NU 578 Advanced Pharmacology – Unit
4 Exam Questions And Answers Plus
Rationales | Qs & Ans 2026 | Instant Pdf
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1. A patient with hypertension and chronic kidney disease (stage 3,
eGFR 45 mL/min) has a urine albumin-to-creatinine ratio (UACR) of
400 mg/g. Which antihypertensive class is preferred for renal
protection?
A. Thiazide diuretic
B. ACE inhibitor or ARB
C. Beta-blocker
D. Calcium channel blocker (dihydropyridine)
Answer: B
Rationale: ACE inhibitors (lisinopril) or ARBs (losartan) reduce
intraglomerular pressure and proteinuria, slowing CKD progression,
regardless of blood pressure reduction.
2. A patient with heart failure (HFrEF, EF 35%) is started on
carvedilol. Which finding indicates a therapeutic response?
A. Increased ejection fraction on follow-up echocardiogram after 3–6
months
B. Heart rate 110 bpm
,C. Worsening dyspnea
D. Weight gain of 2 kg in 2 days
Answer: A
Rationale: Carvedilol (beta-blocker) improves left ventricular remodeling
and ejection fraction over time. Acute effects may include bradycardia
and mild fluid retention.
3. A patient with hypertension and gout is started on
hydrochlorothiazide (HCTZ). Which finding is expected?
A. Decreased uric acid
B. Increased uric acid (may precipitate gout flare)
C. Hypokalemia
D. Both B and C
Answer: D
Rationale: Thiazide diuretics (HCTZ) cause hyperuricemia (increased
reabsorption) and hypokalemia. May worsen or precipitate gout.
4. A patient with heart failure (HFrEF) is on furosemide 80 mg twice
daily. Which laboratory value should be monitored most closely?
A. Serum sodium
B. Serum potassium
C. Serum magnesium
D. Serum potassium and magnesium
,Answer: D
Rationale: Loop diuretics (furosemide) cause hypokalemia and
hypomagnesemia, increasing risk of arrhythmias and digoxin toxicity.
5. A patient with atrial fibrillation is started on amiodarone. Which
adverse effects require long-term monitoring?
A. Pulmonary fibrosis (cough, dyspnea)
B. Thyroid dysfunction (hyper or hypothyroidism)
C. Corneal microdeposits (usually benign)
D. All of the above
Answer: D
Rationale: Amiodarone causes pulmonary toxicity (fibrosis), thyroid
dysfunction, hepatotoxicity, corneal deposits, photosensitivity, and QT
prolongation.
6. A patient with deep vein thrombosis (DVT) is started on warfarin
and enoxaparin (LMWH) together. Why is enoxaparin continued
after warfarin is started?
A. Enoxaparin treats pain
B. Warfarin causes transient hypercoagulability (protein C and S
depletion), so enoxaparin is used as a bridge until INR is therapeutic
C. Enoxaparin increases warfarin absorption
D. Warfarin has no effect on DVT
Answer: B
Rationale: Warfarin initially depletes protein C (anticoagulant), causing
, transient hypercoagulability. LMWH (enoxaparin) is used as a bridge for
at least 5 days until INR ≥2.0 for 24 hours.
7. A patient with a mechanical heart valve is prescribed warfarin.
Which target INR range is appropriate?
A. 2.0–3.0
B. 2.5–3.5
C. 3.0–4.0
D. 1.5–2.0
Answer: B
Rationale: Mechanical heart valves (especially mitral or older aortic)
require higher INR target (2.5–3.5). Bioprosthetic valves or atrial
fibrillation target INR 2.0–3.0.
8. A patient with an acute ST-elevation myocardial infarction
(STEMI) is given aspirin and ticagrelor. Which statement about
ticagrelor is correct?
A. It is a prodrug (requires activation)
B. It is a reversible, direct-acting P2Y12 inhibitor (no prodrug activation)
C. It is an irreversible COX-1 inhibitor
D. It is contraindicated with aspirin
Answer: B
Rationale: Ticagrelor is a reversible, direct-acting P2Y12 inhibitor (no
prodrug, unlike clopidogrel). Given with low-dose aspirin (81 mg) for
dual antiplatelet therapy.
4 Exam Questions And Answers Plus
Rationales | Qs & Ans 2026 | Instant Pdf
Download
1. A patient with hypertension and chronic kidney disease (stage 3,
eGFR 45 mL/min) has a urine albumin-to-creatinine ratio (UACR) of
400 mg/g. Which antihypertensive class is preferred for renal
protection?
A. Thiazide diuretic
B. ACE inhibitor or ARB
C. Beta-blocker
D. Calcium channel blocker (dihydropyridine)
Answer: B
Rationale: ACE inhibitors (lisinopril) or ARBs (losartan) reduce
intraglomerular pressure and proteinuria, slowing CKD progression,
regardless of blood pressure reduction.
2. A patient with heart failure (HFrEF, EF 35%) is started on
carvedilol. Which finding indicates a therapeutic response?
A. Increased ejection fraction on follow-up echocardiogram after 3–6
months
B. Heart rate 110 bpm
,C. Worsening dyspnea
D. Weight gain of 2 kg in 2 days
Answer: A
Rationale: Carvedilol (beta-blocker) improves left ventricular remodeling
and ejection fraction over time. Acute effects may include bradycardia
and mild fluid retention.
3. A patient with hypertension and gout is started on
hydrochlorothiazide (HCTZ). Which finding is expected?
A. Decreased uric acid
B. Increased uric acid (may precipitate gout flare)
C. Hypokalemia
D. Both B and C
Answer: D
Rationale: Thiazide diuretics (HCTZ) cause hyperuricemia (increased
reabsorption) and hypokalemia. May worsen or precipitate gout.
4. A patient with heart failure (HFrEF) is on furosemide 80 mg twice
daily. Which laboratory value should be monitored most closely?
A. Serum sodium
B. Serum potassium
C. Serum magnesium
D. Serum potassium and magnesium
,Answer: D
Rationale: Loop diuretics (furosemide) cause hypokalemia and
hypomagnesemia, increasing risk of arrhythmias and digoxin toxicity.
5. A patient with atrial fibrillation is started on amiodarone. Which
adverse effects require long-term monitoring?
A. Pulmonary fibrosis (cough, dyspnea)
B. Thyroid dysfunction (hyper or hypothyroidism)
C. Corneal microdeposits (usually benign)
D. All of the above
Answer: D
Rationale: Amiodarone causes pulmonary toxicity (fibrosis), thyroid
dysfunction, hepatotoxicity, corneal deposits, photosensitivity, and QT
prolongation.
6. A patient with deep vein thrombosis (DVT) is started on warfarin
and enoxaparin (LMWH) together. Why is enoxaparin continued
after warfarin is started?
A. Enoxaparin treats pain
B. Warfarin causes transient hypercoagulability (protein C and S
depletion), so enoxaparin is used as a bridge until INR is therapeutic
C. Enoxaparin increases warfarin absorption
D. Warfarin has no effect on DVT
Answer: B
Rationale: Warfarin initially depletes protein C (anticoagulant), causing
, transient hypercoagulability. LMWH (enoxaparin) is used as a bridge for
at least 5 days until INR ≥2.0 for 24 hours.
7. A patient with a mechanical heart valve is prescribed warfarin.
Which target INR range is appropriate?
A. 2.0–3.0
B. 2.5–3.5
C. 3.0–4.0
D. 1.5–2.0
Answer: B
Rationale: Mechanical heart valves (especially mitral or older aortic)
require higher INR target (2.5–3.5). Bioprosthetic valves or atrial
fibrillation target INR 2.0–3.0.
8. A patient with an acute ST-elevation myocardial infarction
(STEMI) is given aspirin and ticagrelor. Which statement about
ticagrelor is correct?
A. It is a prodrug (requires activation)
B. It is a reversible, direct-acting P2Y12 inhibitor (no prodrug activation)
C. It is an irreversible COX-1 inhibitor
D. It is contraindicated with aspirin
Answer: B
Rationale: Ticagrelor is a reversible, direct-acting P2Y12 inhibitor (no
prodrug, unlike clopidogrel). Given with low-dose aspirin (81 mg) for
dual antiplatelet therapy.
