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NUR 641 Advanced Clinical Pharmacology — Midterm
Examination 2026/2027 | Graduate Nursing Program
Part 1: Pharmacokinetics & Pharmacodynamics
Q1. Pharmacokinetics is defined as:
A) What the drug does to the body
B) What the body does to the drug
C) The study of drug toxicity
D) The study of drug receptors
Answer: B
Rationale: Pharmacokinetics refers to the processes of absorption, distribution, metabolism, and
excretion (ADME) — essentially what the body does to the drug. Pharmacodynamics is what the drug
does to the body.
Q2. A drug reaches steady state after approximately how many half-lives?
A) 1–2
B) 2–3
C) 4–5
D) 6–7
Answer: C
Rationale: Steady state is achieved after about 4 to 5 half-lives, at which point drug accumulation and
elimination are balanced. This is independent of the route of administration.
Q3. Which of the following factors does NOT affect bioavailability?
A) First-pass metabolism
B) Protein binding
C) Drug solubility
D) Chemical instability
Answer: B
Rationale: Bioavailability is the fraction of an administered dose that reaches systemic circulation. It is
affected by first-pass metabolism, solubility, chemical instability, and route of administration. Protein
binding affects distribution, not bioavailability.
Q4. A patient is taking warfarin and omeprazole together. What is the expected interaction?
A) Decreased warfarin effect due to enzyme induction
B) Increased warfarin effect due to CYP2C19 inhibition
C) No interaction
D) Increased metabolism of warfarin
,2
Answer: B
Rationale: Omeprazole inhibits CYP2C19, the enzyme responsible for metabolizing warfarin, leading to
increased warfarin levels and an elevated INR, increasing bleeding risk.
Q5. Which of the following is an example of a CYP450 inducer?
A) Omeprazole
B) Cimetidine
C) Rifampin
D) Erythromycin
Answer: C
Rationale: Rifampin is a potent CYP450 inducer, increasing the metabolism of many drugs and
reducing their plasma levels. Omeprazole, cimetidine, and erythromycin are CYP450 inhibitors.
Q6. A patient with a genetic polymorphism resulting in poor CYP2C19 metabolism is prescribed
clopidogrel. What is the expected outcome?
A) Increased antiplatelet effect
B) Reduced antiplatelet effect
C) No change
D) Increased bleeding risk
Answer: B
Rationale: Clopidogrel is a prodrug that requires activation by CYP2C19. Poor metabolizers have
reduced conversion to the active metabolite, leading to diminished antiplatelet effect and increased risk
of cardiovascular events.
Q7. Bioequivalence refers to:
A) Same chemical structure
B) Same rate and extent of absorption
C) Same cost
D) Same manufacturer
Answer: B
Rationale: Two drugs are bioequivalent if they have the same rate and extent of absorption, meaning
their bioavailability is comparable. Bioequivalence does not guarantee identical therapeutic effects, but
it is required for generic approval.
Q8. Which route of administration has 100% bioavailability?
A) Oral
B) Sublingual
C) Intravenous
D) Intramuscular
Answer: C
Rationale: Intravenous administration delivers the drug directly into systemic circulation, bypassing
absorption and first-pass metabolism, resulting in 100% bioavailability.
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Part 2: Anticoagulants & Antiplatelet Agents
Q9. A patient with atrial fibrillation is started on warfarin. What is the therapeutic INR target range
for this patient?
A) 1.0–1.5
B) 2.0–3.0
C) 3.0–4.0
D) 4.0–5.0
Answer: B
Rationale: For atrial fibrillation and most venous thromboembolism indications, the target INR is 2.0–
3.0. For mechanical heart valves, a higher target of 2.5–3.5 may be used.
Q10. Warfarin exerts its anticoagulant effect by antagonizing which vitamin?
A) Vitamin A
B) Vitamin K
C) Vitamin E
D) Vitamin D
Answer: B
Rationale: Warfarin is a vitamin K antagonist that inhibits the synthesis of vitamin K-dependent
clotting factors II, VII, IX, and X.
Q11. What is the antidote for warfarin?
A) Protamine sulfate
B) Idarucizumab
C) Vitamin K
D) Andexanet alfa
Answer: C
Rationale: Vitamin K is the specific antidote for warfarin. Protamine is for heparin; idarucizumab is for
dabigatran; andexanet alfa is for factor Xa inhibitors.
Q12. Heparin’s mechanism of action involves binding to which endogenous anticoagulant?
A) Protein C
B) Antithrombin III
C) Protein S
D) Plasminogen
Answer: B
Rationale: Heparin binds to antithrombin III, accelerating its inactivation of thrombin (factor IIa) and
factor Xa. Low-dose subcutaneous heparin does not require aPTT monitoring.
Q13. Which of the following is a direct thrombin inhibitor?
A) Apixaban
B) Rivaroxaban
C) Dabigatran
D) Fondaparinux
, 4
Answer: C
Rationale: Dabigatran (Pradaxa) is a direct thrombin inhibitor (factor IIa inhibitor). Apixaban,
rivaroxaban, and fondaparinux are factor Xa inhibitors.
Q14. What is the specific reversal agent for dabigatran?
A) Vitamin K
B) Protamine sulfate
C) Idarucizumab
D) Andexanet alfa
Answer: C
Rationale: Idarucizumab (Praxbind) is a monoclonal antibody fragment that specifically reverses
dabigatran. Andexanet alfa reverses factor Xa inhibitors.
Q15. A patient with a history of GI bleeding is prescribed clopidogrel after a recent stent placement.
Which PPI should be avoided due to drug interaction?
A) Pantoprazole
B) Lansoprazole
C) Rabeprazole
D) Omeprazole
Answer: D
Rationale: Omeprazole is a strong CYP2C19 inhibitor and can reduce the activation of clopidogrel,
decreasing its antiplatelet effect. Pantoprazole, lansoprazole, and rabeprazole have less CYP2C19
inhibition and are preferred.
Q16. Which of the following is a factor Xa inhibitor? (Select all that apply)
A) Warfarin
B) Apixaban
C) Rivaroxaban
D) Edoxaban
E) Fondaparinux
Answer: B, C, D, E
Rationale: Apixaban (Eliquis), rivaroxaban (Xarelto), edoxaban (Savaysa), and fondaparinux (Arixtra)
are factor Xa inhibitors. Warfarin is a vitamin K antagonist.
Part 3: Cardiovascular Pharmacology
Q17. A patient with heart failure with reduced ejection fraction (HFrEF) is prescribed an ACE inhibitor.
The NP should assess which laboratory value prior to initiation?
A) Hemoglobin
B) Renal function (creatinine, eGFR)
C) Liver enzymes
D) Thyroid function
NUR 641 Advanced Clinical Pharmacology — Midterm
Examination 2026/2027 | Graduate Nursing Program
Part 1: Pharmacokinetics & Pharmacodynamics
Q1. Pharmacokinetics is defined as:
A) What the drug does to the body
B) What the body does to the drug
C) The study of drug toxicity
D) The study of drug receptors
Answer: B
Rationale: Pharmacokinetics refers to the processes of absorption, distribution, metabolism, and
excretion (ADME) — essentially what the body does to the drug. Pharmacodynamics is what the drug
does to the body.
Q2. A drug reaches steady state after approximately how many half-lives?
A) 1–2
B) 2–3
C) 4–5
D) 6–7
Answer: C
Rationale: Steady state is achieved after about 4 to 5 half-lives, at which point drug accumulation and
elimination are balanced. This is independent of the route of administration.
Q3. Which of the following factors does NOT affect bioavailability?
A) First-pass metabolism
B) Protein binding
C) Drug solubility
D) Chemical instability
Answer: B
Rationale: Bioavailability is the fraction of an administered dose that reaches systemic circulation. It is
affected by first-pass metabolism, solubility, chemical instability, and route of administration. Protein
binding affects distribution, not bioavailability.
Q4. A patient is taking warfarin and omeprazole together. What is the expected interaction?
A) Decreased warfarin effect due to enzyme induction
B) Increased warfarin effect due to CYP2C19 inhibition
C) No interaction
D) Increased metabolism of warfarin
,2
Answer: B
Rationale: Omeprazole inhibits CYP2C19, the enzyme responsible for metabolizing warfarin, leading to
increased warfarin levels and an elevated INR, increasing bleeding risk.
Q5. Which of the following is an example of a CYP450 inducer?
A) Omeprazole
B) Cimetidine
C) Rifampin
D) Erythromycin
Answer: C
Rationale: Rifampin is a potent CYP450 inducer, increasing the metabolism of many drugs and
reducing their plasma levels. Omeprazole, cimetidine, and erythromycin are CYP450 inhibitors.
Q6. A patient with a genetic polymorphism resulting in poor CYP2C19 metabolism is prescribed
clopidogrel. What is the expected outcome?
A) Increased antiplatelet effect
B) Reduced antiplatelet effect
C) No change
D) Increased bleeding risk
Answer: B
Rationale: Clopidogrel is a prodrug that requires activation by CYP2C19. Poor metabolizers have
reduced conversion to the active metabolite, leading to diminished antiplatelet effect and increased risk
of cardiovascular events.
Q7. Bioequivalence refers to:
A) Same chemical structure
B) Same rate and extent of absorption
C) Same cost
D) Same manufacturer
Answer: B
Rationale: Two drugs are bioequivalent if they have the same rate and extent of absorption, meaning
their bioavailability is comparable. Bioequivalence does not guarantee identical therapeutic effects, but
it is required for generic approval.
Q8. Which route of administration has 100% bioavailability?
A) Oral
B) Sublingual
C) Intravenous
D) Intramuscular
Answer: C
Rationale: Intravenous administration delivers the drug directly into systemic circulation, bypassing
absorption and first-pass metabolism, resulting in 100% bioavailability.
,3
Part 2: Anticoagulants & Antiplatelet Agents
Q9. A patient with atrial fibrillation is started on warfarin. What is the therapeutic INR target range
for this patient?
A) 1.0–1.5
B) 2.0–3.0
C) 3.0–4.0
D) 4.0–5.0
Answer: B
Rationale: For atrial fibrillation and most venous thromboembolism indications, the target INR is 2.0–
3.0. For mechanical heart valves, a higher target of 2.5–3.5 may be used.
Q10. Warfarin exerts its anticoagulant effect by antagonizing which vitamin?
A) Vitamin A
B) Vitamin K
C) Vitamin E
D) Vitamin D
Answer: B
Rationale: Warfarin is a vitamin K antagonist that inhibits the synthesis of vitamin K-dependent
clotting factors II, VII, IX, and X.
Q11. What is the antidote for warfarin?
A) Protamine sulfate
B) Idarucizumab
C) Vitamin K
D) Andexanet alfa
Answer: C
Rationale: Vitamin K is the specific antidote for warfarin. Protamine is for heparin; idarucizumab is for
dabigatran; andexanet alfa is for factor Xa inhibitors.
Q12. Heparin’s mechanism of action involves binding to which endogenous anticoagulant?
A) Protein C
B) Antithrombin III
C) Protein S
D) Plasminogen
Answer: B
Rationale: Heparin binds to antithrombin III, accelerating its inactivation of thrombin (factor IIa) and
factor Xa. Low-dose subcutaneous heparin does not require aPTT monitoring.
Q13. Which of the following is a direct thrombin inhibitor?
A) Apixaban
B) Rivaroxaban
C) Dabigatran
D) Fondaparinux
, 4
Answer: C
Rationale: Dabigatran (Pradaxa) is a direct thrombin inhibitor (factor IIa inhibitor). Apixaban,
rivaroxaban, and fondaparinux are factor Xa inhibitors.
Q14. What is the specific reversal agent for dabigatran?
A) Vitamin K
B) Protamine sulfate
C) Idarucizumab
D) Andexanet alfa
Answer: C
Rationale: Idarucizumab (Praxbind) is a monoclonal antibody fragment that specifically reverses
dabigatran. Andexanet alfa reverses factor Xa inhibitors.
Q15. A patient with a history of GI bleeding is prescribed clopidogrel after a recent stent placement.
Which PPI should be avoided due to drug interaction?
A) Pantoprazole
B) Lansoprazole
C) Rabeprazole
D) Omeprazole
Answer: D
Rationale: Omeprazole is a strong CYP2C19 inhibitor and can reduce the activation of clopidogrel,
decreasing its antiplatelet effect. Pantoprazole, lansoprazole, and rabeprazole have less CYP2C19
inhibition and are preferred.
Q16. Which of the following is a factor Xa inhibitor? (Select all that apply)
A) Warfarin
B) Apixaban
C) Rivaroxaban
D) Edoxaban
E) Fondaparinux
Answer: B, C, D, E
Rationale: Apixaban (Eliquis), rivaroxaban (Xarelto), edoxaban (Savaysa), and fondaparinux (Arixtra)
are factor Xa inhibitors. Warfarin is a vitamin K antagonist.
Part 3: Cardiovascular Pharmacology
Q17. A patient with heart failure with reduced ejection fraction (HFrEF) is prescribed an ACE inhibitor.
The NP should assess which laboratory value prior to initiation?
A) Hemoglobin
B) Renal function (creatinine, eGFR)
C) Liver enzymes
D) Thyroid function
