NURS 5334 (Advanced Pharmacology) Assessment 1
Practice Questions and Answers
Q1. Which route of drug administration bypasses first‑pass metabolism?
A. Oral
B. Sublingual
C. Intravenous
Rationale: IV administration delivers drug directly into systemic circulation, avoiding
hepatic first‑pass metabolism.
Q2. The therapeutic index (TI) of a drug is defined as:
A. Ratio of absorption to distribution
B. Ratio of toxic dose to effective dose
C. Ratio of metabolism to excretion
Rationale: TI = TD50/ED50. A higher TI indicates a safer drug.
Q3. Which CYP450 enzyme is most involved in drug metabolism?
A. CYP2D6
B. CYP3A4
C. CYP1A2
Rationale: CYP3A4 metabolizes ~50% of clinically used drugs.
Q4. A patient on warfarin begins therapy with trimethoprim‑sulfamethoxazole. What is
the primary concern?
A. Decreased INR
B. Increased risk of bleeding
C. Enhanced warfarin clearance
Rationale: TMP‑SMX inhibits warfarin metabolism, raising INR and bleeding risk.
Q5. Which antihypertensive is contraindicated in pregnancy?
A. Methyldopa
B. Labetalol
C. ACE inhibitors
Rationale: ACE inhibitors are teratogenic, causing fetal renal malformations.
Q6. Which drug class is most associated with ototoxicity?
A. Beta‑blockers
B. Aminoglycosides
C. Calcium channel blockers
Rationale: Aminoglycosides (e.g., gentamicin) can damage cochlear hair cells.
Q7. A patient with asthma should avoid which antihypertensive?
A. ACE inhibitor
B. Non‑selective beta‑blocker
C. ARB
, Rationale: Non‑selective beta‑blockers (e.g., propranolol) can trigger bronchospasm.
Q8. The half‑life of a drug is primarily determined by:
A. Absorption rate
B. Clearance and volume of distribution
C. Protein binding
Rationale: Half‑life = (0.693 × Vd) ÷ Clearance.
Q9. Which drug is contraindicated in G6PD deficiency?
A. Penicillin
B. Sulfonamides
C. Macrolides
Rationale: Sulfonamides can cause hemolysis in G6PD deficiency.
Q10. Which opioid is safest in renal impairment?
A. Morphine
B. Codeine
C. Fentanyl
Rationale: Fentanyl has no active metabolites and is safer in renal dysfunction.
Q11. Grapefruit juice inhibits which enzyme?
A. CYP2D6
B. CYP3A4
C. CYP2C9
Rationale: Grapefruit juice inhibits intestinal CYP3A4, increasing drug levels.
Q12. Which antibiotic is contraindicated in pregnancy due to teeth discoloration?
A. Penicillin
B. Macrolides
C. Tetracyclines
Rationale: Tetracyclines deposit in fetal bone/teeth.
Q13. Which drug requires monitoring of serum levels due to narrow therapeutic index?
A. Amoxicillin
B. Digoxin
C. Lisinopril
Rationale: Digoxin has a narrow therapeutic window; toxicity risk is high.
Q14. Which drug is first‑line for status epilepticus?
A. Phenytoin
B. Lorazepam
C. Valproic acid
Rationale: Benzodiazepines (lorazepam) are first‑line for acute seizure control.
Q15. Which drug is most associated with lactic acidosis?
A. Insulin
Practice Questions and Answers
Q1. Which route of drug administration bypasses first‑pass metabolism?
A. Oral
B. Sublingual
C. Intravenous
Rationale: IV administration delivers drug directly into systemic circulation, avoiding
hepatic first‑pass metabolism.
Q2. The therapeutic index (TI) of a drug is defined as:
A. Ratio of absorption to distribution
B. Ratio of toxic dose to effective dose
C. Ratio of metabolism to excretion
Rationale: TI = TD50/ED50. A higher TI indicates a safer drug.
Q3. Which CYP450 enzyme is most involved in drug metabolism?
A. CYP2D6
B. CYP3A4
C. CYP1A2
Rationale: CYP3A4 metabolizes ~50% of clinically used drugs.
Q4. A patient on warfarin begins therapy with trimethoprim‑sulfamethoxazole. What is
the primary concern?
A. Decreased INR
B. Increased risk of bleeding
C. Enhanced warfarin clearance
Rationale: TMP‑SMX inhibits warfarin metabolism, raising INR and bleeding risk.
Q5. Which antihypertensive is contraindicated in pregnancy?
A. Methyldopa
B. Labetalol
C. ACE inhibitors
Rationale: ACE inhibitors are teratogenic, causing fetal renal malformations.
Q6. Which drug class is most associated with ototoxicity?
A. Beta‑blockers
B. Aminoglycosides
C. Calcium channel blockers
Rationale: Aminoglycosides (e.g., gentamicin) can damage cochlear hair cells.
Q7. A patient with asthma should avoid which antihypertensive?
A. ACE inhibitor
B. Non‑selective beta‑blocker
C. ARB
, Rationale: Non‑selective beta‑blockers (e.g., propranolol) can trigger bronchospasm.
Q8. The half‑life of a drug is primarily determined by:
A. Absorption rate
B. Clearance and volume of distribution
C. Protein binding
Rationale: Half‑life = (0.693 × Vd) ÷ Clearance.
Q9. Which drug is contraindicated in G6PD deficiency?
A. Penicillin
B. Sulfonamides
C. Macrolides
Rationale: Sulfonamides can cause hemolysis in G6PD deficiency.
Q10. Which opioid is safest in renal impairment?
A. Morphine
B. Codeine
C. Fentanyl
Rationale: Fentanyl has no active metabolites and is safer in renal dysfunction.
Q11. Grapefruit juice inhibits which enzyme?
A. CYP2D6
B. CYP3A4
C. CYP2C9
Rationale: Grapefruit juice inhibits intestinal CYP3A4, increasing drug levels.
Q12. Which antibiotic is contraindicated in pregnancy due to teeth discoloration?
A. Penicillin
B. Macrolides
C. Tetracyclines
Rationale: Tetracyclines deposit in fetal bone/teeth.
Q13. Which drug requires monitoring of serum levels due to narrow therapeutic index?
A. Amoxicillin
B. Digoxin
C. Lisinopril
Rationale: Digoxin has a narrow therapeutic window; toxicity risk is high.
Q14. Which drug is first‑line for status epilepticus?
A. Phenytoin
B. Lorazepam
C. Valproic acid
Rationale: Benzodiazepines (lorazepam) are first‑line for acute seizure control.
Q15. Which drug is most associated with lactic acidosis?
A. Insulin
