Advanced Pharmacology NSG 533 Exam r r r r
Questions with Correct Answers 2025
r r r r r
EP is a 38-year-
r r r
old female patient that comes in for diabetes education and management. She was diagnosed 12
r r r r r r r r r r r r r r
year s ago and states lately she is not able to control her diet although she continues a 1600 calorie diet
r r r r r r r r r r r r r r r r r r r r r
wi th appropriate daily carbohydrate intake (per dietitian prescription) and walks 40 minutes every
r r r r r r r r r r r r r r
day of the week. She states compliance with all medications. She denies any history of hypoglycemia
r r r r r r r r r r r r r r r r
despite being able to identify signs and symptoms and describe appropriate treatment strategies.
r r r r r r r r r r r r r
PMH: T2DM, HTN, obesity, depression, s/p thyroidectomy due to thyroid cancer
r r r r r r r r r r
r FmHx: Noncontributory r
SHx: (−) Smoking, alcohol use, past marijuana use while in high school
r r r r r r r r r r r
Medications: Metformin 850 mg tid, glipizide 20 mg bid, lisinopril 20 mg daily, sertraline 100 mg daily, r r r r r r r r r r r r r r r r
multivitamin daily
r r
Vitals: BP 128/82 mg Hg; P 72 beats/min; BMI 31 m/kg2
r r r r r r r r r r
Laboratory test results: Na 134 mEq/L, K 5.4 mEq/L, Cl 106 mEq/L, BUN - CORRECT ANSWER - r r r r r r r r r r r r r r r r
Exenatide -
r r
Exenatide (Bydureon) once weekly has been able to demonstrate weight loss and decrease A1C% by 0
r r r r r r r r r r r r r r r
.7% to 1.2% in clinical trials; however it is contraindicated for EP due to the self-
r r r r r r r r r r r r r r r
reported history of thyroid cancer.
r r r r r
Dapagliflozin - r
Dapagliflozin (Farxiga) is contraindicated in this patient due to hyperkalemia which could be made wo r r r r r r r r r r r r r r
rse by this drug. The package insert does not indicate a specific potassium concentration cut off to no
r r r r r r r r r r r r r r r r r r
longer use this medication; however, there are better choices in this patient.
r r r r r r r r r r r r
Sitagliptin - r
Sitagliptin (Januvia) is able to obtain an A1C goal of less than 7% based on clinical trials and currently
r r r r r r r r r r r r r r r r r r
rthe patient does not have any cautionary objective measures to not use this medication. DPP-
r r r r r r r r r r r r r r
IV inhibitors are weight neutral. DPP-
r r r r r
IV inhibitors can be used in patients taking sulfonylureas; however, it may be recommended to reduce
r r r r r r r r r r r r r r r
or stop the sulfonylurea dose.
r r r r r
Acarbose - r
Acarbose (Precose) is not recommended for initial management and is associated with significant GI s
r r r r r r r r r r r r r r
ide effects. More information would be needed regarding fasting and post-
r r r r r r r r r r r
prandial numbers. In addition, adding acarbose would only lower A1c by 0.8% at best and therefore w
r r r r r r r r r r r r r r r r
ould not achieve the desired A1C goal of <7%
r r r r r r r r r
,JR is a 68-year- r r r
old African American man with a new diagnosis of T2DM. He was classified as having prediabetes (at r
r r r r r r r r r r r r r r r r r
isk for developing diabetes) 5 years before the diagnosis and has a strong family history of type 2 diab
r r r r r r r r r r r r r r r r r r r
etes. JR's blood pressure was 150/92 mm Hg. His laboratory results revealed an A1C of 8.1%, normal c
r r r r r r r r r r r r r r r r r r
holesterol panel, and normal renal/hepatic function were noted with today's laboratory test results.
r r r r r r r r r r r r r
Past medical history: Hypertension (diagnosed 4 y ago) Hyperlipidemia (diagnosed 2 y ago) Pancreatiti
r r r r r r r r r r r r r
rs (idiopathic) (acute hospitalization 3 y ago)
r r r r r r
Family history: Type 2 diabetes r r r r
Medication: HCTZ 25 mg daily, simvastatin 10 mg daily r r r r r r r r
r Allergies: SMZ/TMP r
Vitals: BP: 150/92 mm Hg P: 78 beats/min RR: 12 rpm Waist Circumference: 46 in Weight: 267 lb Heig
r r r r r r r r r r r r r r r r r r
ht: 5 ′ 6 ″ BMI: 43.1 kg/m 2
r r r r r r r r r
Despite improvements in the past six weeks due to lifestyle changes and exercise, drug therapy is to b
r r r r r r r r r r r r r r r r r
re started for JR's diabet - CORRECT ANSWER -
r r r r r r r r
Metformin is the drug of choice recommended for most patients with diabetes in addition to lifestyle r r r r r r r r r r r r r r r
modifications assuming no contraindications or intolerabilities are present upon evaluation. Metformin
r r r r r r r r r r r
has also shown to provide positive weight neutral/loss effects in obese patients. It is crucial to know t
r r r r r r r r r r r r r r r r r r
rhe renal status of patients commencing metformin therapy to limit the risk of lactic acidosis (JR is with
r r r r r r r r r r r r r r r r r
out contraindication).
r r
Since his entry A1C is >7.5%, dual therapy is indicated. There are several potential choices. The second
r r r r r r r r r r r r r r r r
step can be a dipeptidyl peptidase-4 inhibitor, it can be a glucagon-like peptide-1 (GLP-
r r r r r r r r r r r r r r
1) receptor agonist, it can be a TZD, it can be a sulfonylurea agent, it can be a SGLT2 inhibitor, or it co
r r r r r r r r r r r r r r r r r r r r r r
ruld be basal insulin. Anything next can be tried depending on what suits the circumstance
r r r r r r r r r r r r r r
DPP4 inhibitors are weight neutral bet relatively benign side effect profile. Sitagliptin has been associat
r r r r r r r r r r r r r r
ed with case reports of pancreatitis, so this specific agent should be avoided. $$$
r r r r r r r r r r r r r r
GLP-
1 analog and has data to support an A1C reduction necessary to gain glycemic control and may assist
r r r r r r r r r r r r r r r r r
with weight loss goals for this patient. New information suggests these agents may provide benefits in
r r r r r r r r r r r r r r r r
those with ASCVD. JR has a past history of pancreatitis and GLP-
r r r r r r r r r r r r
1 analogs are not recommended due to this contraindication
r r r r r r r r
TZDs have data to support an A1C reduction necessary to gain glycemic control, but are associated wit
r r r r r r r r r r r r r r r r
rh weight gain, negative effects on lipids and increased risk of fracture. Until recently, TZDs have also b
r r r r r r r r r r r r r r r r r
een linked to increased CV events and use has fallen out of favor
r r r r r r r r r r r r r
, Sulfonylureas provide excellent A1C lowering, but are also associated with weight gain. They also have r r r r r r r r r r r r r r
the potential to cause hypoglycemia, so patient education is crucial. Because of his allergies to
r r r r r r r r r r r r r r r
"sulfa"
r
, use would be contr
r r r r
A patient with type 1 diabetes reports taking propranolol for hypertension. What concern does this inf
r r r r r r r r r r r r r r r
ormation present for the provider? - CORRECT ANSWER -
r r r r r r r r r
A patient with Type 1 DM is insulin dependent for glucose control and at high risk for hypoglycemic ep
r r r r r r r r r r r r r r r r r r
isodes. Propanolol causes prolonged hypoglycemic episodes. Needs to switch to ACE or ARB.
r r r r r r r r r r r r r
A provider teaches a patient who has been diagnosed with hypothyroidism about a new prescription f
r r r r r r r r r r r r r r r
or levothyroxine. Which statement by the patient indicates a need for further teaching?
r r r r r r r r r r r r r
a. "I should not take heartburn medication without consulting my provider first."
r r r r r r r r r r
b. "I should report insomnia, tremors, and an increased heart rate to my provider."
r r r r r r r r r r r r
c. "If I take a multivitamin with iron, I should take it 4 hours after the levothyroxine."
r r r r r r r r r r r r r r r
d. "If I take calcium supplements, I may need to decrease my dose of levothyroxine." -
r r r r r r r r r r r r r r
CORRECT ANSWER -
r r r
D. Calcium may reduce levothyroxine absorption. Further education is needed if the patient feels she c
r r r r r r r r r r r r r r r
an take half of a prescribed medication.
r r r r r r r
MC has undiagnosed multiple gastric ulcers. Shortly after consuming a large meal and alcohol he expe
r r r r r r r r r r r r r r r
riences significant GI distress. He takes an OTC heartburn remedy. Within a minute or two he develops
r r r r r r r r r r r r r r r r r
what he will later describe as "belching, nausea and a bad bloated feeling". Several of the ulcers
r r r r r r r r r r r r r r r r r
bega n to bleed and he becomes profoundly hypotensive from the blood loss and is taken to the ED.
r r r r r r r r r r r r r r r r r r r
Endos copy confirms multiple bleeds; the endoscopist remarks that it appears as if the lesions had been
r r r r r r r r r r r r r r r r r
liter ally stretched apart causing additional tissue damage. What did the patient most likely take (i.e.
r r r r r r r r r r r r r r r r
what was the OTC remedy)? - CORRECT ANSWER -I would accept Alka-
r r r r r r r r r r r r
Selzer. I contains NaHCO3 (as well as ASA). In the presence of HCL it Liberates CO2, that can cause gas
r r r r r r r r r r r r r r r r r r r
tric distention, belching and nausea. The reaction is fairly swift allowing little time for dissipation. Tum
r r r r r r r r r r r r r r r r
rs, its primary ingredient calcium carbonate which when taken cause a reaction with the stomach acid
r r r r r r r r r r r r r r r
such as production of carbon dioxide gas which can cause bloating and the stomach to stretch to tear
r r r r r r r r r r r r r r r r r r
the ulcers open.
r r r
On your way to this examination, you experience the vulnerable feeling that an attack of acute diarrhe
r r r r r r r r r r r r r r r r
ra is imminent! If you stop at a drug store, which anti-
r r r r r r r r r r r
diarrheal drugs could you buy without a prescription even though it is chemically related to the strong
r r r r r r r r r r r r r r r r
opioid analgesic meperidine (but acts only on the peripheral opioid receptor)? - CORRECT ANSWER -
r r r r r r r r r r r r r r r
Loperamide
r
Questions with Correct Answers 2025
r r r r r
EP is a 38-year-
r r r
old female patient that comes in for diabetes education and management. She was diagnosed 12
r r r r r r r r r r r r r r
year s ago and states lately she is not able to control her diet although she continues a 1600 calorie diet
r r r r r r r r r r r r r r r r r r r r r
wi th appropriate daily carbohydrate intake (per dietitian prescription) and walks 40 minutes every
r r r r r r r r r r r r r r
day of the week. She states compliance with all medications. She denies any history of hypoglycemia
r r r r r r r r r r r r r r r r
despite being able to identify signs and symptoms and describe appropriate treatment strategies.
r r r r r r r r r r r r r
PMH: T2DM, HTN, obesity, depression, s/p thyroidectomy due to thyroid cancer
r r r r r r r r r r
r FmHx: Noncontributory r
SHx: (−) Smoking, alcohol use, past marijuana use while in high school
r r r r r r r r r r r
Medications: Metformin 850 mg tid, glipizide 20 mg bid, lisinopril 20 mg daily, sertraline 100 mg daily, r r r r r r r r r r r r r r r r
multivitamin daily
r r
Vitals: BP 128/82 mg Hg; P 72 beats/min; BMI 31 m/kg2
r r r r r r r r r r
Laboratory test results: Na 134 mEq/L, K 5.4 mEq/L, Cl 106 mEq/L, BUN - CORRECT ANSWER - r r r r r r r r r r r r r r r r
Exenatide -
r r
Exenatide (Bydureon) once weekly has been able to demonstrate weight loss and decrease A1C% by 0
r r r r r r r r r r r r r r r
.7% to 1.2% in clinical trials; however it is contraindicated for EP due to the self-
r r r r r r r r r r r r r r r
reported history of thyroid cancer.
r r r r r
Dapagliflozin - r
Dapagliflozin (Farxiga) is contraindicated in this patient due to hyperkalemia which could be made wo r r r r r r r r r r r r r r
rse by this drug. The package insert does not indicate a specific potassium concentration cut off to no
r r r r r r r r r r r r r r r r r r
longer use this medication; however, there are better choices in this patient.
r r r r r r r r r r r r
Sitagliptin - r
Sitagliptin (Januvia) is able to obtain an A1C goal of less than 7% based on clinical trials and currently
r r r r r r r r r r r r r r r r r r
rthe patient does not have any cautionary objective measures to not use this medication. DPP-
r r r r r r r r r r r r r r
IV inhibitors are weight neutral. DPP-
r r r r r
IV inhibitors can be used in patients taking sulfonylureas; however, it may be recommended to reduce
r r r r r r r r r r r r r r r
or stop the sulfonylurea dose.
r r r r r
Acarbose - r
Acarbose (Precose) is not recommended for initial management and is associated with significant GI s
r r r r r r r r r r r r r r
ide effects. More information would be needed regarding fasting and post-
r r r r r r r r r r r
prandial numbers. In addition, adding acarbose would only lower A1c by 0.8% at best and therefore w
r r r r r r r r r r r r r r r r
ould not achieve the desired A1C goal of <7%
r r r r r r r r r
,JR is a 68-year- r r r
old African American man with a new diagnosis of T2DM. He was classified as having prediabetes (at r
r r r r r r r r r r r r r r r r r
isk for developing diabetes) 5 years before the diagnosis and has a strong family history of type 2 diab
r r r r r r r r r r r r r r r r r r r
etes. JR's blood pressure was 150/92 mm Hg. His laboratory results revealed an A1C of 8.1%, normal c
r r r r r r r r r r r r r r r r r r
holesterol panel, and normal renal/hepatic function were noted with today's laboratory test results.
r r r r r r r r r r r r r
Past medical history: Hypertension (diagnosed 4 y ago) Hyperlipidemia (diagnosed 2 y ago) Pancreatiti
r r r r r r r r r r r r r
rs (idiopathic) (acute hospitalization 3 y ago)
r r r r r r
Family history: Type 2 diabetes r r r r
Medication: HCTZ 25 mg daily, simvastatin 10 mg daily r r r r r r r r
r Allergies: SMZ/TMP r
Vitals: BP: 150/92 mm Hg P: 78 beats/min RR: 12 rpm Waist Circumference: 46 in Weight: 267 lb Heig
r r r r r r r r r r r r r r r r r r
ht: 5 ′ 6 ″ BMI: 43.1 kg/m 2
r r r r r r r r r
Despite improvements in the past six weeks due to lifestyle changes and exercise, drug therapy is to b
r r r r r r r r r r r r r r r r r
re started for JR's diabet - CORRECT ANSWER -
r r r r r r r r
Metformin is the drug of choice recommended for most patients with diabetes in addition to lifestyle r r r r r r r r r r r r r r r
modifications assuming no contraindications or intolerabilities are present upon evaluation. Metformin
r r r r r r r r r r r
has also shown to provide positive weight neutral/loss effects in obese patients. It is crucial to know t
r r r r r r r r r r r r r r r r r r
rhe renal status of patients commencing metformin therapy to limit the risk of lactic acidosis (JR is with
r r r r r r r r r r r r r r r r r
out contraindication).
r r
Since his entry A1C is >7.5%, dual therapy is indicated. There are several potential choices. The second
r r r r r r r r r r r r r r r r
step can be a dipeptidyl peptidase-4 inhibitor, it can be a glucagon-like peptide-1 (GLP-
r r r r r r r r r r r r r r
1) receptor agonist, it can be a TZD, it can be a sulfonylurea agent, it can be a SGLT2 inhibitor, or it co
r r r r r r r r r r r r r r r r r r r r r r
ruld be basal insulin. Anything next can be tried depending on what suits the circumstance
r r r r r r r r r r r r r r
DPP4 inhibitors are weight neutral bet relatively benign side effect profile. Sitagliptin has been associat
r r r r r r r r r r r r r r
ed with case reports of pancreatitis, so this specific agent should be avoided. $$$
r r r r r r r r r r r r r r
GLP-
1 analog and has data to support an A1C reduction necessary to gain glycemic control and may assist
r r r r r r r r r r r r r r r r r
with weight loss goals for this patient. New information suggests these agents may provide benefits in
r r r r r r r r r r r r r r r r
those with ASCVD. JR has a past history of pancreatitis and GLP-
r r r r r r r r r r r r
1 analogs are not recommended due to this contraindication
r r r r r r r r
TZDs have data to support an A1C reduction necessary to gain glycemic control, but are associated wit
r r r r r r r r r r r r r r r r
rh weight gain, negative effects on lipids and increased risk of fracture. Until recently, TZDs have also b
r r r r r r r r r r r r r r r r r
een linked to increased CV events and use has fallen out of favor
r r r r r r r r r r r r r
, Sulfonylureas provide excellent A1C lowering, but are also associated with weight gain. They also have r r r r r r r r r r r r r r
the potential to cause hypoglycemia, so patient education is crucial. Because of his allergies to
r r r r r r r r r r r r r r r
"sulfa"
r
, use would be contr
r r r r
A patient with type 1 diabetes reports taking propranolol for hypertension. What concern does this inf
r r r r r r r r r r r r r r r
ormation present for the provider? - CORRECT ANSWER -
r r r r r r r r r
A patient with Type 1 DM is insulin dependent for glucose control and at high risk for hypoglycemic ep
r r r r r r r r r r r r r r r r r r
isodes. Propanolol causes prolonged hypoglycemic episodes. Needs to switch to ACE or ARB.
r r r r r r r r r r r r r
A provider teaches a patient who has been diagnosed with hypothyroidism about a new prescription f
r r r r r r r r r r r r r r r
or levothyroxine. Which statement by the patient indicates a need for further teaching?
r r r r r r r r r r r r r
a. "I should not take heartburn medication without consulting my provider first."
r r r r r r r r r r
b. "I should report insomnia, tremors, and an increased heart rate to my provider."
r r r r r r r r r r r r
c. "If I take a multivitamin with iron, I should take it 4 hours after the levothyroxine."
r r r r r r r r r r r r r r r
d. "If I take calcium supplements, I may need to decrease my dose of levothyroxine." -
r r r r r r r r r r r r r r
CORRECT ANSWER -
r r r
D. Calcium may reduce levothyroxine absorption. Further education is needed if the patient feels she c
r r r r r r r r r r r r r r r
an take half of a prescribed medication.
r r r r r r r
MC has undiagnosed multiple gastric ulcers. Shortly after consuming a large meal and alcohol he expe
r r r r r r r r r r r r r r r
riences significant GI distress. He takes an OTC heartburn remedy. Within a minute or two he develops
r r r r r r r r r r r r r r r r r
what he will later describe as "belching, nausea and a bad bloated feeling". Several of the ulcers
r r r r r r r r r r r r r r r r r
bega n to bleed and he becomes profoundly hypotensive from the blood loss and is taken to the ED.
r r r r r r r r r r r r r r r r r r r
Endos copy confirms multiple bleeds; the endoscopist remarks that it appears as if the lesions had been
r r r r r r r r r r r r r r r r r
liter ally stretched apart causing additional tissue damage. What did the patient most likely take (i.e.
r r r r r r r r r r r r r r r r
what was the OTC remedy)? - CORRECT ANSWER -I would accept Alka-
r r r r r r r r r r r r
Selzer. I contains NaHCO3 (as well as ASA). In the presence of HCL it Liberates CO2, that can cause gas
r r r r r r r r r r r r r r r r r r r
tric distention, belching and nausea. The reaction is fairly swift allowing little time for dissipation. Tum
r r r r r r r r r r r r r r r r
rs, its primary ingredient calcium carbonate which when taken cause a reaction with the stomach acid
r r r r r r r r r r r r r r r
such as production of carbon dioxide gas which can cause bloating and the stomach to stretch to tear
r r r r r r r r r r r r r r r r r r
the ulcers open.
r r r
On your way to this examination, you experience the vulnerable feeling that an attack of acute diarrhe
r r r r r r r r r r r r r r r r
ra is imminent! If you stop at a drug store, which anti-
r r r r r r r r r r r
diarrheal drugs could you buy without a prescription even though it is chemically related to the strong
r r r r r r r r r r r r r r r r
opioid analgesic meperidine (but acts only on the peripheral opioid receptor)? - CORRECT ANSWER -
r r r r r r r r r r r r r r r
Loperamide
r
