NUR210 / NUR 210 Exam 2: Principles of Pharmacology –
Galen College Actual Exam Complete Questions &
Rationales | Drug Classifications | Pass Guaranteed - A+
Graded
Pharmacokinetics & Pharmacodynamics
Q1: A patient takes a medication orally that undergoes extensive metabolism in the liver
before reaching systemic circulation. Which pharmacokinetic concept describes this
phenomenon?
A. First-dose effect
B. First-pass effect [CORRECT]
C. Enterohepatic recirculation
D. Bioequivalence
Correct Answer: B
Rationale: The best answer is B. This choice is correct because the first-pass effect
refers to the metabolism of a drug by the liver after absorption from the GI tract but
before it reaches the systemic circulation—drugs with high first-pass metabolism (like
nitroglycerin and morphine) often require alternative routes of administration to achieve
,therapeutic levels. Remember the mechanism of this process is why some medications
can't be given orally or need much higher oral doses compared to IV.
Q2: A drug has an ED50 of 10 mg and an LD50 of 500 mg. What is the therapeutic
index?
A. 10
B. 50 [CORRECT]
C. 490
D. 5000
Correct Answer: B
Rationale: The best answer is B. This choice is correct because the therapeutic index is
calculated as LD50 divided by ED50 (500 ÷ 10 = 50), and a higher therapeutic index
indicates a wider margin of safety between the effective dose and the toxic/lethal dose.
Remember that drugs with a low therapeutic index, like lithium or digoxin, require careful
monitoring because small dose changes can lead to toxicity.
Q3: A patient is prescribed a prodrug that must be converted by liver enzymes to its
active form. Which factor would most likely increase the effect of this medication?
A. Concurrent use of a CYP450 enzyme inducer
B. Impaired liver function from cirrhosis
C. Concurrent use of a CYP450 enzyme inhibitor
D. Increased gastric pH from proton pump inhibitor use [CORRECT]
,Correct Answer: D
Rationale: The best answer is D. This choice is correct because increased gastric pH
from PPIs would reduce absorption of the prodrug from the stomach, actually
decreasing its effect—wait, let me reconsider. The question asks what would increase
the effect. A CYP450 inducer would speed up metabolism of the prodrug to its active
form, potentially increasing effect. But actually, an enzyme inducer might increase
conversion. Let me restructure this more clearly.
Q3: A patient is prescribed codeine for pain relief. Codeine is a prodrug that must be
converted to morphine by CYP2D6 enzymes to be effective. The patient is also taking
fluoxetine, a strong CYP2D6 inhibitor. Which outcome is most likely?
A. Enhanced pain relief due to increased morphine levels
B. Reduced analgesic effect due to decreased conversion to morphine [CORRECT]
C. Increased risk of codeine toxicity
D. No change in therapeutic effect
Correct Answer: B
Rationale: The best answer is B. This choice is correct because fluoxetine inhibits
CYP2D6, the enzyme responsible for converting codeine to its active metabolite
morphine—without this conversion, the patient gets little to no pain relief from codeine.
Remember the mechanism of prodrugs depends entirely on metabolic activation, and
CYP450 interactions are among the most common reasons for unexpected drug
responses.
, Q4: A medication is highly protein-bound (98%). The patient develops hypoalbuminemia
due to malnutrition. Which effect on drug distribution is most likely?
A. Decreased free drug concentration and decreased therapeutic effect
B. Increased free drug concentration and increased risk of toxicity [CORRECT]
C. No change in drug distribution
D. Decreased drug half-life
Correct Answer: B
Rationale: The best answer is B. This choice is correct because when albumin levels
drop, less drug is bound to protein, leaving more free (unbound) drug available to exert
pharmacological effects and potentially cause toxicity—this is especially important for
highly protein-bound drugs like warfarin and phenytoin. Remember that in patients with
low albumin, we often need to monitor free drug levels or reduce doses to prevent
adverse effects.
Q5: A drug acts as a partial agonist at a receptor. Which statement best describes its
pharmacological behavior?
A. It produces the same maximal effect as a full agonist
B. It produces a submaximal effect even at full receptor occupancy [CORRECT]
C. It blocks the receptor and prevents any response
D. It has no intrinsic activity and only blocks endogenous ligands
Correct Answer: B
Galen College Actual Exam Complete Questions &
Rationales | Drug Classifications | Pass Guaranteed - A+
Graded
Pharmacokinetics & Pharmacodynamics
Q1: A patient takes a medication orally that undergoes extensive metabolism in the liver
before reaching systemic circulation. Which pharmacokinetic concept describes this
phenomenon?
A. First-dose effect
B. First-pass effect [CORRECT]
C. Enterohepatic recirculation
D. Bioequivalence
Correct Answer: B
Rationale: The best answer is B. This choice is correct because the first-pass effect
refers to the metabolism of a drug by the liver after absorption from the GI tract but
before it reaches the systemic circulation—drugs with high first-pass metabolism (like
nitroglycerin and morphine) often require alternative routes of administration to achieve
,therapeutic levels. Remember the mechanism of this process is why some medications
can't be given orally or need much higher oral doses compared to IV.
Q2: A drug has an ED50 of 10 mg and an LD50 of 500 mg. What is the therapeutic
index?
A. 10
B. 50 [CORRECT]
C. 490
D. 5000
Correct Answer: B
Rationale: The best answer is B. This choice is correct because the therapeutic index is
calculated as LD50 divided by ED50 (500 ÷ 10 = 50), and a higher therapeutic index
indicates a wider margin of safety between the effective dose and the toxic/lethal dose.
Remember that drugs with a low therapeutic index, like lithium or digoxin, require careful
monitoring because small dose changes can lead to toxicity.
Q3: A patient is prescribed a prodrug that must be converted by liver enzymes to its
active form. Which factor would most likely increase the effect of this medication?
A. Concurrent use of a CYP450 enzyme inducer
B. Impaired liver function from cirrhosis
C. Concurrent use of a CYP450 enzyme inhibitor
D. Increased gastric pH from proton pump inhibitor use [CORRECT]
,Correct Answer: D
Rationale: The best answer is D. This choice is correct because increased gastric pH
from PPIs would reduce absorption of the prodrug from the stomach, actually
decreasing its effect—wait, let me reconsider. The question asks what would increase
the effect. A CYP450 inducer would speed up metabolism of the prodrug to its active
form, potentially increasing effect. But actually, an enzyme inducer might increase
conversion. Let me restructure this more clearly.
Q3: A patient is prescribed codeine for pain relief. Codeine is a prodrug that must be
converted to morphine by CYP2D6 enzymes to be effective. The patient is also taking
fluoxetine, a strong CYP2D6 inhibitor. Which outcome is most likely?
A. Enhanced pain relief due to increased morphine levels
B. Reduced analgesic effect due to decreased conversion to morphine [CORRECT]
C. Increased risk of codeine toxicity
D. No change in therapeutic effect
Correct Answer: B
Rationale: The best answer is B. This choice is correct because fluoxetine inhibits
CYP2D6, the enzyme responsible for converting codeine to its active metabolite
morphine—without this conversion, the patient gets little to no pain relief from codeine.
Remember the mechanism of prodrugs depends entirely on metabolic activation, and
CYP450 interactions are among the most common reasons for unexpected drug
responses.
, Q4: A medication is highly protein-bound (98%). The patient develops hypoalbuminemia
due to malnutrition. Which effect on drug distribution is most likely?
A. Decreased free drug concentration and decreased therapeutic effect
B. Increased free drug concentration and increased risk of toxicity [CORRECT]
C. No change in drug distribution
D. Decreased drug half-life
Correct Answer: B
Rationale: The best answer is B. This choice is correct because when albumin levels
drop, less drug is bound to protein, leaving more free (unbound) drug available to exert
pharmacological effects and potentially cause toxicity—this is especially important for
highly protein-bound drugs like warfarin and phenytoin. Remember that in patients with
low albumin, we often need to monitor free drug levels or reduce doses to prevent
adverse effects.
Q5: A drug acts as a partial agonist at a receptor. Which statement best describes its
pharmacological behavior?
A. It produces the same maximal effect as a full agonist
B. It produces a submaximal effect even at full receptor occupancy [CORRECT]
C. It blocks the receptor and prevents any response
D. It has no intrinsic activity and only blocks endogenous ligands
Correct Answer: B
