NSG 533 ADVANCED PHARMACOLOGY
EXAM 3 QUESTIONS AND ANSWERS
1. A patient with a history of heart failure is prescribed an ACE inhibitor. Which physiological
mechanism explains the development of a persistent, dry cough in this patient?
A. Inhibition of angiotensin II production in the lung parenchyma
B. Direct irritation of the bronchial mucosa by the drug metabolites
C. Accumulation of bradykinin and substance P in the upper airways
D. Increased production of prostaglandins leading to bronchoconstriction
Answer: C
Conceptual Explanation: ACE inhibitors block the enzyme responsible for breaking down
bradykinin and substance P. Their accumulation in the respiratory tract leads to the
common side effect of a dry cough.
2. When prescribing Clozapine (Clozaril), which laboratory parameter must be monitored
most strictly due to the risk of a life-threatening adverse effect?
A. Liver function tests (ALT/AST)
B. Absolute Neutrophil Count (ANC)
,C. Serum creatinine and eGFR
D. Glycated hemoglobin (HbA1c)
Answer: B
Conceptual Explanation: Clozapine carries a black box warning for agranulocytosis.
Frequent monitoring of the ANC is required by the FDA-mandated REMS program to
ensure patient safety.
3. A patient is started on Lithium for Bipolar Disorder. The provider should instruct the
patient that which of the following can lead to Lithium toxicity?
A. High sodium intake
B. Excessive caffeine consumption
C. Hyponatremia or dehydration
D. Concurrent use of acetaminophen
Answer: C
Conceptual Explanation: Lithium is handled by the kidneys similarly to sodium. When
sodium levels are low (hyponatremia) or the patient is dehydrated, the kidneys reabsorb
more Lithium, leading to toxic serum levels.
4. Which mechanism of action is characteristic of SGLT2 inhibitors like Empagliflozin in the
management of Type 2 Diabetes?
A. Inhibiting the reabsorption of glucose in the proximal convoluted tubule
, B. Increasing insulin sensitivity in peripheral tissues
C. Stimulating the release of insulin from pancreatic beta cells
D. Delaying gastric emptying and increasing satiety
Answer: A
Conceptual Explanation: SGLT2 inhibitors lower blood glucose by preventing the kidneys
from reabsorbing glucose, resulting in glucose excretion through the urine (glucosuria).
5. A patient on Warfarin therapy requires an antibiotic for a respiratory infection. Which
antibiotic would most significantly increase the risk of bleeding by inhibiting Warfarin
metabolism?
A. Amoxicillin
B. Bactrim (Trimethoprim/Sulfamethoxazole)
C. Azithromycin
D. Cephalexin
Answer: B
Conceptual Explanation: Bactrim is a potent inhibitor of CYP2C9, the primary enzyme
responsible for metabolizing the S-isomer of Warfarin. This interaction significantly
increases INR and bleeding risk.
EXAM 3 QUESTIONS AND ANSWERS
1. A patient with a history of heart failure is prescribed an ACE inhibitor. Which physiological
mechanism explains the development of a persistent, dry cough in this patient?
A. Inhibition of angiotensin II production in the lung parenchyma
B. Direct irritation of the bronchial mucosa by the drug metabolites
C. Accumulation of bradykinin and substance P in the upper airways
D. Increased production of prostaglandins leading to bronchoconstriction
Answer: C
Conceptual Explanation: ACE inhibitors block the enzyme responsible for breaking down
bradykinin and substance P. Their accumulation in the respiratory tract leads to the
common side effect of a dry cough.
2. When prescribing Clozapine (Clozaril), which laboratory parameter must be monitored
most strictly due to the risk of a life-threatening adverse effect?
A. Liver function tests (ALT/AST)
B. Absolute Neutrophil Count (ANC)
,C. Serum creatinine and eGFR
D. Glycated hemoglobin (HbA1c)
Answer: B
Conceptual Explanation: Clozapine carries a black box warning for agranulocytosis.
Frequent monitoring of the ANC is required by the FDA-mandated REMS program to
ensure patient safety.
3. A patient is started on Lithium for Bipolar Disorder. The provider should instruct the
patient that which of the following can lead to Lithium toxicity?
A. High sodium intake
B. Excessive caffeine consumption
C. Hyponatremia or dehydration
D. Concurrent use of acetaminophen
Answer: C
Conceptual Explanation: Lithium is handled by the kidneys similarly to sodium. When
sodium levels are low (hyponatremia) or the patient is dehydrated, the kidneys reabsorb
more Lithium, leading to toxic serum levels.
4. Which mechanism of action is characteristic of SGLT2 inhibitors like Empagliflozin in the
management of Type 2 Diabetes?
A. Inhibiting the reabsorption of glucose in the proximal convoluted tubule
, B. Increasing insulin sensitivity in peripheral tissues
C. Stimulating the release of insulin from pancreatic beta cells
D. Delaying gastric emptying and increasing satiety
Answer: A
Conceptual Explanation: SGLT2 inhibitors lower blood glucose by preventing the kidneys
from reabsorbing glucose, resulting in glucose excretion through the urine (glucosuria).
5. A patient on Warfarin therapy requires an antibiotic for a respiratory infection. Which
antibiotic would most significantly increase the risk of bleeding by inhibiting Warfarin
metabolism?
A. Amoxicillin
B. Bactrim (Trimethoprim/Sulfamethoxazole)
C. Azithromycin
D. Cephalexin
Answer: B
Conceptual Explanation: Bactrim is a potent inhibitor of CYP2C9, the primary enzyme
responsible for metabolizing the S-isomer of Warfarin. This interaction significantly
increases INR and bleeding risk.
