WGU D116 ADVANCED PHARMACOLOGY FINAL
EXAM OBJECTIVE ASSEMENT & PRE-ASSESMENT
700 QUESTIONS AND ANSWERS LATEST UPDATE
THIS YEAR - JUST RELEASED
Cardiovascular Pharmacology & Complex Case Management
Q1.
A 68-year-old male with HFrEF (EF 30%), type 2 diabetes, and CKD Stage
3b (eGFR 38) presents with persistent dyspnea despite being on Lisinopril
20mg daily, Metoprolol succinate 100mg daily, and Furosemide 40mg daily.
His BP is 142/88 mmHg, HR 72 bpm. According to 2026 GDMT guidelines,
which medication modification offers the greatest mortality benefit?
A. Increase Lisinopril to 40mg daily
B. Add Dapagliflozin 10mg daily
C. Add Spironolactone 25mg daily
D. Switch Metoprolol to Carvedilol 25mg BID
Answer: B) Add Dapagliflozin 10mg daily
Rationale: 2026 ACC/AHA/HFSA HF guidelines emphasize SGLT2
inhibitors (dapagliflozin or empagliflozin) as foundational GDMT for
HFrEF, showing significant reductions in cardiovascular death and
hospitalization (DAPA-HF and DELIVER trials).
,Q2.
A 45-year-old female with treatment-resistant depression (failed
sertraline 200mg and venlafaxine 225mg) is started on phenelzine 15mg
TID. Two weeks later, she presents with occipital headache, neck stiffness,
and BP 192/118 mmHg after eating at a restaurant. Which dietary
component is most likely responsible?
A. Aged parmesan cheese
B. Grilled chicken breast
C. Fresh mozzarella
D. Steamed broccoli
Answer: A) Aged parmesan cheese
Rationale: Phenelzine is an irreversible MAO inhibitor requiring
strict tyramine avoidance to prevent hypertensive crisis. Aged
cheeses are high in tyramine.
Q3.
A 72-year-old female with atrial fibrillation (CHADS₂-VASc 5) on
rivaroxaban 20mg daily presents with acute GI bleeding (Hgb 8.2 g/dL).
Her creatinine is 1.4 mg/dL (eGFR 42). After stabilization, when should
anticoagulation be restarted?
A. Immediately after endoscopic hemostasis
B. 7 days after bleeding control
C. 3-4 days after bleeding control with reassessment of risk/benefit
D. Switch to aspirin indefinitely
Answer: C) 3-4 days after bleeding control with reassessment of
risk/benefit
,Rationale: 2026 CHEST guidelines support early resumption of
DOACs (3–4 days) in patients with high thromboembolic risk
(CHA₂DS₂-VASc ≥4) after GI bleeding is controlled.
Q4.
A 58-year-old male with HIV (CD4 450, undetectable VL) on
bictegravir/tenofovir alafenamide/emtricitabine develops community-
acquired pneumonia requiring clarithromycin. Which modification is
necessary?
A. Continue current regimen; no interaction
B. Switch HIV regimen to dolutegravir-based therapy
C. Switch antibiotic to azithromycin
D. Hold bictegravir during antibiotic course
Answer: C) Switch antibiotic to azithromycin
Rationale: Clarithromycin is a potent CYP3A4 and P-gp inhibitor that
significantly increases bictegravir levels, risking toxicity. 2026
DHHS guidelines recommend switching to azithromycin.
Q5.
A 35-year-old female with partial-onset seizures on carbamazepine
600mg BID presents with dizziness, ataxia, and nausea. Level is 14
mcg/mL (therapeutic 4-12). She recently started a new medication for
mood stabilization. Which drug likely caused this toxicity?
A. Lithium carbonate
B. Valproic acid
C. Lamotrigine
, D. Aripiprazole
Answer: B) Valproic acid
Rationale: Valproic acid inhibits epoxide hydrolase, the enzyme
responsible for metabolizing carbamazepine-10,11-epoxide, leading to
increased carbamazepine toxicity.
Q6.
A patient on chronic prednisone 20mg daily for polymyalgia rheumatica
develops new-onset hypertension (BP 168/102) and glucose 248 mg/dL.
Which strategy best manages these corticosteroid-induced adverse
effects?
A. Switch to methylprednisolone 16mg daily
B. Add lisinopril and metformin; continue current prednisone dose
C. Rapid taper to 5mg daily over 2 weeks
D. Initiate prophylactic calcium and vitamin D only
Answer: B) Add lisinopril and metformin; continue current
prednisone dose
Rationale: Corticosteroid-induced hypertension and hyperglycemia
require active management rather than regimen changes that might
compromise disease control.
Q7.
A patient with chronic pain on morphine 30mg ER BID and morphine 15mg
IR q4h PRN reports sedation and respiratory rate of 10. Besides naloxone
administration, which intervention is most appropriate to prevent
renarcotization?
EXAM OBJECTIVE ASSEMENT & PRE-ASSESMENT
700 QUESTIONS AND ANSWERS LATEST UPDATE
THIS YEAR - JUST RELEASED
Cardiovascular Pharmacology & Complex Case Management
Q1.
A 68-year-old male with HFrEF (EF 30%), type 2 diabetes, and CKD Stage
3b (eGFR 38) presents with persistent dyspnea despite being on Lisinopril
20mg daily, Metoprolol succinate 100mg daily, and Furosemide 40mg daily.
His BP is 142/88 mmHg, HR 72 bpm. According to 2026 GDMT guidelines,
which medication modification offers the greatest mortality benefit?
A. Increase Lisinopril to 40mg daily
B. Add Dapagliflozin 10mg daily
C. Add Spironolactone 25mg daily
D. Switch Metoprolol to Carvedilol 25mg BID
Answer: B) Add Dapagliflozin 10mg daily
Rationale: 2026 ACC/AHA/HFSA HF guidelines emphasize SGLT2
inhibitors (dapagliflozin or empagliflozin) as foundational GDMT for
HFrEF, showing significant reductions in cardiovascular death and
hospitalization (DAPA-HF and DELIVER trials).
,Q2.
A 45-year-old female with treatment-resistant depression (failed
sertraline 200mg and venlafaxine 225mg) is started on phenelzine 15mg
TID. Two weeks later, she presents with occipital headache, neck stiffness,
and BP 192/118 mmHg after eating at a restaurant. Which dietary
component is most likely responsible?
A. Aged parmesan cheese
B. Grilled chicken breast
C. Fresh mozzarella
D. Steamed broccoli
Answer: A) Aged parmesan cheese
Rationale: Phenelzine is an irreversible MAO inhibitor requiring
strict tyramine avoidance to prevent hypertensive crisis. Aged
cheeses are high in tyramine.
Q3.
A 72-year-old female with atrial fibrillation (CHADS₂-VASc 5) on
rivaroxaban 20mg daily presents with acute GI bleeding (Hgb 8.2 g/dL).
Her creatinine is 1.4 mg/dL (eGFR 42). After stabilization, when should
anticoagulation be restarted?
A. Immediately after endoscopic hemostasis
B. 7 days after bleeding control
C. 3-4 days after bleeding control with reassessment of risk/benefit
D. Switch to aspirin indefinitely
Answer: C) 3-4 days after bleeding control with reassessment of
risk/benefit
,Rationale: 2026 CHEST guidelines support early resumption of
DOACs (3–4 days) in patients with high thromboembolic risk
(CHA₂DS₂-VASc ≥4) after GI bleeding is controlled.
Q4.
A 58-year-old male with HIV (CD4 450, undetectable VL) on
bictegravir/tenofovir alafenamide/emtricitabine develops community-
acquired pneumonia requiring clarithromycin. Which modification is
necessary?
A. Continue current regimen; no interaction
B. Switch HIV regimen to dolutegravir-based therapy
C. Switch antibiotic to azithromycin
D. Hold bictegravir during antibiotic course
Answer: C) Switch antibiotic to azithromycin
Rationale: Clarithromycin is a potent CYP3A4 and P-gp inhibitor that
significantly increases bictegravir levels, risking toxicity. 2026
DHHS guidelines recommend switching to azithromycin.
Q5.
A 35-year-old female with partial-onset seizures on carbamazepine
600mg BID presents with dizziness, ataxia, and nausea. Level is 14
mcg/mL (therapeutic 4-12). She recently started a new medication for
mood stabilization. Which drug likely caused this toxicity?
A. Lithium carbonate
B. Valproic acid
C. Lamotrigine
, D. Aripiprazole
Answer: B) Valproic acid
Rationale: Valproic acid inhibits epoxide hydrolase, the enzyme
responsible for metabolizing carbamazepine-10,11-epoxide, leading to
increased carbamazepine toxicity.
Q6.
A patient on chronic prednisone 20mg daily for polymyalgia rheumatica
develops new-onset hypertension (BP 168/102) and glucose 248 mg/dL.
Which strategy best manages these corticosteroid-induced adverse
effects?
A. Switch to methylprednisolone 16mg daily
B. Add lisinopril and metformin; continue current prednisone dose
C. Rapid taper to 5mg daily over 2 weeks
D. Initiate prophylactic calcium and vitamin D only
Answer: B) Add lisinopril and metformin; continue current
prednisone dose
Rationale: Corticosteroid-induced hypertension and hyperglycemia
require active management rather than regimen changes that might
compromise disease control.
Q7.
A patient with chronic pain on morphine 30mg ER BID and morphine 15mg
IR q4h PRN reports sedation and respiratory rate of 10. Besides naloxone
administration, which intervention is most appropriate to prevent
renarcotization?
