NURS 5334 Advanced Pharmacology Final Exam:
Multiple-Choice Questions With Answers &
Explanations | Instant Pdf Download
Section 1: Pharmacokinetics & Pharmacodynamics (Qs 1-15)
1. A 72-year-old male with heart failure is on digoxin and furosemide. He presents with
nausea, vomiting, and yellow vision. Lab: K+ 3.1 mEq/L. What is the most likely cause?
o A) Furosemide toxicity
o B) Digoxin toxicity
o C) Myocardial infarction
o D) Gastroenteritis
o Explanation: Hypokalemia from furosemide increases digoxin binding to Na+/K+-ATPase,
leading to digoxin toxicity (nausea, vomiting, yellow vision).
2. A patient on warfarin starts taking sulfamethoxazole-trimethoprim for a UTI. His INR rises
from 2.5 to 5.0. What is the mechanism?
o A) Displacement from plasma proteins
o B) Induction of warfarin metabolism
o C) Reduced warfarin absorption
o D) Additive antiplatelet effect
o Explanation: Sulfa drugs displace warfarin from albumin, increasing free warfarin levels
and INR.
3. A patient with epilepsy on phenytoin develops toxicity after valproate is added. Why?
o A) Inhibition of phenytoin metabolism
o B) Induction of phenytoin excretion
o C) Displacement from protein binding
o D) Reduced renal blood flow
o *Explanation: Valproate inhibits CYP2C9/2C19, reducing phenytoin metabolism and
increasing levels.*
,4. A 45-year-old chronic alcohol user requires higher doses of midazolam for sedation. What is
the mechanism?
o A) CYP3A4 enzyme induction
o B) Receptor down-regulation
o C) Increased renal clearance
o D) Decreased bioavailability
o Explanation: Chronic alcohol induces CYP3A4, increasing midazolam metabolism and
reducing effect.
5. A neonate given chloramphenicol develops gray baby syndrome. Why are neonates at risk?
o A) Immature glucuronidation
o B) Increased protein binding
o C) Enhanced renal excretion
o D) Blood-brain barrier immaturity
o Explanation: Neonates lack UDP-glucuronosyltransferase, leading to toxic chloramphenicol
accumulation.
6. An 80-year-old woman on multiple medications presents with confusion and falls. Serum
creatinine is 0.8 mg/dL. What is the best next step?
o A) Check creatinine clearance
o B) Check creatinine clearance
o C) Stop all antihypertensives
o D) Order head CT
o Explanation: Normal creatinine can mask low GFR in elderly; creatinine clearance is the
proper index of renal function.
7. A drug has a half-life of 24 hours and is given once daily. How many days to reach steady
state?
o A) 2 days
o B) 5 days
o C) 7 days
o D) 10 days
,o *Explanation: Steady state is achieved in approximately 5 half-lives (5 × 24 hours = 120
hours = 5 days).*
8. A patient on lithium (narrow therapeutic index) has a level of 1.8 mEq/L and shows tremor
and confusion. This illustrates:
o A) Small dose changes cause large effect changes
o B) Long half-life
o C) Zero-order kinetics
o D) First-pass effect
o Explanation: Narrow therapeutic index means toxic and effective doses are close; small
changes can cause toxicity.
9. A patient using albuterol every 4 hours for 3 days notes decreased effectiveness. What is
the mechanism?
o A) Beta-2 receptor down-regulation
o B) Antagonist competition
o C) Reduced drug absorption
o D) Increased metabolism
o *Explanation: Continuous agonist exposure leads to down-regulation of beta-2 receptors,
reducing response.*
10. A patient stops metoprolol abruptly after 2 years of use. He develops tachycardia and
hypertension. Why?
o A) Beta-1 receptor up-regulation
o B) Alpha receptor stimulation
o C) Withdrawal syndrome only
o D) Rebound angina
o *Explanation: Chronic beta-blocker use up-regulates beta-1 receptors; abrupt withdrawal
causes supersensitivity.*
11. A patient ingests a massive overdose of a lipophilic drug. Which intervention is most
effective?
o A) Activated charcoal
, o B) Hemodialysis
o C) Forced diuresis
o D) Alkalinization of urine
o Explanation: Lipophilic drugs distribute into tissues; activated charcoal binds unabsorbed
drug in the gut.
12. A patient with short bowel syndrome on oral digoxin has subtherapeutic levels. What
change improves bioavailability?
o A) Switch to IV digoxin
o B) Double oral dose
o C) Take with fatty meal
o D) Crush tablets
o Explanation: IV administration bypasses malabsorption issues, ensuring full bioavailability.
13. A patient with Child-Pugh class C cirrhosis receives a single dose of lorazepam and
remains sedated for 24 hours. Why?
o A) Reduced hepatic glucuronidation
o B) Increased blood-brain barrier permeability
o C) Reduced renal excretion
o D) Increased protein binding
o Explanation: Cirrhosis impairs phase II metabolism (glucuronidation) of lorazepam,
prolonging effects.
14. A patient on rifampin (a CYP inducer) for TB has breakthrough seizures on phenytoin. What
is the mechanism?
o A) Increased phenytoin metabolism
o B) Reduced phenytoin absorption
o C) Displacement from proteins
o D) Additive neurotoxicity
o Explanation: Rifampin induces CYP enzymes, increasing phenytoin metabolism and
reducing seizure control.
15. A patient has a theophylline level of 35 mcg/mL (toxic >20) and presents with tachycardia
and seizures. Theophylline follows:
Multiple-Choice Questions With Answers &
Explanations | Instant Pdf Download
Section 1: Pharmacokinetics & Pharmacodynamics (Qs 1-15)
1. A 72-year-old male with heart failure is on digoxin and furosemide. He presents with
nausea, vomiting, and yellow vision. Lab: K+ 3.1 mEq/L. What is the most likely cause?
o A) Furosemide toxicity
o B) Digoxin toxicity
o C) Myocardial infarction
o D) Gastroenteritis
o Explanation: Hypokalemia from furosemide increases digoxin binding to Na+/K+-ATPase,
leading to digoxin toxicity (nausea, vomiting, yellow vision).
2. A patient on warfarin starts taking sulfamethoxazole-trimethoprim for a UTI. His INR rises
from 2.5 to 5.0. What is the mechanism?
o A) Displacement from plasma proteins
o B) Induction of warfarin metabolism
o C) Reduced warfarin absorption
o D) Additive antiplatelet effect
o Explanation: Sulfa drugs displace warfarin from albumin, increasing free warfarin levels
and INR.
3. A patient with epilepsy on phenytoin develops toxicity after valproate is added. Why?
o A) Inhibition of phenytoin metabolism
o B) Induction of phenytoin excretion
o C) Displacement from protein binding
o D) Reduced renal blood flow
o *Explanation: Valproate inhibits CYP2C9/2C19, reducing phenytoin metabolism and
increasing levels.*
,4. A 45-year-old chronic alcohol user requires higher doses of midazolam for sedation. What is
the mechanism?
o A) CYP3A4 enzyme induction
o B) Receptor down-regulation
o C) Increased renal clearance
o D) Decreased bioavailability
o Explanation: Chronic alcohol induces CYP3A4, increasing midazolam metabolism and
reducing effect.
5. A neonate given chloramphenicol develops gray baby syndrome. Why are neonates at risk?
o A) Immature glucuronidation
o B) Increased protein binding
o C) Enhanced renal excretion
o D) Blood-brain barrier immaturity
o Explanation: Neonates lack UDP-glucuronosyltransferase, leading to toxic chloramphenicol
accumulation.
6. An 80-year-old woman on multiple medications presents with confusion and falls. Serum
creatinine is 0.8 mg/dL. What is the best next step?
o A) Check creatinine clearance
o B) Check creatinine clearance
o C) Stop all antihypertensives
o D) Order head CT
o Explanation: Normal creatinine can mask low GFR in elderly; creatinine clearance is the
proper index of renal function.
7. A drug has a half-life of 24 hours and is given once daily. How many days to reach steady
state?
o A) 2 days
o B) 5 days
o C) 7 days
o D) 10 days
,o *Explanation: Steady state is achieved in approximately 5 half-lives (5 × 24 hours = 120
hours = 5 days).*
8. A patient on lithium (narrow therapeutic index) has a level of 1.8 mEq/L and shows tremor
and confusion. This illustrates:
o A) Small dose changes cause large effect changes
o B) Long half-life
o C) Zero-order kinetics
o D) First-pass effect
o Explanation: Narrow therapeutic index means toxic and effective doses are close; small
changes can cause toxicity.
9. A patient using albuterol every 4 hours for 3 days notes decreased effectiveness. What is
the mechanism?
o A) Beta-2 receptor down-regulation
o B) Antagonist competition
o C) Reduced drug absorption
o D) Increased metabolism
o *Explanation: Continuous agonist exposure leads to down-regulation of beta-2 receptors,
reducing response.*
10. A patient stops metoprolol abruptly after 2 years of use. He develops tachycardia and
hypertension. Why?
o A) Beta-1 receptor up-regulation
o B) Alpha receptor stimulation
o C) Withdrawal syndrome only
o D) Rebound angina
o *Explanation: Chronic beta-blocker use up-regulates beta-1 receptors; abrupt withdrawal
causes supersensitivity.*
11. A patient ingests a massive overdose of a lipophilic drug. Which intervention is most
effective?
o A) Activated charcoal
, o B) Hemodialysis
o C) Forced diuresis
o D) Alkalinization of urine
o Explanation: Lipophilic drugs distribute into tissues; activated charcoal binds unabsorbed
drug in the gut.
12. A patient with short bowel syndrome on oral digoxin has subtherapeutic levels. What
change improves bioavailability?
o A) Switch to IV digoxin
o B) Double oral dose
o C) Take with fatty meal
o D) Crush tablets
o Explanation: IV administration bypasses malabsorption issues, ensuring full bioavailability.
13. A patient with Child-Pugh class C cirrhosis receives a single dose of lorazepam and
remains sedated for 24 hours. Why?
o A) Reduced hepatic glucuronidation
o B) Increased blood-brain barrier permeability
o C) Reduced renal excretion
o D) Increased protein binding
o Explanation: Cirrhosis impairs phase II metabolism (glucuronidation) of lorazepam,
prolonging effects.
14. A patient on rifampin (a CYP inducer) for TB has breakthrough seizures on phenytoin. What
is the mechanism?
o A) Increased phenytoin metabolism
o B) Reduced phenytoin absorption
o C) Displacement from proteins
o D) Additive neurotoxicity
o Explanation: Rifampin induces CYP enzymes, increasing phenytoin metabolism and
reducing seizure control.
15. A patient has a theophylline level of 35 mcg/mL (toxic >20) and presents with tachycardia
and seizures. Theophylline follows:
