NGR 5172 — Advanced Pharmacology Final
Practice Exam — 70 Questions with Correct
Answers & Rationales
1. Which term describes the relationship between drug concentration at the site
of action and the magnitude of pharmacologic effect?
Answer: Pharmacodynamics
Rationale: Pharmacodynamics is “what the drug does to the body” (receptor
binding, efficacy, potency). Pharmacokinetics describes absorption, distribution,
metabolism, elimination.
2. A drug with a low therapeutic index means:
A. Wide margin of safety
B. Narrow margin of safety — small dose changes may cause toxicity
C. No monitoring required
D. Safe in pregnancy
Answer: B
Rationale: Low TI implies therapeutic and toxic doses are close; requires close
monitoring (e.g., digoxin, warfarin, lithium).
3. For oral drugs, first-pass metabolism most directly affects:
A. Distribution volume
B. Bioavailability
C. Clearance by kidney
D. Protein binding
Answer: B
Rationale: First-pass (hepatic) metabolism reduces the fraction of drug reaching
systemic circulation after oral dosing → lowers oral bioavailability.
,4. A patient with severe renal impairment needs dose adjustment for a renally
cleared drug. Which PK parameter is most critical?
Answer: Clearance (CL)
Rationale: Clearance determines elimination rate. Reduced renal CL increases
half-life and AUC; dosing must be altered (lower dose or extend interval).
5. Agonist vs antagonist: A full agonist produces maximal effect by receptor
activation; a competitive antagonist:
A. Increases efficacy
B. Decreases potency but can be overcome by higher agonist concentration
C. Binds irreversibly
D. Acts as partial agonist
Answer: B
Rationale: Competitive antagonists shift dose-response curve right (decrease
potency) without reducing maximal efficacy unless antagonist concentration is
very high; overcome by more agonist.
6. Which antibiotic class inhibits bacterial cell wall synthesis by binding
penicillin-binding proteins?
Answer: Beta-lactams (penicillins, cephalosporins, carbapenems)
Rationale: Beta-lactams prevent cross-linking of peptidoglycan by inhibiting PBPs
→ bactericidal activity against growing bacteria.
7. A patient on warfarin starts trimethoprim-sulfamethoxazole — what happens
to INR and why?
Answer: INR increases (warfarin effect enhanced)
Rationale: TMP-SMX inhibits warfarin metabolism (and displaces protein binding)
→ increased warfarin levels and bleeding risk; monitor INR and consider dose
adjustment.
, 8. Which antibiotic is contraindicated in children because of cartilage toxicity
risk?
Answer: Fluoroquinolones (e.g., ciprofloxacin) — generally avoided in children
unless benefits outweigh risks
Rationale: Fluoroquinolones are associated with arthropathy in juvenile animals
and cautious use in children; occasionally used for specific infections when no
alternatives exist.
9. The mechanism of action of vancomycin is:
A. Inhibits DNA gyrase
B. Binds D-Ala-D-Ala, inhibiting cell wall synthesis
C. Inhibits 30S ribosomal subunit
D. Inhibits folate synthesis
Answer: B
Rationale: Vancomycin binds D-Ala-D-Ala termini of peptidoglycan precursors,
blocking cell wall synthesis — effective against Gram-positive organisms including
MRSA.
10. Best monitoring parameter for vancomycin to avoid nephrotoxicity while
ensuring efficacy?
Answer: Trough concentration (or AUC-guided dosing)
Rationale: Traditional monitoring uses trough levels (aims vary by severity), but
AUC-guided dosing (AUC/MIC) is more accurate for efficacy and safety. Watch
renal function.
11. Which antihypertensive class provides mortality benefit post-MI and in heart
failure with reduced EF?
Answer: Beta-blockers and ACE inhibitors (also ARNI/ARB, mineralocorticoid
antagonists)
Practice Exam — 70 Questions with Correct
Answers & Rationales
1. Which term describes the relationship between drug concentration at the site
of action and the magnitude of pharmacologic effect?
Answer: Pharmacodynamics
Rationale: Pharmacodynamics is “what the drug does to the body” (receptor
binding, efficacy, potency). Pharmacokinetics describes absorption, distribution,
metabolism, elimination.
2. A drug with a low therapeutic index means:
A. Wide margin of safety
B. Narrow margin of safety — small dose changes may cause toxicity
C. No monitoring required
D. Safe in pregnancy
Answer: B
Rationale: Low TI implies therapeutic and toxic doses are close; requires close
monitoring (e.g., digoxin, warfarin, lithium).
3. For oral drugs, first-pass metabolism most directly affects:
A. Distribution volume
B. Bioavailability
C. Clearance by kidney
D. Protein binding
Answer: B
Rationale: First-pass (hepatic) metabolism reduces the fraction of drug reaching
systemic circulation after oral dosing → lowers oral bioavailability.
,4. A patient with severe renal impairment needs dose adjustment for a renally
cleared drug. Which PK parameter is most critical?
Answer: Clearance (CL)
Rationale: Clearance determines elimination rate. Reduced renal CL increases
half-life and AUC; dosing must be altered (lower dose or extend interval).
5. Agonist vs antagonist: A full agonist produces maximal effect by receptor
activation; a competitive antagonist:
A. Increases efficacy
B. Decreases potency but can be overcome by higher agonist concentration
C. Binds irreversibly
D. Acts as partial agonist
Answer: B
Rationale: Competitive antagonists shift dose-response curve right (decrease
potency) without reducing maximal efficacy unless antagonist concentration is
very high; overcome by more agonist.
6. Which antibiotic class inhibits bacterial cell wall synthesis by binding
penicillin-binding proteins?
Answer: Beta-lactams (penicillins, cephalosporins, carbapenems)
Rationale: Beta-lactams prevent cross-linking of peptidoglycan by inhibiting PBPs
→ bactericidal activity against growing bacteria.
7. A patient on warfarin starts trimethoprim-sulfamethoxazole — what happens
to INR and why?
Answer: INR increases (warfarin effect enhanced)
Rationale: TMP-SMX inhibits warfarin metabolism (and displaces protein binding)
→ increased warfarin levels and bleeding risk; monitor INR and consider dose
adjustment.
, 8. Which antibiotic is contraindicated in children because of cartilage toxicity
risk?
Answer: Fluoroquinolones (e.g., ciprofloxacin) — generally avoided in children
unless benefits outweigh risks
Rationale: Fluoroquinolones are associated with arthropathy in juvenile animals
and cautious use in children; occasionally used for specific infections when no
alternatives exist.
9. The mechanism of action of vancomycin is:
A. Inhibits DNA gyrase
B. Binds D-Ala-D-Ala, inhibiting cell wall synthesis
C. Inhibits 30S ribosomal subunit
D. Inhibits folate synthesis
Answer: B
Rationale: Vancomycin binds D-Ala-D-Ala termini of peptidoglycan precursors,
blocking cell wall synthesis — effective against Gram-positive organisms including
MRSA.
10. Best monitoring parameter for vancomycin to avoid nephrotoxicity while
ensuring efficacy?
Answer: Trough concentration (or AUC-guided dosing)
Rationale: Traditional monitoring uses trough levels (aims vary by severity), but
AUC-guided dosing (AUC/MIC) is more accurate for efficacy and safety. Watch
renal function.
11. Which antihypertensive class provides mortality benefit post-MI and in heart
failure with reduced EF?
Answer: Beta-blockers and ACE inhibitors (also ARNI/ARB, mineralocorticoid
antagonists)
