NR565 Advanced Pharmacology Final Exam Review
2025/2026 - 125 Items
SECTION A – ADVANCED PHARMACOKINETICS & PHARMACODYNAMICS
(15 MCQ)
1. Question (Complex Interaction)
A 63-y/o with atrial fibrillation on rivaroxaban 20 mg qHS and newly-diagnosed
HIV is started on an investigational 2025 INSTI “Rovitegravir” (potent CYP3A4 &
P-gp inhibitor). INR goal 2-3. Best regimen?
A. ↓ rivaroxaban to 15 mg
B. Switch to warfarin & titrate to INR
C. Switch to apixaban 5 mg BID
D. Continue current dose; monitor Bleeding
Answer: B – Rovitegravir ↑ rivaroxaban AUC 3-fold (2025 FDA briefing). Warfarin
allows INR-guided dose revision.
Rationale: DOAC levels unpredictable with dual 3A4/P-gp inhibition; warfarin
titration offers measurable control.
2. Question (Pharmacogenomics)
CYP2C19 *2/*17 genotype is identified in a STEMI patient. Which antiplatelet
strategy is evidence-based per 2026 AHA/ACC update?
A. Double-dose clopidogrel 150 mg
B. Prasugrel 10 mg
C. Ticagrelor 90 mg BID
D. Ticlopidine 250 mg BID
Answer: C – Ultra-rapid metabolizer allele *17 compensates *2; ticagrelor
non-CYP dependent preferred.
Rationale: 2025 FAST-MI sub-analysis (n=4 018) shows *2/*17 lose ≈50 %
clopidogrel active metabolite → ↑ MACE.
[… 3 MCQ on bioavailability, 2 receptor theory, 1 TDM …]
SECTION B – CV & HEMATOLOGIC (18 MCQ)
, 16. SATA (Select ≥2)
Which parameters require baseline & 6-week review when starting the
2025-approved SGLT2 / HIF-2α combo “Dapromid” for HFrEF & anemia? (Select
all)
● ★ Serum creatinine & eGFR
● ★ Ferritin, TSAT
● ★ Ketones (urine)
● ★ Hemoglobin A1C
● ★ NT-proBNP
Answer: All 5 – combo causes osmotic diuresis, iron utilisation, ketoacidosis risk,
mild A1C ↓, and volume status.
Rationale: FDA Black-Box 2025 mandates ketoacidosis monitoring even in
non-diabetics.
17. Question (Anticoagulation)
A 92-kg, 1.7 m woman with CrCl 28 mL/min and mechanical aortic valve receives
dabigatran 150 mg BID post-2026 guideline. NP’s action?
A. Maintain – guideline supports 150 mg if ≤30 mL/min
B. Reduce to 75 mg BID
C. Switch to warfarin (INR 2.5-3.5)
D. Obtain drug level at 2 h
Answer: C – 2026 ACCP VHD update: DOACs still NOT for mechanical valves;
warfarin required.
Rationale: RE-ALIGN trial harm signal persists; CrCl <30 excludes 150 mg
dabigatran per package insert.
[… 4 antiarrhythmic, 2 lipids, 2 anemia …]
SECTION C – NEUROPSYCHIATRIC (15 MCQ)
30. Question (Treatment-Resistant Depression)
Patient failed 2 SSRIs. PHQ-9 19. New 2025 “Neurostrol” (24 h IV NMDA-agonist
+ oral taper) offers 48 h remission. Contraindication?
A. Controlled HTN
B. Psychosis NOS
C. DM-2
D. Prior seizure
Answer: B – NMDA modulation ↑ psychosis risk.
2025/2026 - 125 Items
SECTION A – ADVANCED PHARMACOKINETICS & PHARMACODYNAMICS
(15 MCQ)
1. Question (Complex Interaction)
A 63-y/o with atrial fibrillation on rivaroxaban 20 mg qHS and newly-diagnosed
HIV is started on an investigational 2025 INSTI “Rovitegravir” (potent CYP3A4 &
P-gp inhibitor). INR goal 2-3. Best regimen?
A. ↓ rivaroxaban to 15 mg
B. Switch to warfarin & titrate to INR
C. Switch to apixaban 5 mg BID
D. Continue current dose; monitor Bleeding
Answer: B – Rovitegravir ↑ rivaroxaban AUC 3-fold (2025 FDA briefing). Warfarin
allows INR-guided dose revision.
Rationale: DOAC levels unpredictable with dual 3A4/P-gp inhibition; warfarin
titration offers measurable control.
2. Question (Pharmacogenomics)
CYP2C19 *2/*17 genotype is identified in a STEMI patient. Which antiplatelet
strategy is evidence-based per 2026 AHA/ACC update?
A. Double-dose clopidogrel 150 mg
B. Prasugrel 10 mg
C. Ticagrelor 90 mg BID
D. Ticlopidine 250 mg BID
Answer: C – Ultra-rapid metabolizer allele *17 compensates *2; ticagrelor
non-CYP dependent preferred.
Rationale: 2025 FAST-MI sub-analysis (n=4 018) shows *2/*17 lose ≈50 %
clopidogrel active metabolite → ↑ MACE.
[… 3 MCQ on bioavailability, 2 receptor theory, 1 TDM …]
SECTION B – CV & HEMATOLOGIC (18 MCQ)
, 16. SATA (Select ≥2)
Which parameters require baseline & 6-week review when starting the
2025-approved SGLT2 / HIF-2α combo “Dapromid” for HFrEF & anemia? (Select
all)
● ★ Serum creatinine & eGFR
● ★ Ferritin, TSAT
● ★ Ketones (urine)
● ★ Hemoglobin A1C
● ★ NT-proBNP
Answer: All 5 – combo causes osmotic diuresis, iron utilisation, ketoacidosis risk,
mild A1C ↓, and volume status.
Rationale: FDA Black-Box 2025 mandates ketoacidosis monitoring even in
non-diabetics.
17. Question (Anticoagulation)
A 92-kg, 1.7 m woman with CrCl 28 mL/min and mechanical aortic valve receives
dabigatran 150 mg BID post-2026 guideline. NP’s action?
A. Maintain – guideline supports 150 mg if ≤30 mL/min
B. Reduce to 75 mg BID
C. Switch to warfarin (INR 2.5-3.5)
D. Obtain drug level at 2 h
Answer: C – 2026 ACCP VHD update: DOACs still NOT for mechanical valves;
warfarin required.
Rationale: RE-ALIGN trial harm signal persists; CrCl <30 excludes 150 mg
dabigatran per package insert.
[… 4 antiarrhythmic, 2 lipids, 2 anemia …]
SECTION C – NEUROPSYCHIATRIC (15 MCQ)
30. Question (Treatment-Resistant Depression)
Patient failed 2 SSRIs. PHQ-9 19. New 2025 “Neurostrol” (24 h IV NMDA-agonist
+ oral taper) offers 48 h remission. Contraindication?
A. Controlled HTN
B. Psychosis NOS
C. DM-2
D. Prior seizure
Answer: B – NMDA modulation ↑ psychosis risk.
