MIDTERM & FINAL COMPREHENSIVE EXAMINATION PACKAGE | VERIFIED QUESTIONS & RATIONALES | NEWEST EXAM 2026/2027
NR 565
ADVANCED PHARMACOLOGY
FUNDAMENTALS
CHAMBERLAIN COLLEGE OF NURSING
2026/2027 NEWEST EXAM!!
Midterm & Final Comprehensive Examination Package with Verified Questions and Correct Answer
Rationales
MIDTERM + FINAL VERIFIED Q&A RATIONALES 2026/2027 NEWEST
, EXAM COVERAGE AREAS
NR 565 Advanced Pharmacology Fundamentals - Midterm & Final | 2026/2027 Newest Exam!!
Week 1-2: Pharmacokinetics, Pharmacodynamics & Prescribing
• Pharmacokinetics ADME absorption distribution metabolism CYP450 excretion half-life
• Pharmacodynamics receptor agonist antagonist potency efficacy
• Prescribing principles Beers criteria renal hepatic dosing
• Pharmacogenomics
Week 3-4: Autonomic, Cardiovascular & Hypertension
• Autonomic cholinergic adrenergic sympathomimetics
• Hypertension JNC8 ACE inhibitor cough ARB CCB thiazide
• Heart failure HFrEF guideline meds ARNI beta-blocker MRA SGLT2
• Dyslipidemia statins
Week 5-6: Diabetes, Endocrine & Respiratory
• Diabetes ADA Type 2 metformin GLP-1 SGLT2 insulin types
• Endocrine thyroid hypo/hyper
• Respiratory asthma COPD stepwise GINA inhalers LABA ICS
• Allergy
Midterm: Chapters 1-20 High Yield
• Midterm focus autonomic HTN HF dyslipidemia anticoag diabetes respiratory
• Drug interactions CYP450 inducers inhibitors
• Black box warnings
• Prescriptive authority
Week 7-8: Infectious Disease, Pain, Psych & Final
• Antibiotics classes coverage resistance stewardship
• Pain analgesics opioids NSAIDs CDC guidelines
• Psych antidepressants SSRIs antipsychotics anxiolytics Beers elderly
• Final: All systems cumulative antibiotics GI GU neuro MSK dermatology
Latest 2026/2027 Updates Chamberlain NR 565
• Newest 2026/2027 guidelines ADA 2026 AHA/ACC/HFSA 2023-2024 GOLD 2025 GINA 2025
• New drugs GLP-1 tirzepatide semaglutide SGLT2
• Opioid REMS CDC 2022
• Midterm & Final Package verified rationales
NR 565 Advanced Pharmacology Fundamentals 2026/2027 Midterm & Final Comprehensive Exam Package Page 2
, QUESTION 1: A drug with high first-pass effect needs dose adjustment in liver disease.
Example?
A) Nitroglycerin, morphine, propranolol extensive hepatic metabolism requires lower dose
B) No adjustment
C) Only renal
D) Increase dose
CORRECT ANSWER: A) Nitroglycerin, morphine, propranolol extensive hepatic
metabolism requires lower dose
RATIONALE: Pharmacokinetics: First-pass extensive hepatic metabolism CYP450 liver disease reduces
metabolism increases bioavailability requires dose reduction. Half-life prolonged hepatic/renal impairment.
CYP450 inhibitors increase levels e.g., fluconazole, inhibitors: grapefruit. Inducers: rifampin carbamazepine
St John's wort decrease levels.
QUESTION 2: ACE inhibitor dry cough mechanism and alternative?
A) Bradykinin accumulation; switch to ARB losartan valsartan
B) Histamine
C) No cough
D) Continue ACE
CORRECT ANSWER: A) Bradykinin accumulation; switch to ARB losartan valsartan
RATIONALE: ACE inhibitors: cough due to bradykinin accumulation, angioedema risk. ARB blocks AT1
receptor no bradykinin cough. Both cause hyperkalemia, teratogenic, avoid bilateral renal artery stenosis.
First line HTN per JNC8 thiazide, ACE/ARB, CCB.
QUESTION 3: Metformin contraindications and new ADA 2026 use?
A) eGFR <30 contraindicated, <45 caution; first-line T2DM unless contraindicated, does not cause
hypoglycemia, weight neutral, lactic acidosis rare
B) No contraindication
C) Causes hypoglycemia
D) Stop if eGFR 50
CORRECT ANSWER: A) eGFR <30 contraindicated, <45 caution; first-line T2DM unless
contraindicated, does not cause hypoglycemia, weight neutral, lactic acidosis rare
RATIONALE: Metformin first-line T2DM ADA 2026, MOA decreases hepatic glucose production improves
insulin sensitivity. Hold before contrast if eGFR <30. B12 deficiency long term. No hypoglycemia alone.
GLP-1 RA semaglutide tirzepatide weight loss CV benefit, SGLT2i empagliflozin HF renal benefit.
QUESTION 4: Asthma step therapy GINA 2025 controller?
A) ICS-formoterol PRN or low-dose ICS-LABA maintenance, avoid SABA-only, LABA never alone
B) SABA only
C) LABA alone
D) No ICS
CORRECT ANSWER: A) ICS-formoterol PRN or low-dose ICS-LABA maintenance, avoid
SABA-only, LABA never alone
RATIONALE: GINA 2025 asthma: Track 1 preferred low-dose ICS-formoterol PRN mild or MART
maintenance and reliever, Track 2 ICS-SABA PRN. LABA never monotherapy increases mortality. COPD
NR 565 Advanced Pharmacology Fundamentals 2026/2027 Midterm & Final Comprehensive Exam Package Page 3
, GOLD 2025 LAMA or LABA-LAMA first, ICS if exacerbations eosinophils.
QUESTION 5: Warfarin vs DOAC apixaban monitoring?
A) Warfarin INR 2-3 CYP2C9 VKORC1 many interactions vitamin K reversal; apixaban no INR factor
Xa inhibitor bleeding reversal andexanet
B) Same
C) No monitoring
D) Only INR for both
CORRECT ANSWER: A) Warfarin INR 2-3 CYP2C9 VKORC1 many interactions vitamin K
reversal; apixaban no INR factor Xa inhibitor bleeding reversal andexanet
RATIONALE: Anticoagulants: Warfarin vitamin K antagonist INR 2-3 AF DVT 2.5-3.5 mechanical valve
many interactions CYP450 protein bound diet vitamin K. DOACs apixaban rivaroxaban edoxaban
dabigatran no routine INR renal dosing bleeding risk andexanet idarucizumab. Heparin HIT platelet drop.
QUESTION 6: SSRI first-line depression, when to switch?
A) SSRI sertraline escitalopram first-line, 4-6 weeks response, taper avoid discontinuation syndrome,
Black box suicidality <25yo
B) No first-line
C) Immediate effect
D) No taper
CORRECT ANSWER: A) SSRI sertraline escitalopram first-line, 4-6 weeks response,
taper avoid discontinuation syndrome, Black box suicidality <25yo
RATIONALE: Antidepressants: SSRI first-line depression anxiety, takes 4-6 weeks, SE serotonin syndrome
with MAOI washout 2 weeks 5 weeks fluoxetine, hyponatremia SIADH. SNRI venlafaxine HTN. TCA
anticholinergic Beers elderly. Bupropion seizures. Monitor suicidality.
QUESTION 7: Opioid CDC 2022 guidelines and naloxone?
A) Start low short-acting lowest dose <50 MME caution >50 avoid >90, assess risk PDMP, naloxone
co-prescribe if >50 MME or benzodiazepine hx
B) No guidelines
C) High dose start
D) No naloxone
CORRECT ANSWER: A) Start low short-acting lowest dose <50 MME caution >50 avoid
>90, assess risk PDMP, naloxone co-prescribe if >50 MME or benzodiazepine hx
RATIONALE: Pain: CDC 2022 opioid guidelines acute pain max 3-7 days, chronic assess benefits risks
non-opioid first NSAIDs acetaminophen gabapentin, PDMP check urine drug screen informed consent.
Naloxone co-prescribe risk factors. NSAIDs black box CV GI bleed renal. Acetaminophen liver max 3g
chronic 4g acute.
QUESTION 8: Antibiotic stewardship: MRSA coverage?
A) Vancomycin linezolid daptomycin not pneumonia TMP-SMX MRSA skin
B) No coverage
C) Amoxicillin covers MRSA
D) Only penicillin
NR 565 Advanced Pharmacology Fundamentals 2026/2027 Midterm & Final Comprehensive Exam Package Page 4
NR 565
ADVANCED PHARMACOLOGY
FUNDAMENTALS
CHAMBERLAIN COLLEGE OF NURSING
2026/2027 NEWEST EXAM!!
Midterm & Final Comprehensive Examination Package with Verified Questions and Correct Answer
Rationales
MIDTERM + FINAL VERIFIED Q&A RATIONALES 2026/2027 NEWEST
, EXAM COVERAGE AREAS
NR 565 Advanced Pharmacology Fundamentals - Midterm & Final | 2026/2027 Newest Exam!!
Week 1-2: Pharmacokinetics, Pharmacodynamics & Prescribing
• Pharmacokinetics ADME absorption distribution metabolism CYP450 excretion half-life
• Pharmacodynamics receptor agonist antagonist potency efficacy
• Prescribing principles Beers criteria renal hepatic dosing
• Pharmacogenomics
Week 3-4: Autonomic, Cardiovascular & Hypertension
• Autonomic cholinergic adrenergic sympathomimetics
• Hypertension JNC8 ACE inhibitor cough ARB CCB thiazide
• Heart failure HFrEF guideline meds ARNI beta-blocker MRA SGLT2
• Dyslipidemia statins
Week 5-6: Diabetes, Endocrine & Respiratory
• Diabetes ADA Type 2 metformin GLP-1 SGLT2 insulin types
• Endocrine thyroid hypo/hyper
• Respiratory asthma COPD stepwise GINA inhalers LABA ICS
• Allergy
Midterm: Chapters 1-20 High Yield
• Midterm focus autonomic HTN HF dyslipidemia anticoag diabetes respiratory
• Drug interactions CYP450 inducers inhibitors
• Black box warnings
• Prescriptive authority
Week 7-8: Infectious Disease, Pain, Psych & Final
• Antibiotics classes coverage resistance stewardship
• Pain analgesics opioids NSAIDs CDC guidelines
• Psych antidepressants SSRIs antipsychotics anxiolytics Beers elderly
• Final: All systems cumulative antibiotics GI GU neuro MSK dermatology
Latest 2026/2027 Updates Chamberlain NR 565
• Newest 2026/2027 guidelines ADA 2026 AHA/ACC/HFSA 2023-2024 GOLD 2025 GINA 2025
• New drugs GLP-1 tirzepatide semaglutide SGLT2
• Opioid REMS CDC 2022
• Midterm & Final Package verified rationales
NR 565 Advanced Pharmacology Fundamentals 2026/2027 Midterm & Final Comprehensive Exam Package Page 2
, QUESTION 1: A drug with high first-pass effect needs dose adjustment in liver disease.
Example?
A) Nitroglycerin, morphine, propranolol extensive hepatic metabolism requires lower dose
B) No adjustment
C) Only renal
D) Increase dose
CORRECT ANSWER: A) Nitroglycerin, morphine, propranolol extensive hepatic
metabolism requires lower dose
RATIONALE: Pharmacokinetics: First-pass extensive hepatic metabolism CYP450 liver disease reduces
metabolism increases bioavailability requires dose reduction. Half-life prolonged hepatic/renal impairment.
CYP450 inhibitors increase levels e.g., fluconazole, inhibitors: grapefruit. Inducers: rifampin carbamazepine
St John's wort decrease levels.
QUESTION 2: ACE inhibitor dry cough mechanism and alternative?
A) Bradykinin accumulation; switch to ARB losartan valsartan
B) Histamine
C) No cough
D) Continue ACE
CORRECT ANSWER: A) Bradykinin accumulation; switch to ARB losartan valsartan
RATIONALE: ACE inhibitors: cough due to bradykinin accumulation, angioedema risk. ARB blocks AT1
receptor no bradykinin cough. Both cause hyperkalemia, teratogenic, avoid bilateral renal artery stenosis.
First line HTN per JNC8 thiazide, ACE/ARB, CCB.
QUESTION 3: Metformin contraindications and new ADA 2026 use?
A) eGFR <30 contraindicated, <45 caution; first-line T2DM unless contraindicated, does not cause
hypoglycemia, weight neutral, lactic acidosis rare
B) No contraindication
C) Causes hypoglycemia
D) Stop if eGFR 50
CORRECT ANSWER: A) eGFR <30 contraindicated, <45 caution; first-line T2DM unless
contraindicated, does not cause hypoglycemia, weight neutral, lactic acidosis rare
RATIONALE: Metformin first-line T2DM ADA 2026, MOA decreases hepatic glucose production improves
insulin sensitivity. Hold before contrast if eGFR <30. B12 deficiency long term. No hypoglycemia alone.
GLP-1 RA semaglutide tirzepatide weight loss CV benefit, SGLT2i empagliflozin HF renal benefit.
QUESTION 4: Asthma step therapy GINA 2025 controller?
A) ICS-formoterol PRN or low-dose ICS-LABA maintenance, avoid SABA-only, LABA never alone
B) SABA only
C) LABA alone
D) No ICS
CORRECT ANSWER: A) ICS-formoterol PRN or low-dose ICS-LABA maintenance, avoid
SABA-only, LABA never alone
RATIONALE: GINA 2025 asthma: Track 1 preferred low-dose ICS-formoterol PRN mild or MART
maintenance and reliever, Track 2 ICS-SABA PRN. LABA never monotherapy increases mortality. COPD
NR 565 Advanced Pharmacology Fundamentals 2026/2027 Midterm & Final Comprehensive Exam Package Page 3
, GOLD 2025 LAMA or LABA-LAMA first, ICS if exacerbations eosinophils.
QUESTION 5: Warfarin vs DOAC apixaban monitoring?
A) Warfarin INR 2-3 CYP2C9 VKORC1 many interactions vitamin K reversal; apixaban no INR factor
Xa inhibitor bleeding reversal andexanet
B) Same
C) No monitoring
D) Only INR for both
CORRECT ANSWER: A) Warfarin INR 2-3 CYP2C9 VKORC1 many interactions vitamin K
reversal; apixaban no INR factor Xa inhibitor bleeding reversal andexanet
RATIONALE: Anticoagulants: Warfarin vitamin K antagonist INR 2-3 AF DVT 2.5-3.5 mechanical valve
many interactions CYP450 protein bound diet vitamin K. DOACs apixaban rivaroxaban edoxaban
dabigatran no routine INR renal dosing bleeding risk andexanet idarucizumab. Heparin HIT platelet drop.
QUESTION 6: SSRI first-line depression, when to switch?
A) SSRI sertraline escitalopram first-line, 4-6 weeks response, taper avoid discontinuation syndrome,
Black box suicidality <25yo
B) No first-line
C) Immediate effect
D) No taper
CORRECT ANSWER: A) SSRI sertraline escitalopram first-line, 4-6 weeks response,
taper avoid discontinuation syndrome, Black box suicidality <25yo
RATIONALE: Antidepressants: SSRI first-line depression anxiety, takes 4-6 weeks, SE serotonin syndrome
with MAOI washout 2 weeks 5 weeks fluoxetine, hyponatremia SIADH. SNRI venlafaxine HTN. TCA
anticholinergic Beers elderly. Bupropion seizures. Monitor suicidality.
QUESTION 7: Opioid CDC 2022 guidelines and naloxone?
A) Start low short-acting lowest dose <50 MME caution >50 avoid >90, assess risk PDMP, naloxone
co-prescribe if >50 MME or benzodiazepine hx
B) No guidelines
C) High dose start
D) No naloxone
CORRECT ANSWER: A) Start low short-acting lowest dose <50 MME caution >50 avoid
>90, assess risk PDMP, naloxone co-prescribe if >50 MME or benzodiazepine hx
RATIONALE: Pain: CDC 2022 opioid guidelines acute pain max 3-7 days, chronic assess benefits risks
non-opioid first NSAIDs acetaminophen gabapentin, PDMP check urine drug screen informed consent.
Naloxone co-prescribe risk factors. NSAIDs black box CV GI bleed renal. Acetaminophen liver max 3g
chronic 4g acute.
QUESTION 8: Antibiotic stewardship: MRSA coverage?
A) Vancomycin linezolid daptomycin not pneumonia TMP-SMX MRSA skin
B) No coverage
C) Amoxicillin covers MRSA
D) Only penicillin
NR 565 Advanced Pharmacology Fundamentals 2026/2027 Midterm & Final Comprehensive Exam Package Page 4
