Page 1 of 69
BARKLEY ADVANCED PHARMACOLOGY
REVIEW | EXAM 3 2026 COMPLETE (115)
CURRENT TESTING QUESTIONS AND
CORRECT ANSWERS WITH DETAILED
RATIONALES.
PHARMACOLOGY
Prepare for the Barkley Advanced Pharmacology Review Exam 3 with
focused review materials covering advanced pharmacokinetics and
pharmacodynamics, medication mechanisms of action, adverse effects,
drug interactions, safe prescribing principles, and pharmacologic
management of acute and chronic conditions affecting cardiovascular,
respiratory, endocrine, neurological, renal, infectious, and psychiatric
systems. Suitable for nurse practitioner students and candidates
preparing for advanced pharmacology review and certification readiness
examinations.
MULTIPLE CHOICE.
1. A 68-year-old male with a history of heart failure and chronic
kidney disease stage 3 is prescribed lisinopril. Which adverse
effect requires the most immediate monitoring?
• A. Dry cough
• B. Hyperkalemia
• C. Angioedema
• D. Acute kidney injury
, Page 2 of 69
Correct answer: D. Acute kidney injury
Rationale: In patients with bilateral renal artery stenosis or those
with compromised renal function (CKD stage 3), ACE inhibitors like
lisinopril can precipitate acute kidney injury due to decreased
glomerular filtration pressure. While hyperkalemia is also a concern,
acute kidney injury is the most immediate and potentially reversible
threat. Dry cough is common but not immediately dangerous, and
angioedema, though serious, is less common than renal impairment
in this population.
2. A 72-year-old patient with Parkinson's disease is experiencing
worsening motor fluctuations despite being on carbidopa-
levodopa. Which of the following agents would be most
appropriate as an adjunctive therapy?
• A. Benztropine
• B. Entacapone
• C. Selegiline
• D. Amantadine
Correct answer: B. Entacapone
Rationale: Entacapone is a catechol-O-methyltransferase (COMT)
inhibitor that prolongs the half-life of levodopa by inhibiting its
peripheral metabolism. This reduces "off" time and is the most
appropriate adjunct for managing motor fluctuations. Benztropine is
an anticholinergic used for tremor, selegiline is a MAO-B inhibitor
used earlier in the disease, and amantadine is used for dyskinesias.
, Page 3 of 69
3. A patient with Type 2 diabetes has an eGFR of 35
mL/min/1.73m². Which of the following antihyperglycemic
agents is contraindicated at this level of renal function?
• A. Metformin
• B. Insulin glargine
• C. Liraglutide
• D. Empagliflozin
Correct answer: A. Metformin
Rationale: Metformin is contraindicated in patients with an eGFR
below 30 mL/min/1.73m² and should be used with caution when
eGFR is 30-45 mL/min/1.73m² due to the risk of lactic acidosis.
Insulin glargine, liraglutide (a GLP-1 receptor agonist), and
empagliflozin (an SGLT2 inhibitor) may be used with dose
adjustments at this level of renal function.
4. Which of the following correctly describes the mechanism of
action of dipeptidyl peptidase-4 (DPP-4) inhibitors?
• A. Increase insulin secretion by closing ATP-sensitive
potassium channels
• B. Decrease glucagon secretion and slow gastric emptying
• C. Prolong the action of incretin hormones (GLP-1 and GIP)
• D. Decrease hepatic glucose production and increase
peripheral glucose uptake
, Page 4 of 69
Correct answer: C. Prolong the action of incretin hormones (GLP-
1 and GIP)
Rationale: DPP-4 inhibitors (e.g., sitagliptin, saxagliptin) work by
inhibiting the enzyme DPP-4, which breaks down incretin hormones
(GLP-1 and GIP). This prolongs their action, leading to increased
insulin secretion and decreased glucagon secretion in a glucose-
dependent manner.
5. A 55-year-old female with a history of hypertension and
hyperlipidemia is prescribed atorvastatin 40 mg daily. Which
laboratory value should be monitored at baseline and
periodically?
• A. Serum creatinine
• B. Liver function tests (ALT/AST)
• C. Hemoglobin A1c
• D. Serum sodium
Correct answer: B. Liver function tests (ALT/AST)
Rationale: Statins such as atorvastatin can cause elevated liver
transaminases. Baseline liver function tests should be obtained
before initiation and periodically thereafter. While statins can also
increase blood glucose and cause myopathy (monitored by CK),
liver function monitoring is a standard recommendation.
BARKLEY ADVANCED PHARMACOLOGY
REVIEW | EXAM 3 2026 COMPLETE (115)
CURRENT TESTING QUESTIONS AND
CORRECT ANSWERS WITH DETAILED
RATIONALES.
PHARMACOLOGY
Prepare for the Barkley Advanced Pharmacology Review Exam 3 with
focused review materials covering advanced pharmacokinetics and
pharmacodynamics, medication mechanisms of action, adverse effects,
drug interactions, safe prescribing principles, and pharmacologic
management of acute and chronic conditions affecting cardiovascular,
respiratory, endocrine, neurological, renal, infectious, and psychiatric
systems. Suitable for nurse practitioner students and candidates
preparing for advanced pharmacology review and certification readiness
examinations.
MULTIPLE CHOICE.
1. A 68-year-old male with a history of heart failure and chronic
kidney disease stage 3 is prescribed lisinopril. Which adverse
effect requires the most immediate monitoring?
• A. Dry cough
• B. Hyperkalemia
• C. Angioedema
• D. Acute kidney injury
, Page 2 of 69
Correct answer: D. Acute kidney injury
Rationale: In patients with bilateral renal artery stenosis or those
with compromised renal function (CKD stage 3), ACE inhibitors like
lisinopril can precipitate acute kidney injury due to decreased
glomerular filtration pressure. While hyperkalemia is also a concern,
acute kidney injury is the most immediate and potentially reversible
threat. Dry cough is common but not immediately dangerous, and
angioedema, though serious, is less common than renal impairment
in this population.
2. A 72-year-old patient with Parkinson's disease is experiencing
worsening motor fluctuations despite being on carbidopa-
levodopa. Which of the following agents would be most
appropriate as an adjunctive therapy?
• A. Benztropine
• B. Entacapone
• C. Selegiline
• D. Amantadine
Correct answer: B. Entacapone
Rationale: Entacapone is a catechol-O-methyltransferase (COMT)
inhibitor that prolongs the half-life of levodopa by inhibiting its
peripheral metabolism. This reduces "off" time and is the most
appropriate adjunct for managing motor fluctuations. Benztropine is
an anticholinergic used for tremor, selegiline is a MAO-B inhibitor
used earlier in the disease, and amantadine is used for dyskinesias.
, Page 3 of 69
3. A patient with Type 2 diabetes has an eGFR of 35
mL/min/1.73m². Which of the following antihyperglycemic
agents is contraindicated at this level of renal function?
• A. Metformin
• B. Insulin glargine
• C. Liraglutide
• D. Empagliflozin
Correct answer: A. Metformin
Rationale: Metformin is contraindicated in patients with an eGFR
below 30 mL/min/1.73m² and should be used with caution when
eGFR is 30-45 mL/min/1.73m² due to the risk of lactic acidosis.
Insulin glargine, liraglutide (a GLP-1 receptor agonist), and
empagliflozin (an SGLT2 inhibitor) may be used with dose
adjustments at this level of renal function.
4. Which of the following correctly describes the mechanism of
action of dipeptidyl peptidase-4 (DPP-4) inhibitors?
• A. Increase insulin secretion by closing ATP-sensitive
potassium channels
• B. Decrease glucagon secretion and slow gastric emptying
• C. Prolong the action of incretin hormones (GLP-1 and GIP)
• D. Decrease hepatic glucose production and increase
peripheral glucose uptake
, Page 4 of 69
Correct answer: C. Prolong the action of incretin hormones (GLP-
1 and GIP)
Rationale: DPP-4 inhibitors (e.g., sitagliptin, saxagliptin) work by
inhibiting the enzyme DPP-4, which breaks down incretin hormones
(GLP-1 and GIP). This prolongs their action, leading to increased
insulin secretion and decreased glucagon secretion in a glucose-
dependent manner.
5. A 55-year-old female with a history of hypertension and
hyperlipidemia is prescribed atorvastatin 40 mg daily. Which
laboratory value should be monitored at baseline and
periodically?
• A. Serum creatinine
• B. Liver function tests (ALT/AST)
• C. Hemoglobin A1c
• D. Serum sodium
Correct answer: B. Liver function tests (ALT/AST)
Rationale: Statins such as atorvastatin can cause elevated liver
transaminases. Baseline liver function tests should be obtained
before initiation and periodically thereafter. While statins can also
increase blood glucose and cause myopathy (monitored by CK),
liver function monitoring is a standard recommendation.
