NURS 5334 ADVANCED
PHARMACOLOGY FINAL EXAM PREP
QUESTIONS AND ANSWERS
1. A 65-year-old patient with chronic heart failure is prescribed Sacubitril/Valsartan
(Entresto). Which of the following is the primary mechanism of action for Sacubitril?
A. Direct inhibition of the renin-angiotensin-aldosterone system (RAAS)
B. Blockade of AT1 receptors to prevent vasoconstriction
C. Inhibition of neprilysin to increase levels of natriuretic peptides
D. Inhibition of phosphodiesterase-3 to increase cardiac contractility
Answer: C
Conceptual Explanation: Sacubitril is a neprilysin inhibitor. By inhibiting neprilysin, it
prevents the breakdown of natriuretic peptides, leading to vasodilation and natriuresis,
which is beneficial in heart failure.
2. A patient is being treated with Amiodarone for atrial fibrillation. Which monitoring
parameter is most critical due to the drug’s high iodine content and potential for organ
toxicity?
A. Serum creatinine and BUN
,B. Liver enzymes and pulmonary function tests
C. Prothrombin time and INR
D. Serum glucose and A1C
Answer: B
Conceptual Explanation: Amiodarone is associated with significant pulmonary toxicity
(interstitial pneumonitis) and hepatotoxicity. Periodic PFTs and LFTs are required.
3. Which of the following describes the ‘first-pass effect’ in pharmacokinetics?
A. The rapid excretion of drugs via the kidneys immediately after absorption
B. The binding of drugs to plasma proteins in the bloodstream
C. The metabolism of a drug in the liver or gut wall before it reaches systemic circulation
D. The distribution of a drug to highly vascularized organs like the brain
Answer: C
Conceptual Explanation: The first-pass effect refers to the metabolic reduction of a drug’s
concentration before it reaches the systemic circulation, typically occurring in the liver
after oral administration.
4. A patient with Type 2 Diabetes and established cardiovascular disease requires a new
medication to improve glycemic control. Which class of drugs is preferred due to proven
cardiovascular benefits?
A. SGLT2 inhibitors
, B. DPP-4 inhibitors
C. Sulfonylureas
D. Meglitinides
Answer: A
Conceptual Explanation: SGLT2 inhibitors (like Empagliflozin) and GLP-1 receptor
agonists have shown significant reduction in cardiovascular events and are recommended
for patients with CVD.
5. When prescribing a Fluoroquinolone (e.g., Ciprofloxacin), the nurse practitioner must warn
the patient about which Black Box Warning?
A. Tendon rupture and tendonitis
B. Acute kidney injury
C. Severe hypoglycemia
D. Stevens-Johnson Syndrome
Answer: A
Conceptual Explanation: Fluoroquinolones carry a Black Box Warning for increased risk
of tendonitis and tendon rupture, especially in older adults and those on corticosteroids.
6. Which antidepressant is most likely to cause hypertensive crisis if the patient consumes
foods high in tyramine, such as aged cheese?
A. Phenelzine (MAOI)
PHARMACOLOGY FINAL EXAM PREP
QUESTIONS AND ANSWERS
1. A 65-year-old patient with chronic heart failure is prescribed Sacubitril/Valsartan
(Entresto). Which of the following is the primary mechanism of action for Sacubitril?
A. Direct inhibition of the renin-angiotensin-aldosterone system (RAAS)
B. Blockade of AT1 receptors to prevent vasoconstriction
C. Inhibition of neprilysin to increase levels of natriuretic peptides
D. Inhibition of phosphodiesterase-3 to increase cardiac contractility
Answer: C
Conceptual Explanation: Sacubitril is a neprilysin inhibitor. By inhibiting neprilysin, it
prevents the breakdown of natriuretic peptides, leading to vasodilation and natriuresis,
which is beneficial in heart failure.
2. A patient is being treated with Amiodarone for atrial fibrillation. Which monitoring
parameter is most critical due to the drug’s high iodine content and potential for organ
toxicity?
A. Serum creatinine and BUN
,B. Liver enzymes and pulmonary function tests
C. Prothrombin time and INR
D. Serum glucose and A1C
Answer: B
Conceptual Explanation: Amiodarone is associated with significant pulmonary toxicity
(interstitial pneumonitis) and hepatotoxicity. Periodic PFTs and LFTs are required.
3. Which of the following describes the ‘first-pass effect’ in pharmacokinetics?
A. The rapid excretion of drugs via the kidneys immediately after absorption
B. The binding of drugs to plasma proteins in the bloodstream
C. The metabolism of a drug in the liver or gut wall before it reaches systemic circulation
D. The distribution of a drug to highly vascularized organs like the brain
Answer: C
Conceptual Explanation: The first-pass effect refers to the metabolic reduction of a drug’s
concentration before it reaches the systemic circulation, typically occurring in the liver
after oral administration.
4. A patient with Type 2 Diabetes and established cardiovascular disease requires a new
medication to improve glycemic control. Which class of drugs is preferred due to proven
cardiovascular benefits?
A. SGLT2 inhibitors
, B. DPP-4 inhibitors
C. Sulfonylureas
D. Meglitinides
Answer: A
Conceptual Explanation: SGLT2 inhibitors (like Empagliflozin) and GLP-1 receptor
agonists have shown significant reduction in cardiovascular events and are recommended
for patients with CVD.
5. When prescribing a Fluoroquinolone (e.g., Ciprofloxacin), the nurse practitioner must warn
the patient about which Black Box Warning?
A. Tendon rupture and tendonitis
B. Acute kidney injury
C. Severe hypoglycemia
D. Stevens-Johnson Syndrome
Answer: A
Conceptual Explanation: Fluoroquinolones carry a Black Box Warning for increased risk
of tendonitis and tendon rupture, especially in older adults and those on corticosteroids.
6. Which antidepressant is most likely to cause hypertensive crisis if the patient consumes
foods high in tyramine, such as aged cheese?
A. Phenelzine (MAOI)
