GALEN COLLEGE OF NURSING
BSL 101 PRINCIPLES OF PHARMACOLOGY
FINAL EXAM
2026
Multiple Choice Questions (MCQs)
A patient with chronic kidney disease is prescribed digoxin. What is the most important pharmacokinetic
parameter to monitor in this patient?
A. Absorption
B. Distribution
C. Metabolism
D. Excretion Answer: D Rationale: Digoxin is primarily excreted renally; impaired kidney function can lead to
toxicity due to decreased clearance.
Which enzyme primarily metabolizes warfarin in the liver?
A. CYP3A4
B. CYP2D6
C. CYP2C9
D. CYP1A2 Answer: C Rationale: CYP2C9 is key for warfarin metabolism, affecting dosing and drug
interactions.
A beta-2 adrenergic receptor agonist causes bronchodilation by:
A. Inhibiting phosphodiesterase
B. Increasing intracellular cAMP
C. Blocking calcium channels
D. Decreasing nitric oxide synthesis Answer: B Rationale: Activation of beta-2 receptors increases cAMP,
relaxing bronchial smooth muscle.
Which of the following is a phase 1 metabolic reaction?
A. Glucuronidation
B. Sulfation
C. Oxidation
D. Methylation Answer: C Rationale: Oxidation is a typical phase 1 metabolism reaction involving CYP450
enzymes.
A patient develops QT prolongation after starting a new medication. Which electrophysiological effect is
responsible?
A. Increased sodium influx
,B. Delayed repolarization via potassium channel blockade
C. Enhanced calcium entry
D. Accelerated repolarization Answer: B Rationale: Blocking cardiac potassium channels delays
repolarization, causing QT prolongation.
True/False Questions
True or False: Bioavailability refers to the fraction of the administered dose that reaches systemic
circulation unchanged.
Answer: True
Rationale: Bioavailability is the measure of unchanged drug that enters the circulation after administration.
True or False: Drugs with a high volume of distribution are mostly confined to the plasma compartment.
Answer: False
Rationale: A high volume of distribution indicates extensive distribution into tissues, not confinement to
plasma.
True or False: Agonists have intrinsic activity and produce a biological response upon receptor binding.
Answer: True
Rationale: Agonists activate receptors, initiating a cellular response.
True or False: Phase 2 metabolism reactions generally make drugs more lipophilic.
Answer: False
Rationale: Phase 2 (conjugation) usually increases water solubility to facilitate excretion.
True or False: Competitive antagonists bind irreversibly to receptors.
Answer: False
Rationale: Competitive antagonists bind reversibly, allowing competition with agonists.
Short Answer Questions
Define the therapeutic index and explain its clinical significance.
Answer: The therapeutic index is the ratio between the toxic dose (TD50) and the effective dose (ED50) of a
drug. It indicates the safety margin; a narrow therapeutic index requires careful dosing and monitoring to
avoid toxicity.
Explain why liver disease might alter drug pharmacokinetics.
Answer: Liver disease impairs hepatic metabolism (phase 1 and phase 2), reducing clearance of drugs
metabolized by the liver, potentially increasing plasma levels and toxicity.
Describe the mechanism of action of nonsteroidal anti-inflammatory drugs (NSAIDs).
Answer: NSAIDs inhibit cyclooxygenase (COX) enzymes, reducing prostaglandin synthesis, which decreases
inflammation, pain, and fever.
What is first-pass metabolism, and which routes of administration avoid it?
Answer: First-pass metabolism is the hepatic metabolism of a drug after oral absorption but before
reaching systemic circulation. Routes avoiding first-pass metabolism include sublingual, intravenous, and
rectal (partially).
, How can pharmacogenetics influence drug response?
Answer: Genetic variations can affect drug-metabolizing enzymes, transporters, or receptors, altering drug
efficacy or toxicity, requiring personalized dosing.
Matching Questions
Match the drug class with its primary mechanism of action:
16.
A. ACE inhibitors
B. Beta-blockers
C. Calcium channel blockers
D. Proton pump inhibitors
E. Selective serotonin reuptake inhibitors (SSRIs)
i. Block angiotensin-converting enzyme reducing angiotensin II levels
ii. Block beta-adrenergic receptors reducing heart rate and contractility
iii. Inhibit L-type calcium channels preventing vasoconstriction
iv. Inhibit H+/K+ ATPase reducing gastric acid secretion
v. Inhibit serotonin reuptake increasing synaptic serotonin levels
Answers: A-i, B-ii, C-iii, D-iv, E-v
Rationale: Each drug class has a distinct and well-characterized mechanism suited to their indications.
Fill in the Blank
The ___________ phase of drug metabolism typically involves conjugation reactions such as
glucuronidation or sulfation.
Answer: Phase 2
Rationale: Phase 2 enzymes add polar groups to drugs/metabolites to increase solubility.
The antidote for acetaminophen overdose that replenishes glutathione stores is __________.
Answer: N-acetylcysteine
Rationale: N-acetylcysteine replenishes glutathione, detoxifying the harmful metabolite NAPQI.
Drugs that bind to the same receptor but produce no effect and block agonist action are called
__________.
Answer: antagonists
Rationale: Antagonists block receptor activation without intrinsic activity.
The main organ responsible for drug excretion through bile is the __________.
Answer: liver
Rationale: Biliary excretion is a route for drugs/metabolites secreted via the liver into bile.
Clinical Case-Based Questions
Case 1: A 68-year-old male with heart failure is taking digoxin and develops nausea, confusion, and visual
BSL 101 PRINCIPLES OF PHARMACOLOGY
FINAL EXAM
2026
Multiple Choice Questions (MCQs)
A patient with chronic kidney disease is prescribed digoxin. What is the most important pharmacokinetic
parameter to monitor in this patient?
A. Absorption
B. Distribution
C. Metabolism
D. Excretion Answer: D Rationale: Digoxin is primarily excreted renally; impaired kidney function can lead to
toxicity due to decreased clearance.
Which enzyme primarily metabolizes warfarin in the liver?
A. CYP3A4
B. CYP2D6
C. CYP2C9
D. CYP1A2 Answer: C Rationale: CYP2C9 is key for warfarin metabolism, affecting dosing and drug
interactions.
A beta-2 adrenergic receptor agonist causes bronchodilation by:
A. Inhibiting phosphodiesterase
B. Increasing intracellular cAMP
C. Blocking calcium channels
D. Decreasing nitric oxide synthesis Answer: B Rationale: Activation of beta-2 receptors increases cAMP,
relaxing bronchial smooth muscle.
Which of the following is a phase 1 metabolic reaction?
A. Glucuronidation
B. Sulfation
C. Oxidation
D. Methylation Answer: C Rationale: Oxidation is a typical phase 1 metabolism reaction involving CYP450
enzymes.
A patient develops QT prolongation after starting a new medication. Which electrophysiological effect is
responsible?
A. Increased sodium influx
,B. Delayed repolarization via potassium channel blockade
C. Enhanced calcium entry
D. Accelerated repolarization Answer: B Rationale: Blocking cardiac potassium channels delays
repolarization, causing QT prolongation.
True/False Questions
True or False: Bioavailability refers to the fraction of the administered dose that reaches systemic
circulation unchanged.
Answer: True
Rationale: Bioavailability is the measure of unchanged drug that enters the circulation after administration.
True or False: Drugs with a high volume of distribution are mostly confined to the plasma compartment.
Answer: False
Rationale: A high volume of distribution indicates extensive distribution into tissues, not confinement to
plasma.
True or False: Agonists have intrinsic activity and produce a biological response upon receptor binding.
Answer: True
Rationale: Agonists activate receptors, initiating a cellular response.
True or False: Phase 2 metabolism reactions generally make drugs more lipophilic.
Answer: False
Rationale: Phase 2 (conjugation) usually increases water solubility to facilitate excretion.
True or False: Competitive antagonists bind irreversibly to receptors.
Answer: False
Rationale: Competitive antagonists bind reversibly, allowing competition with agonists.
Short Answer Questions
Define the therapeutic index and explain its clinical significance.
Answer: The therapeutic index is the ratio between the toxic dose (TD50) and the effective dose (ED50) of a
drug. It indicates the safety margin; a narrow therapeutic index requires careful dosing and monitoring to
avoid toxicity.
Explain why liver disease might alter drug pharmacokinetics.
Answer: Liver disease impairs hepatic metabolism (phase 1 and phase 2), reducing clearance of drugs
metabolized by the liver, potentially increasing plasma levels and toxicity.
Describe the mechanism of action of nonsteroidal anti-inflammatory drugs (NSAIDs).
Answer: NSAIDs inhibit cyclooxygenase (COX) enzymes, reducing prostaglandin synthesis, which decreases
inflammation, pain, and fever.
What is first-pass metabolism, and which routes of administration avoid it?
Answer: First-pass metabolism is the hepatic metabolism of a drug after oral absorption but before
reaching systemic circulation. Routes avoiding first-pass metabolism include sublingual, intravenous, and
rectal (partially).
, How can pharmacogenetics influence drug response?
Answer: Genetic variations can affect drug-metabolizing enzymes, transporters, or receptors, altering drug
efficacy or toxicity, requiring personalized dosing.
Matching Questions
Match the drug class with its primary mechanism of action:
16.
A. ACE inhibitors
B. Beta-blockers
C. Calcium channel blockers
D. Proton pump inhibitors
E. Selective serotonin reuptake inhibitors (SSRIs)
i. Block angiotensin-converting enzyme reducing angiotensin II levels
ii. Block beta-adrenergic receptors reducing heart rate and contractility
iii. Inhibit L-type calcium channels preventing vasoconstriction
iv. Inhibit H+/K+ ATPase reducing gastric acid secretion
v. Inhibit serotonin reuptake increasing synaptic serotonin levels
Answers: A-i, B-ii, C-iii, D-iv, E-v
Rationale: Each drug class has a distinct and well-characterized mechanism suited to their indications.
Fill in the Blank
The ___________ phase of drug metabolism typically involves conjugation reactions such as
glucuronidation or sulfation.
Answer: Phase 2
Rationale: Phase 2 enzymes add polar groups to drugs/metabolites to increase solubility.
The antidote for acetaminophen overdose that replenishes glutathione stores is __________.
Answer: N-acetylcysteine
Rationale: N-acetylcysteine replenishes glutathione, detoxifying the harmful metabolite NAPQI.
Drugs that bind to the same receptor but produce no effect and block agonist action are called
__________.
Answer: antagonists
Rationale: Antagonists block receptor activation without intrinsic activity.
The main organ responsible for drug excretion through bile is the __________.
Answer: liver
Rationale: Biliary excretion is a route for drugs/metabolites secreted via the liver into bile.
Clinical Case-Based Questions
Case 1: A 68-year-old male with heart failure is taking digoxin and develops nausea, confusion, and visual
