NR 566 Advanced Pharmacology ACTUAL EXAM
2026/2027: 100% Verified Questions & Correct
Answers
Question 1: A 58-year-old Black male with CKD stage 3 (eGFR 42 mL/min) and HTN (BP 158/94
mmHg) is on amlodipine 10 mg daily. Urine albumin-creatinine ratio (UACR) is 420 mg/g. Which
regimen best reduces progression of nephropathy?
A. Add hydrochlorothiazide 25 mg daily
B. Switch to diltiazem ER 240 mg daily
C. Add losartan 50 mg twice daily
D. Add doxazosin 4 mg nightly
Correct Answer: C
Rationale: KDIGO 2025 recommends maximally-tolerated ACEi/ARB for albuminuria >300 mg/g;
losartan proven to slow diabetic and non-diabetic CKD.
Question 2: A 34-year-old female with genotype CYP2C19 *2/*17 is started on clopidogrel 75 mg
after DES placement. Which adjustment is indicated?
A. Increase to 150 mg daily
B. Switch to prasugrel 10 mg daily
,C. Add omeprazole for GI protection
D. Continue 75 mg; no change
Correct Answer: B
Rationale: Loss-of-function allele reduces active metabolite; guidelines recommend alternative
P2Y12 inhibitor (prasugrel/ticagrelor) in intermediate metabolizers.
Question 3: A patient on stable warfarin (INR 2.5) is prescribed mifepristone for Cushing’s. INR 7
days later is 4.8. Best action?
A. Hold 2 doses, reduce weekly dose 15 %, resume lower dose
B. Switch to rivaroxaban 20 mg daily
C. Give vitamin K 10 mg IV
D. Increase warfarin to achieve INR 3–4
Correct Answer: A
Rationale: Mifepristone inhibits CYP2C9; temporary hold and dose reduction corrects
supratherapeutic INR without reversal if no bleeding.
Question 4: A 67-year-old with HFrEF (LVEF 30 %) on carvedilol 25 mg BID develops fatigue and
BP 82/50 mmHg. Which change aligns with 2025 ACC/AHA guidelines?
A. Stop carvedilol immediately
B. Reduce to 12.5 mg BID, re-titrate every 2 weeks
,C. Switch to metoprolol tartrate 50 mg BID
D. Add midodrine 10 mg TID
Correct Answer: B
Rationale: Guideline-directed medical therapy should be down-titrated for tolerability, not
withdrawn, to maintain survival benefit.
Question 5: A child weighing 18 kg needs amoxicillin 45 mg/kg/day for otitis media. Suspension is
400 mg/5 mL. Calculate daily volume.
A. 5.1 mL
B. 10.1 mL
C. 15.2 mL
D. 20.3 mL
Correct Answer: B
Rationale: 18 kg × 45 mg = 810 mg/day; 400 mg/5 mL → 810 ÷ 80 = 10.1 mL daily.
Question 6: A patient on phenelzine 45 mg daily presents with occipital headache, BP 210/110
mmHg after eating aged cheese. Drug of choice?
A. Oral nifedipine 10 mg
B. IV labetalol 20 mg
, C. Sublingual nitroglycerin 0.4 mg
D. IV phentolamine 5 mg
Correct Answer: D
Rationale: Phentolamine directly blocks α-receptors unopposed by MAOI-induced catecholamine
surge.
Question 7: A 28-year-old G2P1 at 20 weeks has asymptomatic bacteriuria (>100 K CFU E. coli).
Which antibiotic is safest?
A. Nitrofurantoin 100 mg BID × 5 days
B. Trimethoprim-sulfamethoxazole DS BID × 3 days
C. Doxycycline 100 mg BID × 7 days
D. Ciprofloxacin 250 mg BID × 3 days
Correct Answer: A
Rationale: Nitrofurantoin avoids teratogenicity and is preferred in 2nd trimester; avoid TMP-SMX in
1st trimester folate antagonism.
Question 8: A patient with atrial fibrillation on apixaban 5 mg BID is scheduled for colonoscopy with
polypectomy. When to stop?
A. 12 h before
B. 24 h before
2026/2027: 100% Verified Questions & Correct
Answers
Question 1: A 58-year-old Black male with CKD stage 3 (eGFR 42 mL/min) and HTN (BP 158/94
mmHg) is on amlodipine 10 mg daily. Urine albumin-creatinine ratio (UACR) is 420 mg/g. Which
regimen best reduces progression of nephropathy?
A. Add hydrochlorothiazide 25 mg daily
B. Switch to diltiazem ER 240 mg daily
C. Add losartan 50 mg twice daily
D. Add doxazosin 4 mg nightly
Correct Answer: C
Rationale: KDIGO 2025 recommends maximally-tolerated ACEi/ARB for albuminuria >300 mg/g;
losartan proven to slow diabetic and non-diabetic CKD.
Question 2: A 34-year-old female with genotype CYP2C19 *2/*17 is started on clopidogrel 75 mg
after DES placement. Which adjustment is indicated?
A. Increase to 150 mg daily
B. Switch to prasugrel 10 mg daily
,C. Add omeprazole for GI protection
D. Continue 75 mg; no change
Correct Answer: B
Rationale: Loss-of-function allele reduces active metabolite; guidelines recommend alternative
P2Y12 inhibitor (prasugrel/ticagrelor) in intermediate metabolizers.
Question 3: A patient on stable warfarin (INR 2.5) is prescribed mifepristone for Cushing’s. INR 7
days later is 4.8. Best action?
A. Hold 2 doses, reduce weekly dose 15 %, resume lower dose
B. Switch to rivaroxaban 20 mg daily
C. Give vitamin K 10 mg IV
D. Increase warfarin to achieve INR 3–4
Correct Answer: A
Rationale: Mifepristone inhibits CYP2C9; temporary hold and dose reduction corrects
supratherapeutic INR without reversal if no bleeding.
Question 4: A 67-year-old with HFrEF (LVEF 30 %) on carvedilol 25 mg BID develops fatigue and
BP 82/50 mmHg. Which change aligns with 2025 ACC/AHA guidelines?
A. Stop carvedilol immediately
B. Reduce to 12.5 mg BID, re-titrate every 2 weeks
,C. Switch to metoprolol tartrate 50 mg BID
D. Add midodrine 10 mg TID
Correct Answer: B
Rationale: Guideline-directed medical therapy should be down-titrated for tolerability, not
withdrawn, to maintain survival benefit.
Question 5: A child weighing 18 kg needs amoxicillin 45 mg/kg/day for otitis media. Suspension is
400 mg/5 mL. Calculate daily volume.
A. 5.1 mL
B. 10.1 mL
C. 15.2 mL
D. 20.3 mL
Correct Answer: B
Rationale: 18 kg × 45 mg = 810 mg/day; 400 mg/5 mL → 810 ÷ 80 = 10.1 mL daily.
Question 6: A patient on phenelzine 45 mg daily presents with occipital headache, BP 210/110
mmHg after eating aged cheese. Drug of choice?
A. Oral nifedipine 10 mg
B. IV labetalol 20 mg
, C. Sublingual nitroglycerin 0.4 mg
D. IV phentolamine 5 mg
Correct Answer: D
Rationale: Phentolamine directly blocks α-receptors unopposed by MAOI-induced catecholamine
surge.
Question 7: A 28-year-old G2P1 at 20 weeks has asymptomatic bacteriuria (>100 K CFU E. coli).
Which antibiotic is safest?
A. Nitrofurantoin 100 mg BID × 5 days
B. Trimethoprim-sulfamethoxazole DS BID × 3 days
C. Doxycycline 100 mg BID × 7 days
D. Ciprofloxacin 250 mg BID × 3 days
Correct Answer: A
Rationale: Nitrofurantoin avoids teratogenicity and is preferred in 2nd trimester; avoid TMP-SMX in
1st trimester folate antagonism.
Question 8: A patient with atrial fibrillation on apixaban 5 mg BID is scheduled for colonoscopy with
polypectomy. When to stop?
A. 12 h before
B. 24 h before
