ADVANCED PHARMACOLOGY NSG 527
MASTERY EXAM QUESTIONS AND
ANSWERS
1. A patient with a history of heart failure is prescribed a medication that inhibits the
conversion of Angiotensin I to Angiotensin II. What is the primary mechanism of the dry
cough associated with this drug?
A. Excessive sodium retention in the alveolar spaces
B. Decreased production of pulmonary surfactant
C. Direct stimulation of the vagal cough receptors by the drug
D. Accumulation of bradykinin and substance P in the lungs
Answer: D
Conceptual Explanation: ACE inhibitors block the breakdown of bradykinin, leading to its
accumulation in the respiratory tract, which causes the characteristic dry cough.
2. When prescribing Metformin for a patient with Type 2 Diabetes, at what Glomerular
Filtration Rate (GFR) level should the medication be discontinued?
A. Below 60 mL/min/1.73m²
B. Below 45 mL/min/1.73m²
,C. Below 30 mL/min/1.73m²
D. Below 15 mL/min/1.73m²
Answer: C
Conceptual Explanation: Metformin is contraindicated when GFR falls below 30
mL/min/1.73m² due to the significantly increased risk of lactic acidosis.
3. Which of the following antidepressants requires a ‘washout’ period of at least 5 weeks
before switching to a Monoamine Oxidase Inhibitor (MAOI) to avoid serotonin syndrome?
A. Sertraline
B. Paroxetine
C. Fluoxetine
D. Escitalopram
Answer: C
Conceptual Explanation: Fluoxetine has an exceptionally long half-life (and an active
metabolite), necessitating a 5-week washout period compared to the 2 weeks required for
other SSRIs.
4. A patient taking Warfarin for atrial fibrillation is started on Amiodarone. What adjustment
to the Warfarin dose is typically required?
A. Increase the dose by 50%
B. Maintain the same dose but check INR daily
, C. Decrease the dose by 30% to 50%
D. Discontinue Warfarin and switch to Dabigatran
Answer: C
Conceptual Explanation: Amiodarone inhibits CYP2C9, the primary enzyme that
metabolizes S-warfarin. This interaction increases Warfarin levels, requiring a significant
dose reduction to prevent bleeding.
5. Which class of antihypertensives is considered first-line for a patient with chronic kidney
disease (CKD) and proteinuria, regardless of race?
A. Thiazide diuretics
B. Calcium Channel Blockers
C. Beta-Blockers
D. ACE Inhibitors or ARBs
Answer: D
Conceptual Explanation: ACE inhibitors and ARBs provide renal protection by dilating the
efferent arteriole, reducing intraglomerular pressure and proteinuria in CKD patients.
6. A 65-year-old patient on Digoxin presents with nausea, vomiting, and seeing ‘yellow-green
halos’ around lights. Which electrolyte abnormality increases the risk of this toxicity?
A. Hyperkalemia
B. Hypocalcemia
MASTERY EXAM QUESTIONS AND
ANSWERS
1. A patient with a history of heart failure is prescribed a medication that inhibits the
conversion of Angiotensin I to Angiotensin II. What is the primary mechanism of the dry
cough associated with this drug?
A. Excessive sodium retention in the alveolar spaces
B. Decreased production of pulmonary surfactant
C. Direct stimulation of the vagal cough receptors by the drug
D. Accumulation of bradykinin and substance P in the lungs
Answer: D
Conceptual Explanation: ACE inhibitors block the breakdown of bradykinin, leading to its
accumulation in the respiratory tract, which causes the characteristic dry cough.
2. When prescribing Metformin for a patient with Type 2 Diabetes, at what Glomerular
Filtration Rate (GFR) level should the medication be discontinued?
A. Below 60 mL/min/1.73m²
B. Below 45 mL/min/1.73m²
,C. Below 30 mL/min/1.73m²
D. Below 15 mL/min/1.73m²
Answer: C
Conceptual Explanation: Metformin is contraindicated when GFR falls below 30
mL/min/1.73m² due to the significantly increased risk of lactic acidosis.
3. Which of the following antidepressants requires a ‘washout’ period of at least 5 weeks
before switching to a Monoamine Oxidase Inhibitor (MAOI) to avoid serotonin syndrome?
A. Sertraline
B. Paroxetine
C. Fluoxetine
D. Escitalopram
Answer: C
Conceptual Explanation: Fluoxetine has an exceptionally long half-life (and an active
metabolite), necessitating a 5-week washout period compared to the 2 weeks required for
other SSRIs.
4. A patient taking Warfarin for atrial fibrillation is started on Amiodarone. What adjustment
to the Warfarin dose is typically required?
A. Increase the dose by 50%
B. Maintain the same dose but check INR daily
, C. Decrease the dose by 30% to 50%
D. Discontinue Warfarin and switch to Dabigatran
Answer: C
Conceptual Explanation: Amiodarone inhibits CYP2C9, the primary enzyme that
metabolizes S-warfarin. This interaction increases Warfarin levels, requiring a significant
dose reduction to prevent bleeding.
5. Which class of antihypertensives is considered first-line for a patient with chronic kidney
disease (CKD) and proteinuria, regardless of race?
A. Thiazide diuretics
B. Calcium Channel Blockers
C. Beta-Blockers
D. ACE Inhibitors or ARBs
Answer: D
Conceptual Explanation: ACE inhibitors and ARBs provide renal protection by dilating the
efferent arteriole, reducing intraglomerular pressure and proteinuria in CKD patients.
6. A 65-year-old patient on Digoxin presents with nausea, vomiting, and seeing ‘yellow-green
halos’ around lights. Which electrolyte abnormality increases the risk of this toxicity?
A. Hyperkalemia
B. Hypocalcemia
