NR-565 Pharm Final Exam (Latest 2026/2027 Update) | Advanced
Pharmacology | Q&A | Grade A | 100% Correct (Verified Answers) –
Chamberlain University
Subject: Advanced Pharmacology – NR-565 Final Exam
Source: Chamberlain University College of Nursing – Current Curriculum
Format: Q&A Guide with Rationale • Endocrine • Respiratory • GI • Infectious Disease • Supplements
1: What are the adverse effects of radioactive iodine therapy for hyperthyroidism?
A. Destroys overactive thyroid cells, effectively reducing hormone levels
B. Causes permanent hypothyroidism requiring lifelong levothyroxine replacement
C. May cause radiation thyroiditis and transient hyperthyroidism
D. All of the above are correct
Correct Answer: A. Destroys overactive thyroid cells, effectively reducing hormone levels
1. Radioactive iodine (RAI) is taken up by overactive thyroid cells and destroys them, reducing
hormone levels.
2. Most patients become hypothyroid after RAI and require lifelong levothyroxine replacement.
3. RAI is preferred treatment for adults with Graves' disease who are not pregnant.
2: What is the indication for methimazole?
A. Treats hypothyroidism by replacing thyroid hormone
B. Treats hyperthyroidism by inhibiting thyroid hormone synthesis
C. Treats thyroid storm as an adjunct to beta-blockers
D. Both B and C
Correct Answer: B. Treats hyperthyroidism by inhibiting thyroid hormone synthesis
1. Methimazole is first-line for hyperthyroidism treatment.
2. It blocks thyroid peroxidase, reducing T3 and T4 synthesis.
3. Contraindicated in the first trimester of pregnancy (teratogenic).
,3: What is the mechanism of action (MOA) of methimazole?
A. Blocks the enzyme thyroid peroxidase, which is involved in the synthesis of thyroid hormones T3
and T4, effectively reducing levels in the body
B. Inhibits peripheral conversion of T4 to T3
C. Blocks TSH receptors on the thyroid gland
D. Destroys thyroid tissue via radiation
Correct Answer: A. Blocks the enzyme thyroid peroxidase, which is involved in the synthesis of
thyroid hormones T3 and T4, effectively reducing levels in the body
1. Thyroid peroxidase is essential for iodination of thyroglobulin and coupling of MIT and DIT.
2. Inhibition of this enzyme prevents new thyroid hormone synthesis.
3. Propylthiouracil (PTU) has an additional effect of inhibiting peripheral T4 to T3 conversion.
4: What patient education should be provided for levothyroxine (Synthroid)?
A. Take with food to improve absorption
B. Take on empty stomach 30-60 minutes before breakfast; do not take with supplements (magnesium,
calcium, iron) – wait four hours
C. Take at bedtime with a snack to avoid morning interactions
D. Take with grapefruit juice to enhance absorption
Correct Answer: B. Take on empty stomach 30-60 minutes before breakfast; do not take with
supplements (magnesium, calcium, iron) – wait four hours
1. Food and supplements significantly reduce levothyroxine absorption.
2. Calcium, iron, magnesium, and antacids should be separated by at least 4 hours.
3. Consistent timing is essential for stable TSH levels.
5: What monitoring is required for levothyroxine therapy?
A. Monitor TSH levels 6-8 weeks after starting treatment
B. Monitor free T4 levels only
C. Monitor liver function tests annually
D. Monitor CBC with differential
Correct Answer: A. Monitor TSH levels 6-8 weeks after starting treatment
1. TSH is the most sensitive marker of thyroid hormone status.
2. After dose changes, TSH should be rechecked in 6-8 weeks.
3. Once stable, TSH can be monitored annually.
, 6: What population considerations apply to levothyroxine prescribing?
A. Narrow therapeutic range; caution when prescribing to elderly (start low and go slow); caution
when switching between generic and brand names
B. Safe in all populations without dose adjustment
C. Only contraindicated in pregnancy
D. No special considerations needed
Correct Answer: A. Narrow therapeutic range; caution when prescribing to elderly (start low and go
slow); caution when switching between generic and brand names
1. Levothyroxine has a narrow therapeutic index; small dose changes can cause significant
effects.
2. Elderly patients and those with cardiac disease should start at lower doses (25-50 mcg/day).
3. Switching between brands may alter bioavailability; maintain consistency.
7: What are the drug interactions of levothyroxine?
A. Warfarin (increases anticoagulant effects, increasing bleeding risk); can increase dosing
requirements for insulin and digoxin
B. Only interacts with oral contraceptives
C. No significant drug interactions
D. Interacts only with calcium channel blockers
Correct Answer: A. Warfarin (increases anticoagulant effects, increasing bleeding risk); can increase
dosing requirements for insulin and digoxin
1. Levothyroxine increases metabolism of vitamin K-dependent clotting factors, enhancing
warfarin effect.
2. Thyroid hormone increases insulin and digoxin clearance, requiring dose adjustments.
3. Sevelamer, calcium, and iron reduce levothyroxine absorption.
8: What are the contraindications for pioglitazone?
A. Patients with severe heart failure and history of bladder cancer
B. Patients with type 1 diabetes
C. Patients with renal impairment
D. All of the above
Correct Answer: A. Patients with severe heart failure and history of bladder cancer
1. Pioglitazone causes fluid retention, worsening heart failure (contraindicated in NYHA class
III/IV).
2. Some studies suggest increased risk of bladder cancer with long-term use.
3. Avoid in patients with active bladder cancer or history.
Pharmacology | Q&A | Grade A | 100% Correct (Verified Answers) –
Chamberlain University
Subject: Advanced Pharmacology – NR-565 Final Exam
Source: Chamberlain University College of Nursing – Current Curriculum
Format: Q&A Guide with Rationale • Endocrine • Respiratory • GI • Infectious Disease • Supplements
1: What are the adverse effects of radioactive iodine therapy for hyperthyroidism?
A. Destroys overactive thyroid cells, effectively reducing hormone levels
B. Causes permanent hypothyroidism requiring lifelong levothyroxine replacement
C. May cause radiation thyroiditis and transient hyperthyroidism
D. All of the above are correct
Correct Answer: A. Destroys overactive thyroid cells, effectively reducing hormone levels
1. Radioactive iodine (RAI) is taken up by overactive thyroid cells and destroys them, reducing
hormone levels.
2. Most patients become hypothyroid after RAI and require lifelong levothyroxine replacement.
3. RAI is preferred treatment for adults with Graves' disease who are not pregnant.
2: What is the indication for methimazole?
A. Treats hypothyroidism by replacing thyroid hormone
B. Treats hyperthyroidism by inhibiting thyroid hormone synthesis
C. Treats thyroid storm as an adjunct to beta-blockers
D. Both B and C
Correct Answer: B. Treats hyperthyroidism by inhibiting thyroid hormone synthesis
1. Methimazole is first-line for hyperthyroidism treatment.
2. It blocks thyroid peroxidase, reducing T3 and T4 synthesis.
3. Contraindicated in the first trimester of pregnancy (teratogenic).
,3: What is the mechanism of action (MOA) of methimazole?
A. Blocks the enzyme thyroid peroxidase, which is involved in the synthesis of thyroid hormones T3
and T4, effectively reducing levels in the body
B. Inhibits peripheral conversion of T4 to T3
C. Blocks TSH receptors on the thyroid gland
D. Destroys thyroid tissue via radiation
Correct Answer: A. Blocks the enzyme thyroid peroxidase, which is involved in the synthesis of
thyroid hormones T3 and T4, effectively reducing levels in the body
1. Thyroid peroxidase is essential for iodination of thyroglobulin and coupling of MIT and DIT.
2. Inhibition of this enzyme prevents new thyroid hormone synthesis.
3. Propylthiouracil (PTU) has an additional effect of inhibiting peripheral T4 to T3 conversion.
4: What patient education should be provided for levothyroxine (Synthroid)?
A. Take with food to improve absorption
B. Take on empty stomach 30-60 minutes before breakfast; do not take with supplements (magnesium,
calcium, iron) – wait four hours
C. Take at bedtime with a snack to avoid morning interactions
D. Take with grapefruit juice to enhance absorption
Correct Answer: B. Take on empty stomach 30-60 minutes before breakfast; do not take with
supplements (magnesium, calcium, iron) – wait four hours
1. Food and supplements significantly reduce levothyroxine absorption.
2. Calcium, iron, magnesium, and antacids should be separated by at least 4 hours.
3. Consistent timing is essential for stable TSH levels.
5: What monitoring is required for levothyroxine therapy?
A. Monitor TSH levels 6-8 weeks after starting treatment
B. Monitor free T4 levels only
C. Monitor liver function tests annually
D. Monitor CBC with differential
Correct Answer: A. Monitor TSH levels 6-8 weeks after starting treatment
1. TSH is the most sensitive marker of thyroid hormone status.
2. After dose changes, TSH should be rechecked in 6-8 weeks.
3. Once stable, TSH can be monitored annually.
, 6: What population considerations apply to levothyroxine prescribing?
A. Narrow therapeutic range; caution when prescribing to elderly (start low and go slow); caution
when switching between generic and brand names
B. Safe in all populations without dose adjustment
C. Only contraindicated in pregnancy
D. No special considerations needed
Correct Answer: A. Narrow therapeutic range; caution when prescribing to elderly (start low and go
slow); caution when switching between generic and brand names
1. Levothyroxine has a narrow therapeutic index; small dose changes can cause significant
effects.
2. Elderly patients and those with cardiac disease should start at lower doses (25-50 mcg/day).
3. Switching between brands may alter bioavailability; maintain consistency.
7: What are the drug interactions of levothyroxine?
A. Warfarin (increases anticoagulant effects, increasing bleeding risk); can increase dosing
requirements for insulin and digoxin
B. Only interacts with oral contraceptives
C. No significant drug interactions
D. Interacts only with calcium channel blockers
Correct Answer: A. Warfarin (increases anticoagulant effects, increasing bleeding risk); can increase
dosing requirements for insulin and digoxin
1. Levothyroxine increases metabolism of vitamin K-dependent clotting factors, enhancing
warfarin effect.
2. Thyroid hormone increases insulin and digoxin clearance, requiring dose adjustments.
3. Sevelamer, calcium, and iron reduce levothyroxine absorption.
8: What are the contraindications for pioglitazone?
A. Patients with severe heart failure and history of bladder cancer
B. Patients with type 1 diabetes
C. Patients with renal impairment
D. All of the above
Correct Answer: A. Patients with severe heart failure and history of bladder cancer
1. Pioglitazone causes fluid retention, worsening heart failure (contraindicated in NYHA class
III/IV).
2. Some studies suggest increased risk of bladder cancer with long-term use.
3. Avoid in patients with active bladder cancer or history.
