1|Page
NR 565 – ADVANCED PHARMACOLOGY Midterm Practice ALL QUESTIONS AND 100%
CORRECT ANSWERS ALREADY GRADED A+ - LATEST UPDATE 2026-2027
1. A patient taking warfarin is prescribed trimethoprim-sulfamethoxazole. What is the primary
concern?
A. Decreased INR
B. Increased INR and bleeding risk
C. Reduced antibiotic effectiveness
D. Increased clot formation
Answer: B
Rationale: TMP-SMX inhibits warfarin metabolism, increasing INR and bleeding risk.
2. Which factor MOST increases drug toxicity in older adults?
A. Increased gastric pH
B. Reduced hepatic metabolism
C. Increased body fat
D. Decreased renal clearance
Answer: D
Rationale: Renal clearance decline is the most clinically significant contributor to toxicity.
3. A patient with asthma is prescribed propranolol. Why is this inappropriate?
A. It increases BP
B. It causes tachycardia
C. It blocks beta-2 receptors
D. It decreases drug absorption
Answer: C
Rationale: Nonselective beta-blockers worsen bronchoconstriction.
UPDATED exam 2026
,2|Page
4. Which CYP450 enzyme metabolizes the MOST drugs?
A. CYP1A2
B. CYP2C9
C. CYP2D6
D. CYP3A4
Answer: D
Rationale: CYP3A4 metabolizes ~50% of drugs.
5. A CYP450 inhibitor will cause
A. Decreased drug levels
B. Increased drug clearance
C. Increased drug levels
D. Decreased half-life
Answer: C
Rationale: Inhibitors slow metabolism, increasing serum levels.
6. Which medication is a strong CYP450 inducer?
A. Fluconazole
B. Rifampin
C. Erythromycin
D. Grapefruit juice
Answer: B
Rationale: Rifampin markedly increases enzyme activity.
7. A patient taking digoxin develops nausea and vision changes. What is the FIRST action?
A. Increase the dose
B. Stop digoxin
C. Obtain a digoxin level
D. Administer calcium
Answer: C
Rationale: Symptoms suggest toxicity — confirm serum level.
UPDATED exam 2026
,3|Page
8. Which lab value is MOST important before starting an ACE inhibitor?
A. Sodium
B. Potassium
C. Hemoglobin
D. Calcium
Answer: B
Rationale: ACE inhibitors can cause hyperkalemia.
9. Which antihypertensive is safest in pregnancy?
A. Lisinopril
B. Losartan
C. Methyldopa
D. Hydrochlorothiazide
Answer: C
Rationale: Methyldopa has the longest safety record in pregnancy.
10. A patient taking NSAIDs chronically is MOST at risk for
A. Hypoglycemia
B. Renal impairment
C. Bradycardia
D. Hypercalcemia
Answer: B
Rationale: NSAIDs reduce renal prostaglandins, impairing kidney function.
11. Which insulin has NO peak?
A. Regular
B. NPH
C. Lispro
D. Glargine
Answer: D
Rationale: Glargine provides steady basal insulin.
UPDATED exam 2026
, 4|Page
12. A patient with type 2 diabetes and heart failure should avoid
A. Metformin
B. GLP-1 agonists
C. Thiazolidinediones
D. DPP-4 inhibitors
Answer: C
Rationale: TZDs cause fluid retention and worsen HF.
13. Which medication delays gastric emptying and promotes satiety?
A. Sitagliptin
B. Exenatide
C. Glyburide
D. Insulin glargine
Answer: B
Rationale: GLP-1 agonists slow gastric emptying.
14. The MOST common adverse effect of metformin is
A. Hypoglycemia
B. Weight gain
C. GI upset
D. Pancreatitis
Answer: C
15. A patient on statins reports muscle pain. What should be assessed FIRST?
A. Lipid panel
B. Liver enzymes
C. Creatine kinase
D. Potassium
Answer: C
Rationale: Myopathy risk requires CK evaluation.
UPDATED exam 2026
NR 565 – ADVANCED PHARMACOLOGY Midterm Practice ALL QUESTIONS AND 100%
CORRECT ANSWERS ALREADY GRADED A+ - LATEST UPDATE 2026-2027
1. A patient taking warfarin is prescribed trimethoprim-sulfamethoxazole. What is the primary
concern?
A. Decreased INR
B. Increased INR and bleeding risk
C. Reduced antibiotic effectiveness
D. Increased clot formation
Answer: B
Rationale: TMP-SMX inhibits warfarin metabolism, increasing INR and bleeding risk.
2. Which factor MOST increases drug toxicity in older adults?
A. Increased gastric pH
B. Reduced hepatic metabolism
C. Increased body fat
D. Decreased renal clearance
Answer: D
Rationale: Renal clearance decline is the most clinically significant contributor to toxicity.
3. A patient with asthma is prescribed propranolol. Why is this inappropriate?
A. It increases BP
B. It causes tachycardia
C. It blocks beta-2 receptors
D. It decreases drug absorption
Answer: C
Rationale: Nonselective beta-blockers worsen bronchoconstriction.
UPDATED exam 2026
,2|Page
4. Which CYP450 enzyme metabolizes the MOST drugs?
A. CYP1A2
B. CYP2C9
C. CYP2D6
D. CYP3A4
Answer: D
Rationale: CYP3A4 metabolizes ~50% of drugs.
5. A CYP450 inhibitor will cause
A. Decreased drug levels
B. Increased drug clearance
C. Increased drug levels
D. Decreased half-life
Answer: C
Rationale: Inhibitors slow metabolism, increasing serum levels.
6. Which medication is a strong CYP450 inducer?
A. Fluconazole
B. Rifampin
C. Erythromycin
D. Grapefruit juice
Answer: B
Rationale: Rifampin markedly increases enzyme activity.
7. A patient taking digoxin develops nausea and vision changes. What is the FIRST action?
A. Increase the dose
B. Stop digoxin
C. Obtain a digoxin level
D. Administer calcium
Answer: C
Rationale: Symptoms suggest toxicity — confirm serum level.
UPDATED exam 2026
,3|Page
8. Which lab value is MOST important before starting an ACE inhibitor?
A. Sodium
B. Potassium
C. Hemoglobin
D. Calcium
Answer: B
Rationale: ACE inhibitors can cause hyperkalemia.
9. Which antihypertensive is safest in pregnancy?
A. Lisinopril
B. Losartan
C. Methyldopa
D. Hydrochlorothiazide
Answer: C
Rationale: Methyldopa has the longest safety record in pregnancy.
10. A patient taking NSAIDs chronically is MOST at risk for
A. Hypoglycemia
B. Renal impairment
C. Bradycardia
D. Hypercalcemia
Answer: B
Rationale: NSAIDs reduce renal prostaglandins, impairing kidney function.
11. Which insulin has NO peak?
A. Regular
B. NPH
C. Lispro
D. Glargine
Answer: D
Rationale: Glargine provides steady basal insulin.
UPDATED exam 2026
, 4|Page
12. A patient with type 2 diabetes and heart failure should avoid
A. Metformin
B. GLP-1 agonists
C. Thiazolidinediones
D. DPP-4 inhibitors
Answer: C
Rationale: TZDs cause fluid retention and worsen HF.
13. Which medication delays gastric emptying and promotes satiety?
A. Sitagliptin
B. Exenatide
C. Glyburide
D. Insulin glargine
Answer: B
Rationale: GLP-1 agonists slow gastric emptying.
14. The MOST common adverse effect of metformin is
A. Hypoglycemia
B. Weight gain
C. GI upset
D. Pancreatitis
Answer: C
15. A patient on statins reports muscle pain. What should be assessed FIRST?
A. Lipid panel
B. Liver enzymes
C. Creatine kinase
D. Potassium
Answer: C
Rationale: Myopathy risk requires CK evaluation.
UPDATED exam 2026
