NURS 711 ADVANCED
PHARMACOTHERAPIES
COMPREHENSIVE EXAM QUESTIONS &
VERIFIED ANSWERS | UNIVERSITY OF
SOUTH CAROLINA | GUARANTEE PASS
1. A patient stabilized on Warfarin (Coumadin) is prescribed Amiodarone for atrial fibrillation.
Which pharmacokinetic interaction is most likely to occur?
A. Amiodarone inhibits CYP2C9, leading to an increase in INR.
B. Amiodarone induces CYP2C9, leading to a decrease in INR.
C. Amiodarone displaces Warfarin from albumin, causing immediate toxicity.
D. There is no significant interaction between these two medications.
Answer: A
Conceptual Explanation: Amiodarone is a potent inhibitor of CYP2C9, the primary
enzyme responsible for the metabolism of the more active S-enantiomer of Warfarin, thus
increasing the risk of bleeding.
2. Which physiological mechanism accounts for the dry cough and angioedema associated
with ACE inhibitors?
A. Direct irritation of the bronchial mucosa by the drug molecule.
,B. Competitive inhibition of the AT1 receptor in the lungs.
C. Accumulation of bradykinin and substance P due to inhibition of kininase II.
D. Increased production of aldosterone causing pulmonary edema.
Answer: C
Conceptual Explanation: ACE (also known as kininase II) breaks down bradykinin.
Inhibition leads to bradykinin accumulation, which causes vasodilation, inflammation, and
coughing.
3. A 65-year-old patient with Type 2 Diabetes and a GFR of 28 mL/min is evaluated. Why is
Metformin contraindicated in this patient?
A. Metformin causes acute interstitial nephritis in elderly patients.
B. Potential for drug-induced nephrogenic diabetes insipidus.
C. High risk of hypoglycemic coma in renal impairment.
D. Increased risk of lactic acidosis due to reduced renal clearance.
Answer: D
Conceptual Explanation: Metformin is renally excreted; accumulation in patients with
GFR < 30 mL/min significantly increases the risk of life-threatening lactic acidosis.
4. Which electrolyte imbalance significantly increases the risk of Digoxin toxicity even if
serum digoxin levels are within therapeutic range?
A. Hypernatremia
, B. Hyperkalemia
C. Hypokalemia
D. Hypocalcemia
Answer: C
Conceptual Explanation: Digoxin competes with potassium for binding sites on the
Na+/K+ ATPase pump. Low potassium levels allow more digoxin to bind, enhancing its
effects and toxicity.
5. A patient on long-term Amiodarone therapy should be monitored for which of the
following multi-organ toxicities?
A. Ototoxicity and Peripheral Neuropathy
B. Nephrotic syndrome and Hypertension
C. Pulmonary fibrosis, Hypothyroidism, and Hepatotoxicity
D. Marrow suppression and Aplastic anemia
Answer: C
Conceptual Explanation: Amiodarone contains iodine and has a long half-life,
concentrating in lungs, liver, and thyroid, necessitating regular monitoring of PFTs, LFTs,
and TSH.
PHARMACOTHERAPIES
COMPREHENSIVE EXAM QUESTIONS &
VERIFIED ANSWERS | UNIVERSITY OF
SOUTH CAROLINA | GUARANTEE PASS
1. A patient stabilized on Warfarin (Coumadin) is prescribed Amiodarone for atrial fibrillation.
Which pharmacokinetic interaction is most likely to occur?
A. Amiodarone inhibits CYP2C9, leading to an increase in INR.
B. Amiodarone induces CYP2C9, leading to a decrease in INR.
C. Amiodarone displaces Warfarin from albumin, causing immediate toxicity.
D. There is no significant interaction between these two medications.
Answer: A
Conceptual Explanation: Amiodarone is a potent inhibitor of CYP2C9, the primary
enzyme responsible for the metabolism of the more active S-enantiomer of Warfarin, thus
increasing the risk of bleeding.
2. Which physiological mechanism accounts for the dry cough and angioedema associated
with ACE inhibitors?
A. Direct irritation of the bronchial mucosa by the drug molecule.
,B. Competitive inhibition of the AT1 receptor in the lungs.
C. Accumulation of bradykinin and substance P due to inhibition of kininase II.
D. Increased production of aldosterone causing pulmonary edema.
Answer: C
Conceptual Explanation: ACE (also known as kininase II) breaks down bradykinin.
Inhibition leads to bradykinin accumulation, which causes vasodilation, inflammation, and
coughing.
3. A 65-year-old patient with Type 2 Diabetes and a GFR of 28 mL/min is evaluated. Why is
Metformin contraindicated in this patient?
A. Metformin causes acute interstitial nephritis in elderly patients.
B. Potential for drug-induced nephrogenic diabetes insipidus.
C. High risk of hypoglycemic coma in renal impairment.
D. Increased risk of lactic acidosis due to reduced renal clearance.
Answer: D
Conceptual Explanation: Metformin is renally excreted; accumulation in patients with
GFR < 30 mL/min significantly increases the risk of life-threatening lactic acidosis.
4. Which electrolyte imbalance significantly increases the risk of Digoxin toxicity even if
serum digoxin levels are within therapeutic range?
A. Hypernatremia
, B. Hyperkalemia
C. Hypokalemia
D. Hypocalcemia
Answer: C
Conceptual Explanation: Digoxin competes with potassium for binding sites on the
Na+/K+ ATPase pump. Low potassium levels allow more digoxin to bind, enhancing its
effects and toxicity.
5. A patient on long-term Amiodarone therapy should be monitored for which of the
following multi-organ toxicities?
A. Ototoxicity and Peripheral Neuropathy
B. Nephrotic syndrome and Hypertension
C. Pulmonary fibrosis, Hypothyroidism, and Hepatotoxicity
D. Marrow suppression and Aplastic anemia
Answer: C
Conceptual Explanation: Amiodarone contains iodine and has a long half-life,
concentrating in lungs, liver, and thyroid, necessitating regular monitoring of PFTs, LFTs,
and TSH.
