NR 565 ADVANCED PHARMACOLOGY
COMPREHENSIVE EXAM STUDY GUIDE
1. When initiating metformin for a patient with Type 2 Diabetes, what is the most
appropriate strategy to minimize gastrointestinal side effects?
A. Administer the medication on an empty stomach 1 hour before meals.
B. Administer the dose concurrently with a proton pump inhibitor.
C. Immediately start the maximum therapeutic dose to achieve rapid glycemic control.
D. Start with a low dose and titrate upward slowly while taking with meals.
Answer: D
Conceptual Explanation: Metformin frequently causes GI upset (nausea, diarrhea).
Starting at a low dose (e.g., 500mg daily) and increasing slowly, while taking the
medication with food, is the standard practice to improve tolerability.
2. Which of the following thyroid medications is preferred during the first trimester of
pregnancy due to a lower risk of teratogenicity?
A. Methimazole
B. Levothyroxine
,C. Propylthiouracil (PTU)
D. Radioactive Iodine
Answer: C
Conceptual Explanation: PTU is preferred in the first trimester of pregnancy because
Methimazole is associated with aplasia cutis and other congenital malformations.
Methimazole is usually switched to after the first trimester due to PTU’s risk of
hepatotoxicity.
3. An elderly patient is being started on Levothyroxine for hypothyroidism. Which initial
dosage is most appropriate to avoid cardiovascular complications?
A. 100 mcg daily
B. 12.5 to 25 mcg daily
C. 75 mcg daily
D. 50 mcg daily
Answer: B
Conceptual Explanation: In elderly patients or those with underlying cardiac disease, the
rule is ‘start low and go slow’ to prevent tachyarrhythmias or angina; 12.5 to 25 mcg is the
standard starting range.
, 4. A patient taking Lisinopril develops a dry, hacking cough. Which medication class is the
most appropriate alternative that avoids the mechanism causing this cough?
A. Beta-Blockers
B. Angiotensin II Receptor Blockers (ARBs)
C. Calcium Channel Blockers
D. Loop Diuretics
Answer: B
Conceptual Explanation: The ACE inhibitor cough is caused by the accumulation of
bradykinin. ARBs do not inhibit the breakdown of bradykinin and are therefore the
preferred alternative for patients who cannot tolerate ACE inhibitors.
5. Which laboratory value is most critical to monitor in a patient receiving long-term
Amiodarone therapy for cardiac arrhythmias?
A. Urinary microalbumin
B. Serum Amylase
C. Hemoglobin A1c
D. Thyroid Stimulating Hormone (TSH)
Answer: D
COMPREHENSIVE EXAM STUDY GUIDE
1. When initiating metformin for a patient with Type 2 Diabetes, what is the most
appropriate strategy to minimize gastrointestinal side effects?
A. Administer the medication on an empty stomach 1 hour before meals.
B. Administer the dose concurrently with a proton pump inhibitor.
C. Immediately start the maximum therapeutic dose to achieve rapid glycemic control.
D. Start with a low dose and titrate upward slowly while taking with meals.
Answer: D
Conceptual Explanation: Metformin frequently causes GI upset (nausea, diarrhea).
Starting at a low dose (e.g., 500mg daily) and increasing slowly, while taking the
medication with food, is the standard practice to improve tolerability.
2. Which of the following thyroid medications is preferred during the first trimester of
pregnancy due to a lower risk of teratogenicity?
A. Methimazole
B. Levothyroxine
,C. Propylthiouracil (PTU)
D. Radioactive Iodine
Answer: C
Conceptual Explanation: PTU is preferred in the first trimester of pregnancy because
Methimazole is associated with aplasia cutis and other congenital malformations.
Methimazole is usually switched to after the first trimester due to PTU’s risk of
hepatotoxicity.
3. An elderly patient is being started on Levothyroxine for hypothyroidism. Which initial
dosage is most appropriate to avoid cardiovascular complications?
A. 100 mcg daily
B. 12.5 to 25 mcg daily
C. 75 mcg daily
D. 50 mcg daily
Answer: B
Conceptual Explanation: In elderly patients or those with underlying cardiac disease, the
rule is ‘start low and go slow’ to prevent tachyarrhythmias or angina; 12.5 to 25 mcg is the
standard starting range.
, 4. A patient taking Lisinopril develops a dry, hacking cough. Which medication class is the
most appropriate alternative that avoids the mechanism causing this cough?
A. Beta-Blockers
B. Angiotensin II Receptor Blockers (ARBs)
C. Calcium Channel Blockers
D. Loop Diuretics
Answer: B
Conceptual Explanation: The ACE inhibitor cough is caused by the accumulation of
bradykinin. ARBs do not inhibit the breakdown of bradykinin and are therefore the
preferred alternative for patients who cannot tolerate ACE inhibitors.
5. Which laboratory value is most critical to monitor in a patient receiving long-term
Amiodarone therapy for cardiac arrhythmias?
A. Urinary microalbumin
B. Serum Amylase
C. Hemoglobin A1c
D. Thyroid Stimulating Hormone (TSH)
Answer: D
