NUR 354 PHARMACOLOGY ACTUAL EXAM
SCRIPT 2026 QUESTIONS WITH SOLUTIONS
GRADED A+
▶ Absorption Answer: absorption from the administration site either directly
or indirectly into the blood/plasma.
▶ Distribution Answer: reversibly/irreversibly movement of drug from the
bloodstream into the interstitial and intracellular fluid.
▶ Metabolism Answer: drug biotransformation via metabolic pathways,
primarily the liver, or by other tissues.
▶ Elimination Answer: how parent drug & its metabolites are eliminated
from the body
▶ Absorption factors Answer: · Gastrointestinal pH changes
· Gastric emptying
· Gastric/intestinal enzymes
· Bile acids & biliary function
· Gastrointestinal flora (type and quantity of bacteria)
· Food & nutrient interactions (most common interaction influencing GI drug
absorption)
· Lipid solubility of the drug
▶ Distribution factors Answer: · Membrane permeability: Cross membranes
to site of action
· Blood brain barrier reduces the speed of drug passage into and out of
brain tissue
· Plasma protein binding: drugs bound to plasma proteins do not cross
membranes (Note: Malnutrition = âalbumin = á free drug = greater
pharmacologic response)
· Aging cause a reduction in production of plasma proteins
· Lipophilicity of drug: lipophilic drugs concentrate in adipose tissue; remain
in the body for a longer period of time
,▶ Volume of distribution Answer: · Body Composition
- Increased Total body water and extracellular fluid
-Decreased Adipose tissue and skeletal muscle
· Protein Binding (changes with aging)
-Albumin, bilirubin, a1-acid glycoprotein
-Albumin affected by nutrition
-Low albumin (hypoalbuminemia) can cause less protein-bound drug
reaching the tissue site of action.
· Tissue Binding
- Compositional changes
▶ Metabolism factors Answer: o Drugs can undergo metabolism in the
lungs, blood, liver, intestines and kidney
o Volatile drugs are primarily excreted by the lungs
· The body changes drugs to more or less active forms (metabolites),
increases water solubility to increase elimination.
▶ Phase 1 Metabolism Answer: · Cytochrome P450 system
· Located within the endoplasmic reticulum of hepatocytes.
· Through electron transport chain, a drug bound to the CYP450 system
undergoes oxidation or reduction.
· Drug metabolism in the liver is also affected by:
-Enzyme induction
- Drug interactions
▶ CYP450 Answer: · CYP: a set of isozymes primarily found in the liver
and GI tract
· Convert lipophilic drugs into more polar (and soluble) molecules
· Considerable genetic variability exists across race and gender
· Results in CYP450 polymorphisms which have a direct effect on drug
metabolism.
▶ Four isozymes are responsible for the majority of Phase I Metabolism
reactions Answer: 1. CYP3A4/5
2. CYP2D6
3. CYP2C8/9
4. CYP1A2
▶ If you have a patient experiencing a pharmacokinetic drug interaction,
consider...... Answer: CYP450.
,▶ · Some drugs or exogenous substances can induce CYP isozymes (less
effect). Example.... Answer: St. John's wort (CYP3A4) and hormonal birth
control
▶ CYP450-related drug interactions can make predicting blood plasma
levels/steady state levels difficult.
Example.... Answer: If a drug inhibits enzymatic activity, a substrate drug
for that enzyme system will have a greater concentration in the blood.
▶ If a drug inhibits CYP isozymes, what is the effect of the substrate drug
Answer: The substrate drug will have greater effect
▶ Phase 2 Metabolism Answer: · Polar group is conjugated to the drug
· Results in increased polarity of the drug
▶ Types of phase 2 metabolism reactions Answer: - Glycine conjugation
-Glucuronide conjugation
-Sulfate conjugation
▶ What is competitive antagonism? Answer: where one drug displaces
another on cell receptors.
▶ How is metabolism effected by different ethnic groups? Answer: Different
ethnic groups may have different hepatic metabolism rates
▶ Routes of elimination Answer: 1. Pulmonary = expired in the air (volatile
substances)
2. Bile = excreted in feces
3. Renal
-glomerular filtration
- tubular reabsorption
- tubular secretion
▶ Glomerular filtration rate (GFR) (Normal) Answer: 90-125L/min
▶ Most elimination involves..... Answer: renal function. (Renal blood flow,
creatinine clearance (CrCl) )
, ▶ Linear drug elimination Answer: Rate of elimination is proportional to
amount of drug present
▶ volatile drugs are excreted by the.... Answer: lungs
▶ Bioavailability Answer: A measure of the extent of drug absorption for a
given drug and route (from 0% to 100%).
▶ Which route of administration has the greatest bioavailability Answer:
intravenous, putting entire dose into a patients vein and bypassing
absorption.
▶ Which route of administration bypasses first-pass metabolism in the liver
Answer: intravenous
▶ Which method of administration has variable and erratic absorption
Answer: rectal
▶ What is a half-life? Answer: the time required for serum plasma
concentrations to decrease by one-half, 50%
▶ When is a steady state reached? Answer: after 4-5 half lives
▶ What is zero-order (nonlinear) pharmacokinetics Answer: a drug is
metabolized at a constant rate per unit time
▶ Why is help life important Answer: -determines how frequently a drug
must be administered.
-predicts how long toxic effects can last (when the drug is over the
minimum toxic level)
▶ what is Michaelis-menten pharmacokinetics Answer: the rate of drug
elimination is directly proportional to the concentration of free drug
▶ Why is peak and trough measured Answer: to see if a drug is within its
therapeutic range
▶ What is narrow therapeutic index Answer: when the difference between
effective dose and a toxic blood level is small
SCRIPT 2026 QUESTIONS WITH SOLUTIONS
GRADED A+
▶ Absorption Answer: absorption from the administration site either directly
or indirectly into the blood/plasma.
▶ Distribution Answer: reversibly/irreversibly movement of drug from the
bloodstream into the interstitial and intracellular fluid.
▶ Metabolism Answer: drug biotransformation via metabolic pathways,
primarily the liver, or by other tissues.
▶ Elimination Answer: how parent drug & its metabolites are eliminated
from the body
▶ Absorption factors Answer: · Gastrointestinal pH changes
· Gastric emptying
· Gastric/intestinal enzymes
· Bile acids & biliary function
· Gastrointestinal flora (type and quantity of bacteria)
· Food & nutrient interactions (most common interaction influencing GI drug
absorption)
· Lipid solubility of the drug
▶ Distribution factors Answer: · Membrane permeability: Cross membranes
to site of action
· Blood brain barrier reduces the speed of drug passage into and out of
brain tissue
· Plasma protein binding: drugs bound to plasma proteins do not cross
membranes (Note: Malnutrition = âalbumin = á free drug = greater
pharmacologic response)
· Aging cause a reduction in production of plasma proteins
· Lipophilicity of drug: lipophilic drugs concentrate in adipose tissue; remain
in the body for a longer period of time
,▶ Volume of distribution Answer: · Body Composition
- Increased Total body water and extracellular fluid
-Decreased Adipose tissue and skeletal muscle
· Protein Binding (changes with aging)
-Albumin, bilirubin, a1-acid glycoprotein
-Albumin affected by nutrition
-Low albumin (hypoalbuminemia) can cause less protein-bound drug
reaching the tissue site of action.
· Tissue Binding
- Compositional changes
▶ Metabolism factors Answer: o Drugs can undergo metabolism in the
lungs, blood, liver, intestines and kidney
o Volatile drugs are primarily excreted by the lungs
· The body changes drugs to more or less active forms (metabolites),
increases water solubility to increase elimination.
▶ Phase 1 Metabolism Answer: · Cytochrome P450 system
· Located within the endoplasmic reticulum of hepatocytes.
· Through electron transport chain, a drug bound to the CYP450 system
undergoes oxidation or reduction.
· Drug metabolism in the liver is also affected by:
-Enzyme induction
- Drug interactions
▶ CYP450 Answer: · CYP: a set of isozymes primarily found in the liver
and GI tract
· Convert lipophilic drugs into more polar (and soluble) molecules
· Considerable genetic variability exists across race and gender
· Results in CYP450 polymorphisms which have a direct effect on drug
metabolism.
▶ Four isozymes are responsible for the majority of Phase I Metabolism
reactions Answer: 1. CYP3A4/5
2. CYP2D6
3. CYP2C8/9
4. CYP1A2
▶ If you have a patient experiencing a pharmacokinetic drug interaction,
consider...... Answer: CYP450.
,▶ · Some drugs or exogenous substances can induce CYP isozymes (less
effect). Example.... Answer: St. John's wort (CYP3A4) and hormonal birth
control
▶ CYP450-related drug interactions can make predicting blood plasma
levels/steady state levels difficult.
Example.... Answer: If a drug inhibits enzymatic activity, a substrate drug
for that enzyme system will have a greater concentration in the blood.
▶ If a drug inhibits CYP isozymes, what is the effect of the substrate drug
Answer: The substrate drug will have greater effect
▶ Phase 2 Metabolism Answer: · Polar group is conjugated to the drug
· Results in increased polarity of the drug
▶ Types of phase 2 metabolism reactions Answer: - Glycine conjugation
-Glucuronide conjugation
-Sulfate conjugation
▶ What is competitive antagonism? Answer: where one drug displaces
another on cell receptors.
▶ How is metabolism effected by different ethnic groups? Answer: Different
ethnic groups may have different hepatic metabolism rates
▶ Routes of elimination Answer: 1. Pulmonary = expired in the air (volatile
substances)
2. Bile = excreted in feces
3. Renal
-glomerular filtration
- tubular reabsorption
- tubular secretion
▶ Glomerular filtration rate (GFR) (Normal) Answer: 90-125L/min
▶ Most elimination involves..... Answer: renal function. (Renal blood flow,
creatinine clearance (CrCl) )
, ▶ Linear drug elimination Answer: Rate of elimination is proportional to
amount of drug present
▶ volatile drugs are excreted by the.... Answer: lungs
▶ Bioavailability Answer: A measure of the extent of drug absorption for a
given drug and route (from 0% to 100%).
▶ Which route of administration has the greatest bioavailability Answer:
intravenous, putting entire dose into a patients vein and bypassing
absorption.
▶ Which route of administration bypasses first-pass metabolism in the liver
Answer: intravenous
▶ Which method of administration has variable and erratic absorption
Answer: rectal
▶ What is a half-life? Answer: the time required for serum plasma
concentrations to decrease by one-half, 50%
▶ When is a steady state reached? Answer: after 4-5 half lives
▶ What is zero-order (nonlinear) pharmacokinetics Answer: a drug is
metabolized at a constant rate per unit time
▶ Why is help life important Answer: -determines how frequently a drug
must be administered.
-predicts how long toxic effects can last (when the drug is over the
minimum toxic level)
▶ what is Michaelis-menten pharmacokinetics Answer: the rate of drug
elimination is directly proportional to the concentration of free drug
▶ Why is peak and trough measured Answer: to see if a drug is within its
therapeutic range
▶ What is narrow therapeutic index Answer: when the difference between
effective dose and a toxic blood level is small
