NUR 641E ADVANCED PHARMACOLOGY FINAL
EXAM STUDY GUIDE 2025: CARDIOVASCULAR,
RESPIRATORY, ENDOCRINE & INFECTIOUS
DISEASES
Section 1: Cardiovascular Pharmacology
(Questions 1–20)
1. A 68yearold patient with HFrEF (EF 32%) is on carvedilol, sacubitril/valsartan, and
spironolactone. The provider is considering adding a medication that has been shown in
large trials to reduce cardiovascular death and heart failure hospitalizations through
mechanisms independent of glycemic control. Which medication is most appropriate?
A. Dapagliflozin
B. Ivabradine
C. Digoxin
D. Hydralazine/isosorbide dinitrate
Correct Answer: A
Rationale: SGLT2 inhibitors (dapagliflozin, empagliflozin) have Class 1A recommendations
in the 2022 AHA/ACC/HFSA guidelines for HFrEF regardless of diabetes status. Their
benefits are mediated through natriuresis, reduced myocardial inflammation, improved
, cardiac energetics, and inhibition of the Na+/H+ exchanger. Ivabradine is only for patients
in sinus rhythm with HR >70 on maximal betablocker. Digoxin provides symptom relief but
does not reduce mortality. Hydralazine/ISDN is primarily reserved for African American
patients or those intolerant to ACEI/ARNI.
2. A patient on simvastatin 80 mg daily develops severe myalgias and dark urine. Which
genetic polymorphism is most strongly associated with increased risk of statininduced
myopathy?
A. CYP3A41B
B. SLCO1B1 rs4149056 (C allele)
C. VKORC1 −1639G>A
D. ABCG2 c.421C>A
Correct Answer: B
Rationale: The SLCO1B1 gene encodes OATP1B1, which mediates hepatic uptake of
simvastatin acid. The reducedfunction C allele (particularly homozygous CC) significantly
increases plasma concentrations of simvastatin acid, markedly elevating myopathy risk.
This is the strongest genetic predictor for statin myopathy. CPIC guidelines recommend
avoiding simvastatin 80 mg or using lower doses/alternative statins in patients with the risk
allele.
3. Which anticoagulant is preferred in a patient with mechanical mitral valve replacement
and atrial fibrillation?
A. Apixaban
B. Rivaroxaban
C. Dabigatran
D. Warfarin
EXAM STUDY GUIDE 2025: CARDIOVASCULAR,
RESPIRATORY, ENDOCRINE & INFECTIOUS
DISEASES
Section 1: Cardiovascular Pharmacology
(Questions 1–20)
1. A 68yearold patient with HFrEF (EF 32%) is on carvedilol, sacubitril/valsartan, and
spironolactone. The provider is considering adding a medication that has been shown in
large trials to reduce cardiovascular death and heart failure hospitalizations through
mechanisms independent of glycemic control. Which medication is most appropriate?
A. Dapagliflozin
B. Ivabradine
C. Digoxin
D. Hydralazine/isosorbide dinitrate
Correct Answer: A
Rationale: SGLT2 inhibitors (dapagliflozin, empagliflozin) have Class 1A recommendations
in the 2022 AHA/ACC/HFSA guidelines for HFrEF regardless of diabetes status. Their
benefits are mediated through natriuresis, reduced myocardial inflammation, improved
, cardiac energetics, and inhibition of the Na+/H+ exchanger. Ivabradine is only for patients
in sinus rhythm with HR >70 on maximal betablocker. Digoxin provides symptom relief but
does not reduce mortality. Hydralazine/ISDN is primarily reserved for African American
patients or those intolerant to ACEI/ARNI.
2. A patient on simvastatin 80 mg daily develops severe myalgias and dark urine. Which
genetic polymorphism is most strongly associated with increased risk of statininduced
myopathy?
A. CYP3A41B
B. SLCO1B1 rs4149056 (C allele)
C. VKORC1 −1639G>A
D. ABCG2 c.421C>A
Correct Answer: B
Rationale: The SLCO1B1 gene encodes OATP1B1, which mediates hepatic uptake of
simvastatin acid. The reducedfunction C allele (particularly homozygous CC) significantly
increases plasma concentrations of simvastatin acid, markedly elevating myopathy risk.
This is the strongest genetic predictor for statin myopathy. CPIC guidelines recommend
avoiding simvastatin 80 mg or using lower doses/alternative statins in patients with the risk
allele.
3. Which anticoagulant is preferred in a patient with mechanical mitral valve replacement
and atrial fibrillation?
A. Apixaban
B. Rivaroxaban
C. Dabigatran
D. Warfarin
