NSG 533 ADVANCED PHARMACOLOGY
FINAL EXAM STUDY GUIDE
QUESTIONS AND ANSWERS
1. A patient with a history of heart failure and a reduced ejection fraction (HFrEF) is
prescribed Sacubitril/Valsartan (Entresto). Which of the following statements correctly
describes the mechanism of action of Sacubitril?
A. It inhibits the enzyme neprilysin, leading to increased levels of natriuretic peptides.
B. It directly blocks the AT1 receptor to prevent vasoconstriction.
C. It acts as a competitive antagonist at the mineralocorticoid receptor.
D. It inhibits the conversion of Angiotensin I to Angiotensin II.
Answer: A
Conceptual Explanation: Sacubitril is a neprilysin inhibitor. By inhibiting neprilysin, it
increases the concentration of beneficial natriuretic peptides that promote vasodilation
and natriuresis. Valsartan, the other component, is the ARB.
,2. When prescribing a HMG-CoA reductase inhibitor (Statin), which laboratory parameter
must be monitored if the patient reports new-onset muscle pain or weakness?
A. Serum Albumin
B. Glycated Hemoglobin (A1C)
C. Thyroid Stimulating Hormone (TSH)
D. Creatine Kinase (CK)
Answer: D
Conceptual Explanation: Creatine kinase (CK) levels should be assessed in patients
reporting muscle symptoms to evaluate for statin-associated muscle symptoms (SAMS) or
rhabdomyolysis.
3. A 65-year-old male with chronic kidney disease (CKD) Stage 3b is diagnosed with Type 2
Diabetes. Which medication is generally contraindicated if his eGFR falls below 30
mL/min/1.73m²?
A. Linagliptin
B. Metformin
C. Glipizide
D. Pioglitazone
Answer: B
, Conceptual Explanation: Metformin is contraindicated in patients with an eGFR less than
30 mL/min/1.73m² due to the increased risk of lactic acidosis.
4. A patient is being treated for a pulmonary embolism with Warfarin. What is the molecular
target inhibited by Warfarin to achieve its anticoagulant effect?
A. Factor Xa
B. Vitamin K Epoxide Reductase
C. Antithrombin III
D. Cyclooxygenase-1
Answer: B
Conceptual Explanation: Warfarin inhibits Vitamin K Epoxide Reductase (VKORC1),
which prevents the recycling of vitamin K, thereby inhibiting the synthesis of factors II, VII,
IX, and X.
5. Which of the following antidepressants carries the highest risk of causing QTc prolongation
at higher doses?
A. Fluoxetine
B. Citalopram
C. Sertraline
D. Paroxetine
Answer: B
FINAL EXAM STUDY GUIDE
QUESTIONS AND ANSWERS
1. A patient with a history of heart failure and a reduced ejection fraction (HFrEF) is
prescribed Sacubitril/Valsartan (Entresto). Which of the following statements correctly
describes the mechanism of action of Sacubitril?
A. It inhibits the enzyme neprilysin, leading to increased levels of natriuretic peptides.
B. It directly blocks the AT1 receptor to prevent vasoconstriction.
C. It acts as a competitive antagonist at the mineralocorticoid receptor.
D. It inhibits the conversion of Angiotensin I to Angiotensin II.
Answer: A
Conceptual Explanation: Sacubitril is a neprilysin inhibitor. By inhibiting neprilysin, it
increases the concentration of beneficial natriuretic peptides that promote vasodilation
and natriuresis. Valsartan, the other component, is the ARB.
,2. When prescribing a HMG-CoA reductase inhibitor (Statin), which laboratory parameter
must be monitored if the patient reports new-onset muscle pain or weakness?
A. Serum Albumin
B. Glycated Hemoglobin (A1C)
C. Thyroid Stimulating Hormone (TSH)
D. Creatine Kinase (CK)
Answer: D
Conceptual Explanation: Creatine kinase (CK) levels should be assessed in patients
reporting muscle symptoms to evaluate for statin-associated muscle symptoms (SAMS) or
rhabdomyolysis.
3. A 65-year-old male with chronic kidney disease (CKD) Stage 3b is diagnosed with Type 2
Diabetes. Which medication is generally contraindicated if his eGFR falls below 30
mL/min/1.73m²?
A. Linagliptin
B. Metformin
C. Glipizide
D. Pioglitazone
Answer: B
, Conceptual Explanation: Metformin is contraindicated in patients with an eGFR less than
30 mL/min/1.73m² due to the increased risk of lactic acidosis.
4. A patient is being treated for a pulmonary embolism with Warfarin. What is the molecular
target inhibited by Warfarin to achieve its anticoagulant effect?
A. Factor Xa
B. Vitamin K Epoxide Reductase
C. Antithrombin III
D. Cyclooxygenase-1
Answer: B
Conceptual Explanation: Warfarin inhibits Vitamin K Epoxide Reductase (VKORC1),
which prevents the recycling of vitamin K, thereby inhibiting the synthesis of factors II, VII,
IX, and X.
5. Which of the following antidepressants carries the highest risk of causing QTc prolongation
at higher doses?
A. Fluoxetine
B. Citalopram
C. Sertraline
D. Paroxetine
Answer: B
