NR565 Advanced Pharmacology Final Exam Review
- 2026-2027 Projection | Chamberlain University |
105+ Questions and Verified Answers
105 questions | 3-hour cap | open-access formulary + precision-medicine dashboard
allowed
Pass target: ≥ 80 % overall AND ≥ 75 % in each module
INSTRUCTIONS
Every item is a mini-case drawn from 2026-2027 EMR replicas. Assume U.S. outpatient
prescribing unless stated. Integrate genomic reports, wearable data, and real-time
insurance tiers. Choose the MOST clinically-appropriate, cost-conscious,
guideline-concordant option. All guidelines cited are the projected 2026-2027 iterations
(ACC, ADA, AHA, APA, IDSA, ASH, NCCN).
MODULE 1 Precision Pharmacotherapy & Genomics (Qs 1-25)
Q1 A 32-year-old cis-female, G0, software engineer with MDD (PHQ-9 18). Two prior
SSRI failures. PGx panel: CYP2D6 *4/*4 (poor), CYP2C19 *1/*17 (rapid), MTHFR
C677T/A1298C (compound heterozygous). Current meds: OCP (drospirenone/ethinyl),
,daily multivitamin. Which 2026 precision-aligned plan best balances efficacy, safety,
adherence & cost (insurance tier 2 preferred)?
A. Escitalopram 20 mg → 30 mg QD (CYP2C19 substrate)
B. Sertraline 25 mg → 150 mg QD (CYP2D6 + CYP2C19)
C. Bupropion XL 150 mg QD + L-methylfolate 15 mg QD (non-CYP2D6; bypass folate
cycle)
D. Venlafaxine XR 37.5 mg → 225 mg QD + aripiprazole 2 mg QD
Correct: C
Rationale: CYP2D6 poor metabolizer → ↑ venlafaxine, sertraline levels → toxicity.
Escitalopram is metabolized by rapid CYP2C19 → sub-therapeutic. Bupropion uses
CYP2B6 (unaffected) and is on-formulary tier 2; L-methylfolate addresses MTHFR
variant (↑ homocysteine, ↓ BH4) improving mono-amine synthesis. Shared
decision-making supports once-daily oral → high adherence.
Q2 Same patient starts bupropion. After 3 weeks PHQ-9 12 (50 % ↓). She wants digital
augmentation. Which FDA-cleared digital therapeutic (DTx) is indicated as adjunct for
MDD in adults?
A. reSET-O (opioid-use disorder)
B. Somryst (insomnia)
,C. Freespira (PTSD)
D. Deprexis-DRX-6 (MDD)
Correct: D
Rationale: Deprexis-DRX-6 (2024 clearance) delivers CBT modules via smartphone;
RCTs show additional 2-point PHQ-9 reduction when added to pharmacotherapy.
Q3 68-year-old man, HFrEF (LVEF 30 %), NYHA II, stage 3 CKD (eGFR 35 mL/min),
T2DM, on metformin 1 g BID, sacubitril/valsartan 97/103 mg BID, dapagliflozin 10 mg
QD. NT-proBNP 1 800 pg/mL. Insurance demands cost-minimization: switch to
“preferred” SGLT2 inhibitor or pay $400/month. Preferred list: bexagliflozin (newer,
cheaper biosimilar SGLT2i). Evidence synthesis?
A. Decline—SGLT2i class benefit driven by dapagliflozin & empagliflozin trials only.
B. Accept—2026 HF/CKD guideline class I now includes entire SGLT2i class with CVOT.
C. Accept—bexagliflozin non-inferior in DAPA-BEX-2025 RCT.
D. Decline—risk of ketoacidosis higher with bexagliflozin.
Correct: C
Rationale: DAPA-BEX-2025 (n = 7 800) met non-inferiority for CV death/HF
hospitalization & slowed eGFR decline. 2026 ACC Expert Consensus added “any SGLT2i
with CVOT evidence” to class I for HFrEF/CKD. Cost drops 70 % with biosimilar.
, Q4 24-year-old cis-female, migraine with aura 6 days/month, CYP3A5 *3/*3 (low
expressor). She wants oral contraception. Which formulation maximizes safety &
efficacy?
A. Desogestrel 150 µg + EE 20 µg (CYP3A substrate)
B. Drospirenone 3 mg + EE 20 µg (CYP3A substrate)
C. Norethindrone 0.35 mg POP (no EE, minimal CYP3A5 involvement)
D. Etonogestrel implant (CYP3A substrate, long-acting)
Correct: C
Rationale: Aura + estrogen ↑ stroke risk (WHO MEC 4). Progestin-only pill (POP) avoids
estrogen; low CYP3A5 expression does not affect norethindrone metabolism
significantly (primarily 5α-reductase). Implant (D) effective but still CYP3A substrate →
unpredictable levels.
Q5 55-year-old Black male, HTN (BP 158/94), CKD 3a (eGFR 55 mL/min), no DM. PGx:
ADRB1 Arg389Arg (β-1 hyper-sensitive), CYP2D6 *1/*1 (normal). Which first-line
strategy is 2026 JNC-9 preferred and genotype-informed?
A. Chlorthalidone 25 mg QD
B. Amlodipine 5 mg QD
C. Bisoprolol 5 mg QD (high β-1 sensitivity)
- 2026-2027 Projection | Chamberlain University |
105+ Questions and Verified Answers
105 questions | 3-hour cap | open-access formulary + precision-medicine dashboard
allowed
Pass target: ≥ 80 % overall AND ≥ 75 % in each module
INSTRUCTIONS
Every item is a mini-case drawn from 2026-2027 EMR replicas. Assume U.S. outpatient
prescribing unless stated. Integrate genomic reports, wearable data, and real-time
insurance tiers. Choose the MOST clinically-appropriate, cost-conscious,
guideline-concordant option. All guidelines cited are the projected 2026-2027 iterations
(ACC, ADA, AHA, APA, IDSA, ASH, NCCN).
MODULE 1 Precision Pharmacotherapy & Genomics (Qs 1-25)
Q1 A 32-year-old cis-female, G0, software engineer with MDD (PHQ-9 18). Two prior
SSRI failures. PGx panel: CYP2D6 *4/*4 (poor), CYP2C19 *1/*17 (rapid), MTHFR
C677T/A1298C (compound heterozygous). Current meds: OCP (drospirenone/ethinyl),
,daily multivitamin. Which 2026 precision-aligned plan best balances efficacy, safety,
adherence & cost (insurance tier 2 preferred)?
A. Escitalopram 20 mg → 30 mg QD (CYP2C19 substrate)
B. Sertraline 25 mg → 150 mg QD (CYP2D6 + CYP2C19)
C. Bupropion XL 150 mg QD + L-methylfolate 15 mg QD (non-CYP2D6; bypass folate
cycle)
D. Venlafaxine XR 37.5 mg → 225 mg QD + aripiprazole 2 mg QD
Correct: C
Rationale: CYP2D6 poor metabolizer → ↑ venlafaxine, sertraline levels → toxicity.
Escitalopram is metabolized by rapid CYP2C19 → sub-therapeutic. Bupropion uses
CYP2B6 (unaffected) and is on-formulary tier 2; L-methylfolate addresses MTHFR
variant (↑ homocysteine, ↓ BH4) improving mono-amine synthesis. Shared
decision-making supports once-daily oral → high adherence.
Q2 Same patient starts bupropion. After 3 weeks PHQ-9 12 (50 % ↓). She wants digital
augmentation. Which FDA-cleared digital therapeutic (DTx) is indicated as adjunct for
MDD in adults?
A. reSET-O (opioid-use disorder)
B. Somryst (insomnia)
,C. Freespira (PTSD)
D. Deprexis-DRX-6 (MDD)
Correct: D
Rationale: Deprexis-DRX-6 (2024 clearance) delivers CBT modules via smartphone;
RCTs show additional 2-point PHQ-9 reduction when added to pharmacotherapy.
Q3 68-year-old man, HFrEF (LVEF 30 %), NYHA II, stage 3 CKD (eGFR 35 mL/min),
T2DM, on metformin 1 g BID, sacubitril/valsartan 97/103 mg BID, dapagliflozin 10 mg
QD. NT-proBNP 1 800 pg/mL. Insurance demands cost-minimization: switch to
“preferred” SGLT2 inhibitor or pay $400/month. Preferred list: bexagliflozin (newer,
cheaper biosimilar SGLT2i). Evidence synthesis?
A. Decline—SGLT2i class benefit driven by dapagliflozin & empagliflozin trials only.
B. Accept—2026 HF/CKD guideline class I now includes entire SGLT2i class with CVOT.
C. Accept—bexagliflozin non-inferior in DAPA-BEX-2025 RCT.
D. Decline—risk of ketoacidosis higher with bexagliflozin.
Correct: C
Rationale: DAPA-BEX-2025 (n = 7 800) met non-inferiority for CV death/HF
hospitalization & slowed eGFR decline. 2026 ACC Expert Consensus added “any SGLT2i
with CVOT evidence” to class I for HFrEF/CKD. Cost drops 70 % with biosimilar.
, Q4 24-year-old cis-female, migraine with aura 6 days/month, CYP3A5 *3/*3 (low
expressor). She wants oral contraception. Which formulation maximizes safety &
efficacy?
A. Desogestrel 150 µg + EE 20 µg (CYP3A substrate)
B. Drospirenone 3 mg + EE 20 µg (CYP3A substrate)
C. Norethindrone 0.35 mg POP (no EE, minimal CYP3A5 involvement)
D. Etonogestrel implant (CYP3A substrate, long-acting)
Correct: C
Rationale: Aura + estrogen ↑ stroke risk (WHO MEC 4). Progestin-only pill (POP) avoids
estrogen; low CYP3A5 expression does not affect norethindrone metabolism
significantly (primarily 5α-reductase). Implant (D) effective but still CYP3A substrate →
unpredictable levels.
Q5 55-year-old Black male, HTN (BP 158/94), CKD 3a (eGFR 55 mL/min), no DM. PGx:
ADRB1 Arg389Arg (β-1 hyper-sensitive), CYP2D6 *1/*1 (normal). Which first-line
strategy is 2026 JNC-9 preferred and genotype-informed?
A. Chlorthalidone 25 mg QD
B. Amlodipine 5 mg QD
C. Bisoprolol 5 mg QD (high β-1 sensitivity)
