Advanced Pharmacology NSG 533 Exam
2025 Questions and Answers
EP is a 38-year-old female patient that comes in for diabetes education and
management. She was diagnosed 12 years ago and states lately she is not able to control
her diet although she continues a 1600 calorie diet with appropriate daily carbohydrate
intake (per dietitian prescription) and walks 40 minutes every day of the week. She states
compliance with all medications. She denies any history of hypoglycemia despite being
able to identify signs and symptoms and describe appropriate treatment strategies.
PMH: T2DM, HTN, obesity, depression, s/p thyroidectomy due to thyroid cancer
FmHx: Noncontributory
SHx: (−) Smoking, alcohol use, past marijuana use while in high school
Medications: Metformin 850 mg tid, glipizide 20 mg bid, lisinopril 20 mg daily, sertraline
100 mg daily, multivitamin daily
Vitals: BP 128/82 mg Hg; P 72 beats/min; BMI 31 m/kg2
Laboratory test results: Na 134 mEq/L, K 5.4 mEq/L, Cl 106 mEq/L, BUN -
....ANSWER ...-Exenatide - Exenatide (Bydureon) once weekly has been able to
demonstrate weight loss and decrease A1C% by 0.7% to 1.2% in clinical trials; however it
is contraindicated for EP due to the self-reported history of thyroid cancer.
Dapagliflozin - Dapagliflozin (Farxiga) is contraindicated in this patient due to
hyperkalemia which could be made worse by this drug. The package insert does not
…FOR STUDENTS ONLY…©️2025 ALL RIGHTS RESERVED… 1
,indicate a specific potassium concentration cut off to no longer use this medication;
however, there are better choices in this patient.
Sitagliptin - Sitagliptin (Januvia) is able to obtain an A1C goal of less than 7% based on
clinical trials and currently the patient does not have any cautionary objective measures
to not use this medication. DPP-IV inhibitors are weight neutral. DPP-IV inhibitors can
be used in patients taking sulfonylureas; however, it may be recommended to reduce or
stop the sulfonylurea dose.
Acarbose - Acarbose (Precose) is not recommended for initial management and is
associated with significant GI side effects. More information would be needed regarding
fasting and post-prandial numbers. In addition, adding acarbose would only lower A1c
by 0.8% at best and therefore would not achieve the desired A1C goal of <7%
JR is a 68-year-old African American man with a new diagnosis of T2DM. He was
classified as having prediabetes (at risk for developing diabetes) 5 years before the
diagnosis and has a strong family history of type 2 diabetes. JR's blood pressure was
150/92 mm Hg. His laboratory results revealed an A1C of 8.1%, normal cholesterol panel,
and normal renal/hepatic function were noted with today's laboratory test results.
Past medical history: Hypertension (diagnosed 4 y ago) Hyperlipidemia (diagnosed 2 y
ago) Pancreatitis (idiopathic) (acute hospitalization 3 y ago)
Family history: Type 2 diabetes
Medication: HCTZ 25 mg daily, simvastatin 10 mg daily
Allergies: SMZ/TMP
Vitals: BP: 150/92 mm Hg P: 78 beats/min RR: 12 rpm Waist Circumference: 46 in
Weight: 267 lb Height: 5 ′ 6 ″ BMI: 43.1 kg/m 2
…FOR STUDENTS ONLY…©️2025 ALL RIGHTS RESERVED… 2
,Despite improvements in the past six weeks due to lifestyle changes and exercise, drug
therapy is to be started for JR's diabet - ....ANSWER ...-Metformin is the drug of
choice recommended for most patients with diabetes in addition to lifestyle
modifications assuming no contraindications or intolerabilities are present upon
evaluation. Metformin has also shown to provide positive weight neutral/loss effects in
obese patients. It is crucial to know the renal status of patients commencing metformin
therapy to limit the risk of lactic acidosis (JR is without contraindication).
Since his entry A1C is >7.5%, dual therapy is indicated. There are several potential
choices. The second step can be a dipeptidyl peptidase-4 inhibitor, it can be a glucagon-
like peptide-1 (GLP-1) receptor agonist, it can be a TZD, it can be a sulfonylurea agent,
it can be a SGLT2 inhibitor, or it could be basal insulin. Anything next can be tried
depending on what suits the circumstance
DPP4 inhibitors are weight neutral bet relatively benign side effect profile. Sitagliptin
has been associated with case reports of pancreatitis, so this specific agent should be
avoided. $$$
GLP-1 analog and has data to support an A1C reduction necessary to gain glycemic
control and may assist with weight loss goals for this patient. New information suggests
these agents may provide benefits in those with ASCVD. JR has a past history of
pancreatitis and GLP-1 analogs are not recommended due to this contraindication
TZDs have data to support an A1C reduction necessary to gain glycemic control, but are
associated with weight gain, negative effects on lipids and increased risk of fracture.
…FOR STUDENTS ONLY…©️2025 ALL RIGHTS RESERVED… 3
, Until recently, TZDs have also been linked to increased CV events and use has fallen out
of favor
Sulfonylureas provide excellent A1C lowering, but are also associated with weight gain.
They also have the potential to cause hypoglycemia, so patient education is crucial.
Because of his allergies to "sulfa", use would be contr
A patient with type 1 diabetes reports taking propranolol for hypertension. What concern
does this information present for the provider? - ....ANSWER ...-A patient with
Type 1 DM is insulin dependent for glucose control and at high risk for hypoglycemic
episodes. Propanolol causes prolonged hypoglycemic episodes. Needs to switch to ACE
or ARB.
A provider teaches a patient who has been diagnosed with hypothyroidism about a new
prescription for levothyroxine. Which statement by the patient indicates a need for
further teaching?
a. "I should not take heartburn medication without consulting my provider first."
b. "I should report insomnia, tremors, and an increased heart rate to my provider."
c. "If I take a multivitamin with iron, I should take it 4 hours after the levothyroxine."
d. "If I take calcium supplements, I may need to decrease my dose of levothyroxine." -
....ANSWER ...-D. Calcium may reduce levothyroxine absorption. Further
education is needed if the patient feels she can take half of a prescribed medication.
MC has undiagnosed multiple gastric ulcers. Shortly after consuming a large meal and
alcohol he experiences significant GI distress. He takes an OTC heartburn remedy.
Within a minute or two he develops what he will later describe as "belching, nausea and
a bad bloated feeling". Several of the ulcers began to bleed and he becomes profoundly
…FOR STUDENTS ONLY…©️2025 ALL RIGHTS RESERVED… 4
2025 Questions and Answers
EP is a 38-year-old female patient that comes in for diabetes education and
management. She was diagnosed 12 years ago and states lately she is not able to control
her diet although she continues a 1600 calorie diet with appropriate daily carbohydrate
intake (per dietitian prescription) and walks 40 minutes every day of the week. She states
compliance with all medications. She denies any history of hypoglycemia despite being
able to identify signs and symptoms and describe appropriate treatment strategies.
PMH: T2DM, HTN, obesity, depression, s/p thyroidectomy due to thyroid cancer
FmHx: Noncontributory
SHx: (−) Smoking, alcohol use, past marijuana use while in high school
Medications: Metformin 850 mg tid, glipizide 20 mg bid, lisinopril 20 mg daily, sertraline
100 mg daily, multivitamin daily
Vitals: BP 128/82 mg Hg; P 72 beats/min; BMI 31 m/kg2
Laboratory test results: Na 134 mEq/L, K 5.4 mEq/L, Cl 106 mEq/L, BUN -
....ANSWER ...-Exenatide - Exenatide (Bydureon) once weekly has been able to
demonstrate weight loss and decrease A1C% by 0.7% to 1.2% in clinical trials; however it
is contraindicated for EP due to the self-reported history of thyroid cancer.
Dapagliflozin - Dapagliflozin (Farxiga) is contraindicated in this patient due to
hyperkalemia which could be made worse by this drug. The package insert does not
…FOR STUDENTS ONLY…©️2025 ALL RIGHTS RESERVED… 1
,indicate a specific potassium concentration cut off to no longer use this medication;
however, there are better choices in this patient.
Sitagliptin - Sitagliptin (Januvia) is able to obtain an A1C goal of less than 7% based on
clinical trials and currently the patient does not have any cautionary objective measures
to not use this medication. DPP-IV inhibitors are weight neutral. DPP-IV inhibitors can
be used in patients taking sulfonylureas; however, it may be recommended to reduce or
stop the sulfonylurea dose.
Acarbose - Acarbose (Precose) is not recommended for initial management and is
associated with significant GI side effects. More information would be needed regarding
fasting and post-prandial numbers. In addition, adding acarbose would only lower A1c
by 0.8% at best and therefore would not achieve the desired A1C goal of <7%
JR is a 68-year-old African American man with a new diagnosis of T2DM. He was
classified as having prediabetes (at risk for developing diabetes) 5 years before the
diagnosis and has a strong family history of type 2 diabetes. JR's blood pressure was
150/92 mm Hg. His laboratory results revealed an A1C of 8.1%, normal cholesterol panel,
and normal renal/hepatic function were noted with today's laboratory test results.
Past medical history: Hypertension (diagnosed 4 y ago) Hyperlipidemia (diagnosed 2 y
ago) Pancreatitis (idiopathic) (acute hospitalization 3 y ago)
Family history: Type 2 diabetes
Medication: HCTZ 25 mg daily, simvastatin 10 mg daily
Allergies: SMZ/TMP
Vitals: BP: 150/92 mm Hg P: 78 beats/min RR: 12 rpm Waist Circumference: 46 in
Weight: 267 lb Height: 5 ′ 6 ″ BMI: 43.1 kg/m 2
…FOR STUDENTS ONLY…©️2025 ALL RIGHTS RESERVED… 2
,Despite improvements in the past six weeks due to lifestyle changes and exercise, drug
therapy is to be started for JR's diabet - ....ANSWER ...-Metformin is the drug of
choice recommended for most patients with diabetes in addition to lifestyle
modifications assuming no contraindications or intolerabilities are present upon
evaluation. Metformin has also shown to provide positive weight neutral/loss effects in
obese patients. It is crucial to know the renal status of patients commencing metformin
therapy to limit the risk of lactic acidosis (JR is without contraindication).
Since his entry A1C is >7.5%, dual therapy is indicated. There are several potential
choices. The second step can be a dipeptidyl peptidase-4 inhibitor, it can be a glucagon-
like peptide-1 (GLP-1) receptor agonist, it can be a TZD, it can be a sulfonylurea agent,
it can be a SGLT2 inhibitor, or it could be basal insulin. Anything next can be tried
depending on what suits the circumstance
DPP4 inhibitors are weight neutral bet relatively benign side effect profile. Sitagliptin
has been associated with case reports of pancreatitis, so this specific agent should be
avoided. $$$
GLP-1 analog and has data to support an A1C reduction necessary to gain glycemic
control and may assist with weight loss goals for this patient. New information suggests
these agents may provide benefits in those with ASCVD. JR has a past history of
pancreatitis and GLP-1 analogs are not recommended due to this contraindication
TZDs have data to support an A1C reduction necessary to gain glycemic control, but are
associated with weight gain, negative effects on lipids and increased risk of fracture.
…FOR STUDENTS ONLY…©️2025 ALL RIGHTS RESERVED… 3
, Until recently, TZDs have also been linked to increased CV events and use has fallen out
of favor
Sulfonylureas provide excellent A1C lowering, but are also associated with weight gain.
They also have the potential to cause hypoglycemia, so patient education is crucial.
Because of his allergies to "sulfa", use would be contr
A patient with type 1 diabetes reports taking propranolol for hypertension. What concern
does this information present for the provider? - ....ANSWER ...-A patient with
Type 1 DM is insulin dependent for glucose control and at high risk for hypoglycemic
episodes. Propanolol causes prolonged hypoglycemic episodes. Needs to switch to ACE
or ARB.
A provider teaches a patient who has been diagnosed with hypothyroidism about a new
prescription for levothyroxine. Which statement by the patient indicates a need for
further teaching?
a. "I should not take heartburn medication without consulting my provider first."
b. "I should report insomnia, tremors, and an increased heart rate to my provider."
c. "If I take a multivitamin with iron, I should take it 4 hours after the levothyroxine."
d. "If I take calcium supplements, I may need to decrease my dose of levothyroxine." -
....ANSWER ...-D. Calcium may reduce levothyroxine absorption. Further
education is needed if the patient feels she can take half of a prescribed medication.
MC has undiagnosed multiple gastric ulcers. Shortly after consuming a large meal and
alcohol he experiences significant GI distress. He takes an OTC heartburn remedy.
Within a minute or two he develops what he will later describe as "belching, nausea and
a bad bloated feeling". Several of the ulcers began to bleed and he becomes profoundly
…FOR STUDENTS ONLY…©️2025 ALL RIGHTS RESERVED… 4
