Chamberlain University NR 566 Midterm
Exam: Advanced Pharmacology for Care of
the Family Comprehensive Practice Question
Bank 2025/2026 Update
Section 1: Pharmacokinetics & Drug Interactions
Q1. A patient with an eGFR of 25 mL/min is prescribed a medication that is 80% renally
excreted. What adjustment is most appropriate?
• A) Increase the dose by 50%
• B) Decrease the dose or extend the dosing interval
• C) No adjustment needed
• D) Switch to IV administration
☑ Correct Answer: B) Decrease the dose or extend the dosing interval
Rationale: Reduced eGFR decreases drug clearance, requiring dose reduction or extended
intervals to prevent accumulation and toxicity.
Q2. Grapefruit juice increases the levels of many medications by inhibiting which CYP450
enzyme?
• A) CYP2D6
• B) CYP3A4
, • C) CYP2C9
• D) CYP1A2
☑ Correct Answer: B) CYP3A4
Rationale: Grapefruit juice inhibits CYP3A4 in the gut and liver, increasing bioavailability of
drugs like statins and calcium channel blockers.
Q3. The "first-pass effect" refers to:
• A) Rapid drug absorption from the GI tract
• B) Rapid inactivation of an oral drug by the liver before it reaches systemic circulation
• C) Distribution to highly perfused organs
• D) Elimination through the kidneys after the first dose
☑ Correct Answer: B) Rapid inactivation of an oral drug by the liver before it reaches
systemic circulation
Rationale: First-pass metabolism reduces bioavailability of orally administered drugs; sublingual
or IV routes bypass this effect.
Section 2: Antifungals & Antivirals
Q4. Which antifungal agent requires an acidic environment (e.g., cola) for proper absorption
and should not be taken with PPIs?
• A) Fluconazole
• B) Itraconazole
, • C) Terbinafine
• D) Nystatin
☑ Correct Answer: B) Itraconazole
Rationale: Itraconazole capsules require gastric acid for dissolution. Patients with achlorhydria
or on PPIs should take with cola or switch to the solution formulation.
Q5. A patient on itraconazole is also taking simvastatin. What is the primary risk?
• A) Increased bleeding
• B) Rhabdomyolysis
• C) Nephrotoxicity
• D) QT prolongation
☑ Correct Answer: B) Rhabdomyolysis
Rationale: Itraconazole is a potent CYP3A4 inhibitor, which significantly increases simvastatin
levels, raising the risk of myopathy and rhabdomyolysis.
Q6. What is the standard loading dose for caspofungin when treating invasive aspergillosis?
• A) 50 mg IV
• B) 70 mg IV
• C) 100 mg IV
• D) 200 mg IV
, ☑ Correct Answer: B) 70 mg IV
*Rationale: Caspofungin requires a 70 mg loading dose on day 1, followed by 50 mg daily
thereafter for invasive candidiasis/aspergillosis.*
Q7. Why must household members be treated simultaneously for enterobiasis (pinworm)?
• A) To prevent medication resistance
• B) Pinworms are highly contagious and easily spread within households
• C) The medication only kills adult worms, not eggs
• D) All of the above
☑ Correct Answer: D) All of the above
Rationale: Pinworm eggs are easily transmitted via contaminated surfaces. Reinfection is
common if all household contacts are not treated simultaneously.
Q8. A patient is prescribed oseltamivir (Tamiflu) for influenza. Within how many hours of
symptom onset must it be initiated to be effective?
• A) 12 hours
• B) 24 hours
• C) 48 hours
• D) 72 hours
Exam: Advanced Pharmacology for Care of
the Family Comprehensive Practice Question
Bank 2025/2026 Update
Section 1: Pharmacokinetics & Drug Interactions
Q1. A patient with an eGFR of 25 mL/min is prescribed a medication that is 80% renally
excreted. What adjustment is most appropriate?
• A) Increase the dose by 50%
• B) Decrease the dose or extend the dosing interval
• C) No adjustment needed
• D) Switch to IV administration
☑ Correct Answer: B) Decrease the dose or extend the dosing interval
Rationale: Reduced eGFR decreases drug clearance, requiring dose reduction or extended
intervals to prevent accumulation and toxicity.
Q2. Grapefruit juice increases the levels of many medications by inhibiting which CYP450
enzyme?
• A) CYP2D6
• B) CYP3A4
, • C) CYP2C9
• D) CYP1A2
☑ Correct Answer: B) CYP3A4
Rationale: Grapefruit juice inhibits CYP3A4 in the gut and liver, increasing bioavailability of
drugs like statins and calcium channel blockers.
Q3. The "first-pass effect" refers to:
• A) Rapid drug absorption from the GI tract
• B) Rapid inactivation of an oral drug by the liver before it reaches systemic circulation
• C) Distribution to highly perfused organs
• D) Elimination through the kidneys after the first dose
☑ Correct Answer: B) Rapid inactivation of an oral drug by the liver before it reaches
systemic circulation
Rationale: First-pass metabolism reduces bioavailability of orally administered drugs; sublingual
or IV routes bypass this effect.
Section 2: Antifungals & Antivirals
Q4. Which antifungal agent requires an acidic environment (e.g., cola) for proper absorption
and should not be taken with PPIs?
• A) Fluconazole
• B) Itraconazole
, • C) Terbinafine
• D) Nystatin
☑ Correct Answer: B) Itraconazole
Rationale: Itraconazole capsules require gastric acid for dissolution. Patients with achlorhydria
or on PPIs should take with cola or switch to the solution formulation.
Q5. A patient on itraconazole is also taking simvastatin. What is the primary risk?
• A) Increased bleeding
• B) Rhabdomyolysis
• C) Nephrotoxicity
• D) QT prolongation
☑ Correct Answer: B) Rhabdomyolysis
Rationale: Itraconazole is a potent CYP3A4 inhibitor, which significantly increases simvastatin
levels, raising the risk of myopathy and rhabdomyolysis.
Q6. What is the standard loading dose for caspofungin when treating invasive aspergillosis?
• A) 50 mg IV
• B) 70 mg IV
• C) 100 mg IV
• D) 200 mg IV
, ☑ Correct Answer: B) 70 mg IV
*Rationale: Caspofungin requires a 70 mg loading dose on day 1, followed by 50 mg daily
thereafter for invasive candidiasis/aspergillosis.*
Q7. Why must household members be treated simultaneously for enterobiasis (pinworm)?
• A) To prevent medication resistance
• B) Pinworms are highly contagious and easily spread within households
• C) The medication only kills adult worms, not eggs
• D) All of the above
☑ Correct Answer: D) All of the above
Rationale: Pinworm eggs are easily transmitted via contaminated surfaces. Reinfection is
common if all household contacts are not treated simultaneously.
Q8. A patient is prescribed oseltamivir (Tamiflu) for influenza. Within how many hours of
symptom onset must it be initiated to be effective?
• A) 12 hours
• B) 24 hours
• C) 48 hours
• D) 72 hours
