NR566 – Advanced Pharmacology for Care
of the Family
2025 Practice Mid-Term Exam
Question 1
A 34-year-old G2P1 at 18 weeks’ gestation presents with symptomatic UTI. Urine culture grows
>10⁵ CFU/mL of Escherichia coli susceptible to nitrofurantoin, amoxicillin-clavulanate, and
trimethoprim-sulfamethoxazole. Her last menstrual period was irregular and first-trimester
ultrasound is pending. Which empiric agent is safest?
A. Trimethoprim-sulfamethoxazole PO × 3 days
B. Amoxicillin-clavulanate 875/125 mg PO BID × 5 days
C. Nitrofurantoin 100 mg PO BID × 5 days
D. Cephalexin 250 mg PO QID × 3 days
Correct Answer: C
Rationale: Nitrofurantoin is Category B, avoided only at term because of theoretical neonatal
hemolysis; use in 2nd trimester is endorsed by ACOG (C). TMP-SMX (A) is a folate antagonist
and contraindicated in 1st trimester until neural-tube status known. Amox-clav (B) increases
necrotizing enterocolitis risk in neonates when given near delivery, not relevant now but broader
spectrum than needed. Cephalexin (D) is safe but 3 days is subtherapeutic for pyelonephritis
prevention in pregnancy.
Question 2
A 58-year-old man with HFrEF (EF 30 %), type 2 diabetes, and stage 3 CKD (eGFR 38 mL/min)
is started on dapagliflozin 10 mg daily. Which monitoring parameter is most important at 2
weeks?
A. Serum creatinine and eGFR
B. Serum lactate
C. NT-proBNP
D. 24-hr urine free cortisol
Correct Answer: A
Rationale: SGLT2 inhibitors cause an initial 0.2–0.3 mg/dL creatinine rise; verify non-
progressive to acute kidney injury (A). Lactate (B) is monitored with metformin or epinephrine,
not SGLT2. NT-proBNP (C) useful at 12 weeks. Cortisol (D) unrelated.
,Question 3
A 17-year-old female with acne conglobata is prescribed oral isotretinoin. She weighs 58 kg.
Which iPLEDGE requirement must be met before the NP sends the prescription?
A. Two negative urine β-hCG tests ≥30 days apart
B. Two negative serum β-hCG tests ≥7 days apart
C. One negative urine β-hCG within 7 days of start
D. One negative serum β-hCG on day of start if amenorrheic
Correct Answer: B
Rationale: iPLEDGE mandates two serum β-hCG ≥7 days apart for females capable of
pregnancy (B). Urine (A,C) not accepted. Single test (D) insufficient.
Question 4
A 62-year-old woman with atrial fibrillation (CrCl 28 mL/min) is discharged on apixaban 5 mg
BID. Which adjustment is required?
A. Reduce to 2.5 mg BID
B. Reduce to 5 mg daily
C. Switch to rivaroxaban 15 mg daily
D. No change – appropriate dose
Correct Answer: A
Rationale: Apixaban 2.5 mg BID if ≥80 y OR ≤60 kg OR Scr ≥1.5 mg/dL; she meets two criteria
(A). 5 mg daily (B) under-doses. Rivaroxaban 15 mg (C) is for CrCl 15–29 but not preferred if
apixaban can be dose-reduced.
Question 5
A 9-year-old (32 kg) with community-acquired pneumonia needs amoxicillin high-dose (90
mg/kg/day) divided BID. What is the correct morning dose?
A. 750 mg
B. 900 mg
C. 1,000 mg
D. 1,200 mg
Correct Answer: D
Rationale: 32 kg × 90 mg = 2,880 mg/day → 1,440 mg BID; closest commercially available is
1,200 mg (two 600-mg chewables) (D). 1,000 mg (C) under-doses; 1,200 mg within 10 %
acceptable.
Question 6
A breastfeeding mother is started on sertraline 50 mg daily for post-partum depression. Which
counseling point is most accurate?
,A. “Pump and discard milk for the first 48 hours.”
B. “Paroxetine would have been safer.”
C. “Observe infant for sedation and poor feeding.”
D. “Sertraline is contraindicated during lactation.”
Correct Answer: C
Rationale: Sertraline has low milk transfer; monitor infant for SSRI effects (C). No need to pump
(A). Paroxetine (B) has more transfer and longer half-life. Not contraindicated (D).
Question 7
A 48-year-old man with genotype-3 hepatitis C, CrCl 45 mL/min, receives
glecaprevir/pibrentasvir × 8 weeks. Which baseline test is essential?
A. Hepatic ultrasound
B. HBV surface antigen
C. HBV DNA
D. Alpha-fetoprotein
Correct Answer: C
Rationale: DAA reactivation risk mandates HBV DNA (C). HBsAg (B) alone insufficient if
DNA negative. US (A) and AFP (D) for HCC screening, not mandatory pre-DAA.
Question 8
A 36-year-old woman with RRMS is planning pregnancy. Which disease-modifying drug should
be discontinued 2 months before conception?
A. Interferon β-1a
B. Glatiramer acetate
C. Fingolimod
D. Natalizumab
Correct Answer: C
Rationale: Fingolimod (S1P modulator) is Category C and teratogenic in animals; wash-out 2
months (C). Interferon (A) and glatiramer (B) can continue. Natalizumab (D) individual
decision.
Question 9
A 77-year-old man with insomnia is prescribed zolpidem 5 mg HS. He reports “sleep-walking”
to the kitchen nightly. Which is the best next step?
A. Increase dose to 10 mg with earlier administration
B. Switch to eszopiclone 2 mg
C. Taper zolpidem and initiate CBT-I
D. Add melatonin 10 mg
, Correct Answer: C
Rationale: Complex sleep behaviors are black-box warning for zolpidem; taper and use non-
pharmacologic CBT-I (C). Escalation (A) unsafe. Eszopiclone (B) same class. Melatonin (D)
adjunct only.
Question 10
A 24-year-old woman takes combined oral contraceptive (ethinyl estradiol 30 µg/drospirenone).
She is prescribed rifampin for latent TB. Which counseling is correct?
A. “Use backup contraception only during rifampin therapy.”
B. “Continue COC; rifampin does not affect efficacy.”
C. “Switch to progestin-only pill.”
D. “Use condoms for the entire rifampin course and for 4 weeks after.”
Correct Answer: D
Rationale: Rifampin induces CYP3A4 for ≥4 weeks after stop; backup needed throughout plus 4
weeks (D). A omits post-therapy. Progestin-only (C) also induced.
Question 11
A 42-year-old man with HIV (CD4 220, VL 85 000) starts bictegravir/emtricitabine/tenofovir
alafenamide. Which baseline lab is most important to document before the first dose?
A. Hepatitis B surface antigen
B. Serum lipase
C. Bone density scan
D. Lactate dehydrogenase
Correct Answer: A
Rationale: All integrase-STR products carry HBV reactivation/black-box warning; document
HBsAg (A). Lipase (B) only if symptomatic. TAF has less bone (C) and lactate (D) risk than
TDF.
Question 12
A 63-year-old woman with type 2 diabetes and heart failure (EF 45 %) is taking empagliflozin 10
mg daily. She reports a “yeast infection” every 6 weeks. Which change is most appropriate?
A. Add weekly fluconazole prophylaxis
B. Switch to semaglutide 1 mg weekly
C. Reduce empagliflozin to 5 mg daily
D. Counsel on perineal hygiene only
Correct Answer: B
Rationale: GLP-1 RA reduces MACE and weight without genital infections (B). Fluconazole (A)
fosters resistance. SGLT2 dose (C) not linked to infection rate. Hygiene (D) insufficient.
of the Family
2025 Practice Mid-Term Exam
Question 1
A 34-year-old G2P1 at 18 weeks’ gestation presents with symptomatic UTI. Urine culture grows
>10⁵ CFU/mL of Escherichia coli susceptible to nitrofurantoin, amoxicillin-clavulanate, and
trimethoprim-sulfamethoxazole. Her last menstrual period was irregular and first-trimester
ultrasound is pending. Which empiric agent is safest?
A. Trimethoprim-sulfamethoxazole PO × 3 days
B. Amoxicillin-clavulanate 875/125 mg PO BID × 5 days
C. Nitrofurantoin 100 mg PO BID × 5 days
D. Cephalexin 250 mg PO QID × 3 days
Correct Answer: C
Rationale: Nitrofurantoin is Category B, avoided only at term because of theoretical neonatal
hemolysis; use in 2nd trimester is endorsed by ACOG (C). TMP-SMX (A) is a folate antagonist
and contraindicated in 1st trimester until neural-tube status known. Amox-clav (B) increases
necrotizing enterocolitis risk in neonates when given near delivery, not relevant now but broader
spectrum than needed. Cephalexin (D) is safe but 3 days is subtherapeutic for pyelonephritis
prevention in pregnancy.
Question 2
A 58-year-old man with HFrEF (EF 30 %), type 2 diabetes, and stage 3 CKD (eGFR 38 mL/min)
is started on dapagliflozin 10 mg daily. Which monitoring parameter is most important at 2
weeks?
A. Serum creatinine and eGFR
B. Serum lactate
C. NT-proBNP
D. 24-hr urine free cortisol
Correct Answer: A
Rationale: SGLT2 inhibitors cause an initial 0.2–0.3 mg/dL creatinine rise; verify non-
progressive to acute kidney injury (A). Lactate (B) is monitored with metformin or epinephrine,
not SGLT2. NT-proBNP (C) useful at 12 weeks. Cortisol (D) unrelated.
,Question 3
A 17-year-old female with acne conglobata is prescribed oral isotretinoin. She weighs 58 kg.
Which iPLEDGE requirement must be met before the NP sends the prescription?
A. Two negative urine β-hCG tests ≥30 days apart
B. Two negative serum β-hCG tests ≥7 days apart
C. One negative urine β-hCG within 7 days of start
D. One negative serum β-hCG on day of start if amenorrheic
Correct Answer: B
Rationale: iPLEDGE mandates two serum β-hCG ≥7 days apart for females capable of
pregnancy (B). Urine (A,C) not accepted. Single test (D) insufficient.
Question 4
A 62-year-old woman with atrial fibrillation (CrCl 28 mL/min) is discharged on apixaban 5 mg
BID. Which adjustment is required?
A. Reduce to 2.5 mg BID
B. Reduce to 5 mg daily
C. Switch to rivaroxaban 15 mg daily
D. No change – appropriate dose
Correct Answer: A
Rationale: Apixaban 2.5 mg BID if ≥80 y OR ≤60 kg OR Scr ≥1.5 mg/dL; she meets two criteria
(A). 5 mg daily (B) under-doses. Rivaroxaban 15 mg (C) is for CrCl 15–29 but not preferred if
apixaban can be dose-reduced.
Question 5
A 9-year-old (32 kg) with community-acquired pneumonia needs amoxicillin high-dose (90
mg/kg/day) divided BID. What is the correct morning dose?
A. 750 mg
B. 900 mg
C. 1,000 mg
D. 1,200 mg
Correct Answer: D
Rationale: 32 kg × 90 mg = 2,880 mg/day → 1,440 mg BID; closest commercially available is
1,200 mg (two 600-mg chewables) (D). 1,000 mg (C) under-doses; 1,200 mg within 10 %
acceptable.
Question 6
A breastfeeding mother is started on sertraline 50 mg daily for post-partum depression. Which
counseling point is most accurate?
,A. “Pump and discard milk for the first 48 hours.”
B. “Paroxetine would have been safer.”
C. “Observe infant for sedation and poor feeding.”
D. “Sertraline is contraindicated during lactation.”
Correct Answer: C
Rationale: Sertraline has low milk transfer; monitor infant for SSRI effects (C). No need to pump
(A). Paroxetine (B) has more transfer and longer half-life. Not contraindicated (D).
Question 7
A 48-year-old man with genotype-3 hepatitis C, CrCl 45 mL/min, receives
glecaprevir/pibrentasvir × 8 weeks. Which baseline test is essential?
A. Hepatic ultrasound
B. HBV surface antigen
C. HBV DNA
D. Alpha-fetoprotein
Correct Answer: C
Rationale: DAA reactivation risk mandates HBV DNA (C). HBsAg (B) alone insufficient if
DNA negative. US (A) and AFP (D) for HCC screening, not mandatory pre-DAA.
Question 8
A 36-year-old woman with RRMS is planning pregnancy. Which disease-modifying drug should
be discontinued 2 months before conception?
A. Interferon β-1a
B. Glatiramer acetate
C. Fingolimod
D. Natalizumab
Correct Answer: C
Rationale: Fingolimod (S1P modulator) is Category C and teratogenic in animals; wash-out 2
months (C). Interferon (A) and glatiramer (B) can continue. Natalizumab (D) individual
decision.
Question 9
A 77-year-old man with insomnia is prescribed zolpidem 5 mg HS. He reports “sleep-walking”
to the kitchen nightly. Which is the best next step?
A. Increase dose to 10 mg with earlier administration
B. Switch to eszopiclone 2 mg
C. Taper zolpidem and initiate CBT-I
D. Add melatonin 10 mg
, Correct Answer: C
Rationale: Complex sleep behaviors are black-box warning for zolpidem; taper and use non-
pharmacologic CBT-I (C). Escalation (A) unsafe. Eszopiclone (B) same class. Melatonin (D)
adjunct only.
Question 10
A 24-year-old woman takes combined oral contraceptive (ethinyl estradiol 30 µg/drospirenone).
She is prescribed rifampin for latent TB. Which counseling is correct?
A. “Use backup contraception only during rifampin therapy.”
B. “Continue COC; rifampin does not affect efficacy.”
C. “Switch to progestin-only pill.”
D. “Use condoms for the entire rifampin course and for 4 weeks after.”
Correct Answer: D
Rationale: Rifampin induces CYP3A4 for ≥4 weeks after stop; backup needed throughout plus 4
weeks (D). A omits post-therapy. Progestin-only (C) also induced.
Question 11
A 42-year-old man with HIV (CD4 220, VL 85 000) starts bictegravir/emtricitabine/tenofovir
alafenamide. Which baseline lab is most important to document before the first dose?
A. Hepatitis B surface antigen
B. Serum lipase
C. Bone density scan
D. Lactate dehydrogenase
Correct Answer: A
Rationale: All integrase-STR products carry HBV reactivation/black-box warning; document
HBsAg (A). Lipase (B) only if symptomatic. TAF has less bone (C) and lactate (D) risk than
TDF.
Question 12
A 63-year-old woman with type 2 diabetes and heart failure (EF 45 %) is taking empagliflozin 10
mg daily. She reports a “yeast infection” every 6 weeks. Which change is most appropriate?
A. Add weekly fluconazole prophylaxis
B. Switch to semaglutide 1 mg weekly
C. Reduce empagliflozin to 5 mg daily
D. Counsel on perineal hygiene only
Correct Answer: B
Rationale: GLP-1 RA reduces MACE and weight without genital infections (B). Fluconazole (A)
fosters resistance. SGLT2 dose (C) not linked to infection rate. Hygiene (D) insufficient.
