NUR 521: Advanced Pharmacology – Study Guide
(2026/2027 Syllabus)
Unit 1: Pharmacokinetics, Pharmacodynamics, &
Pharmacogenomics
1. A patient with liver cirrhosis is prescribed a prodrug. Why might this patient have
a reduced therapeutic response?
o ANSWER ✓ The liver may have decreased ability to convert the prodrug to its active
metabolite due to reduced hepatic enzyme function.
2. Which pharmacokinetic process is most affected in a patient with end-stage renal
disease (ESRD)?
o ANSWER ✓ Excretion, particularly of water-soluble drugs and metabolites.
3. A drug follows zero-order kinetics. After doubling the dose, what happens to the
half-life?
o ANSWER ✓ The half-life increases because clearance is saturated and constant amount
(not constant fraction) is eliminated per unit time.
4. What is the clinical significance of a narrow therapeutic index (NTI) drug?
o ANSWER ✓ Small changes in dose or drug concentration can lead to serious toxicity or
therapeutic failure; requires therapeutic drug monitoring.
5. A patient is a poor metabolizer of CYP2D6 substrates. Which medication would
require a significant dose reduction?
o ANSWER ✓ Codeine (poor conversion to morphine) – alternative: avoid codeine; but for
drugs dependent on 2D6 for elimination (e.g., metoprolol), dose reduction needed.
6. Genetic variation in VKORC1 affects response to which drug?
o ANSWER ✓ Warfarin – patients with certain VKORC1 variants require lower doses.
7. What is the effect of pregnancy on drug metabolism via CYP3A4?
o ANSWER ✓ CYP3A4 activity is induced, leading to increased clearance of substrates like
nifedipine, protease inhibitors.
8. A patient develops tolerance to morphine. What pharmacodynamic mechanism
explains this?
o ANSWER ✓ Receptor desensitization or downregulation of mu-opioid receptors.
9. Which organ is primarily responsible for drug metabolism via Phase I reactions?
, o ANSWER ✓ Liver.
10. A drug has a volume of distribution (Vd) of 40 L. What does this suggest?
o ANSWER ✓ Extensive tissue distribution beyond plasma and extracellular fluid; Vd > 0.5
L/kg suggests tissue binding.
Unit 2: Autonomic & CNS Pharmacology
11. A patient on donepezil for Alzheimer’s disease complains of nausea and
bradycardia. What is the mechanism?
o ANSWER ✓ Cholinesterase inhibition increases acetylcholine at muscarinic receptors
(M2 in heart, M1 in GI).
12. Which anticholinergic drug is preferred for Parkinson’s disease tremor in a young
patient?
o ANSWER ✓ Benztropine – centrally acting antimuscarinic.
13. A patient with myasthenia gravis develops cholinergic crisis. Which medication is
first-line?
o ANSWER ✓ Atropine (to block excess muscarinic effects) and supportive care; adjust
pyridostigmine dose.
14. What is the mechanism of action of tizanidine for spasticity?
o ANSWER ✓ Alpha-2 adrenergic agonist in the spinal cord, reducing excitatory
neurotransmitter release.
15. A patient on carbidopa/levodopa develops dyskinesias. What class of drug can be
added to reduce “off” time without worsening dyskinesia?
o ANSWER ✓ COMT inhibitor (e.g., entacapone).
16. Which SSRI has the highest risk of drug interactions due to CYP2D6 inhibition?
o ANSWER ✓ Paroxetine.
17. A patient on phenelzine (MAOI) eats aged cheese and develops hypertensive crisis.
What is the mechanism?
o ANSWER ✓ Tyramine-induced norepinephrine release unopposed by MAO-A, leading
to massive sympathetic surge.
18. First-line pharmacotherapy for generalized anxiety disorder (GAD) in a patient
with no other comorbidities?
o ANSWER ✓ SSRI (e.g., escitalopram) or SNRI (e.g., duloxetine).
(2026/2027 Syllabus)
Unit 1: Pharmacokinetics, Pharmacodynamics, &
Pharmacogenomics
1. A patient with liver cirrhosis is prescribed a prodrug. Why might this patient have
a reduced therapeutic response?
o ANSWER ✓ The liver may have decreased ability to convert the prodrug to its active
metabolite due to reduced hepatic enzyme function.
2. Which pharmacokinetic process is most affected in a patient with end-stage renal
disease (ESRD)?
o ANSWER ✓ Excretion, particularly of water-soluble drugs and metabolites.
3. A drug follows zero-order kinetics. After doubling the dose, what happens to the
half-life?
o ANSWER ✓ The half-life increases because clearance is saturated and constant amount
(not constant fraction) is eliminated per unit time.
4. What is the clinical significance of a narrow therapeutic index (NTI) drug?
o ANSWER ✓ Small changes in dose or drug concentration can lead to serious toxicity or
therapeutic failure; requires therapeutic drug monitoring.
5. A patient is a poor metabolizer of CYP2D6 substrates. Which medication would
require a significant dose reduction?
o ANSWER ✓ Codeine (poor conversion to morphine) – alternative: avoid codeine; but for
drugs dependent on 2D6 for elimination (e.g., metoprolol), dose reduction needed.
6. Genetic variation in VKORC1 affects response to which drug?
o ANSWER ✓ Warfarin – patients with certain VKORC1 variants require lower doses.
7. What is the effect of pregnancy on drug metabolism via CYP3A4?
o ANSWER ✓ CYP3A4 activity is induced, leading to increased clearance of substrates like
nifedipine, protease inhibitors.
8. A patient develops tolerance to morphine. What pharmacodynamic mechanism
explains this?
o ANSWER ✓ Receptor desensitization or downregulation of mu-opioid receptors.
9. Which organ is primarily responsible for drug metabolism via Phase I reactions?
, o ANSWER ✓ Liver.
10. A drug has a volume of distribution (Vd) of 40 L. What does this suggest?
o ANSWER ✓ Extensive tissue distribution beyond plasma and extracellular fluid; Vd > 0.5
L/kg suggests tissue binding.
Unit 2: Autonomic & CNS Pharmacology
11. A patient on donepezil for Alzheimer’s disease complains of nausea and
bradycardia. What is the mechanism?
o ANSWER ✓ Cholinesterase inhibition increases acetylcholine at muscarinic receptors
(M2 in heart, M1 in GI).
12. Which anticholinergic drug is preferred for Parkinson’s disease tremor in a young
patient?
o ANSWER ✓ Benztropine – centrally acting antimuscarinic.
13. A patient with myasthenia gravis develops cholinergic crisis. Which medication is
first-line?
o ANSWER ✓ Atropine (to block excess muscarinic effects) and supportive care; adjust
pyridostigmine dose.
14. What is the mechanism of action of tizanidine for spasticity?
o ANSWER ✓ Alpha-2 adrenergic agonist in the spinal cord, reducing excitatory
neurotransmitter release.
15. A patient on carbidopa/levodopa develops dyskinesias. What class of drug can be
added to reduce “off” time without worsening dyskinesia?
o ANSWER ✓ COMT inhibitor (e.g., entacapone).
16. Which SSRI has the highest risk of drug interactions due to CYP2D6 inhibition?
o ANSWER ✓ Paroxetine.
17. A patient on phenelzine (MAOI) eats aged cheese and develops hypertensive crisis.
What is the mechanism?
o ANSWER ✓ Tyramine-induced norepinephrine release unopposed by MAO-A, leading
to massive sympathetic surge.
18. First-line pharmacotherapy for generalized anxiety disorder (GAD) in a patient
with no other comorbidities?
o ANSWER ✓ SSRI (e.g., escitalopram) or SNRI (e.g., duloxetine).
