NUR 354 PHARMACOLOGY
COMPREHENSIVE EXAMINATION TEST 2026
FULL QUESTIONS AND CORRECT ANSWERS
▶ 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
▶ what is a wide therapeutic index? Answer: Greater distance between
effective dose and toxic dose, requires less intense monitoring
▶ what is drug potency Answer: the concentration needed to produce
measurable effect
▶ what is the onset of action Answer: the point in time when the drug's
blood concentration level elicits a response, the first indication that the drug
is having a therapeutic effect
▶ What is bioequivalence? Answer: Two drugs that demonstrate
comparable bioavailability and similar times to achieve peak blood
concentrations
▶ what is therapeutic equivalent Answer: Drug products are considered to
be therapeutic equivalents only if they are pharmaceutical equivalents and
if they can be expected to have the same clinical effect and safety profile
when administered to patients.
example: ACE inhibitors (lisinopril, ramipril)
▶ what is therapeutic index Answer: Ratio of a drug's toxic level to the level
that provides therapeutic benefits
Calculation LD 50 / ED 50
▶ What is margin of safety Answer: The margin between the therapeutic
and lethal doses of a drug
▶ Why are loading doses given? Answer: reach a therapeutic effect
quicker
COMPREHENSIVE EXAMINATION TEST 2026
FULL QUESTIONS AND CORRECT ANSWERS
▶ 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
▶ what is a wide therapeutic index? Answer: Greater distance between
effective dose and toxic dose, requires less intense monitoring
▶ what is drug potency Answer: the concentration needed to produce
measurable effect
▶ what is the onset of action Answer: the point in time when the drug's
blood concentration level elicits a response, the first indication that the drug
is having a therapeutic effect
▶ What is bioequivalence? Answer: Two drugs that demonstrate
comparable bioavailability and similar times to achieve peak blood
concentrations
▶ what is therapeutic equivalent Answer: Drug products are considered to
be therapeutic equivalents only if they are pharmaceutical equivalents and
if they can be expected to have the same clinical effect and safety profile
when administered to patients.
example: ACE inhibitors (lisinopril, ramipril)
▶ what is therapeutic index Answer: Ratio of a drug's toxic level to the level
that provides therapeutic benefits
Calculation LD 50 / ED 50
▶ What is margin of safety Answer: The margin between the therapeutic
and lethal doses of a drug
▶ Why are loading doses given? Answer: reach a therapeutic effect
quicker
