NSG 533 ADVANCED PHARMACOLOGY
EXAM 2 - COMPREHENSIVE STUDY
GUIDE
1. A patient with a history of heart failure is prescribed Sacubitril/Valsartan (Entresto). Which
of the following is a mandatory requirement when transitioning from an ACE inhibitor to this
ARNI?
A. Decrease the ACE inhibitor dose by 50% for one week prior to starting.
B. Begin the ARNI immediately to prevent rebound hypertension.
C. Observe a washout period of at least 36 hours after the last ACE inhibitor dose.
D. Monitor potassium levels for 48 hours before the first dose.
Answer: C
Conceptual Explanation: A washout period of 36 hours is required when switching from
an ACE inhibitor to an ARNI (Sacubitril/Valsartan) to minimize the risk of angioedema due
to the overlapping effects on bradykinin metabolism.
,2. Which of the following mechanisms best explains why patients taking ACE inhibitors
develop a dry, non-productive cough?
A. Direct irritation of the bronchial mucosa by the drug molecule.
B. Increased production of prostaglandins in the lung tissue.
C. Accumulation of substance P and bradykinin in the upper airways.
D. Reflex bronchospasm due to decreased systemic vascular resistance.
Answer: C
Conceptual Explanation: ACE inhibitors prevent the breakdown of bradykinin and
substance P. The accumulation of these substances in the respiratory tract leads to the
characteristic dry cough.
3. A patient is started on Amiodarone for refractory ventricular tachycardia. Which
monitoring parameter is most critical during long-term therapy due to the drug’s high iodine
content?
A. Complete blood count with differential
B. Serum magnesium levels
C. Thyroid function tests (TSH, T3, T4)
D. Renal ultrasound
Answer: C
, Conceptual Explanation: Amiodarone contains significant amounts of organic iodine,
which can cause both hyperthyroidism and hypothyroidism (Wolff-Chaikoff effect or Jod-
Basedow phenomenon).
4. A patient with chronic kidney disease (CKD) requires a diuretic for volume overload. Which
class of diuretics remains effective even when the glomerular filtration rate (GFR) falls below
30 mL/min?
A. Thiazide diuretics
B. Potassium-sparing diuretics
C. Loop diuretics
D. Carbonic anhydrase inhibitors
Answer: C
Conceptual Explanation: Loop diuretics (e.g., Furosemide) are the most potent and
remain effective in patients with significantly impaired renal function (low GFR), whereas
thiazides generally lose efficacy below a GFR of 30.
5. Which of the following medications is a prodrug that requires activation by the CYP2C19
enzyme, potentially leading to reduced efficacy in ‘poor metabolizers’?
A. Aspirin
B. Warfarin
C. Clopidogrel
EXAM 2 - COMPREHENSIVE STUDY
GUIDE
1. A patient with a history of heart failure is prescribed Sacubitril/Valsartan (Entresto). Which
of the following is a mandatory requirement when transitioning from an ACE inhibitor to this
ARNI?
A. Decrease the ACE inhibitor dose by 50% for one week prior to starting.
B. Begin the ARNI immediately to prevent rebound hypertension.
C. Observe a washout period of at least 36 hours after the last ACE inhibitor dose.
D. Monitor potassium levels for 48 hours before the first dose.
Answer: C
Conceptual Explanation: A washout period of 36 hours is required when switching from
an ACE inhibitor to an ARNI (Sacubitril/Valsartan) to minimize the risk of angioedema due
to the overlapping effects on bradykinin metabolism.
,2. Which of the following mechanisms best explains why patients taking ACE inhibitors
develop a dry, non-productive cough?
A. Direct irritation of the bronchial mucosa by the drug molecule.
B. Increased production of prostaglandins in the lung tissue.
C. Accumulation of substance P and bradykinin in the upper airways.
D. Reflex bronchospasm due to decreased systemic vascular resistance.
Answer: C
Conceptual Explanation: ACE inhibitors prevent the breakdown of bradykinin and
substance P. The accumulation of these substances in the respiratory tract leads to the
characteristic dry cough.
3. A patient is started on Amiodarone for refractory ventricular tachycardia. Which
monitoring parameter is most critical during long-term therapy due to the drug’s high iodine
content?
A. Complete blood count with differential
B. Serum magnesium levels
C. Thyroid function tests (TSH, T3, T4)
D. Renal ultrasound
Answer: C
, Conceptual Explanation: Amiodarone contains significant amounts of organic iodine,
which can cause both hyperthyroidism and hypothyroidism (Wolff-Chaikoff effect or Jod-
Basedow phenomenon).
4. A patient with chronic kidney disease (CKD) requires a diuretic for volume overload. Which
class of diuretics remains effective even when the glomerular filtration rate (GFR) falls below
30 mL/min?
A. Thiazide diuretics
B. Potassium-sparing diuretics
C. Loop diuretics
D. Carbonic anhydrase inhibitors
Answer: C
Conceptual Explanation: Loop diuretics (e.g., Furosemide) are the most potent and
remain effective in patients with significantly impaired renal function (low GFR), whereas
thiazides generally lose efficacy below a GFR of 30.
5. Which of the following medications is a prodrug that requires activation by the CYP2C19
enzyme, potentially leading to reduced efficacy in ‘poor metabolizers’?
A. Aspirin
B. Warfarin
C. Clopidogrel
