NURS 676 ADVANCED PHARMACOLOGY
MIDTERM COMPREHENSIVE TEST PAPER 2026
TESTED QUESTIONS AND SOLUTIONS
GUARANTEED TO PASS
◉ Pharmacokinetics includes the following: Answer: ADME
(absorption, distribution, metabolism and elimination).
◉ Pharmacokinetics is... Answer: How the body effects the drug
◉ 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 = aalbumin = a 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.
MIDTERM COMPREHENSIVE TEST PAPER 2026
TESTED QUESTIONS AND SOLUTIONS
GUARANTEED TO PASS
◉ Pharmacokinetics includes the following: Answer: ADME
(absorption, distribution, metabolism and elimination).
◉ Pharmacokinetics is... Answer: How the body effects the drug
◉ 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 = aalbumin = a 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.
