NUR 354 PHARMACOLOGY TEST BANK 2026
SOLVED QUESTIONS AND EXAM SCRIPT
FULL SOLUTION
▶ 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
▶ Examples of medications with loading doses Answer: aminoglycosides
(gentamicin) or azithromycin, digoxin
▶ Do loading doses altered for patient metabolism or elimination Answer:
No. Loading doses are the same for every patient
▶ What initiates biochemical reactions Answer: Drugs bind to cellular
receptors. Pharmacological effect is due to the alteration of an intrinsic
physiological process and not the creation of a new process.
,▶ Example of the actions that can occur when a drug binds to a receptor
Answer: -ion channel is opened or closed
-second messenger is activated (cAMP, cGMP, inositol phosphate, initiates
a series of reactions
-normal cellular function is inhibited
-cellular function is "turned on"
▶ What is affinity? Answer: refers to the strength of the attraction between
a drug and its receptor
*Number of occupied receptors is a function of a balance between bound
and free drug
▶ What is the dissociation constant (Kd) Answer: A measure of a drug's
affinity for a given receptor. It is the concentration of a drug required to
achieve 50% occupancy of its receptors
▶ What is an agonist? Answer: drugs that occupy receptors and activate
them. These drugs alter the physiology of a cell by binding to plasma
membrane or intracellular receptors.
Agonists downregulate the receptors with chronic use
▶ What is a partial agonist? Answer: A drug that binds to its receptor but
produces a smaller effect at full dosage than a full agonist
▶ What is an antagonist? Answer: They block the action of an agonist
getting to the receptor to elicit a response, therefore no response is made
*When antagonist are stopped abruptly, they can cause an enhanced
response
▶ What is a competitive antagonist Answer: Competes with agonists for
receptors. high doses of an agonist can generally overcome antagonist
▶ What is a noncompetitive antagonist? Answer: Binds to a site other than
the agonist-binding site, which causes a conformational change in the
receptor so the agonist no longer can bind to its receptor.
*High doses of an agonist do not overcome the antagonist in this situation
▶ What is an irreversible antagonist Answer: Binds permanently to the
receptor site.
*cannot be overcome with agonist
, ▶ What are proteins or glycoproteins? Answer: Present on cell surface, on
an organelle within the cell, or in the cytoplasm.
-Finite number of receptors in a given cell.
-- Receptor mediated responses plateau upon saturation of all receptors.
--Receptors can be recycled/down-regulated (to be revisited in pain
pharmacology).
▶ Examples of diseases that can alter pharmacodynamics Answer: -acid
base status
-electrolyte imbalance
-altered intravascular volume
-tolerance
▶ What is a target-effect strategy of drug management Answer:
Predetermined efficacy endpoint
(Example: Reduction of blood pressure to 120/80 mmHg with
Lotensin/benazepril)
-Titrate drug to desired effect
· Monitor for efficacy
· If plateau occurs, may need to add additional drug or choose alternative
agent.
· Monitor for toxicity
· May require decrease in dose or alternative agent.
▶ What is a target concentration strategy of drug management Answer:
Example: Aminoglycoside drugs (i.e., gentamicin)
-Predetermined concentration goal
--Based on population-based PK
--Target concentration based on efficacy or toxicity
- Know the PK of the drug you are prescribing
--Presence of an active metabolite?
--Should the level of the active metabolite be measured?
-- Zero-order or first-order kinetics?
· Does it change with increasing serum concentrations?
▶ What is synergistic activity Answer: when two drugs, used together, have
an effect larger than the sum of each drug's effect(s) by itself
SOLVED QUESTIONS AND EXAM SCRIPT
FULL SOLUTION
▶ 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
▶ Examples of medications with loading doses Answer: aminoglycosides
(gentamicin) or azithromycin, digoxin
▶ Do loading doses altered for patient metabolism or elimination Answer:
No. Loading doses are the same for every patient
▶ What initiates biochemical reactions Answer: Drugs bind to cellular
receptors. Pharmacological effect is due to the alteration of an intrinsic
physiological process and not the creation of a new process.
,▶ Example of the actions that can occur when a drug binds to a receptor
Answer: -ion channel is opened or closed
-second messenger is activated (cAMP, cGMP, inositol phosphate, initiates
a series of reactions
-normal cellular function is inhibited
-cellular function is "turned on"
▶ What is affinity? Answer: refers to the strength of the attraction between
a drug and its receptor
*Number of occupied receptors is a function of a balance between bound
and free drug
▶ What is the dissociation constant (Kd) Answer: A measure of a drug's
affinity for a given receptor. It is the concentration of a drug required to
achieve 50% occupancy of its receptors
▶ What is an agonist? Answer: drugs that occupy receptors and activate
them. These drugs alter the physiology of a cell by binding to plasma
membrane or intracellular receptors.
Agonists downregulate the receptors with chronic use
▶ What is a partial agonist? Answer: A drug that binds to its receptor but
produces a smaller effect at full dosage than a full agonist
▶ What is an antagonist? Answer: They block the action of an agonist
getting to the receptor to elicit a response, therefore no response is made
*When antagonist are stopped abruptly, they can cause an enhanced
response
▶ What is a competitive antagonist Answer: Competes with agonists for
receptors. high doses of an agonist can generally overcome antagonist
▶ What is a noncompetitive antagonist? Answer: Binds to a site other than
the agonist-binding site, which causes a conformational change in the
receptor so the agonist no longer can bind to its receptor.
*High doses of an agonist do not overcome the antagonist in this situation
▶ What is an irreversible antagonist Answer: Binds permanently to the
receptor site.
*cannot be overcome with agonist
, ▶ What are proteins or glycoproteins? Answer: Present on cell surface, on
an organelle within the cell, or in the cytoplasm.
-Finite number of receptors in a given cell.
-- Receptor mediated responses plateau upon saturation of all receptors.
--Receptors can be recycled/down-regulated (to be revisited in pain
pharmacology).
▶ Examples of diseases that can alter pharmacodynamics Answer: -acid
base status
-electrolyte imbalance
-altered intravascular volume
-tolerance
▶ What is a target-effect strategy of drug management Answer:
Predetermined efficacy endpoint
(Example: Reduction of blood pressure to 120/80 mmHg with
Lotensin/benazepril)
-Titrate drug to desired effect
· Monitor for efficacy
· If plateau occurs, may need to add additional drug or choose alternative
agent.
· Monitor for toxicity
· May require decrease in dose or alternative agent.
▶ What is a target concentration strategy of drug management Answer:
Example: Aminoglycoside drugs (i.e., gentamicin)
-Predetermined concentration goal
--Based on population-based PK
--Target concentration based on efficacy or toxicity
- Know the PK of the drug you are prescribing
--Presence of an active metabolite?
--Should the level of the active metabolite be measured?
-- Zero-order or first-order kinetics?
· Does it change with increasing serum concentrations?
▶ What is synergistic activity Answer: when two drugs, used together, have
an effect larger than the sum of each drug's effect(s) by itself
