Bardal: Applied Pharmacology
Chapter 1: Basic Principles and Pharmacodynamics
Test Bank
MULTIPLE CHOICE
1. A drug company representative is promoting a newly released hypnotic agent. The presentation
includes description of quantal dose-response curves and comparison of the associated ED50
values between the new drug and competitor drugs. In this setting, what does the ED50 represent?
a. The dose that produces a 50% of the maximum possible response
b. The dose that produces a response in 50% of patients
c. The dose that represents 50% of the therapeutic index
d. The dose that represents 50% of the certain safety factor
ANS: B
The ED50 derived from quantal dose-response curves represents the dose at which 50% of the
patient population responds to the drug.
2. A patient’s unpredictable symptoms are traced to a tumor that secretes varying amounts of a
hormone into the bloodstream. Under these circumstances, what would be the best
pharmacologic treatment to block the effects of this hormone and thereby alleviate the patient’s
symptoms?
a. A noncompetitive antagonist
b. A competitive antagonist
c. A competitive partial agonist
d. A noncompetitive agonist
ANS: A
A noncompetitive antagonist will inhibit the action of the hormone by binding to a site distinct
from the hormone binding site. Consequently the noncompetitive antagonist will not compete
with the hormone for binding, and thus its ability to block the effect of the hormone will not be
influenced by fluctuations in hormone concentrations.
3. E.S. is a 63-year-old nurse who was diagnosed with breast cancer. Tamoxifen was prescribed as
part of her therapeutic regimen. Tamoxifen belongs to a group of drugs with a common
mechanism of action within the cell. What is this mechanism of action?
a. Inhibition of G proteins
b. Stimulation of ligand gated transmembrane ion channels
c. Stimulation of receptor coupled enzymes
d. Inhibition of ligand gated transcriptional regulation
ANS: D
Tamoxifen belongs to a class of drugs called selective estrogen receptor modulators. These
agents bind to and, in a tissue-specific way, either activate or inhibit gene transcription via a
mechanism called ligand gated transcriptional regulation. In many tissues, including the breast,
tamoxifen inhibits the effect of estrogen at intracellular receptors.
Copyright © 2011 by Saunders, an imprint of Elsevier Inc.
, Test Bank 1-2
4. A patient was prescribed drug treatment with Drug A, which he is to take as needed to control
symptoms of a chronic condition. Although he was initially satisfied with his treatment regimen,
over the course of 6 months he has reported progressively increasing dissatisfaction with his
therapy. This is corroborated by increasing frequency of drug use (prescription fills). At
assessment, evaluation of critical markers shows that the disease has not progressed since his
initial diagnosis. The patient is prescribed a different medication (Drug B) that acts via the same
drug receptor as Drug A, and he achieves adequate control of his symptoms. Which of the
following is a plausible explanation for therapeutic failure with drug A?
a. More drug was required because of up-regulation of drug receptor numbers as a
result of chronic drug use.
b. Up-regulation of elimination of Drug A occurred as a result of chronic drug use.
c. Uncoupling of G proteins mediating the response to Drug A occurred because of
chronic drug use.
d. Down-regulation of second messenger systems occurred because of chronic drug
use.
ANS: B
Because Drug A was replaced by Drug B, which acts at the same receptor as Drug A, it is likely
that the receptor numbers and signaling are not the problem. Chronic administration of many
drugs can lead to up-regulation of elimination mechanisms, particularly hepatic metabolizing
enzymes via a process called enzyme induction. Increased elimination of the drug over time
caused therapeutic failure because drug concentrations would not reach the minimally effective
concentration. This in turn necessitated increased dosage of the drug.
Copyright © 2011 by Saunders, an imprint of Elsevier Inc.
, Bardal: Applied Pharmacology
Chapter 2: Pharmacokinetics
Test Bank
MULTIPLE CHOICE
1. Most drugs are weak acids or bases. Manipulation of pH in body compartments can be used
clinically to increase or decrease the absorption or elimination of acidic or basic drugs by
shifting the relative proportions of ionized and nonionized drug molecules. An extremely useful
concept to predict how manipulation of pH will affect drug disposition is the Henderson-
Hasselbalch equation. Which of the following is an accurate prediction of the Henderson-
Hasselbalch equation?
a. Acidic drugs are more ionized in acidic environments such as the stomach and thus
will be less well absorbed.
b. Basic drugs are more ionized in acidic environments such as the stomach and thus
will be less well absorbed.
c. Basic drugs will be less ionized in alkaline urine and thus will be excreted more in
the urine.
d. Acidic drugs will be less ionized in alkaline urine and will be excreted more in the
urine.
ANS: B
The Henderson-Hasselbalch equation for basic drugs predicts that the drug will be protonated
and thus ionized in acidic environments. The ionized form of the drug is much less lipid soluble
and less able to pass through lipid membranes. Accordingly, drugs that are weak bases are not
absorbed well from acidic environments.
2. A patient is prescribed a drug that follows zero-order elimination kinetics. An appreciation of the
differences between first-order and zero-order elimination kinetics will be crucial in the
management of this patient. What is the most accurate statement regarding first-order or zero-
order kinetics?
a. With first-order kinetics, accurate prediction plasma levels after a dosage change is
not possible.
b. With first-order kinetics, a constant amount of drug is eliminated per unit time
irrespective of dose.
c. With zero-order kinetics, doubling of the drug dose may produce a several-fold
increase in plasma concentrations.
d. With zero-order kinetics, the half-life of the drug is independent of dose.
ANS: C
Zero order kinetics implies that elimination mechanisms are saturated and cannot handle any
more drug. Under these circumstances even small increases in dose may result in very large
increases in plasma concentrations of the drug.
Copyright © 2011 by Saunders, an imprint of Elsevier Inc.
, Test Bank 2-2
3. In prescribing medication, clinicians are interested not only in the effect of the drug but also how
quickly the drug will take effect and how quickly its effects will disappear if there is a need to
discontinue the drug. These parameters can be predicted from the half-life of a drug. Mr. J. is
prescribed a drug with a half-life of 6 hours. What is an important aspect of using such a drug?
a. Assuming first-order kinetics, almost complete drug elimination would occur at
about 18 hours after the last dose.
b. Assuming first-order kinetics, steady state concentrations will be achieved in 30
hours.
c. Assuming first-order kinetics, doubling the dose of drug will achieve steady state
in 12 hours.
d. Assuming zero-order kinetics, half-life will be 6 hours regardless of dose.
e. Assuming zero-order kinetics, doubling the dose will shorten the half-life to 3
hours.
ANS: B
Elimination mechanisms come into play as soon as the drug reaches the systemic circulation.
Plasma drug concentrations will rise until the rate of drug elimination matches the rate of drug
absorption. For drugs that follow first-order kinetics, about five half-lives are required to reach
this point. Thus in this example 30 hours would be required to reach steady state, in which drug
elimination equals drug delivery and average plasma concentrations remain relatively stable.
4. Continuous intravenous administration of a drug is the most effective way to achieve a constant
therapeutically effective plasma concentration. However, for practical reasons, most drugs are
given on an intermittent administration schedule. Which of the following is an important
consideration when using intermittent dosage?
a. An increase in the dosage interval will result in an increase in drug plasma
concentrations.
b. Drugs with higher bioavailability require shorter dosage intervals.
c. An increase in drug clearance will necessitate a decrease in dosage interval.
d. A dosage interval equal to the half-life will result in unacceptable peak and trough
plasma concentrations.
ANS: C
An increase in clearance means that the drug is eliminated from the systemic circulation more
quickly. Accordingly, drug plasma concentrations will fall more rapidly between doses. This
generally necessitates a decrease in dosing interval to deliver drug more frequently to maintain
plasma drug concentrations above the minimally effective concentration.
5. G.H. is prescribed a prodrug that is metabolized by the hepatic mixed function oxygenases. Use
of a prodrug has important implications for therapeutic management. Which of the following is
an important implication of using a prodrug?
a. Phase II biotransformation reactions are necessary to convert the drug to a more
polar and effective agent.
b. An increase in phase I biotransformation will enhance the effect of the drug.
c. Administration of other agents that inhibit phase II biotransformation will reduce
the likelihood of side effects.
d. Monitoring blood levels of the prodrug is the best approach to manage dosage.
Copyright © 2011 by Saunders, an imprint of Elsevier Inc.
Chapter 1: Basic Principles and Pharmacodynamics
Test Bank
MULTIPLE CHOICE
1. A drug company representative is promoting a newly released hypnotic agent. The presentation
includes description of quantal dose-response curves and comparison of the associated ED50
values between the new drug and competitor drugs. In this setting, what does the ED50 represent?
a. The dose that produces a 50% of the maximum possible response
b. The dose that produces a response in 50% of patients
c. The dose that represents 50% of the therapeutic index
d. The dose that represents 50% of the certain safety factor
ANS: B
The ED50 derived from quantal dose-response curves represents the dose at which 50% of the
patient population responds to the drug.
2. A patient’s unpredictable symptoms are traced to a tumor that secretes varying amounts of a
hormone into the bloodstream. Under these circumstances, what would be the best
pharmacologic treatment to block the effects of this hormone and thereby alleviate the patient’s
symptoms?
a. A noncompetitive antagonist
b. A competitive antagonist
c. A competitive partial agonist
d. A noncompetitive agonist
ANS: A
A noncompetitive antagonist will inhibit the action of the hormone by binding to a site distinct
from the hormone binding site. Consequently the noncompetitive antagonist will not compete
with the hormone for binding, and thus its ability to block the effect of the hormone will not be
influenced by fluctuations in hormone concentrations.
3. E.S. is a 63-year-old nurse who was diagnosed with breast cancer. Tamoxifen was prescribed as
part of her therapeutic regimen. Tamoxifen belongs to a group of drugs with a common
mechanism of action within the cell. What is this mechanism of action?
a. Inhibition of G proteins
b. Stimulation of ligand gated transmembrane ion channels
c. Stimulation of receptor coupled enzymes
d. Inhibition of ligand gated transcriptional regulation
ANS: D
Tamoxifen belongs to a class of drugs called selective estrogen receptor modulators. These
agents bind to and, in a tissue-specific way, either activate or inhibit gene transcription via a
mechanism called ligand gated transcriptional regulation. In many tissues, including the breast,
tamoxifen inhibits the effect of estrogen at intracellular receptors.
Copyright © 2011 by Saunders, an imprint of Elsevier Inc.
, Test Bank 1-2
4. A patient was prescribed drug treatment with Drug A, which he is to take as needed to control
symptoms of a chronic condition. Although he was initially satisfied with his treatment regimen,
over the course of 6 months he has reported progressively increasing dissatisfaction with his
therapy. This is corroborated by increasing frequency of drug use (prescription fills). At
assessment, evaluation of critical markers shows that the disease has not progressed since his
initial diagnosis. The patient is prescribed a different medication (Drug B) that acts via the same
drug receptor as Drug A, and he achieves adequate control of his symptoms. Which of the
following is a plausible explanation for therapeutic failure with drug A?
a. More drug was required because of up-regulation of drug receptor numbers as a
result of chronic drug use.
b. Up-regulation of elimination of Drug A occurred as a result of chronic drug use.
c. Uncoupling of G proteins mediating the response to Drug A occurred because of
chronic drug use.
d. Down-regulation of second messenger systems occurred because of chronic drug
use.
ANS: B
Because Drug A was replaced by Drug B, which acts at the same receptor as Drug A, it is likely
that the receptor numbers and signaling are not the problem. Chronic administration of many
drugs can lead to up-regulation of elimination mechanisms, particularly hepatic metabolizing
enzymes via a process called enzyme induction. Increased elimination of the drug over time
caused therapeutic failure because drug concentrations would not reach the minimally effective
concentration. This in turn necessitated increased dosage of the drug.
Copyright © 2011 by Saunders, an imprint of Elsevier Inc.
, Bardal: Applied Pharmacology
Chapter 2: Pharmacokinetics
Test Bank
MULTIPLE CHOICE
1. Most drugs are weak acids or bases. Manipulation of pH in body compartments can be used
clinically to increase or decrease the absorption or elimination of acidic or basic drugs by
shifting the relative proportions of ionized and nonionized drug molecules. An extremely useful
concept to predict how manipulation of pH will affect drug disposition is the Henderson-
Hasselbalch equation. Which of the following is an accurate prediction of the Henderson-
Hasselbalch equation?
a. Acidic drugs are more ionized in acidic environments such as the stomach and thus
will be less well absorbed.
b. Basic drugs are more ionized in acidic environments such as the stomach and thus
will be less well absorbed.
c. Basic drugs will be less ionized in alkaline urine and thus will be excreted more in
the urine.
d. Acidic drugs will be less ionized in alkaline urine and will be excreted more in the
urine.
ANS: B
The Henderson-Hasselbalch equation for basic drugs predicts that the drug will be protonated
and thus ionized in acidic environments. The ionized form of the drug is much less lipid soluble
and less able to pass through lipid membranes. Accordingly, drugs that are weak bases are not
absorbed well from acidic environments.
2. A patient is prescribed a drug that follows zero-order elimination kinetics. An appreciation of the
differences between first-order and zero-order elimination kinetics will be crucial in the
management of this patient. What is the most accurate statement regarding first-order or zero-
order kinetics?
a. With first-order kinetics, accurate prediction plasma levels after a dosage change is
not possible.
b. With first-order kinetics, a constant amount of drug is eliminated per unit time
irrespective of dose.
c. With zero-order kinetics, doubling of the drug dose may produce a several-fold
increase in plasma concentrations.
d. With zero-order kinetics, the half-life of the drug is independent of dose.
ANS: C
Zero order kinetics implies that elimination mechanisms are saturated and cannot handle any
more drug. Under these circumstances even small increases in dose may result in very large
increases in plasma concentrations of the drug.
Copyright © 2011 by Saunders, an imprint of Elsevier Inc.
, Test Bank 2-2
3. In prescribing medication, clinicians are interested not only in the effect of the drug but also how
quickly the drug will take effect and how quickly its effects will disappear if there is a need to
discontinue the drug. These parameters can be predicted from the half-life of a drug. Mr. J. is
prescribed a drug with a half-life of 6 hours. What is an important aspect of using such a drug?
a. Assuming first-order kinetics, almost complete drug elimination would occur at
about 18 hours after the last dose.
b. Assuming first-order kinetics, steady state concentrations will be achieved in 30
hours.
c. Assuming first-order kinetics, doubling the dose of drug will achieve steady state
in 12 hours.
d. Assuming zero-order kinetics, half-life will be 6 hours regardless of dose.
e. Assuming zero-order kinetics, doubling the dose will shorten the half-life to 3
hours.
ANS: B
Elimination mechanisms come into play as soon as the drug reaches the systemic circulation.
Plasma drug concentrations will rise until the rate of drug elimination matches the rate of drug
absorption. For drugs that follow first-order kinetics, about five half-lives are required to reach
this point. Thus in this example 30 hours would be required to reach steady state, in which drug
elimination equals drug delivery and average plasma concentrations remain relatively stable.
4. Continuous intravenous administration of a drug is the most effective way to achieve a constant
therapeutically effective plasma concentration. However, for practical reasons, most drugs are
given on an intermittent administration schedule. Which of the following is an important
consideration when using intermittent dosage?
a. An increase in the dosage interval will result in an increase in drug plasma
concentrations.
b. Drugs with higher bioavailability require shorter dosage intervals.
c. An increase in drug clearance will necessitate a decrease in dosage interval.
d. A dosage interval equal to the half-life will result in unacceptable peak and trough
plasma concentrations.
ANS: C
An increase in clearance means that the drug is eliminated from the systemic circulation more
quickly. Accordingly, drug plasma concentrations will fall more rapidly between doses. This
generally necessitates a decrease in dosing interval to deliver drug more frequently to maintain
plasma drug concentrations above the minimally effective concentration.
5. G.H. is prescribed a prodrug that is metabolized by the hepatic mixed function oxygenases. Use
of a prodrug has important implications for therapeutic management. Which of the following is
an important implication of using a prodrug?
a. Phase II biotransformation reactions are necessary to convert the drug to a more
polar and effective agent.
b. An increase in phase I biotransformation will enhance the effect of the drug.
c. Administration of other agents that inhibit phase II biotransformation will reduce
the likelihood of side effects.
d. Monitoring blood levels of the prodrug is the best approach to manage dosage.
Copyright © 2011 by Saunders, an imprint of Elsevier Inc.
