control. Which of the following statements is correct
regarding oral drug absorption in this patient?
A. Liquid formulations will be absorbed more quickly and completely regardless of gastric pH.
B. Oral absorption of ibuprofen may be affected by delayed gastric emptying and increased
gastric pH associated with age and GERD.
C. Oral absorption is unaffected by the patient’s age, comorbidities, or formulation type.
D. Bioavailability is reduced in liquid formulations compared to tablets.
Correct Answer: B. Oral absorption of ibuprofen may be affected by delayed gastric emptying
and increased gastric pH associated with age and GERD.
Rationale: Age-related physiological changes, including decreased gastric acidity and delayed
gastric emptying, can reduce or delay the absorption of certain oral drugs, especially weak acids
like NSAIDs. GERD and use of proton pump inhibitors can further increase gastric pH,
potentially affecting solubility and absorption. Liquid formulations may speed absorption, but
they do not always overcome these physiological limitations. Understanding patient-specific
factors is crucial when considering changes in drug formulations.
Question 2:
A 45-year-old male with type 2 diabetes presents for routine follow-up. He has been taking oral
metformin 1000 mg twice daily but reports gastrointestinal upset after each dose. He is
considering switching to an extended-release formulation. Which statement best describes the
rationale for using extended-release formulations in terms of absorption?
A. Extended-release formulations increase the peak plasma concentration and improve efficacy.
B. Extended-release formulations slow gastrointestinal absorption, reducing peak plasma levels
and improving tolerability.
C. Extended-release formulations bypass first-pass metabolism entirely.
D. Extended-release formulations are absorbed faster than immediate-release formulations.
,Correct Answer: B. Extended-release formulations slow gastrointestinal absorption, reducing
peak plasma levels and improving tolerability.
Rationale: Extended-release formulations are designed to release the drug slowly over time,
reducing peak plasma concentrations and minimizing gastrointestinal side effects while
maintaining therapeutic levels. They do not bypass first-pass metabolism and typically have
similar total bioavailability as immediate-release formulations. Patient-specific factors such as
kidney function must still be considered when prescribing these formulations.
Question 3:
A 32-year-old male patient is prescribed an oral antifungal medication for recurrent tinea pedis.
He mentions that he often consumes grapefruit juice with his breakfast. Which of the following
statements best describes how grapefruit juice may influence drug absorption?
A. Grapefruit juice enhances the absorption of all oral medications.
B. Grapefruit juice inhibits intestinal CYP3A4 enzymes, increasing systemic drug levels and risk
of toxicity.
C. Grapefruit juice has no effect on drug absorption or metabolism.
D. Grapefruit juice promotes first-pass metabolism, reducing drug efficacy.
Correct Answer: B. Grapefruit juice inhibits intestinal CYP3A4 enzymes, increasing systemic
drug levels and risk of toxicity.
Rationale: Grapefruit juice contains furanocoumarins, which inhibit CYP3A4 enzymes in the
small intestine. This can reduce the first-pass metabolism of certain drugs, leading to increased
systemic concentrations and potential toxicity. Drugs with narrow therapeutic windows, such as
certain antifungals, statins, and calcium channel blockers, are particularly affected. Educating
patients about dietary interactions is essential for safe drug administration.
Question 4:
A 70-year-old female patient with Parkinson’s disease is taking a new oral dopaminergic
medication. She reports inconsistent symptom control despite adherence. She also takes a high-
fiber diet and several antacids for dyspepsia. How might her dietary habits and antacid use affect
drug absorption?
A. Fiber and antacids can bind the drug or alter gastric pH, decreasing oral absorption.
B. High-fiber diets enhance drug absorption by increasing gastric motility.
C. Antacids accelerate drug dissolution and absorption.
D. Dietary fiber and antacids do not impact drug absorption.
Correct Answer: A. Fiber and antacids can bind the drug or alter gastric pH, decreasing oral
absorption.
,Rationale: Dietary fiber can physically bind drugs in the gastrointestinal tract, reducing
absorption. Antacids can alter gastric pH, affecting solubility and ionization of weak acids and
bases, potentially reducing the fraction of drug absorbed. These interactions are especially
important for drugs with a narrow therapeutic index. Clinicians must assess dietary and OTC
medication influences when evaluating variable drug response.
Question 5:
A 50-year-old male patient with hypertension is prescribed oral propranolol but reports
inadequate blood pressure control. He drinks alcohol regularly and takes proton pump inhibitors
for GERD. Which factor is most likely affecting his oral drug absorption?
A. Increased gastric emptying due to alcohol
B. Altered gastric pH from proton pump inhibitors
C. Decreased protein binding
D. Renal excretion
Correct Answer: B. Altered gastric pH from proton pump inhibitors
Rationale: Drugs like propranolol, a weak base, are more soluble in acidic environments. Proton
pump inhibitors increase gastric pH, which can reduce solubility and delay absorption,
potentially decreasing efficacy. Alcohol can also alter gastrointestinal motility but is less
impactful on weak base absorption than pH changes. Clinicians should consider pH-dependent
absorption when evaluating poor therapeutic response.
Question 6:
A 60-year-old male patient with type 2 diabetes and peripheral neuropathy has been prescribed
oral glipizide. He reports erratic blood sugar control despite adherence. He also takes over-the-
counter antacids daily for dyspepsia. Which of the following best explains how the antacids may
affect glipizide absorption?
A. Antacids can bind to glipizide and reduce its gastrointestinal absorption.
B. Antacids increase the solubility of glipizide, enhancing its absorption.
C. Antacids have no effect on oral sulfonylurea drugs.
D. Antacids increase first-pass metabolism of glipizide in the liver.
Correct Answer: A. Antacids can bind to glipizide and reduce its gastrointestinal absorption.
Rationale: Antacids can alter the gastric environment by increasing pH or physically binding to
some drugs, reducing their absorption. Glipizide is a weak acid and its solubility is pH-
dependent; binding or changes in pH can reduce the fraction of the drug absorbed, leading to
suboptimal glycemic control. Clinicians must review OTC medication use when evaluating
inconsistent responses to therapy.
, Question 7:
A 72-year-old female patient with osteoporosis has been prescribed oral alendronate 70 mg once
weekly. She reports difficulty taking it due to nausea and prefers taking it with breakfast
alongside her orange juice. Which statement best describes the concern regarding absorption of
alendronate?
A. Orange juice enhances alendronate absorption due to its acidity.
B. Alendronate absorption is significantly reduced when taken with food or beverages, including
acidic juices.
C. Alendronate is well absorbed regardless of food or fluid intake.
D. Alendronate can be taken with breakfast to reduce gastrointestinal upset without affecting
absorption.
Correct Answer: B. Alendronate absorption is significantly reduced when taken with food or
beverages, including acidic juices.
Rationale: Alendronate has very poor oral bioavailability and is further reduced if taken with
food or beverages. Patients must take it on an empty stomach with plain water, and remain
upright for at least 30 minutes to optimize absorption and reduce esophageal irritation. Improper
administration can result in subtherapeutic effects, increasing fracture risk.
Question 8:
A 55-year-old male patient with chronic angina has been prescribed oral nifedipine extended-
release tablets. He complains of chest pain despite adherence. He also consumes a high-fat
breakfast daily. Which of the following statements correctly describes how food may influence
drug absorption?
A. High-fat meals have no impact on absorption of extended-release nifedipine.
B. High-fat meals can delay absorption and peak plasma concentrations, potentially affecting
onset of action.
C. High-fat meals accelerate absorption and increase peak plasma levels, increasing toxicity risk.
D. Nifedipine absorption is not affected by meals because it is metabolized hepatically.
Correct Answer: B. High-fat meals can delay absorption and peak plasma concentrations,
potentially affecting onset of action.
Rationale: Food, particularly high-fat meals, can delay gastric emptying and slow absorption of
extended-release formulations. While total bioavailability may remain unchanged, the delayed
peak can impact onset of action, which is important for symptom control in angina. Clinicians
should provide administration instructions in relation to meals to optimize drug efficacy.
FUNDAMENTALS
(2025/2026) Final Exam
Question 1:
A 65-year-old female patient with osteoarthritis presents to your clinic complaining of persistent
joint pain. She has been taking oral ibuprofen 400 mg three times daily for the past month, but
she reports minimal relief. Her medical history includes chronic kidney disease stage 3 and
gastroesophageal reflux disease (GERD). She asks whether switching to a liquid formulation of
ibuprofen would improve her pain control. Which of the following statements is correct
regarding oral drug absorption in this patient?
A. Liquid formulations will be absorbed more quickly and completely regardless of gastric pH.
B. Oral absorption of ibuprofen may be affected by delayed gastric emptying and increased
gastric pH associated with age and GERD.
C. Oral absorption is unaffected by the patient’s age, comorbidities, or formulation type.
D. Bioavailability is reduced in liquid formulations compared to tablets.
Correct Answer: B. Oral absorption of ibuprofen may be affected by delayed gastric emptying
and increased gastric pH associated with age and GERD.
Rationale: Age-related physiological changes, including decreased gastric acidity and delayed
gastric emptying, can reduce or delay the absorption of certain oral drugs, especially weak acids
like NSAIDs. GERD and use of proton pump inhibitors can further increase gastric pH,
potentially affecting solubility and absorption. Liquid formulations may speed absorption, but
they do not always overcome these physiological limitations. Understanding patient-specific
factors is crucial when considering changes in drug formulations.
Question 2:
A 45-year-old male with type 2 diabetes presents for routine follow-up. He has been taking oral
metformin 1000 mg twice daily but reports gastrointestinal upset after each dose. He is
considering switching to an extended-release formulation. Which statement best describes the
rationale for using extended-release formulations in terms of absorption?
A. Extended-release formulations increase the peak plasma concentration and improve efficacy.
B. Extended-release formulations slow gastrointestinal absorption, reducing peak plasma levels
and improving tolerability.
C. Extended-release formulations bypass first-pass metabolism entirely.
D. Extended-release formulations are absorbed faster than immediate-release formulations.
,Correct Answer: B. Extended-release formulations slow gastrointestinal absorption, reducing
peak plasma levels and improving tolerability.
Rationale: Extended-release formulations are designed to release the drug slowly over time,
reducing peak plasma concentrations and minimizing gastrointestinal side effects while
maintaining therapeutic levels. They do not bypass first-pass metabolism and typically have
similar total bioavailability as immediate-release formulations. Patient-specific factors such as
kidney function must still be considered when prescribing these formulations.
Question 3:
A 32-year-old male patient is prescribed an oral antifungal medication for recurrent tinea pedis.
He mentions that he often consumes grapefruit juice with his breakfast. Which of the following
statements best describes how grapefruit juice may influence drug absorption?
A. Grapefruit juice enhances the absorption of all oral medications.
B. Grapefruit juice inhibits intestinal CYP3A4 enzymes, increasing systemic drug levels and risk
of toxicity.
C. Grapefruit juice has no effect on drug absorption or metabolism.
D. Grapefruit juice promotes first-pass metabolism, reducing drug efficacy.
Correct Answer: B. Grapefruit juice inhibits intestinal CYP3A4 enzymes, increasing systemic
drug levels and risk of toxicity.
Rationale: Grapefruit juice contains furanocoumarins, which inhibit CYP3A4 enzymes in the
small intestine. This can reduce the first-pass metabolism of certain drugs, leading to increased
systemic concentrations and potential toxicity. Drugs with narrow therapeutic windows, such as
certain antifungals, statins, and calcium channel blockers, are particularly affected. Educating
patients about dietary interactions is essential for safe drug administration.
Question 4:
A 70-year-old female patient with Parkinson’s disease is taking a new oral dopaminergic
medication. She reports inconsistent symptom control despite adherence. She also takes a high-
fiber diet and several antacids for dyspepsia. How might her dietary habits and antacid use affect
drug absorption?
A. Fiber and antacids can bind the drug or alter gastric pH, decreasing oral absorption.
B. High-fiber diets enhance drug absorption by increasing gastric motility.
C. Antacids accelerate drug dissolution and absorption.
D. Dietary fiber and antacids do not impact drug absorption.
Correct Answer: A. Fiber and antacids can bind the drug or alter gastric pH, decreasing oral
absorption.
,Rationale: Dietary fiber can physically bind drugs in the gastrointestinal tract, reducing
absorption. Antacids can alter gastric pH, affecting solubility and ionization of weak acids and
bases, potentially reducing the fraction of drug absorbed. These interactions are especially
important for drugs with a narrow therapeutic index. Clinicians must assess dietary and OTC
medication influences when evaluating variable drug response.
Question 5:
A 50-year-old male patient with hypertension is prescribed oral propranolol but reports
inadequate blood pressure control. He drinks alcohol regularly and takes proton pump inhibitors
for GERD. Which factor is most likely affecting his oral drug absorption?
A. Increased gastric emptying due to alcohol
B. Altered gastric pH from proton pump inhibitors
C. Decreased protein binding
D. Renal excretion
Correct Answer: B. Altered gastric pH from proton pump inhibitors
Rationale: Drugs like propranolol, a weak base, are more soluble in acidic environments. Proton
pump inhibitors increase gastric pH, which can reduce solubility and delay absorption,
potentially decreasing efficacy. Alcohol can also alter gastrointestinal motility but is less
impactful on weak base absorption than pH changes. Clinicians should consider pH-dependent
absorption when evaluating poor therapeutic response.
Question 6:
A 60-year-old male patient with type 2 diabetes and peripheral neuropathy has been prescribed
oral glipizide. He reports erratic blood sugar control despite adherence. He also takes over-the-
counter antacids daily for dyspepsia. Which of the following best explains how the antacids may
affect glipizide absorption?
A. Antacids can bind to glipizide and reduce its gastrointestinal absorption.
B. Antacids increase the solubility of glipizide, enhancing its absorption.
C. Antacids have no effect on oral sulfonylurea drugs.
D. Antacids increase first-pass metabolism of glipizide in the liver.
Correct Answer: A. Antacids can bind to glipizide and reduce its gastrointestinal absorption.
Rationale: Antacids can alter the gastric environment by increasing pH or physically binding to
some drugs, reducing their absorption. Glipizide is a weak acid and its solubility is pH-
dependent; binding or changes in pH can reduce the fraction of the drug absorbed, leading to
suboptimal glycemic control. Clinicians must review OTC medication use when evaluating
inconsistent responses to therapy.
, Question 7:
A 72-year-old female patient with osteoporosis has been prescribed oral alendronate 70 mg once
weekly. She reports difficulty taking it due to nausea and prefers taking it with breakfast
alongside her orange juice. Which statement best describes the concern regarding absorption of
alendronate?
A. Orange juice enhances alendronate absorption due to its acidity.
B. Alendronate absorption is significantly reduced when taken with food or beverages, including
acidic juices.
C. Alendronate is well absorbed regardless of food or fluid intake.
D. Alendronate can be taken with breakfast to reduce gastrointestinal upset without affecting
absorption.
Correct Answer: B. Alendronate absorption is significantly reduced when taken with food or
beverages, including acidic juices.
Rationale: Alendronate has very poor oral bioavailability and is further reduced if taken with
food or beverages. Patients must take it on an empty stomach with plain water, and remain
upright for at least 30 minutes to optimize absorption and reduce esophageal irritation. Improper
administration can result in subtherapeutic effects, increasing fracture risk.
Question 8:
A 55-year-old male patient with chronic angina has been prescribed oral nifedipine extended-
release tablets. He complains of chest pain despite adherence. He also consumes a high-fat
breakfast daily. Which of the following statements correctly describes how food may influence
drug absorption?
A. High-fat meals have no impact on absorption of extended-release nifedipine.
B. High-fat meals can delay absorption and peak plasma concentrations, potentially affecting
onset of action.
C. High-fat meals accelerate absorption and increase peak plasma levels, increasing toxicity risk.
D. Nifedipine absorption is not affected by meals because it is metabolized hepatically.
Correct Answer: B. High-fat meals can delay absorption and peak plasma concentrations,
potentially affecting onset of action.
Rationale: Food, particularly high-fat meals, can delay gastric emptying and slow absorption of
extended-release formulations. While total bioavailability may remain unchanged, the delayed
peak can impact onset of action, which is important for symptom control in angina. Clinicians
should provide administration instructions in relation to meals to optimize drug efficacy.
