CHAMBERLAIN UNIVERSITY NR 565
ADVANCED PHARMACOLOGY FINAL EXAM |
STUDY GUIDE, PRACTICE QUESTIONS,
CORRECT ANSWERS & DETAILED
RATIONALES(2026) ACTUAL QUESTIONS &
ANSWERS (CHAMBERLAIN)
,A 55-year-old with newly diagnosed type 2 diabetes has an A1C of 7.4%
and no significant comorbidities. Which initial pharmacologic approach is
most appropriate in addition to lifestyle changes?
A. Start basal insulin at bedtime
B. Begin metformin monotherapy
C. Initiate a sulfonylurea as first-line therapy
D. Start a GLP-1 receptor agonist and discontinue lifestyle measures
Correct Answer: B. Begin metformin monotherapy
Rationale:
Metformin is generally recommended as an initial pharmacologic therapy for
most patients with newly diagnosed type 2 diabetes who have mild-to-moderate
hyperglycemia and no contraindications. It effectively lowers blood glucose
and A1C, has a low risk of hypoglycemia when used alone, is generally weight-
neutral or may promote modest weight loss, and is used in conjunction with
lifestyle interventions such as dietary modification and regular physical
activity. Basal insulin is typically reserved for patients with marked
hyperglycemia or symptomatic catabolism, while sulfonylureas carry a higher
risk of hypoglycemia and weight gain. GLP-1 receptor agonists can be
appropriate in selected patients but are not necessary as the routine initial
choice in this clinical scenario.
,A 62-year-old with type 2 diabetes and obesity is already on metformin.
You want to add a medication that promotes weight loss and improves
glycemic control without hypoglycemia. Which class best fits this goal?
A. Sulfonylurea
B. Thiazolidinedione
C. GLP-1 receptor agonist
D. DPP-4 inhibitor
Correct Answer: C. GLP-1 receptor agonist
Rationale:
GLP-1 receptor agonists improve glycemic control while generally having a
low risk of hypoglycemia when used without insulin or insulin secretagogues.
They slow gastric emptying, increase satiety, and reduce appetite, which can
result in clinically meaningful weight loss. This makes them particularly useful
for patients with type 2 diabetes who also have obesity. Sulfonylureas can
cause hypoglycemia and weight gain, whereas thiazolidinediones are associated
with weight gain and fluid retention. DPP-4 inhibitors are generally weight-
neutral rather than producing substantial weight loss.
A patient on canagliflozin reports increased urination and mild genital
itching. Which patient counseling point is most appropriate?
, A. This may reflect euglycemic ketoacidosis and requires emergency care
B. These are expected effects related to glucosuria and mycotic infections
C. This indicates severe volume overload and the drug must be stopped
Correct Answer: B. These are expected effects related to glucosuria and
mycotic infections
Rationale:
Canagliflozin is an SGLT2 inhibitor that lowers blood glucose by reducing
renal glucose reabsorption, thereby increasing urinary glucose excretion
(glucosuria). The resulting osmotic diuresis can cause increased urination,
while the increased glucose concentration in the genital and urinary
environment can predispose patients to genital fungal infections, producing
symptoms such as itching. Patients should be counseled about genital hygiene
and instructed to report persistent or severe symptoms. Euglycemic diabetic
ketoacidosis is an important but uncommon adverse effect and would more
typically present with symptoms such as nausea, vomiting, abdominal pain,
malaise, or difficulty breathing rather than isolated mild genital itching.
A 70-year-old with long-standing type 2 diabetes, advanced neuropathy,
and limited life expectancy asks about glycemic targets. Which A1C goal is
most appropriate?
A. <6.0%
B. <6.5%
C. <7.0%
D. <8.0%
ADVANCED PHARMACOLOGY FINAL EXAM |
STUDY GUIDE, PRACTICE QUESTIONS,
CORRECT ANSWERS & DETAILED
RATIONALES(2026) ACTUAL QUESTIONS &
ANSWERS (CHAMBERLAIN)
,A 55-year-old with newly diagnosed type 2 diabetes has an A1C of 7.4%
and no significant comorbidities. Which initial pharmacologic approach is
most appropriate in addition to lifestyle changes?
A. Start basal insulin at bedtime
B. Begin metformin monotherapy
C. Initiate a sulfonylurea as first-line therapy
D. Start a GLP-1 receptor agonist and discontinue lifestyle measures
Correct Answer: B. Begin metformin monotherapy
Rationale:
Metformin is generally recommended as an initial pharmacologic therapy for
most patients with newly diagnosed type 2 diabetes who have mild-to-moderate
hyperglycemia and no contraindications. It effectively lowers blood glucose
and A1C, has a low risk of hypoglycemia when used alone, is generally weight-
neutral or may promote modest weight loss, and is used in conjunction with
lifestyle interventions such as dietary modification and regular physical
activity. Basal insulin is typically reserved for patients with marked
hyperglycemia or symptomatic catabolism, while sulfonylureas carry a higher
risk of hypoglycemia and weight gain. GLP-1 receptor agonists can be
appropriate in selected patients but are not necessary as the routine initial
choice in this clinical scenario.
,A 62-year-old with type 2 diabetes and obesity is already on metformin.
You want to add a medication that promotes weight loss and improves
glycemic control without hypoglycemia. Which class best fits this goal?
A. Sulfonylurea
B. Thiazolidinedione
C. GLP-1 receptor agonist
D. DPP-4 inhibitor
Correct Answer: C. GLP-1 receptor agonist
Rationale:
GLP-1 receptor agonists improve glycemic control while generally having a
low risk of hypoglycemia when used without insulin or insulin secretagogues.
They slow gastric emptying, increase satiety, and reduce appetite, which can
result in clinically meaningful weight loss. This makes them particularly useful
for patients with type 2 diabetes who also have obesity. Sulfonylureas can
cause hypoglycemia and weight gain, whereas thiazolidinediones are associated
with weight gain and fluid retention. DPP-4 inhibitors are generally weight-
neutral rather than producing substantial weight loss.
A patient on canagliflozin reports increased urination and mild genital
itching. Which patient counseling point is most appropriate?
, A. This may reflect euglycemic ketoacidosis and requires emergency care
B. These are expected effects related to glucosuria and mycotic infections
C. This indicates severe volume overload and the drug must be stopped
Correct Answer: B. These are expected effects related to glucosuria and
mycotic infections
Rationale:
Canagliflozin is an SGLT2 inhibitor that lowers blood glucose by reducing
renal glucose reabsorption, thereby increasing urinary glucose excretion
(glucosuria). The resulting osmotic diuresis can cause increased urination,
while the increased glucose concentration in the genital and urinary
environment can predispose patients to genital fungal infections, producing
symptoms such as itching. Patients should be counseled about genital hygiene
and instructed to report persistent or severe symptoms. Euglycemic diabetic
ketoacidosis is an important but uncommon adverse effect and would more
typically present with symptoms such as nausea, vomiting, abdominal pain,
malaise, or difficulty breathing rather than isolated mild genital itching.
A 70-year-old with long-standing type 2 diabetes, advanced neuropathy,
and limited life expectancy asks about glycemic targets. Which A1C goal is
most appropriate?
A. <6.0%
B. <6.5%
C. <7.0%
D. <8.0%
