NR566 ADVANCED PHARMACOLOGY
MIDTERM EXAM COMPREHENSIVE
PREP QUESTIONS WITH 100%
CORRECT ANSWERS
1. A 65-year-old patient with chronic kidney disease (CKD) and hypertension is prescribed an
ACE inhibitor. What is the primary reason for choosing this class of medication despite its
potential for acute changes in GFR?
A. It reduces intraglomerular pressure by dilating the efferent arteriole.
B. It increases peripheral vascular resistance to maintain perfusion.
C. It directly inhibits the secretion of renin from the juxtaglomerular cells.
D. It promotes potassium excretion to prevent hyperkalemia in CKD.
Answer: A
Conceptual Explanation: ACE inhibitors reduce intraglomerular pressure by dilating the
efferent arteriole, which provides a renoprotective effect over time, despite causing a slight
initial drop in GFR.
2. When initiating Metformin for a patient with Type 2 Diabetes, the provider should warn
the patient about which primary mechanism that leads to gastrointestinal side effects?
A. Stimulation of insulin release from the pancreas.
,B. Increased glucose uptake in skeletal muscle.
C. Delayed gastric emptying and changes in gut microbiome.
D. Accumulation of lactate in the intestinal mucosa.
Answer: C
Conceptual Explanation: Metformin often causes GI distress through mechanisms
including delayed gastric emptying, changes in bile acid absorption, and alterations in the
gut microbiome.
3. Which pharmacokinetic change in geriatric patients leads to a higher risk of toxicity with
lipid-soluble drugs?
A. Increased percentage of body fat.
B. Increased total body water.
C. Decreased albumin levels.
D. Increased hepatic blood flow.
Answer: A
Conceptual Explanation: Geriatric patients typically have an increased percentage of body
fat, which increases the volume of distribution for lipid-soluble drugs, leading to prolonged
half-lives and potential toxicity.
, 4. A patient is taking Warfarin for atrial fibrillation. Which of the following cytochrome P450
interactions is most likely to increase the risk of bleeding?
A. Induction of CYP2C9 by Rifampin.
B. Inhibition of CYP2C9 by Fluconazole.
C. Induction of CYP3A4 by St. John’s Wort.
D. Inhibition of CYP1A2 by smoking cessation.
Answer: B
Conceptual Explanation: Warfarin (S-isomer) is primarily metabolized by CYP2C9.
Inhibition of this enzyme by drugs like Fluconazole leads to higher Warfarin levels and
increased INR/bleeding risk.
5. According to the GINA guidelines, what is now the preferred ‘reliever’ therapy for adults
with mild asthma?
A. Short-acting beta2-agonist (SABA) alone.
B. Low-dose ICS-formoterol as needed.
C. Long-acting beta2-agonist (LABA) alone.
D. Oral corticosteroids for any symptom flare.
Answer: B
MIDTERM EXAM COMPREHENSIVE
PREP QUESTIONS WITH 100%
CORRECT ANSWERS
1. A 65-year-old patient with chronic kidney disease (CKD) and hypertension is prescribed an
ACE inhibitor. What is the primary reason for choosing this class of medication despite its
potential for acute changes in GFR?
A. It reduces intraglomerular pressure by dilating the efferent arteriole.
B. It increases peripheral vascular resistance to maintain perfusion.
C. It directly inhibits the secretion of renin from the juxtaglomerular cells.
D. It promotes potassium excretion to prevent hyperkalemia in CKD.
Answer: A
Conceptual Explanation: ACE inhibitors reduce intraglomerular pressure by dilating the
efferent arteriole, which provides a renoprotective effect over time, despite causing a slight
initial drop in GFR.
2. When initiating Metformin for a patient with Type 2 Diabetes, the provider should warn
the patient about which primary mechanism that leads to gastrointestinal side effects?
A. Stimulation of insulin release from the pancreas.
,B. Increased glucose uptake in skeletal muscle.
C. Delayed gastric emptying and changes in gut microbiome.
D. Accumulation of lactate in the intestinal mucosa.
Answer: C
Conceptual Explanation: Metformin often causes GI distress through mechanisms
including delayed gastric emptying, changes in bile acid absorption, and alterations in the
gut microbiome.
3. Which pharmacokinetic change in geriatric patients leads to a higher risk of toxicity with
lipid-soluble drugs?
A. Increased percentage of body fat.
B. Increased total body water.
C. Decreased albumin levels.
D. Increased hepatic blood flow.
Answer: A
Conceptual Explanation: Geriatric patients typically have an increased percentage of body
fat, which increases the volume of distribution for lipid-soluble drugs, leading to prolonged
half-lives and potential toxicity.
, 4. A patient is taking Warfarin for atrial fibrillation. Which of the following cytochrome P450
interactions is most likely to increase the risk of bleeding?
A. Induction of CYP2C9 by Rifampin.
B. Inhibition of CYP2C9 by Fluconazole.
C. Induction of CYP3A4 by St. John’s Wort.
D. Inhibition of CYP1A2 by smoking cessation.
Answer: B
Conceptual Explanation: Warfarin (S-isomer) is primarily metabolized by CYP2C9.
Inhibition of this enzyme by drugs like Fluconazole leads to higher Warfarin levels and
increased INR/bleeding risk.
5. According to the GINA guidelines, what is now the preferred ‘reliever’ therapy for adults
with mild asthma?
A. Short-acting beta2-agonist (SABA) alone.
B. Low-dose ICS-formoterol as needed.
C. Long-acting beta2-agonist (LABA) alone.
D. Oral corticosteroids for any symptom flare.
Answer: B
