Page 1 of 82
Wilkes NSG 533 Final Exam: Comprehensive
Advanced Pharmacology Practice Test 200
Questions & Answers Explanation
Q1. A patient with advanced heart failure has significant
peripheral edema and reduced cardiac output. Which
pharmacokinetic process is most likely to be impaired?
A) Absorption
B) Distribution
C) Metabolism
D) Excretion
Rationale: Reduced cardiac output and peripheral edema
decrease blood flow to the gastrointestinal tract and peripheral
tissues, altering distribution of drugs (particularly those that are
tissue-bound or highly lipophilic). Absorption may also be
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impaired, but distribution is most directly affected by decreased
perfusion of drug target sites.
Q2. An 85-year-old patient with chronic kidney disease (CKD)
stage 4 has been prescribed digoxin. The prescriber orders a
reduced dose. This adjustment primarily accounts for which
pharmacokinetic change in this patient?
A) Decreased absorption
B) Increased volume of distribution
C) Decreased renal excretion
D) Increased protein binding
Rationale: Digoxin is primarily eliminated by the kidneys via
glomerular filtration. In CKD stage 4 (eGFR 15-29 mL/min), renal
excretion is severely impaired, leading to drug accumulation and
toxicity. Dose reduction is required. Protein binding (digoxin is
~25% protein bound) is minimally affected by CKD.
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Q3. A drug has a half-life of 12 hours. Approximately how
many hours will it take to reach steady state?
A) 24 hours
B) 60 hours (5 × 12 = 60 hours)
C) 48 hours
D) 72 hours
Rationale: Steady state is achieved after 4 to 5 half-lives (for
most drugs). 5 × 12 = 60 hours. This principle applies regardless
of dosing interval, though dosing frequency affects peak-trough
fluctuations.
Q4. Which cytochrome P450 (CYP) enzyme is responsible for
metabolizing the largest percentage of clinically used drugs?
A) CYP2D6
B) CYP3A4
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C) CYP2C9
D) CYP1A2
Rationale: CYP3A4 metabolizes approximately 50% of all
marketed drugs, including statins (simvastatin, atorvastatin),
calcium channel blockers, benzodiazepines, and many others.
CYP2D6 metabolizes about 25% of drugs (including many
antidepressants and antipsychotics).
Q5. A patient taking warfarin starts taking amiodarone for
atrial fibrillation. The international normalized ratio (INR)
increases from 2.5 to 5.5. This interaction is most likely due
to:
A) Additive anticoagulant effect
B) CYP2C9 inhibition by amiodarone (reducing warfarin
metabolism)
Wilkes NSG 533 Final Exam: Comprehensive
Advanced Pharmacology Practice Test 200
Questions & Answers Explanation
Q1. A patient with advanced heart failure has significant
peripheral edema and reduced cardiac output. Which
pharmacokinetic process is most likely to be impaired?
A) Absorption
B) Distribution
C) Metabolism
D) Excretion
Rationale: Reduced cardiac output and peripheral edema
decrease blood flow to the gastrointestinal tract and peripheral
tissues, altering distribution of drugs (particularly those that are
tissue-bound or highly lipophilic). Absorption may also be
,Page 2 of 82
impaired, but distribution is most directly affected by decreased
perfusion of drug target sites.
Q2. An 85-year-old patient with chronic kidney disease (CKD)
stage 4 has been prescribed digoxin. The prescriber orders a
reduced dose. This adjustment primarily accounts for which
pharmacokinetic change in this patient?
A) Decreased absorption
B) Increased volume of distribution
C) Decreased renal excretion
D) Increased protein binding
Rationale: Digoxin is primarily eliminated by the kidneys via
glomerular filtration. In CKD stage 4 (eGFR 15-29 mL/min), renal
excretion is severely impaired, leading to drug accumulation and
toxicity. Dose reduction is required. Protein binding (digoxin is
~25% protein bound) is minimally affected by CKD.
,Page 3 of 82
Q3. A drug has a half-life of 12 hours. Approximately how
many hours will it take to reach steady state?
A) 24 hours
B) 60 hours (5 × 12 = 60 hours)
C) 48 hours
D) 72 hours
Rationale: Steady state is achieved after 4 to 5 half-lives (for
most drugs). 5 × 12 = 60 hours. This principle applies regardless
of dosing interval, though dosing frequency affects peak-trough
fluctuations.
Q4. Which cytochrome P450 (CYP) enzyme is responsible for
metabolizing the largest percentage of clinically used drugs?
A) CYP2D6
B) CYP3A4
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C) CYP2C9
D) CYP1A2
Rationale: CYP3A4 metabolizes approximately 50% of all
marketed drugs, including statins (simvastatin, atorvastatin),
calcium channel blockers, benzodiazepines, and many others.
CYP2D6 metabolizes about 25% of drugs (including many
antidepressants and antipsychotics).
Q5. A patient taking warfarin starts taking amiodarone for
atrial fibrillation. The international normalized ratio (INR)
increases from 2.5 to 5.5. This interaction is most likely due
to:
A) Additive anticoagulant effect
B) CYP2C9 inhibition by amiodarone (reducing warfarin
metabolism)
