NR566 ADVANCED PHARMACOLOGY
MIDTERM & FINAL EXAM PREP
QUESTIONS WITH 100% CORRECT
ANSWERS
1. A patient is diagnosed with Type 2 Diabetes and has an eGFR of 28 mL/min. Which of the
following is the most appropriate action regarding Metformin therapy?
A. Initiate Metformin at a reduced dose of 500mg daily.
B. Metformin is contraindicated and should not be used.
C. Continue Metformin but monitor renal function monthly.
D. Increase Metformin dose to improve glycemic control.
Answer: B
Conceptual Explanation: Metformin is contraindicated in patients with an eGFR below 30
mL/min due to the significantly increased risk of lactic acidosis.
2. Which mechanism explains why ACE inhibitors often cause a dry, persistent cough in
patients?
A. Inhibition of prostaglandin synthesis.
B. Accumulation of bradykinin in the lungs.
,C. Direct irritation of the bronchial mucosa.
D. Increased production of angiotensin II.
Answer: B
Conceptual Explanation: ACE inhibitors prevent the breakdown of bradykinin; its
accumulation in the respiratory tract leads to the characteristic dry cough.
3. A 65-year-old patient on Warfarin therapy for atrial fibrillation has an INR of 5.5 with no
active bleeding. What is the recommended management?
A. Hold Warfarin and monitor closely.
B. Administer 10mg of Vitamin K intravenously.
C. Increase the Warfarin dose to stabilize the INR.
D. Immediate blood transfusion.
Answer: A
Conceptual Explanation: For an INR between 4.5 and 10 without bleeding, the
recommendation is typically to hold Warfarin for one or two doses and monitor.
4. Which statin side effect requires immediate cessation of the drug and evaluation of
Creatine Kinase (CK) levels?
A. Constipation
B. Headache
C. Mild elevation in liver enzymes
, D. Unexplained muscle pain or weakness
Answer: D
Conceptual Explanation: Muscle pain/weakness can indicate rhabdomyolysis, a serious
side effect of statins that requires CK monitoring.
5. According to the Beers Criteria, why should diphenhydramine be avoided in the elderly?
A. Potent anticholinergic effects and risk of falls
B. Risk of hepatotoxicity
C. High risk of gastric ulcers
D. Risk of hypertension
Answer: A
Conceptual Explanation: Diphenhydramine has strong anticholinergic properties which
increase the risk of confusion, blurred vision, and falls in older adults.
6. Which antibiotic class is associated with an increased risk of tendon rupture, particularly in
older adults?
A. Penicillins
B. Tetracyclines
C. Macrolides
D. Fluoroquinolones
MIDTERM & FINAL EXAM PREP
QUESTIONS WITH 100% CORRECT
ANSWERS
1. A patient is diagnosed with Type 2 Diabetes and has an eGFR of 28 mL/min. Which of the
following is the most appropriate action regarding Metformin therapy?
A. Initiate Metformin at a reduced dose of 500mg daily.
B. Metformin is contraindicated and should not be used.
C. Continue Metformin but monitor renal function monthly.
D. Increase Metformin dose to improve glycemic control.
Answer: B
Conceptual Explanation: Metformin is contraindicated in patients with an eGFR below 30
mL/min due to the significantly increased risk of lactic acidosis.
2. Which mechanism explains why ACE inhibitors often cause a dry, persistent cough in
patients?
A. Inhibition of prostaglandin synthesis.
B. Accumulation of bradykinin in the lungs.
,C. Direct irritation of the bronchial mucosa.
D. Increased production of angiotensin II.
Answer: B
Conceptual Explanation: ACE inhibitors prevent the breakdown of bradykinin; its
accumulation in the respiratory tract leads to the characteristic dry cough.
3. A 65-year-old patient on Warfarin therapy for atrial fibrillation has an INR of 5.5 with no
active bleeding. What is the recommended management?
A. Hold Warfarin and monitor closely.
B. Administer 10mg of Vitamin K intravenously.
C. Increase the Warfarin dose to stabilize the INR.
D. Immediate blood transfusion.
Answer: A
Conceptual Explanation: For an INR between 4.5 and 10 without bleeding, the
recommendation is typically to hold Warfarin for one or two doses and monitor.
4. Which statin side effect requires immediate cessation of the drug and evaluation of
Creatine Kinase (CK) levels?
A. Constipation
B. Headache
C. Mild elevation in liver enzymes
, D. Unexplained muscle pain or weakness
Answer: D
Conceptual Explanation: Muscle pain/weakness can indicate rhabdomyolysis, a serious
side effect of statins that requires CK monitoring.
5. According to the Beers Criteria, why should diphenhydramine be avoided in the elderly?
A. Potent anticholinergic effects and risk of falls
B. Risk of hepatotoxicity
C. High risk of gastric ulcers
D. Risk of hypertension
Answer: A
Conceptual Explanation: Diphenhydramine has strong anticholinergic properties which
increase the risk of confusion, blurred vision, and falls in older adults.
6. Which antibiotic class is associated with an increased risk of tendon rupture, particularly in
older adults?
A. Penicillins
B. Tetracyclines
C. Macrolides
D. Fluoroquinolones
