Advanced Pharmacology NSG 533 Exam
Questions with Correct Answers 2025
EP is a 38-year-
old female patient that comes in for diabetes education and management. She was diagnosed 12 year
s ago and states lately she is not able to control her diet although she continues a 1600 calorie diet wi
th 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 - CORRECT 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 wo
rse by this drug. The package insert does not 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 s
ide 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 w
ould 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 r
isk for developing diabetes) 5 years before the diagnosis and has a strong family history of type 2 diab
etes. JR's blood pressure was 150/92 mm Hg. His laboratory results revealed an A1C of 8.1%, normal c
holesterol 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) Pancreatiti
s (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 Heig
ht: 5 ′ 6 ″ BMI: 43.1 kg/m 2
Despite improvements in the past six weeks due to lifestyle changes and exercise, drug therapy is to b
e started for JR's diabet - CORRECT 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 t
he renal status of patients commencing metformin therapy to limit the risk of lactic acidosis (JR is with
out 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 co
uld 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 associat
ed 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 wit
h weight gain, negative effects on lipids and increased risk of fracture. Until recently, TZDs have also b
een linked to increased CV events and use has fallen out of favor
, Sulfonylureas Lprovide Lexcellent LA1C Llowering, Lbut Lare Lalso Lassociated Lwith Lweight Lgain. LThey
Lalso Lhave Lthe L potential Lto L cause L hypoglycemia, L so L patient L education L is L crucial. L Because L of
Lhis L allergies L to L "sulfa"
, L use L would L be L contr
A Lpatient Lwith Ltype L1 Ldiabetes Lreports Ltaking Lpropranolol Lfor Lhypertension. LWhat Lconcern Ldoes
Lthis Linf Lormation Lpresent Lfor Lthe Lprovider? L- LCORRECT LANSWER L-
A Lpatient Lwith LType L1 LDM Lis Linsulin Ldependent Lfor Lglucose Lcontrol Land Lat Lhigh Lrisk Lfor
Lhypoglycemic Lep Lisodes. LPropanolol Lcauses Lprolonged Lhypoglycemic Lepisodes. LNeeds Lto Lswitch
Lto LACE Lor LARB.
A Lprovider Lteaches La Lpatient Lwho Lhas Lbeen Ldiagnosed Lwith Lhypothyroidism Labout La Lnew
Lprescription Lf Lor Llevothyroxine. LWhich Lstatement Lby Lthe Lpatient Lindicates La Lneed Lfor Lfurther
Lteaching?
a. "I L should L not L take L heartburn L medication L without L consulting Lmy L provider L first."
b. "I L should L report L insomnia, L tremors, L and L an L increased L heart L rate L to L my L provider."
c. "If L I L take L a L multivitamin L with L iron, L I L should L take L it L 4 L hours L after L the L levothyroxine."
d. "If LI Ltake Lcalcium Lsupplements, LI Lmay Lneed Lto Ldecrease Lmy Ldose Lof
Llevothyroxine." L- LCORRECT LANSWER L-
D. LCalcium Lmay Lreduce Llevothyroxine Labsorption. LFurther Leducation Lis Lneeded Lif Lthe Lpatient
Lfeels Lshe Lc Lan Ltake Lhalf Lof La Lprescribed Lmedication.
MC Lhas Lundiagnosed Lmultiple Lgastric Lulcers. LShortly Lafter Lconsuming La Llarge Lmeal Land Lalcohol
Lhe Lexpe Lriences Lsignificant LGI Ldistress. LHe Ltakes Lan LOTC Lheartburn Lremedy. LWithin La Lminute Lor
Ltwo Lhe Ldevelops Lwhat L he L will L later L describe L as L "belching, L nausea L and L a L bad L bloated
L feeling". L Several L of L the L ulcers L bega Ln Lto Lbleed Land Lhe Lbecomes Lprofoundly Lhypotensive Lfrom
Lthe Lblood Lloss Land Lis Ltaken Lto Lthe LED. LEndos Lcopy Lconfirms Lmultiple Lbleeds; Lthe Lendoscopist
Lremarks Lthat Lit Lappears Las Lif Lthe Llesions Lhad Lbeen Lliter Lally Lstretched Lapart Lcausing Ladditional
Ltissue Ldamage. LWhat Ldid Lthe Lpatient Lmost Llikely Ltake L(i.e. Lwhat Lwas Lthe LOTC Lremedy)? L-
LCORRECT LANSWER L-I Lwould Laccept LAlka-
Selzer. LI Lcontains LNaHCO3 L(as Lwell Las LASA). LIn Lthe Lpresence Lof LHCL Lit LLiberates LCO2, Lthat Lcan
Lcause Lgas Ltric Ldistention, Lbelching Land Lnausea. LThe Lreaction Lis Lfairly Lswift Lallowing Llittle Ltime
Lfor Ldissipation. LTum L s, Lits Lprimary Lingredient Lcalcium Lcarbonate Lwhich Lwhen Ltaken Lcause La
Lreaction Lwith Lthe Lstomach Lacid Lsuch Las Lproduction Lof Lcarbon Ldioxide Lgas Lwhich Lcan Lcause
Lbloating Land Lthe Lstomach Lto Lstretch Lto Ltear Lthe Lulcers Lopen.
On Lyour Lway Lto Lthis Lexamination, Lyou Lexperience Lthe Lvulnerable Lfeeling Lthat Lan Lattack Lof
Lacute Ldiarrhe L a Lis Limminent! LIf Lyou Lstop Lat La Ldrug Lstore, Lwhich Lanti-
diarrheal Ldrugs Lcould Lyou Lbuy Lwithout La Lprescription Leven Lthough Lit Lis Lchemically Lrelated Lto Lthe
Lstrong Lopioid Lanalgesic Lmeperidine L(but Lacts Lonly Lon Lthe Lperipheral Lopioid Lreceptor)? L-
LCORRECT LANSWER L- LLoperamide
Questions with Correct Answers 2025
EP is a 38-year-
old female patient that comes in for diabetes education and management. She was diagnosed 12 year
s ago and states lately she is not able to control her diet although she continues a 1600 calorie diet wi
th 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 - CORRECT 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 wo
rse by this drug. The package insert does not 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 s
ide 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 w
ould 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 r
isk for developing diabetes) 5 years before the diagnosis and has a strong family history of type 2 diab
etes. JR's blood pressure was 150/92 mm Hg. His laboratory results revealed an A1C of 8.1%, normal c
holesterol 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) Pancreatiti
s (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 Heig
ht: 5 ′ 6 ″ BMI: 43.1 kg/m 2
Despite improvements in the past six weeks due to lifestyle changes and exercise, drug therapy is to b
e started for JR's diabet - CORRECT 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 t
he renal status of patients commencing metformin therapy to limit the risk of lactic acidosis (JR is with
out 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 co
uld 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 associat
ed 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 wit
h weight gain, negative effects on lipids and increased risk of fracture. Until recently, TZDs have also b
een linked to increased CV events and use has fallen out of favor
, Sulfonylureas Lprovide Lexcellent LA1C Llowering, Lbut Lare Lalso Lassociated Lwith Lweight Lgain. LThey
Lalso Lhave Lthe L potential Lto L cause L hypoglycemia, L so L patient L education L is L crucial. L Because L of
Lhis L allergies L to L "sulfa"
, L use L would L be L contr
A Lpatient Lwith Ltype L1 Ldiabetes Lreports Ltaking Lpropranolol Lfor Lhypertension. LWhat Lconcern Ldoes
Lthis Linf Lormation Lpresent Lfor Lthe Lprovider? L- LCORRECT LANSWER L-
A Lpatient Lwith LType L1 LDM Lis Linsulin Ldependent Lfor Lglucose Lcontrol Land Lat Lhigh Lrisk Lfor
Lhypoglycemic Lep Lisodes. LPropanolol Lcauses Lprolonged Lhypoglycemic Lepisodes. LNeeds Lto Lswitch
Lto LACE Lor LARB.
A Lprovider Lteaches La Lpatient Lwho Lhas Lbeen Ldiagnosed Lwith Lhypothyroidism Labout La Lnew
Lprescription Lf Lor Llevothyroxine. LWhich Lstatement Lby Lthe Lpatient Lindicates La Lneed Lfor Lfurther
Lteaching?
a. "I L should L not L take L heartburn L medication L without L consulting Lmy L provider L first."
b. "I L should L report L insomnia, L tremors, L and L an L increased L heart L rate L to L my L provider."
c. "If L I L take L a L multivitamin L with L iron, L I L should L take L it L 4 L hours L after L the L levothyroxine."
d. "If LI Ltake Lcalcium Lsupplements, LI Lmay Lneed Lto Ldecrease Lmy Ldose Lof
Llevothyroxine." L- LCORRECT LANSWER L-
D. LCalcium Lmay Lreduce Llevothyroxine Labsorption. LFurther Leducation Lis Lneeded Lif Lthe Lpatient
Lfeels Lshe Lc Lan Ltake Lhalf Lof La Lprescribed Lmedication.
MC Lhas Lundiagnosed Lmultiple Lgastric Lulcers. LShortly Lafter Lconsuming La Llarge Lmeal Land Lalcohol
Lhe Lexpe Lriences Lsignificant LGI Ldistress. LHe Ltakes Lan LOTC Lheartburn Lremedy. LWithin La Lminute Lor
Ltwo Lhe Ldevelops Lwhat L he L will L later L describe L as L "belching, L nausea L and L a L bad L bloated
L feeling". L Several L of L the L ulcers L bega Ln Lto Lbleed Land Lhe Lbecomes Lprofoundly Lhypotensive Lfrom
Lthe Lblood Lloss Land Lis Ltaken Lto Lthe LED. LEndos Lcopy Lconfirms Lmultiple Lbleeds; Lthe Lendoscopist
Lremarks Lthat Lit Lappears Las Lif Lthe Llesions Lhad Lbeen Lliter Lally Lstretched Lapart Lcausing Ladditional
Ltissue Ldamage. LWhat Ldid Lthe Lpatient Lmost Llikely Ltake L(i.e. Lwhat Lwas Lthe LOTC Lremedy)? L-
LCORRECT LANSWER L-I Lwould Laccept LAlka-
Selzer. LI Lcontains LNaHCO3 L(as Lwell Las LASA). LIn Lthe Lpresence Lof LHCL Lit LLiberates LCO2, Lthat Lcan
Lcause Lgas Ltric Ldistention, Lbelching Land Lnausea. LThe Lreaction Lis Lfairly Lswift Lallowing Llittle Ltime
Lfor Ldissipation. LTum L s, Lits Lprimary Lingredient Lcalcium Lcarbonate Lwhich Lwhen Ltaken Lcause La
Lreaction Lwith Lthe Lstomach Lacid Lsuch Las Lproduction Lof Lcarbon Ldioxide Lgas Lwhich Lcan Lcause
Lbloating Land Lthe Lstomach Lto Lstretch Lto Ltear Lthe Lulcers Lopen.
On Lyour Lway Lto Lthis Lexamination, Lyou Lexperience Lthe Lvulnerable Lfeeling Lthat Lan Lattack Lof
Lacute Ldiarrhe L a Lis Limminent! LIf Lyou Lstop Lat La Ldrug Lstore, Lwhich Lanti-
diarrheal Ldrugs Lcould Lyou Lbuy Lwithout La Lprescription Leven Lthough Lit Lis Lchemically Lrelated Lto Lthe
Lstrong Lopioid Lanalgesic Lmeperidine L(but Lacts Lonly Lon Lthe Lperipheral Lopioid Lreceptor)? L-
LCORRECT LANSWER L- LLoperamide
