NR565 Advanced Pharmacology Fundamentals
Week 8 Final Exam Actual Exam 2026/2027 |
Questions with Verified Answers | 100% Correct |
Pass Guaranteed
SECTION 1: Prescribing Principles & Safety (15 Questions)
Q1: A 28-year-old woman with well-controlled epilepsy on lamotrigine 200 mg BID
requests pre-conception counselling. She plans to conceive in 3 months. Which
recommendation is MOST appropriate?
A. Continue current dose and add folic acid 0.4 mg daily when pregnancy is confirmed.
B. Switch to levetiracetam 1 g BID and start folic acid 4 mg daily now.
C. Discontinue lamotrigine gradually over 4 weeks.
D. Maintain lamotrigine but increase dose by 50 % in the first trimester.
Correct Answer: B
Rationale:
● Step 1 – Guideline: AAN & ACOG recommend prepregnancy optimisation of
antiseizure therapy.
● Step 2 – Drug-specific risk: Lamotrigine clearance ↑ 30-50 % in pregnancy →
breakthrough seizures; also lower folate levels.
, ● Step 3 – Safer alternative: Levetiracetam has stable kinetics, favourable
pregnancy registry data, and no folate antagonism.
● Step 4 – Folate: High-dose 4 mg daily ≥1 month pre-conception ↓ neural-tube
defects (NTD).
● Monitoring: Check lamotrigine level at each trimester if continued; switch now
allows steady state before conception.
● Why others wrong: A = inadequate folate dose & late timing; C = seizure risk >
drug risk; D = empirical increase still leaves NTD risk.
Q2: Which medication carries an FDA Black-Box warning for increased suicidal ideation
in young adults?
A. Metoprolol
B. Lisinopril
C. Sertraline
D. Metformin
Correct Answer: C
Rationale: All SSRIs carry the warning; requires weekly face-to-face follow-up for first 4
weeks of therapy or dose changes.
Q3 (NGN Matrix – partial view): For each anticoagulant, identify if dose adjustment is
needed when CrCl <30 mL/min.
TableCopy
Drug Adjustment needed? (Yes/No)
, Rivaroxaban 20 mg daily Yes
Apixaban 5 mg BID Yes (↓ to 2.5 mg if ≥2 criteria)
Warfarin No (monitor INR)
Dabigatran 150 mg BID Yes (avoid if <30 mL/min)
Rationale: NOACs require renal dosing; warfarin is hepatically metabolised.
Q4: A 35-year-old man with HIV on ritonavir-boosted darunavir needs a statin. Which is
safest?
A. Simvastatin 40 mg
B. Rosuvastatin 20 mg
C. Atorvastatin 80 mg
D. Lovastatin 20 mg
Correct Answer: B
Rationale: Ritonavir potently inhibits CYP3A4 → ↑ levels of simvastatin, atorvastatin,
lovastatin → myopathy risk. Rosuvastatin is minimally metabolised via CYP enzymes →
preferred.
Q5: A 42-year-old woman is started on phenytoin for new-onset focal seizures. What
monitoring is required?
, A. CBC, LFTs, and phenytoin level at baseline and 2-4 weeks
B. Only therapeutic drug level after 1 week
C. Annual eye exam only
D. BMD scan every 6 months
Rationale: Black-box: blood dyscrasias, hepatotoxicity; level monitoring guides dose
(therapeutic 10-20 µg/mL).
Q6: When prescribing isotretinoin, which REMS component is mandatory?
A. Monthly pregnancy tests in iPLEDGE system
B. iPLEDGE registration and two forms of contraception
C. Liver biopsy before therapy
D. Psychiatric clearance
Rationale: iPLEDGE REMS requires two negative pregnancy tests before Rx, monthly
tests, and two contraception methods due to teratogenicity.
Q7: A 55-year-old on metformin 1000 mg BID develops eGFR 48 mL/min/1.73 m².
Metformin dose should:
A. Continue unchanged
B. Reduce to 1000 mg daily
C. Discontinue immediately
D. Switch to insulin
Week 8 Final Exam Actual Exam 2026/2027 |
Questions with Verified Answers | 100% Correct |
Pass Guaranteed
SECTION 1: Prescribing Principles & Safety (15 Questions)
Q1: A 28-year-old woman with well-controlled epilepsy on lamotrigine 200 mg BID
requests pre-conception counselling. She plans to conceive in 3 months. Which
recommendation is MOST appropriate?
A. Continue current dose and add folic acid 0.4 mg daily when pregnancy is confirmed.
B. Switch to levetiracetam 1 g BID and start folic acid 4 mg daily now.
C. Discontinue lamotrigine gradually over 4 weeks.
D. Maintain lamotrigine but increase dose by 50 % in the first trimester.
Correct Answer: B
Rationale:
● Step 1 – Guideline: AAN & ACOG recommend prepregnancy optimisation of
antiseizure therapy.
● Step 2 – Drug-specific risk: Lamotrigine clearance ↑ 30-50 % in pregnancy →
breakthrough seizures; also lower folate levels.
, ● Step 3 – Safer alternative: Levetiracetam has stable kinetics, favourable
pregnancy registry data, and no folate antagonism.
● Step 4 – Folate: High-dose 4 mg daily ≥1 month pre-conception ↓ neural-tube
defects (NTD).
● Monitoring: Check lamotrigine level at each trimester if continued; switch now
allows steady state before conception.
● Why others wrong: A = inadequate folate dose & late timing; C = seizure risk >
drug risk; D = empirical increase still leaves NTD risk.
Q2: Which medication carries an FDA Black-Box warning for increased suicidal ideation
in young adults?
A. Metoprolol
B. Lisinopril
C. Sertraline
D. Metformin
Correct Answer: C
Rationale: All SSRIs carry the warning; requires weekly face-to-face follow-up for first 4
weeks of therapy or dose changes.
Q3 (NGN Matrix – partial view): For each anticoagulant, identify if dose adjustment is
needed when CrCl <30 mL/min.
TableCopy
Drug Adjustment needed? (Yes/No)
, Rivaroxaban 20 mg daily Yes
Apixaban 5 mg BID Yes (↓ to 2.5 mg if ≥2 criteria)
Warfarin No (monitor INR)
Dabigatran 150 mg BID Yes (avoid if <30 mL/min)
Rationale: NOACs require renal dosing; warfarin is hepatically metabolised.
Q4: A 35-year-old man with HIV on ritonavir-boosted darunavir needs a statin. Which is
safest?
A. Simvastatin 40 mg
B. Rosuvastatin 20 mg
C. Atorvastatin 80 mg
D. Lovastatin 20 mg
Correct Answer: B
Rationale: Ritonavir potently inhibits CYP3A4 → ↑ levels of simvastatin, atorvastatin,
lovastatin → myopathy risk. Rosuvastatin is minimally metabolised via CYP enzymes →
preferred.
Q5: A 42-year-old woman is started on phenytoin for new-onset focal seizures. What
monitoring is required?
, A. CBC, LFTs, and phenytoin level at baseline and 2-4 weeks
B. Only therapeutic drug level after 1 week
C. Annual eye exam only
D. BMD scan every 6 months
Rationale: Black-box: blood dyscrasias, hepatotoxicity; level monitoring guides dose
(therapeutic 10-20 µg/mL).
Q6: When prescribing isotretinoin, which REMS component is mandatory?
A. Monthly pregnancy tests in iPLEDGE system
B. iPLEDGE registration and two forms of contraception
C. Liver biopsy before therapy
D. Psychiatric clearance
Rationale: iPLEDGE REMS requires two negative pregnancy tests before Rx, monthly
tests, and two contraception methods due to teratogenicity.
Q7: A 55-year-old on metformin 1000 mg BID develops eGFR 48 mL/min/1.73 m².
Metformin dose should:
A. Continue unchanged
B. Reduce to 1000 mg daily
C. Discontinue immediately
D. Switch to insulin
