NUR 600 PHARMACOLOGY & PRESCRIBING MASTERY
PACK | 150+ NCLEX-STYLE QUESTIONS + HIGH-YIELD
NOTES | NP EXAM PREP
1. A patient with hypoalbuminemia is at risk for which pharmacokinetic change?
A. Decreased free drug levels
B. Increased drug excretion
C. Increased free drug leading to toxicity ✅
D. Reduced hepatic metabolism
Rationale: Low albumin = less protein binding → more active (free) drug → toxicity risk.
2. A drug with a significant first-pass effect will:
A. Be excreted unchanged
B. Be extensively metabolized in the liver before reaching circulation ✅
C. Have prolonged half-life
D. Avoid hepatic metabolism
Rationale: First-pass metabolism reduces bioavailability of oral drugs.
3. When does a drug reach steady state?
A. After 1 half-life
B. After 2 half-lives
C. After 3 half-lives
D. After 4–5 half-lives ✅
Rationale: At steady state, drug intake = elimination.
4. The purpose of a loading dose is to:
A. Prevent toxicity
B. Maintain steady state
C. Achieve therapeutic levels rapidly ✅
D. Reduce metabolism
,SECTION 2: Drug Interactions
�Quick Notes
Additive: 1 + 1 = 2
Synergistic: 1 + 1 > 2
Antagonistic: One drug reduces effect of another
CYP450 (e.g., CYP3A4):
o Inducers ↓ drug levels
o Inhibitors ↑ toxicity
Avoid:
o Polypharmacy
o Same metabolic pathways
�MCQs
5. Two drugs producing a greater-than-expected combined effect demonstrate:
A. Additive effect
B. Antagonism
C. Synergism ✅
D. Potentiation
6. A CYP3A4 inhibitor will most likely cause:
A. Decreased drug levels
B. Increased risk of toxicity ✅
C. Faster metabolism
D. Reduced absorption
7. What is the best strategy to reduce drug-drug interactions?
A. Add another drug
B. Stagger administration times ✅
C. Increase both doses
D. Use only brand-name drugs
, SECTION 3: Pediatric & Geriatric Prescribing
�Quick Notes
Pediatrics:
Immature liver & kidneys → ↓ metabolism/excretion
Higher ADR risk
Dosing varies with age
Poor clinical trial representation
Geriatrics:
↓ renal function (↓ GFR)
↓ albumin → ↑ free drug
↑ fat → ↑ drug storage
Start low, go slow
8. Why are infants at higher risk for adverse drug reactions?
A. Faster metabolism
B. Increased protein binding
C. Lack of safety studies and immature organs ✅
D. Increased renal clearance
9. The best prescribing approach for elderly patients is:
A. High initial dose
B. Rapid titration
C. Start low and increase slowly ✅
D. Avoid all medications
PACK | 150+ NCLEX-STYLE QUESTIONS + HIGH-YIELD
NOTES | NP EXAM PREP
1. A patient with hypoalbuminemia is at risk for which pharmacokinetic change?
A. Decreased free drug levels
B. Increased drug excretion
C. Increased free drug leading to toxicity ✅
D. Reduced hepatic metabolism
Rationale: Low albumin = less protein binding → more active (free) drug → toxicity risk.
2. A drug with a significant first-pass effect will:
A. Be excreted unchanged
B. Be extensively metabolized in the liver before reaching circulation ✅
C. Have prolonged half-life
D. Avoid hepatic metabolism
Rationale: First-pass metabolism reduces bioavailability of oral drugs.
3. When does a drug reach steady state?
A. After 1 half-life
B. After 2 half-lives
C. After 3 half-lives
D. After 4–5 half-lives ✅
Rationale: At steady state, drug intake = elimination.
4. The purpose of a loading dose is to:
A. Prevent toxicity
B. Maintain steady state
C. Achieve therapeutic levels rapidly ✅
D. Reduce metabolism
,SECTION 2: Drug Interactions
�Quick Notes
Additive: 1 + 1 = 2
Synergistic: 1 + 1 > 2
Antagonistic: One drug reduces effect of another
CYP450 (e.g., CYP3A4):
o Inducers ↓ drug levels
o Inhibitors ↑ toxicity
Avoid:
o Polypharmacy
o Same metabolic pathways
�MCQs
5. Two drugs producing a greater-than-expected combined effect demonstrate:
A. Additive effect
B. Antagonism
C. Synergism ✅
D. Potentiation
6. A CYP3A4 inhibitor will most likely cause:
A. Decreased drug levels
B. Increased risk of toxicity ✅
C. Faster metabolism
D. Reduced absorption
7. What is the best strategy to reduce drug-drug interactions?
A. Add another drug
B. Stagger administration times ✅
C. Increase both doses
D. Use only brand-name drugs
, SECTION 3: Pediatric & Geriatric Prescribing
�Quick Notes
Pediatrics:
Immature liver & kidneys → ↓ metabolism/excretion
Higher ADR risk
Dosing varies with age
Poor clinical trial representation
Geriatrics:
↓ renal function (↓ GFR)
↓ albumin → ↑ free drug
↑ fat → ↑ drug storage
Start low, go slow
8. Why are infants at higher risk for adverse drug reactions?
A. Faster metabolism
B. Increased protein binding
C. Lack of safety studies and immature organs ✅
D. Increased renal clearance
9. The best prescribing approach for elderly patients is:
A. High initial dose
B. Rapid titration
C. Start low and increase slowly ✅
D. Avoid all medications
