NSG 533 Advanced Pharmacology Exams
Actual Questions and Verified Answers|
Latest 2026/2027 | Graded A+
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 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%
BPH combination therapy - ✔✔✔ ANSWER-◦ a-blocker and PDE-
5Is
For men with moderate symptoms of BPH and erectile
dysfunction, treatment with daily tadalafil (5 mg/day) alone or
in combination with tamsulosin (0.4 mg/day) can be
considered
Addition of PDE-5Is to alpha blockers may improve lower
urinary tract symptoms
◦PDE-5i and 5a-RIs
Addition of PDE-5i to 5a-RIs can offset erectile dysfunction
commonly seen with 5a-RIs
Red Flag medications in pregnancy
,- Commonly used / teratogenic - ✔✔✔ ANSWER-Warfarin,
Phenytoin, Valproic Acid, Carbamazepine, Lithium, ACE
inhibitors/ARBs, Thalidomide, Ethanol, statins .. etc
Considerations must be given to not only those who ARE
pregnant, but all women of child bearing years where
pregnancy is possible (planned or un-planned)
Note: this is NOT a comprehensive list, but a good
representation for exam purposes
Combined Oral Contraception: - ✔✔✔ ANSWER-choosing a
formulation based on fertility goals, patient preference,
discussion of risk/benefits, Hx (to rule out contraindications ..
see US MEC attached)
World Health Organization and the Food and Drug
Administration recommend using the lowest dose pill that is
effective (as noted below, efficacy can be impacted by several
factors .. including other medications. Thus, the lowest dose
available is not always the lowest most effective dose)
Combined Oral Contraceptives - ✔✔✔ ANSWER-Risks can
include, but not limited to cancers, CV events/HTN, VTE, drug
interactions
Concomitant use of broad spectrum antibiotics and
combination contraceptives may result in decreased
contraceptive efficacy; however this is Category 1 under US
MEC
If a typical failure rate of 1% to 3% is a concern for the
patient, consider additional or alternative forms of birth
control
, Concomitant use of P450 enzyme inducers (rifampin,
phenytoin, carbamazepine, phenobarbital) may result in
decreased contraceptive efficacy
If use COC - use higher doses (at least 35 mcg EE) + high
progestin, shorten hormone free interval to 4 days or less
Avoid low progestin - the patch, POP
Consider additional or alternative forms of birth control
Concomitant use of Anti-HIV protease inhibitors can either
increase or decrease serum levels of estrogens and progestins
- may need backup method
Drospirenone can cause hyperkalemia, especially if used with
other agents that can increase potassium (ACEIs, heparin,
aldosterone antagonists, etc)
Benefits can include favorable effect on bone, menstrual
effects, improved acne, improved PMDD, etc
Managing hormone concerns - ✔✔✔ ANSWER-Estrogen
Excess - N/V, cervical mucorrhea, hypertension, headache,
breast tenderness, edema, melasma, bloating
Deficiency - Early or mid-cycle breakthrough bleeding,
increased spotting, hypomenorrhea, vasomotor symptoms
Progestin
Excess - breast tenderness, headache, fatigue, changes in
mood
Deficiency - Late break through bleeding, hypermenorrhea,
dysmenorrhea
Androgen
Excess - increased appetite, weight gain, acne, oily skin,
Actual Questions and Verified Answers|
Latest 2026/2027 | Graded A+
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 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%
BPH combination therapy - ✔✔✔ ANSWER-◦ a-blocker and PDE-
5Is
For men with moderate symptoms of BPH and erectile
dysfunction, treatment with daily tadalafil (5 mg/day) alone or
in combination with tamsulosin (0.4 mg/day) can be
considered
Addition of PDE-5Is to alpha blockers may improve lower
urinary tract symptoms
◦PDE-5i and 5a-RIs
Addition of PDE-5i to 5a-RIs can offset erectile dysfunction
commonly seen with 5a-RIs
Red Flag medications in pregnancy
,- Commonly used / teratogenic - ✔✔✔ ANSWER-Warfarin,
Phenytoin, Valproic Acid, Carbamazepine, Lithium, ACE
inhibitors/ARBs, Thalidomide, Ethanol, statins .. etc
Considerations must be given to not only those who ARE
pregnant, but all women of child bearing years where
pregnancy is possible (planned or un-planned)
Note: this is NOT a comprehensive list, but a good
representation for exam purposes
Combined Oral Contraception: - ✔✔✔ ANSWER-choosing a
formulation based on fertility goals, patient preference,
discussion of risk/benefits, Hx (to rule out contraindications ..
see US MEC attached)
World Health Organization and the Food and Drug
Administration recommend using the lowest dose pill that is
effective (as noted below, efficacy can be impacted by several
factors .. including other medications. Thus, the lowest dose
available is not always the lowest most effective dose)
Combined Oral Contraceptives - ✔✔✔ ANSWER-Risks can
include, but not limited to cancers, CV events/HTN, VTE, drug
interactions
Concomitant use of broad spectrum antibiotics and
combination contraceptives may result in decreased
contraceptive efficacy; however this is Category 1 under US
MEC
If a typical failure rate of 1% to 3% is a concern for the
patient, consider additional or alternative forms of birth
control
, Concomitant use of P450 enzyme inducers (rifampin,
phenytoin, carbamazepine, phenobarbital) may result in
decreased contraceptive efficacy
If use COC - use higher doses (at least 35 mcg EE) + high
progestin, shorten hormone free interval to 4 days or less
Avoid low progestin - the patch, POP
Consider additional or alternative forms of birth control
Concomitant use of Anti-HIV protease inhibitors can either
increase or decrease serum levels of estrogens and progestins
- may need backup method
Drospirenone can cause hyperkalemia, especially if used with
other agents that can increase potassium (ACEIs, heparin,
aldosterone antagonists, etc)
Benefits can include favorable effect on bone, menstrual
effects, improved acne, improved PMDD, etc
Managing hormone concerns - ✔✔✔ ANSWER-Estrogen
Excess - N/V, cervical mucorrhea, hypertension, headache,
breast tenderness, edema, melasma, bloating
Deficiency - Early or mid-cycle breakthrough bleeding,
increased spotting, hypomenorrhea, vasomotor symptoms
Progestin
Excess - breast tenderness, headache, fatigue, changes in
mood
Deficiency - Late break through bleeding, hypermenorrhea,
dysmenorrhea
Androgen
Excess - increased appetite, weight gain, acne, oily skin,
