NR566 ADVANCED PHARMACOLOGY
MIDTERM AND FINAL EXAM REVIEW
QUESTIONS WITH 100% CORRECT
ANSWERS
1. A patient with a history of heart failure and an eGFR of 25 mL/min requires management
for Type 2 Diabetes. Which of the following medications is contraindicated in this patient?
A. Linagliptin
B. Glipizide
C. Empagliflozin
D. Metformin
Answer: D
Conceptual Explanation: Metformin is contraindicated when the estimated glomerular
filtration rate (eGFR) falls below 30 mL/min/1.73 m² due to the increased risk of lactic
acidosis.
2. When initiating an ACE inhibitor in a patient already taking a high-dose loop diuretic, the
provider should be most concerned about:
A. Ototoxicity
B. Hypokalemia
,C. First-dose hypotension
D. Hypernatremia
Answer: C
Conceptual Explanation: Patients on high-dose diuretics are often volume-depleted,
making them highly susceptible to significant hypotension when starting an ACE inhibitor.
3. A patient is prescribed Warfarin for atrial fibrillation. Which of the following supplements
should they be advised to avoid as it significantly increases the risk of bleeding?
A. St. John’s Wort
B. Vitamin C
C. Ginkgo biloba
D. Coenzyme Q10
Answer: C
Conceptual Explanation: Ginkgo biloba has antiplatelet properties that can synergize with
Warfarin, increasing the risk of spontaneous bleeding.
4. Which antibiotic class is associated with a Black Box Warning regarding the risk of tendon
rupture and peripheral neuropathy?
A. Fluoroquinolones
B. Macrolides
C. Cephalosporins
, D. Tetracyclines
Answer: A
Conceptual Explanation: Fluoroquinolones (e.g., Ciprofloxacin, Levofloxacin) carry Black
Box Warnings for tendon rupture, peripheral neuropathy, and CNS effects.
5. A 65-year-old female is diagnosed with osteoporosis. When prescribing Alendronate, what
instruction is critical to prevent esophageal erosion?
A. Take the medication with food to buffer the stomach.
B. Take the medication at bedtime with a snack.
C. Take the medication with milk to increase calcium absorption.
D. Remain upright for at least 30 minutes after taking the dose.
Answer: D
Conceptual Explanation: Bisphosphonates like Alendronate must be taken on an empty
stomach with plain water, and the patient must remain upright for at least 30 minutes to
prevent gastroesophageal reflux and esophageal irritation.
6. In the treatment of Community-Acquired Pneumonia (CAP) in a healthy adult with no
recent antibiotic use, which is currently recommended as a first-line monotherapy option?
A. Azithromycin 500mg once then 250mg daily
B. Levofloxacin 750mg Daily
C. Ciprofloxacin 500mg BID
MIDTERM AND FINAL EXAM REVIEW
QUESTIONS WITH 100% CORRECT
ANSWERS
1. A patient with a history of heart failure and an eGFR of 25 mL/min requires management
for Type 2 Diabetes. Which of the following medications is contraindicated in this patient?
A. Linagliptin
B. Glipizide
C. Empagliflozin
D. Metformin
Answer: D
Conceptual Explanation: Metformin is contraindicated when the estimated glomerular
filtration rate (eGFR) falls below 30 mL/min/1.73 m² due to the increased risk of lactic
acidosis.
2. When initiating an ACE inhibitor in a patient already taking a high-dose loop diuretic, the
provider should be most concerned about:
A. Ototoxicity
B. Hypokalemia
,C. First-dose hypotension
D. Hypernatremia
Answer: C
Conceptual Explanation: Patients on high-dose diuretics are often volume-depleted,
making them highly susceptible to significant hypotension when starting an ACE inhibitor.
3. A patient is prescribed Warfarin for atrial fibrillation. Which of the following supplements
should they be advised to avoid as it significantly increases the risk of bleeding?
A. St. John’s Wort
B. Vitamin C
C. Ginkgo biloba
D. Coenzyme Q10
Answer: C
Conceptual Explanation: Ginkgo biloba has antiplatelet properties that can synergize with
Warfarin, increasing the risk of spontaneous bleeding.
4. Which antibiotic class is associated with a Black Box Warning regarding the risk of tendon
rupture and peripheral neuropathy?
A. Fluoroquinolones
B. Macrolides
C. Cephalosporins
, D. Tetracyclines
Answer: A
Conceptual Explanation: Fluoroquinolones (e.g., Ciprofloxacin, Levofloxacin) carry Black
Box Warnings for tendon rupture, peripheral neuropathy, and CNS effects.
5. A 65-year-old female is diagnosed with osteoporosis. When prescribing Alendronate, what
instruction is critical to prevent esophageal erosion?
A. Take the medication with food to buffer the stomach.
B. Take the medication at bedtime with a snack.
C. Take the medication with milk to increase calcium absorption.
D. Remain upright for at least 30 minutes after taking the dose.
Answer: D
Conceptual Explanation: Bisphosphonates like Alendronate must be taken on an empty
stomach with plain water, and the patient must remain upright for at least 30 minutes to
prevent gastroesophageal reflux and esophageal irritation.
6. In the treatment of Community-Acquired Pneumonia (CAP) in a healthy adult with no
recent antibiotic use, which is currently recommended as a first-line monotherapy option?
A. Azithromycin 500mg once then 250mg daily
B. Levofloxacin 750mg Daily
C. Ciprofloxacin 500mg BID
