NR 566 ADVANCED PHARMACOLOGY
COMPREHENSIVE EXAM STUDY GUIDE
QUESTIONS AND VERIFIED ANSWERS |
100% CORRECT | GRADE A+
1. A 65-year-old patient with a history of heart failure with reduced ejection fraction (HFrEF)
is currently taking an ACE inhibitor, a beta-blocker, and a loop diuretic. According to recent
guidelines, which medication class should be added to further reduce mortality and
hospitalization?
A. Calcium Channel Blockers
B. SGLT2 inhibitors
C. Alpha-1 Blockers
D. Centrally acting alpha-2 agonists
Answer: B
Conceptual Explanation: SGLT2 inhibitors like dapagliflozin have been shown to
significantly reduce the risk of cardiovascular death and heart failure hospitalization in
patients with HFrEF, regardless of diabetes status.
2. When initiating Levothyroxine for a 72-year-old patient with a history of coronary artery
disease, what is the most appropriate starting dose?
A. 1.6 mcg/kg/day
,B. 12.5 to 25 mcg daily
C. 100 mcg daily
D. 50 mcg daily
Answer: B
Conceptual Explanation: In elderly patients or those with underlying cardiac disease,
Levothyroxine should be started at a low dose (12.5-25 mcg) to avoid precipitating
myocardial ischemia or arrhythmias.
3. Which of the following laboratory parameters must be monitored closely when a patient is
initiated on Spironolactone for hypertension or heart failure?
A. Serum Calcium
B. Serum Potassium
C. Liver Enzymes
D. Hemoglobin A1c
Answer: B
Conceptual Explanation: Spironolactone is a potassium-sparing diuretic
(mineralocorticoid receptor antagonist) and carries a high risk of hyperkalemia, especially
in patients with renal impairment or those taking ACEIs/ARBs.
, 4. A patient is being switched from Lisinopril to Sacubitril/Valsartan (Entresto). What is the
mandatory washout period required to minimize the risk of angioedema?
A. 12 hours
B. 24 hours
C. 36 hours
D. 72 hours
Answer: C
Conceptual Explanation: A 36-hour washout period is required when switching from an
ACE inhibitor to an ARNI (Sacubitril/Valsartan) to prevent the accumulation of bradykinin
and the subsequent risk of angioedema.
5. Metformin is contraindicated in patients with which of the following GFR levels?
A. GFR < 30 mL/min/1.73m²
B. GFR < 45 mL/min/1.73m²
C. GFR < 60 mL/min/1.73m²
D. GFR < 15 mL/min/1.73m²
Answer: A
Conceptual Explanation: Metformin is contraindicated in patients with an eGFR below 30
mL/min/1.73m² due to the increased risk of lactic acidosis.
COMPREHENSIVE EXAM STUDY GUIDE
QUESTIONS AND VERIFIED ANSWERS |
100% CORRECT | GRADE A+
1. A 65-year-old patient with a history of heart failure with reduced ejection fraction (HFrEF)
is currently taking an ACE inhibitor, a beta-blocker, and a loop diuretic. According to recent
guidelines, which medication class should be added to further reduce mortality and
hospitalization?
A. Calcium Channel Blockers
B. SGLT2 inhibitors
C. Alpha-1 Blockers
D. Centrally acting alpha-2 agonists
Answer: B
Conceptual Explanation: SGLT2 inhibitors like dapagliflozin have been shown to
significantly reduce the risk of cardiovascular death and heart failure hospitalization in
patients with HFrEF, regardless of diabetes status.
2. When initiating Levothyroxine for a 72-year-old patient with a history of coronary artery
disease, what is the most appropriate starting dose?
A. 1.6 mcg/kg/day
,B. 12.5 to 25 mcg daily
C. 100 mcg daily
D. 50 mcg daily
Answer: B
Conceptual Explanation: In elderly patients or those with underlying cardiac disease,
Levothyroxine should be started at a low dose (12.5-25 mcg) to avoid precipitating
myocardial ischemia or arrhythmias.
3. Which of the following laboratory parameters must be monitored closely when a patient is
initiated on Spironolactone for hypertension or heart failure?
A. Serum Calcium
B. Serum Potassium
C. Liver Enzymes
D. Hemoglobin A1c
Answer: B
Conceptual Explanation: Spironolactone is a potassium-sparing diuretic
(mineralocorticoid receptor antagonist) and carries a high risk of hyperkalemia, especially
in patients with renal impairment or those taking ACEIs/ARBs.
, 4. A patient is being switched from Lisinopril to Sacubitril/Valsartan (Entresto). What is the
mandatory washout period required to minimize the risk of angioedema?
A. 12 hours
B. 24 hours
C. 36 hours
D. 72 hours
Answer: C
Conceptual Explanation: A 36-hour washout period is required when switching from an
ACE inhibitor to an ARNI (Sacubitril/Valsartan) to prevent the accumulation of bradykinin
and the subsequent risk of angioedema.
5. Metformin is contraindicated in patients with which of the following GFR levels?
A. GFR < 30 mL/min/1.73m²
B. GFR < 45 mL/min/1.73m²
C. GFR < 60 mL/min/1.73m²
D. GFR < 15 mL/min/1.73m²
Answer: A
Conceptual Explanation: Metformin is contraindicated in patients with an eGFR below 30
mL/min/1.73m² due to the increased risk of lactic acidosis.
