NR566 ADVANCED PHARMACOLOGY
PRACTICE EXAM (LATEST 2026/ 2027
UPDATE) QUESTIONS AND 100%
CORRECT VERIFIED ANSWERS| GRADE
A+
1. A patient with a history of heart failure and a sulfa allergy requires a diuretic. Which
medication should be used with extreme caution or avoided due to potential cross-reactivity?
A. Ethacrynic acid
B. Hydrochlorothiazide
C. Spironolactone
D. Triamterene
Answer: B
Conceptual Explanation: Thiazide diuretics like hydrochlorothiazide contain a
sulfonamide moiety and may cross-react in patients with sulfa allergies. Ethacrynic acid is a
loop diuretic that does not contain a sulfa group.
2. Which mechanism best explains why ACE inhibitors are contraindicated in patients with a
history of angioedema?
A. Inhibition of aldosterone
,B. Accumulation of bradykinin
C. Increased renin production
D. Decreased nitric oxide synthesis
Answer: B
Conceptual Explanation: ACE inhibitors block the breakdown of bradykinin; elevated
levels of bradykinin lead to vasodilation and increased vascular permeability, causing
angioedema.
3. A 65-year-old patient on Warfarin therapy presents with an INR of 7.0 and no active
bleeding. According to current guidelines, what is the most appropriate management?
A. Hold Warfarin and monitor closely
B. Administer Vitamin K 10mg IV immediately
C. Administer Fresh Frozen Plasma
D. Administer Protamine Sulfate
Answer: A
Conceptual Explanation: For an INR between 4.5 and 10 with no bleeding, the
recommendation is to hold warfarin and monitor. Vitamin K is usually reserved for higher
INRs or active bleeding.
, 4. Which of the following statins is preferred for a patient also taking a potent CYP3A4
inhibitor due to its metabolism via other pathways?
A. Simvastatin
B. Lovastatin
C. Atorvastatin
D. Pravastatin
Answer: D
Conceptual Explanation: Pravastatin and Rosuvastatin are not metabolized by CYP3A4,
unlike Simvastatin, Lovastatin, and Atorvastatin, making them safer with CYP3A4
inhibitors.
5. A patient with Type 2 Diabetes has an eGFR of 28 mL/min/1.73m2. Which action regarding
Metformin is most appropriate?
A. Discontinue Metformin
B. Maintain current dose but monitor lactic acid
C. Reduce dose to 500mg daily
D. Switch to a Sulfonylurea
Answer: A
Conceptual Explanation: Metformin is contraindicated when eGFR falls below 30
mL/min/1.73m2 due to the high risk of lactic acidosis.
PRACTICE EXAM (LATEST 2026/ 2027
UPDATE) QUESTIONS AND 100%
CORRECT VERIFIED ANSWERS| GRADE
A+
1. A patient with a history of heart failure and a sulfa allergy requires a diuretic. Which
medication should be used with extreme caution or avoided due to potential cross-reactivity?
A. Ethacrynic acid
B. Hydrochlorothiazide
C. Spironolactone
D. Triamterene
Answer: B
Conceptual Explanation: Thiazide diuretics like hydrochlorothiazide contain a
sulfonamide moiety and may cross-react in patients with sulfa allergies. Ethacrynic acid is a
loop diuretic that does not contain a sulfa group.
2. Which mechanism best explains why ACE inhibitors are contraindicated in patients with a
history of angioedema?
A. Inhibition of aldosterone
,B. Accumulation of bradykinin
C. Increased renin production
D. Decreased nitric oxide synthesis
Answer: B
Conceptual Explanation: ACE inhibitors block the breakdown of bradykinin; elevated
levels of bradykinin lead to vasodilation and increased vascular permeability, causing
angioedema.
3. A 65-year-old patient on Warfarin therapy presents with an INR of 7.0 and no active
bleeding. According to current guidelines, what is the most appropriate management?
A. Hold Warfarin and monitor closely
B. Administer Vitamin K 10mg IV immediately
C. Administer Fresh Frozen Plasma
D. Administer Protamine Sulfate
Answer: A
Conceptual Explanation: For an INR between 4.5 and 10 with no bleeding, the
recommendation is to hold warfarin and monitor. Vitamin K is usually reserved for higher
INRs or active bleeding.
, 4. Which of the following statins is preferred for a patient also taking a potent CYP3A4
inhibitor due to its metabolism via other pathways?
A. Simvastatin
B. Lovastatin
C. Atorvastatin
D. Pravastatin
Answer: D
Conceptual Explanation: Pravastatin and Rosuvastatin are not metabolized by CYP3A4,
unlike Simvastatin, Lovastatin, and Atorvastatin, making them safer with CYP3A4
inhibitors.
5. A patient with Type 2 Diabetes has an eGFR of 28 mL/min/1.73m2. Which action regarding
Metformin is most appropriate?
A. Discontinue Metformin
B. Maintain current dose but monitor lactic acid
C. Reduce dose to 500mg daily
D. Switch to a Sulfonylurea
Answer: A
Conceptual Explanation: Metformin is contraindicated when eGFR falls below 30
mL/min/1.73m2 due to the high risk of lactic acidosis.
