NR 566 ADVANCED PHARMACOLOGY CARE OF THE FAMILY
MIDTERM REVIEW 2026/2027 | Quiz Bank with Questions and
Verified Answers | Chamberlain College | Pass Guaranteed
Unit 1: Pharmacokinetics & Pharmacodynamics in Family Care (15
Questions)
Q1: A 68-year-old male with heart failure presents with declining renal function (eGFR 35
mL/min/1.73m²). He is currently prescribed lisinopril 20mg daily, furosemide 40mg BID,
and digoxin 0.25mg daily. His digoxin level is 2.8 ng/mL (therapeutic: 0.5-0.9 ng/mL for
heart failure). Which pharmacokinetic principle best explains this elevation?
A. Decreased hepatic metabolism due to aging
B. Reduced renal clearance and decreased volume of distribution [CORRECT]
C. Increased protein binding in chronic disease states
D. Enhanced P-glycoprotein activity in the elderly
Correct Answer: B
Rationale: Digoxin is primarily eliminated unchanged by the kidneys (60-80%). In this
elderly patient with reduced eGFR, renal clearance is significantly impaired, leading to
drug accumulation. Additionally, aging decreases muscle mass, reducing the volume of
distribution (Vd) for digoxin, which distributes into muscle tissue. A lower Vd with
normal dosing results in higher plasma concentrations. The therapeutic range for heart
failure is lower (0.5-0.9 ng/mL) than for atrial fibrillation (0.5-2.0 ng/mL), making this
level toxic for his indication. Option A is incorrect because digoxin undergoes minimal
hepatic metabolism. Option C is incorrect because digoxin is not highly protein bound
(~25%). Option D is incorrect because P-glycoprotein activity typically decreases with
age, potentially increasing absorption rather than decreasing it.
,Q2: A 4-year-old child weighing 18 kg requires amoxicillin for acute otitis media. The
recommended dose is 80-90 mg/kg/day divided BID. The suspension available is
400mg/5mL. What is the appropriate single dose and volume per administration?
A. 360 mg; 4.5 mL
B. 400 mg; 5 mL
C. 720 mg; 9 mL [CORRECT]
D. 810 mg; 10.1 mL
Correct Answer: C
Rationale: Using 80 mg/kg/day: 80 mg × 18 kg = 1,440 mg/day. Divided BID = 720 mg
per dose. Concentration is 400mg/5mL = 80 mg/mL. Therefore: 720 mg ÷ 80 mg/mL =
9 mL. High-dose amoxicillin (80-90 mg/kg/day) is recommended for acute otitis media
to overcome penicillin-resistant Streptococcus pneumoniae. Option A represents
underdosing (40 mg/kg/day). Option B represents a convenient but subtherapeutic
dose. Option D represents the maximum dose (90 mg/kg/day) but miscalculates the
volume (should be 10.125 mL, rounded to 10 mL, but 720 mg BID is standard dosing).
Q3: A 32-year-old pregnant woman at 28 weeks gestation presents with new-onset
hypertension (BP 158/96 mmHg). Which medication requires dose adjustment due to
increased volume of distribution and altered protein binding in pregnancy?
A. Labetalol
B. Nifedipine
C. Hydralazine
D. All of the above [CORRECT]
Correct Answer: D
,Rationale: Pregnancy induces significant pharmacokinetic changes: plasma volume
increases 40-50%, increasing volume of distribution for hydrophilic drugs; albumin
decreases due to hemodilution, increasing free fraction of highly protein-bound drugs;
and renal blood flow increases 60-80%, enhancing renal clearance. Labetalol (high
protein binding), nifedipine (high protein binding), and hydralazine (undergoes hepatic
metabolism with increased clearance in pregnancy) all require monitoring and potential
dose adjustment. These changes typically necessitate 20-50% higher doses to maintain
therapeutic concentrations during pregnancy, with dose reduction needed postpartum.
Q4: A 78-year-old female with multiple comorbidities is prescribed ciprofloxacin 500mg
BID for a urinary tract infection. She takes warfarin (INR stable at 2.2), omeprazole
20mg daily, and calcium carbonate 1,200mg daily. Which represents the most
significant pharmacodynamic interaction?
A. Ciprofloxacin chelates with calcium, reducing absorption
B. Ciprofloxacin inhibits CYP1A2, increasing warfarin effects [CORRECT]
C. Omeprazole reduces ciprofloxacin absorption by increasing gastric pH
D. Ciprofloxacin displaces warfarin from protein binding sites
Correct Answer: B
Rationale: Ciprofloxacin is a moderate inhibitor of CYP1A2 and also inhibits CYP3A4
and CYP2C9 to varying degrees. Warfarin is metabolized by multiple CYP enzymes
(primarily CYP2C9, but also CYP1A2 and CYP3A4). Inhibition of these enzymes
increases warfarin plasma concentrations, elevating bleeding risk. This
pharmacodynamic interaction requires close INR monitoring and potential warfarin
dose reduction (typically 10-20%). While option A (chelation with calcium) and option C
(increased gastric pH affecting absorption) are valid pharmacokinetic concerns, they
can be managed with timing of administration. Option D is incorrect because warfarin is
highly protein bound but ciprofloxacin does not significantly displace it.
, Q5: A 45-year-old male with cirrhosis (Child-Pugh Class B) requires pain management
following surgery. Which opioid requires the most significant dose reduction due to
altered pharmacokinetics in hepatic impairment?
A. Morphine
B. Oxycodone
C. Fentanyl
D. Hydromorphone [CORRECT]
Correct Answer: D
Rationale: Hydromorphone undergoes extensive hepatic metabolism (glucuronidation)
with active metabolites. In cirrhosis, reduced hepatic blood flow and impaired
glucuronidation lead to accumulation of both parent drug and active metabolites,
prolonging duration and increasing sedation risk. Dose reduction of 50-75% is
recommended. While morphine (option A) also requires reduction, its glucuronidation is
somewhat preserved. Oxycodone (option B) requires monitoring but less dramatic
reduction. Fentanyl (option C) is metabolized by CYP3A4 and while clearance is
reduced, its high lipid solubility and large volume of distribution make it relatively safer
than hydromorphone in hepatic impairment, though still requiring caution.
Q6: A 28-year-old breastfeeding mother is prescribed metronidazole 500mg TID for
bacterial vaginosis. Which pharmacokinetic principle guides the recommendation to
pump and discard milk for 24 hours after the final dose?
A. Metronidazole has a long half-life requiring extended elimination
B. Metronidazole concentrates in breast milk, reaching levels equivalent to maternal
serum [CORRECT]
C. Metronidazole forms irreversible protein adducts in milk
D. Metronidazole undergoes enterohepatic recirculation via breast milk
MIDTERM REVIEW 2026/2027 | Quiz Bank with Questions and
Verified Answers | Chamberlain College | Pass Guaranteed
Unit 1: Pharmacokinetics & Pharmacodynamics in Family Care (15
Questions)
Q1: A 68-year-old male with heart failure presents with declining renal function (eGFR 35
mL/min/1.73m²). He is currently prescribed lisinopril 20mg daily, furosemide 40mg BID,
and digoxin 0.25mg daily. His digoxin level is 2.8 ng/mL (therapeutic: 0.5-0.9 ng/mL for
heart failure). Which pharmacokinetic principle best explains this elevation?
A. Decreased hepatic metabolism due to aging
B. Reduced renal clearance and decreased volume of distribution [CORRECT]
C. Increased protein binding in chronic disease states
D. Enhanced P-glycoprotein activity in the elderly
Correct Answer: B
Rationale: Digoxin is primarily eliminated unchanged by the kidneys (60-80%). In this
elderly patient with reduced eGFR, renal clearance is significantly impaired, leading to
drug accumulation. Additionally, aging decreases muscle mass, reducing the volume of
distribution (Vd) for digoxin, which distributes into muscle tissue. A lower Vd with
normal dosing results in higher plasma concentrations. The therapeutic range for heart
failure is lower (0.5-0.9 ng/mL) than for atrial fibrillation (0.5-2.0 ng/mL), making this
level toxic for his indication. Option A is incorrect because digoxin undergoes minimal
hepatic metabolism. Option C is incorrect because digoxin is not highly protein bound
(~25%). Option D is incorrect because P-glycoprotein activity typically decreases with
age, potentially increasing absorption rather than decreasing it.
,Q2: A 4-year-old child weighing 18 kg requires amoxicillin for acute otitis media. The
recommended dose is 80-90 mg/kg/day divided BID. The suspension available is
400mg/5mL. What is the appropriate single dose and volume per administration?
A. 360 mg; 4.5 mL
B. 400 mg; 5 mL
C. 720 mg; 9 mL [CORRECT]
D. 810 mg; 10.1 mL
Correct Answer: C
Rationale: Using 80 mg/kg/day: 80 mg × 18 kg = 1,440 mg/day. Divided BID = 720 mg
per dose. Concentration is 400mg/5mL = 80 mg/mL. Therefore: 720 mg ÷ 80 mg/mL =
9 mL. High-dose amoxicillin (80-90 mg/kg/day) is recommended for acute otitis media
to overcome penicillin-resistant Streptococcus pneumoniae. Option A represents
underdosing (40 mg/kg/day). Option B represents a convenient but subtherapeutic
dose. Option D represents the maximum dose (90 mg/kg/day) but miscalculates the
volume (should be 10.125 mL, rounded to 10 mL, but 720 mg BID is standard dosing).
Q3: A 32-year-old pregnant woman at 28 weeks gestation presents with new-onset
hypertension (BP 158/96 mmHg). Which medication requires dose adjustment due to
increased volume of distribution and altered protein binding in pregnancy?
A. Labetalol
B. Nifedipine
C. Hydralazine
D. All of the above [CORRECT]
Correct Answer: D
,Rationale: Pregnancy induces significant pharmacokinetic changes: plasma volume
increases 40-50%, increasing volume of distribution for hydrophilic drugs; albumin
decreases due to hemodilution, increasing free fraction of highly protein-bound drugs;
and renal blood flow increases 60-80%, enhancing renal clearance. Labetalol (high
protein binding), nifedipine (high protein binding), and hydralazine (undergoes hepatic
metabolism with increased clearance in pregnancy) all require monitoring and potential
dose adjustment. These changes typically necessitate 20-50% higher doses to maintain
therapeutic concentrations during pregnancy, with dose reduction needed postpartum.
Q4: A 78-year-old female with multiple comorbidities is prescribed ciprofloxacin 500mg
BID for a urinary tract infection. She takes warfarin (INR stable at 2.2), omeprazole
20mg daily, and calcium carbonate 1,200mg daily. Which represents the most
significant pharmacodynamic interaction?
A. Ciprofloxacin chelates with calcium, reducing absorption
B. Ciprofloxacin inhibits CYP1A2, increasing warfarin effects [CORRECT]
C. Omeprazole reduces ciprofloxacin absorption by increasing gastric pH
D. Ciprofloxacin displaces warfarin from protein binding sites
Correct Answer: B
Rationale: Ciprofloxacin is a moderate inhibitor of CYP1A2 and also inhibits CYP3A4
and CYP2C9 to varying degrees. Warfarin is metabolized by multiple CYP enzymes
(primarily CYP2C9, but also CYP1A2 and CYP3A4). Inhibition of these enzymes
increases warfarin plasma concentrations, elevating bleeding risk. This
pharmacodynamic interaction requires close INR monitoring and potential warfarin
dose reduction (typically 10-20%). While option A (chelation with calcium) and option C
(increased gastric pH affecting absorption) are valid pharmacokinetic concerns, they
can be managed with timing of administration. Option D is incorrect because warfarin is
highly protein bound but ciprofloxacin does not significantly displace it.
, Q5: A 45-year-old male with cirrhosis (Child-Pugh Class B) requires pain management
following surgery. Which opioid requires the most significant dose reduction due to
altered pharmacokinetics in hepatic impairment?
A. Morphine
B. Oxycodone
C. Fentanyl
D. Hydromorphone [CORRECT]
Correct Answer: D
Rationale: Hydromorphone undergoes extensive hepatic metabolism (glucuronidation)
with active metabolites. In cirrhosis, reduced hepatic blood flow and impaired
glucuronidation lead to accumulation of both parent drug and active metabolites,
prolonging duration and increasing sedation risk. Dose reduction of 50-75% is
recommended. While morphine (option A) also requires reduction, its glucuronidation is
somewhat preserved. Oxycodone (option B) requires monitoring but less dramatic
reduction. Fentanyl (option C) is metabolized by CYP3A4 and while clearance is
reduced, its high lipid solubility and large volume of distribution make it relatively safer
than hydromorphone in hepatic impairment, though still requiring caution.
Q6: A 28-year-old breastfeeding mother is prescribed metronidazole 500mg TID for
bacterial vaginosis. Which pharmacokinetic principle guides the recommendation to
pump and discard milk for 24 hours after the final dose?
A. Metronidazole has a long half-life requiring extended elimination
B. Metronidazole concentrates in breast milk, reaching levels equivalent to maternal
serum [CORRECT]
C. Metronidazole forms irreversible protein adducts in milk
D. Metronidazole undergoes enterohepatic recirculation via breast milk
