NR.120.507
Pharmacology
Midterm Exam Review
(Questions & Solutions)
2025
1
,1. A 60-year-old cirrhotic patient is started on propranolol. Which change
in pharmacokinetics is most likely?
A. Increased first-pass extraction
B. Increased oral bioavailability
C. Increased renal clearance
D. Decreased volume of distribution
ANS: B
Rationale: Hepatic impairment reduces first-pass metabolism, raising
propranolol’s oral bioavailability.
2. A drug’s effect increases disproportionately when dose is doubled,
suggesting __________________ kinetics.
A. First-order
B. Zero-order
C. Michaelis–Menten
D. Nonlinear
ANS: B
Rationale: Zero-order kinetics eliminates a constant amount per time;
higher concentrations accumulate disproportionately.
3. For a drug with a high volume of distribution (Vd), which statement is
true?
A. It remains primarily in plasma
B. It extensively distributes into tissues
C. It is excreted unchanged in urine
D. It has low lipid solubility
ANS: B
Rationale: A large Vd indicates tissue sequestration and high lipid
solubility.
2
, 4. Which parameter solely determines the loading dose of a drug?
A. Clearance
B. Bioavailability
C. Volume of distribution
D. Elimination half-life
ANS: C
Rationale: Loading dose = (target concentration × Vd) ÷
bioavailability.
5. A partial agonist at the mu opioid receptor will:
A. Produce maximal analgesia
B. Block opioid withdrawal
C. Provide analgesia with ceiling effect
D. Act as a full antagonist in overdose
ANS: C
Rationale: Partial agonists activate the receptor but plateau—offering
analgesia with limited efficacy and lower respiratory depression risk.
6. A patient on warfarin begins trimethoprim-sulfamethoxazole. His INR
rises. Mechanism?
A. Induction of CYP3A4
B. Inhibition of CYP2C9
C. Increased vitamin K production
D. Reduced protein binding
ANS: B
Rationale: TMP-SMX inhibits CYP2C9, decreasing warfarin
metabolism and increasing anticoagulant effect.
7. Which pharmacodynamic concept describes the concentration
required to elicit 50% of maximal effect?
A. EC₅₀
B. ED₅₀
3
Pharmacology
Midterm Exam Review
(Questions & Solutions)
2025
1
,1. A 60-year-old cirrhotic patient is started on propranolol. Which change
in pharmacokinetics is most likely?
A. Increased first-pass extraction
B. Increased oral bioavailability
C. Increased renal clearance
D. Decreased volume of distribution
ANS: B
Rationale: Hepatic impairment reduces first-pass metabolism, raising
propranolol’s oral bioavailability.
2. A drug’s effect increases disproportionately when dose is doubled,
suggesting __________________ kinetics.
A. First-order
B. Zero-order
C. Michaelis–Menten
D. Nonlinear
ANS: B
Rationale: Zero-order kinetics eliminates a constant amount per time;
higher concentrations accumulate disproportionately.
3. For a drug with a high volume of distribution (Vd), which statement is
true?
A. It remains primarily in plasma
B. It extensively distributes into tissues
C. It is excreted unchanged in urine
D. It has low lipid solubility
ANS: B
Rationale: A large Vd indicates tissue sequestration and high lipid
solubility.
2
, 4. Which parameter solely determines the loading dose of a drug?
A. Clearance
B. Bioavailability
C. Volume of distribution
D. Elimination half-life
ANS: C
Rationale: Loading dose = (target concentration × Vd) ÷
bioavailability.
5. A partial agonist at the mu opioid receptor will:
A. Produce maximal analgesia
B. Block opioid withdrawal
C. Provide analgesia with ceiling effect
D. Act as a full antagonist in overdose
ANS: C
Rationale: Partial agonists activate the receptor but plateau—offering
analgesia with limited efficacy and lower respiratory depression risk.
6. A patient on warfarin begins trimethoprim-sulfamethoxazole. His INR
rises. Mechanism?
A. Induction of CYP3A4
B. Inhibition of CYP2C9
C. Increased vitamin K production
D. Reduced protein binding
ANS: B
Rationale: TMP-SMX inhibits CYP2C9, decreasing warfarin
metabolism and increasing anticoagulant effect.
7. Which pharmacodynamic concept describes the concentration
required to elicit 50% of maximal effect?
A. EC₅₀
B. ED₅₀
3
