Wilkes NSG 533 Advanced Pharmacology Exam 2 (Newest 2026) –
Practice Questions with Correct Answers & Comprehensive
Rationales | Rated A+ | Latest Update.PDF
Q1. A 72-year-old with heart failure (EF 30%) is on lisinopril, carvedilol, and furosemide.
Which addition would most improve mortality?
A) Digoxin
B) Spironolactone
C) Amlodipine
D) Hydralazine/isosorbide dinitrate
Answer: B – Spironolactone (an aldosterone antagonist) reduces mortality in HFrEF when
added to standard therapy. Digoxin reduces hospitalizations but not mortality. Amlodipine is
neutral. Hydralazine/isosorbide is used in African Americans if intolerant to ACEi/ARB, but
not first-line add-on.
Q2. A patient on warfarin is started on trimethoprim-sulfamethoxazole. What is the primary
mechanism of interaction?
A) CYP3A4 induction
B) Displacement from protein binding
C) Inhibition of CYP2C9 and reduced vitamin K synthesis
D) Increased warfarin renal clearance
,Answer: C – TMP-SMX inhibits CYP2C9 (warfarin metabolism) and reduces gut vitamin K
production, significantly increasing INR.
Q3. Which diabetic drug is absolutely contraindicated with a personal/family history of
medullary thyroid carcinoma?
A) Pioglitazone
B) Liraglutide
C) Canagliflozin
D) Glyburide
Answer: B – GLP-1 receptor agonists (liraglutide) have a boxed warning for medullary
thyroid carcinoma.
Q4. A patient taking an MAOI (phenelzine) presents with severe headache, hypertension,
and diaphoresis. Which food likely triggered this?
A) Bananas
B) Aged cheese
C) Chocolate
D) Oranges
Answer: B – Tyramine in aged cheese can cause a hypertensive crisis with MAOIs.
,Q5. A patient on metformin develops lactic acidosis. Which risk factor is most likely?
A) Concurrent sulfonylurea
B) Acute kidney injury (eGFR <30)
C) Beta-blocker use
D) Alcohol withdrawal
Answer: B – Metformin is contraindicated if eGFR <30 due to lactic acidosis risk.
Q6. Which antiarrhythmic increases digoxin levels and can cause toxicity?
A) Amiodarone
B) Lidocaine
C) Mexiletine
D) Sotalol
Answer: A – Amiodarone inhibits P-glycoprotein, reducing digoxin renal clearance and
raising levels.
Q7. A patient on clopidogrel for ACS requires a PPI for GI protection. Which PPI is preferred
to avoid reduced clopidogrel efficacy?
A) Omeprazole
B) Esomeprazole
C) Pantoprazole
D) Lansoprazole
, Answer: C – Pantoprazole is a weaker CYP2C19 inhibitor and least likely to interfere with
clopidogrel activation.
Q8. An 80-year-old with dementia and agitation is given haloperidol. What adverse effect is
highest risk in this population?
A) Tardive dyskinesia
B) Neuroleptic malignant syndrome
C) Stroke and mortality
D) Acute dystonia
Answer: C – Elderly with dementia-related psychosis have increased risk of
cerebrovascular events and death with antipsychotics (boxed warning).
Q9. A patient on lithium develops tremor, polyuria, and a low urine specific gravity. What
adverse effect is likely?
A) Hypothyroidism
B) Nephrogenic diabetes insipidus
C) Renal calculi
D) Hypercalcemia
Answer: B – Lithium causes nephrogenic diabetes insipidus (polyuria, dilute urine) via
antagonism of ADH at the collecting duct.
Practice Questions with Correct Answers & Comprehensive
Rationales | Rated A+ | Latest Update.PDF
Q1. A 72-year-old with heart failure (EF 30%) is on lisinopril, carvedilol, and furosemide.
Which addition would most improve mortality?
A) Digoxin
B) Spironolactone
C) Amlodipine
D) Hydralazine/isosorbide dinitrate
Answer: B – Spironolactone (an aldosterone antagonist) reduces mortality in HFrEF when
added to standard therapy. Digoxin reduces hospitalizations but not mortality. Amlodipine is
neutral. Hydralazine/isosorbide is used in African Americans if intolerant to ACEi/ARB, but
not first-line add-on.
Q2. A patient on warfarin is started on trimethoprim-sulfamethoxazole. What is the primary
mechanism of interaction?
A) CYP3A4 induction
B) Displacement from protein binding
C) Inhibition of CYP2C9 and reduced vitamin K synthesis
D) Increased warfarin renal clearance
,Answer: C – TMP-SMX inhibits CYP2C9 (warfarin metabolism) and reduces gut vitamin K
production, significantly increasing INR.
Q3. Which diabetic drug is absolutely contraindicated with a personal/family history of
medullary thyroid carcinoma?
A) Pioglitazone
B) Liraglutide
C) Canagliflozin
D) Glyburide
Answer: B – GLP-1 receptor agonists (liraglutide) have a boxed warning for medullary
thyroid carcinoma.
Q4. A patient taking an MAOI (phenelzine) presents with severe headache, hypertension,
and diaphoresis. Which food likely triggered this?
A) Bananas
B) Aged cheese
C) Chocolate
D) Oranges
Answer: B – Tyramine in aged cheese can cause a hypertensive crisis with MAOIs.
,Q5. A patient on metformin develops lactic acidosis. Which risk factor is most likely?
A) Concurrent sulfonylurea
B) Acute kidney injury (eGFR <30)
C) Beta-blocker use
D) Alcohol withdrawal
Answer: B – Metformin is contraindicated if eGFR <30 due to lactic acidosis risk.
Q6. Which antiarrhythmic increases digoxin levels and can cause toxicity?
A) Amiodarone
B) Lidocaine
C) Mexiletine
D) Sotalol
Answer: A – Amiodarone inhibits P-glycoprotein, reducing digoxin renal clearance and
raising levels.
Q7. A patient on clopidogrel for ACS requires a PPI for GI protection. Which PPI is preferred
to avoid reduced clopidogrel efficacy?
A) Omeprazole
B) Esomeprazole
C) Pantoprazole
D) Lansoprazole
, Answer: C – Pantoprazole is a weaker CYP2C19 inhibitor and least likely to interfere with
clopidogrel activation.
Q8. An 80-year-old with dementia and agitation is given haloperidol. What adverse effect is
highest risk in this population?
A) Tardive dyskinesia
B) Neuroleptic malignant syndrome
C) Stroke and mortality
D) Acute dystonia
Answer: C – Elderly with dementia-related psychosis have increased risk of
cerebrovascular events and death with antipsychotics (boxed warning).
Q9. A patient on lithium develops tremor, polyuria, and a low urine specific gravity. What
adverse effect is likely?
A) Hypothyroidism
B) Nephrogenic diabetes insipidus
C) Renal calculi
D) Hypercalcemia
Answer: B – Lithium causes nephrogenic diabetes insipidus (polyuria, dilute urine) via
antagonism of ADH at the collecting duct.
