ADVANCED PHARMACOLOGY STUDY GUIDE | EXAM 2 | 2026/2027 UPDATE
NSG 533 EXAM 2
ADVANCED PHARMACOLOGY
STUDY GUIDE 2026/2027
Comprehensive Study Guide for Advanced Pharmacology Exam 2 | Verified Content
EXAM 2 ADVANCED PHARM VERIFIED 2026/2027 UPDATE
, EXAM COVERAGE AREAS
Advanced Pharmacology - Exam 2 Domains | NSG 533 | 2026/2027 Update
Cardiovascular Pharmacology
• Antihypertensives: ACE, ARB, CCB, diuretics, beta-blockers - mechanism, SE, monitoring
• Heart failure: ACE, ARB, ARNI, beta-blockers, diuretics, digoxin
• Antiarrhythmics: Class I-IV, amiodarone, lidocaine, drug of choice per arrhythmia
• Anticoagulants & antiplatelets: heparin, warfarin, DOACs, clopidogrel
Respiratory & Endocrine Pharmacology
• Asthma/COPD: SABA, LABA, ICS, LAMA, leukotriene modifiers, theophylline
• Diabetes: insulin types, metformin, sulfonylureas, GLP-1 agonists, SGLT2 inhibitors
• Thyroid: levothyroxine, methimazole, PTU
• Adrenal: corticosteroids - dosing, tapering, SE
Neurological & Psychiatric Pharmacology
• Seizure meds: phenytoin, carbamazepine, valproate, levetiracetam - levels, interactions
• Parkinson: levodopa/carbidopa, dopamine agonists, MAO-B inhibitors
• Psych: antidepressants SSRIs SNRIs, antipsychotics typical/atypical, mood stabilizers
• Pain: opioids, non-opioids, adjuvants, opioid conversion
Antimicrobial & Immunologic Pharmacology
• Antibiotics: penicillins, cephalosporins, macrolides, fluoroquinolones, aminoglycosides, vancomycin
• Antiviral, antifungal, TB drugs
• Vaccines & immunosuppressants
• Antibiotic stewardship & resistance
GI, Renal & Special Populations
• GI: PPI, H2 blockers, antiemetics, laxatives
• Renal: diuretics, fluid & electrolytes
• Geriatric: Beers criteria, polypharmacy, renal dosing
• Pediatric: weight-based dosing, safe administration
Pharmacokinetics, Interactions & 2026/2027 Updates
• ADME: absorption, distribution, metabolism CYP450, excretion
• Drug interactions: CYP inducers/inhibitors, protein binding, QT prolongation
• Pharmacogenomics basics
• 2026/2027 new drugs & guideline updates: HF, diabetes, obesity meds
NSG 533 Exam 2 Advanced Pharmacology Study Guide 2026/2027 UPDATE Page 2
, QUESTION 1: NSG 533: Patient on warfarin INR 4.5 with bleeding, antidote?
A) Hold warfarin, Vitamin K, consider 4F-PCC if major bleeding
B) Continue warfarin
C) Give heparin
D) No treatment needed
CORRECT ANSWER: A) Hold warfarin, Vitamin K, consider 4F-PCC if major bleeding
RATIONALE: Warfarin toxicity: INR supratherapeutic >4.5 bleeding risk. Antidote Vitamin K PO/IV, 4-factor
PCC for major bleeding. Heparin antidote protamine. Monitor INR. Warfarin narrow therapeutic 2-3
(mechanical valve 2.5-3.5).
QUESTION 2: First-line HTN in African American per 2024 guidelines?
A) Thiazide diuretic or CCB
B) ACE inhibitor alone first-line
C) Beta-blocker first-line
D) Loop diuretic first-line
CORRECT ANSWER: A) Thiazide diuretic or CCB
RATIONALE: 2024 HTN guidelines: African American first-line thiazide or CCB more effective than ACE
alone due to lower renin. Non-Black first-line thiazide, ACE, ARB, or CCB. Beta-blocker not first-line unless
compelling indication HF, post-MI.
QUESTION 3: Metformin contraindication & monitoring?
A) Contraindicated eGFR <30, hold before contrast, monitor B12, lactic acidosis rare but serious, no
hypoglycemia alone
B) Causes hypoglycemia always
C) No monitoring needed
D) Safe in eGFR 10
CORRECT ANSWER: A) Contraindicated eGFR <30, hold before contrast, monitor B12,
lactic acidosis rare but serious, no hypoglycemia alone
RATIONALE: Metformin first-line T2DM, contraindicated eGFR <30, caution 30-45, hold before
contrast/surgery if eGFR <60 or risk AKI. Monitor renal function, B12 deficiency long-term, lactic acidosis
risk. Does NOT cause hypoglycemia alone.
QUESTION 4: Phenytoin therapeutic level & toxicity signs?
A) Level 10-20 mcg/mL, toxicity nystagmus, ataxia, slurred speech, sedation, zero-order kinetics
B) Level 50-100
C) No toxicity
D) No level monitoring
CORRECT ANSWER: A) Level 10-20 mcg/mL, toxicity nystagmus, ataxia, slurred
speech, sedation, zero-order kinetics
RATIONALE: Phenytoin narrow therapeutic 10-20 mcg/mL, zero-order kinetics small dose increase large
level increase, toxicity nystagmus ataxia slurred speech. Highly protein bound, CYP inducer, many drug
interactions. Fosphenytoin IV safer.
NSG 533 Exam 2 Advanced Pharmacology Study Guide 2026/2027 UPDATE Page 3
, QUESTION 5: SSRI discontinuation syndrome vs serotonin syndrome?
A) Discontinuation: dizziness, nausea, flu-like after abrupt stop SSRI - taper needed. Serotonin
syndrome: agitation, hyperthermia, clonus, rigidity from excess serotonin - emergency
B) Same thing
C) No difference
D) Only discontinuation exists
CORRECT ANSWER: A) Discontinuation: dizziness, nausea, flu-like after abrupt stop
SSRI - taper needed. Serotonin syndrome: agitation, hyperthermia, clonus, rigidity from
excess serotonin - emergency
RATIONALE: SSRI discontinuation syndrome after abrupt stop: dizziness, nausea, headache, irritability,
flu-like - taper slowly. Serotonin syndrome from excess serotonin with SSRI + MAOI or 2 serotonergic drugs:
hyperthermia, agitation, clonus, rigidity, autonomic instability - stop drug, supportive, cyproheptadine.
QUESTION 6: Vancomycin monitoring & red man syndrome?
A) Monitor trough 10-20 (15-20 for serious MRSA), nephrotoxicity, ototoxicity, red man from rapid
infusion - slow infusion, antihistamine
B) No monitoring needed
C) Only ototoxicity
D) No red man syndrome
CORRECT ANSWER: A) Monitor trough 10-20 (15-20 for serious MRSA), nephrotoxicity,
ototoxicity, red man from rapid infusion - slow infusion, antihistamine
RATIONALE: Vancomycin glycopeptide MRSA: monitor trough 10-20 mcg/mL (15-20 for serious infections),
nephrotoxicity, ototoxicity, red man syndrome flushing pruritus from rapid infusion histamine release - slow
infusion over 1-2 hr, antihistamine. AUC monitoring preferred now 400-600.
QUESTION 7: NSG 533: Patient on warfarin INR 4.5 with bleeding, antidote?
A) Hold warfarin, Vitamin K, consider 4F-PCC if major bleeding
B) Continue warfarin
C) Give heparin
D) No treatment needed
CORRECT ANSWER: A) Hold warfarin, Vitamin K, consider 4F-PCC if major bleeding
RATIONALE: Warfarin toxicity: INR supratherapeutic >4.5 bleeding risk. Antidote Vitamin K PO/IV, 4-factor
PCC for major bleeding. Heparin antidote protamine. Monitor INR. Warfarin narrow therapeutic 2-3
(mechanical valve 2.5-3.5).
QUESTION 8: First-line HTN in African American per 2024 guidelines?
A) Thiazide diuretic or CCB
B) ACE inhibitor alone first-line
C) Beta-blocker first-line
D) Loop diuretic first-line
CORRECT ANSWER: A) Thiazide diuretic or CCB
RATIONALE: 2024 HTN guidelines: African American first-line thiazide or CCB more effective than ACE
alone due to lower renin. Non-Black first-line thiazide, ACE, ARB, or CCB. Beta-blocker not first-line unless
compelling indication HF, post-MI.
NSG 533 Exam 2 Advanced Pharmacology Study Guide 2026/2027 UPDATE Page 4
NSG 533 EXAM 2
ADVANCED PHARMACOLOGY
STUDY GUIDE 2026/2027
Comprehensive Study Guide for Advanced Pharmacology Exam 2 | Verified Content
EXAM 2 ADVANCED PHARM VERIFIED 2026/2027 UPDATE
, EXAM COVERAGE AREAS
Advanced Pharmacology - Exam 2 Domains | NSG 533 | 2026/2027 Update
Cardiovascular Pharmacology
• Antihypertensives: ACE, ARB, CCB, diuretics, beta-blockers - mechanism, SE, monitoring
• Heart failure: ACE, ARB, ARNI, beta-blockers, diuretics, digoxin
• Antiarrhythmics: Class I-IV, amiodarone, lidocaine, drug of choice per arrhythmia
• Anticoagulants & antiplatelets: heparin, warfarin, DOACs, clopidogrel
Respiratory & Endocrine Pharmacology
• Asthma/COPD: SABA, LABA, ICS, LAMA, leukotriene modifiers, theophylline
• Diabetes: insulin types, metformin, sulfonylureas, GLP-1 agonists, SGLT2 inhibitors
• Thyroid: levothyroxine, methimazole, PTU
• Adrenal: corticosteroids - dosing, tapering, SE
Neurological & Psychiatric Pharmacology
• Seizure meds: phenytoin, carbamazepine, valproate, levetiracetam - levels, interactions
• Parkinson: levodopa/carbidopa, dopamine agonists, MAO-B inhibitors
• Psych: antidepressants SSRIs SNRIs, antipsychotics typical/atypical, mood stabilizers
• Pain: opioids, non-opioids, adjuvants, opioid conversion
Antimicrobial & Immunologic Pharmacology
• Antibiotics: penicillins, cephalosporins, macrolides, fluoroquinolones, aminoglycosides, vancomycin
• Antiviral, antifungal, TB drugs
• Vaccines & immunosuppressants
• Antibiotic stewardship & resistance
GI, Renal & Special Populations
• GI: PPI, H2 blockers, antiemetics, laxatives
• Renal: diuretics, fluid & electrolytes
• Geriatric: Beers criteria, polypharmacy, renal dosing
• Pediatric: weight-based dosing, safe administration
Pharmacokinetics, Interactions & 2026/2027 Updates
• ADME: absorption, distribution, metabolism CYP450, excretion
• Drug interactions: CYP inducers/inhibitors, protein binding, QT prolongation
• Pharmacogenomics basics
• 2026/2027 new drugs & guideline updates: HF, diabetes, obesity meds
NSG 533 Exam 2 Advanced Pharmacology Study Guide 2026/2027 UPDATE Page 2
, QUESTION 1: NSG 533: Patient on warfarin INR 4.5 with bleeding, antidote?
A) Hold warfarin, Vitamin K, consider 4F-PCC if major bleeding
B) Continue warfarin
C) Give heparin
D) No treatment needed
CORRECT ANSWER: A) Hold warfarin, Vitamin K, consider 4F-PCC if major bleeding
RATIONALE: Warfarin toxicity: INR supratherapeutic >4.5 bleeding risk. Antidote Vitamin K PO/IV, 4-factor
PCC for major bleeding. Heparin antidote protamine. Monitor INR. Warfarin narrow therapeutic 2-3
(mechanical valve 2.5-3.5).
QUESTION 2: First-line HTN in African American per 2024 guidelines?
A) Thiazide diuretic or CCB
B) ACE inhibitor alone first-line
C) Beta-blocker first-line
D) Loop diuretic first-line
CORRECT ANSWER: A) Thiazide diuretic or CCB
RATIONALE: 2024 HTN guidelines: African American first-line thiazide or CCB more effective than ACE
alone due to lower renin. Non-Black first-line thiazide, ACE, ARB, or CCB. Beta-blocker not first-line unless
compelling indication HF, post-MI.
QUESTION 3: Metformin contraindication & monitoring?
A) Contraindicated eGFR <30, hold before contrast, monitor B12, lactic acidosis rare but serious, no
hypoglycemia alone
B) Causes hypoglycemia always
C) No monitoring needed
D) Safe in eGFR 10
CORRECT ANSWER: A) Contraindicated eGFR <30, hold before contrast, monitor B12,
lactic acidosis rare but serious, no hypoglycemia alone
RATIONALE: Metformin first-line T2DM, contraindicated eGFR <30, caution 30-45, hold before
contrast/surgery if eGFR <60 or risk AKI. Monitor renal function, B12 deficiency long-term, lactic acidosis
risk. Does NOT cause hypoglycemia alone.
QUESTION 4: Phenytoin therapeutic level & toxicity signs?
A) Level 10-20 mcg/mL, toxicity nystagmus, ataxia, slurred speech, sedation, zero-order kinetics
B) Level 50-100
C) No toxicity
D) No level monitoring
CORRECT ANSWER: A) Level 10-20 mcg/mL, toxicity nystagmus, ataxia, slurred
speech, sedation, zero-order kinetics
RATIONALE: Phenytoin narrow therapeutic 10-20 mcg/mL, zero-order kinetics small dose increase large
level increase, toxicity nystagmus ataxia slurred speech. Highly protein bound, CYP inducer, many drug
interactions. Fosphenytoin IV safer.
NSG 533 Exam 2 Advanced Pharmacology Study Guide 2026/2027 UPDATE Page 3
, QUESTION 5: SSRI discontinuation syndrome vs serotonin syndrome?
A) Discontinuation: dizziness, nausea, flu-like after abrupt stop SSRI - taper needed. Serotonin
syndrome: agitation, hyperthermia, clonus, rigidity from excess serotonin - emergency
B) Same thing
C) No difference
D) Only discontinuation exists
CORRECT ANSWER: A) Discontinuation: dizziness, nausea, flu-like after abrupt stop
SSRI - taper needed. Serotonin syndrome: agitation, hyperthermia, clonus, rigidity from
excess serotonin - emergency
RATIONALE: SSRI discontinuation syndrome after abrupt stop: dizziness, nausea, headache, irritability,
flu-like - taper slowly. Serotonin syndrome from excess serotonin with SSRI + MAOI or 2 serotonergic drugs:
hyperthermia, agitation, clonus, rigidity, autonomic instability - stop drug, supportive, cyproheptadine.
QUESTION 6: Vancomycin monitoring & red man syndrome?
A) Monitor trough 10-20 (15-20 for serious MRSA), nephrotoxicity, ototoxicity, red man from rapid
infusion - slow infusion, antihistamine
B) No monitoring needed
C) Only ototoxicity
D) No red man syndrome
CORRECT ANSWER: A) Monitor trough 10-20 (15-20 for serious MRSA), nephrotoxicity,
ototoxicity, red man from rapid infusion - slow infusion, antihistamine
RATIONALE: Vancomycin glycopeptide MRSA: monitor trough 10-20 mcg/mL (15-20 for serious infections),
nephrotoxicity, ototoxicity, red man syndrome flushing pruritus from rapid infusion histamine release - slow
infusion over 1-2 hr, antihistamine. AUC monitoring preferred now 400-600.
QUESTION 7: NSG 533: Patient on warfarin INR 4.5 with bleeding, antidote?
A) Hold warfarin, Vitamin K, consider 4F-PCC if major bleeding
B) Continue warfarin
C) Give heparin
D) No treatment needed
CORRECT ANSWER: A) Hold warfarin, Vitamin K, consider 4F-PCC if major bleeding
RATIONALE: Warfarin toxicity: INR supratherapeutic >4.5 bleeding risk. Antidote Vitamin K PO/IV, 4-factor
PCC for major bleeding. Heparin antidote protamine. Monitor INR. Warfarin narrow therapeutic 2-3
(mechanical valve 2.5-3.5).
QUESTION 8: First-line HTN in African American per 2024 guidelines?
A) Thiazide diuretic or CCB
B) ACE inhibitor alone first-line
C) Beta-blocker first-line
D) Loop diuretic first-line
CORRECT ANSWER: A) Thiazide diuretic or CCB
RATIONALE: 2024 HTN guidelines: African American first-line thiazide or CCB more effective than ACE
alone due to lower renin. Non-Black first-line thiazide, ACE, ARB, or CCB. Beta-blocker not first-line unless
compelling indication HF, post-MI.
NSG 533 Exam 2 Advanced Pharmacology Study Guide 2026/2027 UPDATE Page 4
