,Herzing NU 636 Quiz 4 | Advanced
Pharmacology (2026) Q&A
1. A 52-year-old male with a family history of cardiac disease reports intermittent
chest pain. He was started on synthetic T4 (Synthroid) 112.5 mcg three weeks ago for
a TSH of 7.2. His BP is 142/86 and his resting heart rate is 128. What is the most
appropriate next step?
A) Order a stress test because of his family history
B) Discontinue Synthroid as chest pain is an adverse event
C) Make no changes to the Synthroid dose, but order a TSH and an EKG
D) Decrease the Synthroid dose and order a TSH and an EKG
Correct Answer: D) Decrease the Synthroid dose and order a TSH and an EKG
Rationale: The patient exhibits signs of hyperthyroidism (tachycardia, hypertension,
chest pain) after starting Synthroid, indicating the dose is likely too high. Decreasing
the dose and ordering a TSH and EKG is the appropriate management. Discontinuing
the medication outright is not appropriate for lifelong replacement therapy.
2. A patient with type 2 diabetes has a HgbA1C of 6.7% while on metformin
(Glucophage) 1000 mg BID. According to current standards, what intervention is
anticipated?
A) Add a sulfonylurea drug like Diabenese
B) Decrease Glucophage to 500 mg BID
C) Make no change in the Glucophage dose
D) Add a GLP-1 receptor agonist
Correct Answer: C) Make no change in the Glucophage dose
,Rationale: An A1C of 6.7% is within the target range for many patients with diabetes,
indicating that the current regimen of metformin is effective. Therefore, no change in
the metformin dose is necessary. Adding another agent or decreasing the dose
would be inappropriate.
3. An obese female patient with an HgbA1C of 12.1% reports she cannot commit to a
nutritional lifestyle. According to ADA standards of care, which medication should be
included in the treatment plan?
A) Rosiglitazone (Avandia)
B) Glipizide (Glucotrol)
C) Acarbose (Precose)
D) Metformin (Glucophage)
Correct Answer: D) Metformin (Glucophage)
Rationale: Metformin is the first-line pharmacologic agent for type 2 diabetes
according to ADA standards. It works by inhibiting hepatic glucose production and
improving insulin sensitivity.
4. What is the primary mechanism of action of metformin (Glucophage)?
A) Increases insulin secretion from pancreatic beta cells
B) Slows carbohydrate absorption in the intestine
C) Increases glucose excretion in urine
D) Decreases hepatic glucose production and improves insulin sensitivity
Correct Answer: D) Decreases hepatic glucose production and improves insulin
sensitivity
, Rationale: Metformin's primary action is to decrease hepatic glucose production
(gluconeogenesis) and improve peripheral insulin sensitivity. It does not increase
insulin secretion, which is why it does not typically cause hypoglycemia when used as
monotherapy.
5. A 73-year-old patient has been on thyroid hormone replacement therapy
(Synthroid) since age 19 after a partial thyroidectomy. Chronic treatment with thyroid
hormone can lead to the development of which condition?
A) Insomnia
B) Sweating
C) Tachycardia
D) Osteoporosis
Correct Answer: D) Osteoporosis
Rationale: Chronic treatment with excessive thyroid hormone can result in
hyperthyroidism, which increases the risk of osteoporosis and arrhythmias. While
tachycardia, insomnia, and sweating are symptoms of excess thyroid hormone,
osteoporosis is a significant long-term consequence of chronic overtreatment.
6. A 93-year-old female on 88 mcg of Synthroid daily for hypothyroidism has
numerous potential drug interactions. Which of the following medications can
significantly decrease the absorption of levothyroxine?
A) Metformin
B) Lisinopril
C) Calcium carbonate
D) Furosemide
Correct Answer: C) Calcium carbonate
Pharmacology (2026) Q&A
1. A 52-year-old male with a family history of cardiac disease reports intermittent
chest pain. He was started on synthetic T4 (Synthroid) 112.5 mcg three weeks ago for
a TSH of 7.2. His BP is 142/86 and his resting heart rate is 128. What is the most
appropriate next step?
A) Order a stress test because of his family history
B) Discontinue Synthroid as chest pain is an adverse event
C) Make no changes to the Synthroid dose, but order a TSH and an EKG
D) Decrease the Synthroid dose and order a TSH and an EKG
Correct Answer: D) Decrease the Synthroid dose and order a TSH and an EKG
Rationale: The patient exhibits signs of hyperthyroidism (tachycardia, hypertension,
chest pain) after starting Synthroid, indicating the dose is likely too high. Decreasing
the dose and ordering a TSH and EKG is the appropriate management. Discontinuing
the medication outright is not appropriate for lifelong replacement therapy.
2. A patient with type 2 diabetes has a HgbA1C of 6.7% while on metformin
(Glucophage) 1000 mg BID. According to current standards, what intervention is
anticipated?
A) Add a sulfonylurea drug like Diabenese
B) Decrease Glucophage to 500 mg BID
C) Make no change in the Glucophage dose
D) Add a GLP-1 receptor agonist
Correct Answer: C) Make no change in the Glucophage dose
,Rationale: An A1C of 6.7% is within the target range for many patients with diabetes,
indicating that the current regimen of metformin is effective. Therefore, no change in
the metformin dose is necessary. Adding another agent or decreasing the dose
would be inappropriate.
3. An obese female patient with an HgbA1C of 12.1% reports she cannot commit to a
nutritional lifestyle. According to ADA standards of care, which medication should be
included in the treatment plan?
A) Rosiglitazone (Avandia)
B) Glipizide (Glucotrol)
C) Acarbose (Precose)
D) Metformin (Glucophage)
Correct Answer: D) Metformin (Glucophage)
Rationale: Metformin is the first-line pharmacologic agent for type 2 diabetes
according to ADA standards. It works by inhibiting hepatic glucose production and
improving insulin sensitivity.
4. What is the primary mechanism of action of metformin (Glucophage)?
A) Increases insulin secretion from pancreatic beta cells
B) Slows carbohydrate absorption in the intestine
C) Increases glucose excretion in urine
D) Decreases hepatic glucose production and improves insulin sensitivity
Correct Answer: D) Decreases hepatic glucose production and improves insulin
sensitivity
, Rationale: Metformin's primary action is to decrease hepatic glucose production
(gluconeogenesis) and improve peripheral insulin sensitivity. It does not increase
insulin secretion, which is why it does not typically cause hypoglycemia when used as
monotherapy.
5. A 73-year-old patient has been on thyroid hormone replacement therapy
(Synthroid) since age 19 after a partial thyroidectomy. Chronic treatment with thyroid
hormone can lead to the development of which condition?
A) Insomnia
B) Sweating
C) Tachycardia
D) Osteoporosis
Correct Answer: D) Osteoporosis
Rationale: Chronic treatment with excessive thyroid hormone can result in
hyperthyroidism, which increases the risk of osteoporosis and arrhythmias. While
tachycardia, insomnia, and sweating are symptoms of excess thyroid hormone,
osteoporosis is a significant long-term consequence of chronic overtreatment.
6. A 93-year-old female on 88 mcg of Synthroid daily for hypothyroidism has
numerous potential drug interactions. Which of the following medications can
significantly decrease the absorption of levothyroxine?
A) Metformin
B) Lisinopril
C) Calcium carbonate
D) Furosemide
Correct Answer: C) Calcium carbonate
