NR566 ADVANCED PHARMACOLOGY
MIDTERM EXAM (LATEST 2026/ 2027
UPDATE) QUESTIONS AND 100%
CORRECT VERIFIED ANSWERS| GRADE
A+
1. A patient with a history of heart failure and a reduced ejection fraction (HFrEF) is being
started on a medication that inhibits the enzyme neprilysin. Which of the following
statements is true regarding this medication?
A. It should be administered concurrently with an ACE inhibitor for maximum efficacy.
B. A 36-hour washout period is required when switching from an ACE inhibitor to this
drug.
C. It increases the degradation of natriuretic peptides.
D. It is contraindicated in patients with a history of angioedema related to ARBs only.
Answer: B
Conceptual Explanation: Sacubitril/valsartan (Entresto) requires a 36-hour washout
period when switching from an ACE inhibitor to reduce the risk of angioedema. Neprilysin
inhibition increases levels of natriuretic peptides.
,2. When prescribing Amiodarone, the clinician must be aware of its unique pharmacokinetic
profile. Which of the following is a characteristic of this drug?
A. It has a short half-life of approximately 12 to 24 hours.
B. It is primarily excreted via the kidneys and requires dose adjustment for GFR < 30.
C. It has an exceptionally long half-life, often lasting several weeks to months.
D. It does not interact with the CYP450 system.
Answer: C
Conceptual Explanation: Amiodarone has a very long half-life (average 58 days, ranging
from 15-142 days) due to its high lipid solubility and accumulation in tissues.
3. A 65-year-old male is prescribed Warfarin for atrial fibrillation. He is now starting a course
of Sulfamethoxazole/Trimethoprim for a UTI. What is the expected interaction?
A. The INR will decrease, increasing the risk of thrombosis.
B. The INR will increase, increasing the risk of bleeding.
C. Sulfamethoxazole inhibits the metabolism of Warfarin via CYP3A4 only.
D. There is no clinically significant interaction between these drugs.
Answer: B
Conceptual Explanation: Bactrim (Sulfamethoxazole/Trimethoprim) inhibits the
metabolism of S-warfarin (the more potent isomer) via CYP2C9, leading to a significant
increase in INR and bleeding risk.
, 4. Which of the following describes the mechanism of action of Sodium-Glucose
Cotransporter 2 (SGLT2) inhibitors?
A. Stimulating insulin release from pancreatic beta cells.
B. Reducing glucose reabsorption in the proximal renal tubule.
C. Decreasing hepatic glucose production.
D. Slowing gastric emptying and increasing satiety.
Answer: B
Conceptual Explanation: SGLT2 inhibitors like canagliflozin work in the proximal tubules
of the kidneys to block the reabsorption of glucose, leading to glucosuria.
5. A patient with Type 2 Diabetes has a baseline GFR of 28 mL/min/1.73m2. Which of the
following is the most appropriate action regarding Metformin?
A. Continue current dose but monitor GFR every 3 months.
B. Discontinue Metformin as it is contraindicated for GFR < 30.
C. Reduce the dose by 50%.
D. Metformin is safe as long as the patient is not in acute renal failure.
Answer: B
Conceptual Explanation: Metformin is contraindicated in patients with an eGFR below 30
mL/min/1.73m2 due to the high risk of lactic acidosis.
MIDTERM EXAM (LATEST 2026/ 2027
UPDATE) QUESTIONS AND 100%
CORRECT VERIFIED ANSWERS| GRADE
A+
1. A patient with a history of heart failure and a reduced ejection fraction (HFrEF) is being
started on a medication that inhibits the enzyme neprilysin. Which of the following
statements is true regarding this medication?
A. It should be administered concurrently with an ACE inhibitor for maximum efficacy.
B. A 36-hour washout period is required when switching from an ACE inhibitor to this
drug.
C. It increases the degradation of natriuretic peptides.
D. It is contraindicated in patients with a history of angioedema related to ARBs only.
Answer: B
Conceptual Explanation: Sacubitril/valsartan (Entresto) requires a 36-hour washout
period when switching from an ACE inhibitor to reduce the risk of angioedema. Neprilysin
inhibition increases levels of natriuretic peptides.
,2. When prescribing Amiodarone, the clinician must be aware of its unique pharmacokinetic
profile. Which of the following is a characteristic of this drug?
A. It has a short half-life of approximately 12 to 24 hours.
B. It is primarily excreted via the kidneys and requires dose adjustment for GFR < 30.
C. It has an exceptionally long half-life, often lasting several weeks to months.
D. It does not interact with the CYP450 system.
Answer: C
Conceptual Explanation: Amiodarone has a very long half-life (average 58 days, ranging
from 15-142 days) due to its high lipid solubility and accumulation in tissues.
3. A 65-year-old male is prescribed Warfarin for atrial fibrillation. He is now starting a course
of Sulfamethoxazole/Trimethoprim for a UTI. What is the expected interaction?
A. The INR will decrease, increasing the risk of thrombosis.
B. The INR will increase, increasing the risk of bleeding.
C. Sulfamethoxazole inhibits the metabolism of Warfarin via CYP3A4 only.
D. There is no clinically significant interaction between these drugs.
Answer: B
Conceptual Explanation: Bactrim (Sulfamethoxazole/Trimethoprim) inhibits the
metabolism of S-warfarin (the more potent isomer) via CYP2C9, leading to a significant
increase in INR and bleeding risk.
, 4. Which of the following describes the mechanism of action of Sodium-Glucose
Cotransporter 2 (SGLT2) inhibitors?
A. Stimulating insulin release from pancreatic beta cells.
B. Reducing glucose reabsorption in the proximal renal tubule.
C. Decreasing hepatic glucose production.
D. Slowing gastric emptying and increasing satiety.
Answer: B
Conceptual Explanation: SGLT2 inhibitors like canagliflozin work in the proximal tubules
of the kidneys to block the reabsorption of glucose, leading to glucosuria.
5. A patient with Type 2 Diabetes has a baseline GFR of 28 mL/min/1.73m2. Which of the
following is the most appropriate action regarding Metformin?
A. Continue current dose but monitor GFR every 3 months.
B. Discontinue Metformin as it is contraindicated for GFR < 30.
C. Reduce the dose by 50%.
D. Metformin is safe as long as the patient is not in acute renal failure.
Answer: B
Conceptual Explanation: Metformin is contraindicated in patients with an eGFR below 30
mL/min/1.73m2 due to the high risk of lactic acidosis.
