NSG 533 Advanced
Pharmacology Test 1
Questions With All
Correct Answers
2025/2026
,EP is a 38-year- kr kr kr
old female patient that comes in for diabetes education and management. She was diagnosed 12 y
kr kr kr kr kr kr kr kr kr kr kr kr kr kr kr
ears ago and states lately she is not able to control her diet although she continues a 1600 calorie di
kr kr kr kr kr kr kr kr kr kr kr kr kr kr kr kr kr kr kr
et with appropriate daily carbohydrate intake (per dietitian prescription) and walks 40 minutes eve
kr kr kr kr kr kr kr kr kr kr kr kr kr
ry day of the week. She states compliance with all medications. She denies any history of hypoglyce
kr kr kr kr kr kr kr kr kr kr kr kr kr kr kr kr
mia despite being able to identify signs and symptoms and describe appropriate treatment strategi
kr kr kr kr kr kr kr kr kr kr kr kr kr
es.
PMH: T2DM, HTN, obesity, depression, s/p thyroidectomy due to thyroid cancer
kr kr kr kr kr kr kr kr kr kr
FmHx: Noncontributory kr
SHx: (−) Smoking, alcohol use, past marijuana use while in high school
kr kr kr kr kr kr kr kr kr kr kr
Medications: Metformin 850 mg tid, glipizide 20 mg bid, lisinopril 20 mg daily, sertraline 100 mg dail kr kr kr kr kr kr kr kr kr kr kr kr kr kr kr kr
y, multivitamin daily
kr kr
Vitals: BP 128/82 mg Hg; P 72 beats/min; BMI 31 m/kg2
kr kr kr kr kr kr kr kr kr kr
Laboratory test results: Na 134 mEq/L, K 5.4 mEq/L, Cl 106 mEq/L, BUN Exenatide -kr kr kr kr kr kr kr kr kr kr kr kr kr
Exenatide (Bydureon) once weekly has been able to demonstrate weight loss and decrease A1C% b
kr kr kr kr kr kr kr kr kr kr kr kr kr kr kr
y 0.7% to 1.2% in clinical trials; however it is contraindicated for EP due to the self-
kr kr kr kr kr kr kr kr kr kr kr kr kr kr kr kr
reported history of thyroid cancer. kr kr kr kr
Dapagliflozin - kr
Dapagliflozin (Farxiga) is contraindicated in this patient due to hyperkalemia which could be made
kr kr kr kr kr kr kr kr kr kr kr kr kr kr kr
worse by this drug. The package insert does not indicate a specific potassium concentration cut off t
kr kr kr kr kr kr kr kr kr kr kr kr kr kr kr kr
o no longer use this medication; however, there are better choices in this patient.
kr kr kr kr kr kr kr kr kr kr kr kr kr
Sitagliptin - kr
Sitagliptin (Januvia) is able to obtain an A1C goal of less than 7% based on clinical trials and currentl
kr kr kr kr kr kr kr kr kr kr kr kr kr kr kr kr kr kr kr
y the patient does not have any cautionary objective measures to not use this medication. DPP-
kr kr kr kr kr kr kr kr kr kr kr kr kr kr kr
IV inhibitors are weight neutral. DPP-
kr kr kr kr kr
IV inhibitors can be used in patients taking sulfonylureas; however, it may be recommended to redu
kr kr kr kr kr kr kr kr kr kr kr kr kr kr kr
ce or stop the sulfonylurea dose.
kr kr kr kr kr
Acarbose - kr
Acarbose (Precose) is not recommended for initial management and is associated with significant
kr kr kr kr kr kr kr kr kr kr kr kr kr kr
GI side effects. More information would be needed regarding fasting and post-
kr kr kr kr kr kr kr kr kr kr kr
prandial numbers. In addition, adding acarbose would only lower A1c by 0.8% at best and therefore
kr kr kr kr kr kr kr kr kr kr kr kr kr kr kr k
would not achieve the desired A1C goal of <7%
r kr kr kr kr kr kr kr kr
, JR is a 68-year- kr kr kr
old African American man with a new diagnosis of T2DM. He was classified as having prediabetes (a
kr kr kr kr kr kr kr kr kr kr kr kr kr kr kr kr
t risk for developing diabetes) 5 years before the diagnosis and has a strong family history of type 2
kr kr kr kr kr kr kr kr kr kr kr kr kr kr kr kr kr kr kr
diabetes. JR's blood pressure was 150/92 mm Hg. His laboratory results revealed an A1C of 8.1%, n
kr kr kr kr kr kr kr kr kr kr kr kr kr kr kr kr
ormal cholesterol panel, and normal renal/hepatic function were noted with today's laboratory tes
kr kr kr kr kr kr kr kr kr kr kr kr
t results.
kr
Past medical history: Hypertension (diagnosed 4 y ago) Hyperlipidemia (diagnosed 2 y ago) Pancrea
kr kr kr kr kr kr kr kr kr kr kr kr kr
titis (idiopathic) (acute hospitalization 3 y ago)
kr kr kr kr kr kr
Family history: Type 2 diabetes kr kr kr kr
Medication: HCTZ 25 mg daily, simvastatin 10 mg daily kr kr kr kr kr kr kr kr
Allergies: SMZ/TMP kr
Vitals: BP: 150/92 mm Hg P: 78 beats/min RR: 12 rpm Waist Circumference: 46 in Weight: 267 lb Hei
kr kr kr kr kr kr kr kr kr kr kr kr kr kr kr kr kr kr
ght: 5 ′ 6 ″ BMI: 43.1 kg/m 2 kr kr kr kr kr kr kr kr
Despite improvements in the past six weeks due to lifestyle changes and exercise, drug therapy is to
kr kr kr kr kr kr kr kr kr kr kr kr kr kr kr kr k
be started for JR's diabet
r kr kr kr kr
Metformin is the drug of choice recommended for most patients with diabetes in addition t kr kr kr kr kr kr kr kr kr kr kr kr kr kr
o lifestyle modifications assuming no contraindications or intolerabilities are present upon evaluati
kr kr kr kr kr kr kr kr kr kr kr
on. Metformin has also shown to provide positive weight neutral/loss effects in obese patients. It is
kr kr kr kr kr kr kr kr kr kr kr kr kr kr kr kr
crucial to know the renal status of patients commencing metformin therapy to limit the risk of lactic
kr kr kr kr kr kr kr kr kr kr kr kr kr kr kr kr k
acidosis (JR is without contraindication).
r kr kr kr kr
Since his entry A1C is >7.5%, dual therapy is indicated. There are several potential choices. The seco
kr kr kr kr kr kr kr kr kr kr kr kr kr kr kr kr
nd step can be a dipeptidyl peptidase-4 inhibitor, it can be a glucagon-like peptide-1 (GLP-
kr kr kr kr kr kr kr kr kr kr kr kr kr kr
1) receptor agonist, it can be a TZD, it can be a sulfonylurea agent, it can be a SGLT2 inhibitor, or it co
kr kr kr kr kr kr kr kr kr kr kr kr kr kr kr kr kr kr kr kr kr kr
uld be basal insulin. Anything next can be tried depending on what suits the circumstance
kr kr kr kr kr kr kr kr kr kr kr kr kr kr
DPP4 inhibitors are weight neutral bet relatively benign side effect profile. Sitagliptin has been asso
kr kr kr kr kr kr kr kr kr kr kr kr kr kr
ciated with case reports of pancreatitis, so this specific agent should be avoided. $$$
kr kr kr kr kr kr kr kr kr kr kr kr kr
GLP-
1 analog and has data to support an A1C reduction necessary to gain glycemic control and may assis
kr kr kr kr kr kr kr kr kr kr kr kr kr kr kr kr kr
t with weight loss goals for this patient. New information suggests these agents may provide benefi
kr kr kr kr kr kr kr kr kr kr kr kr kr kr kr
ts in those with ASCVD. JR has a past history of pancreatitis and GLP-
kr kr kr kr kr kr kr kr kr kr kr kr kr
1 analogs are not recommended due to this contraindication
kr kr kr kr kr kr kr kr
Pharmacology Test 1
Questions With All
Correct Answers
2025/2026
,EP is a 38-year- kr kr kr
old female patient that comes in for diabetes education and management. She was diagnosed 12 y
kr kr kr kr kr kr kr kr kr kr kr kr kr kr kr
ears ago and states lately she is not able to control her diet although she continues a 1600 calorie di
kr kr kr kr kr kr kr kr kr kr kr kr kr kr kr kr kr kr kr
et with appropriate daily carbohydrate intake (per dietitian prescription) and walks 40 minutes eve
kr kr kr kr kr kr kr kr kr kr kr kr kr
ry day of the week. She states compliance with all medications. She denies any history of hypoglyce
kr kr kr kr kr kr kr kr kr kr kr kr kr kr kr kr
mia despite being able to identify signs and symptoms and describe appropriate treatment strategi
kr kr kr kr kr kr kr kr kr kr kr kr kr
es.
PMH: T2DM, HTN, obesity, depression, s/p thyroidectomy due to thyroid cancer
kr kr kr kr kr kr kr kr kr kr
FmHx: Noncontributory kr
SHx: (−) Smoking, alcohol use, past marijuana use while in high school
kr kr kr kr kr kr kr kr kr kr kr
Medications: Metformin 850 mg tid, glipizide 20 mg bid, lisinopril 20 mg daily, sertraline 100 mg dail kr kr kr kr kr kr kr kr kr kr kr kr kr kr kr kr
y, multivitamin daily
kr kr
Vitals: BP 128/82 mg Hg; P 72 beats/min; BMI 31 m/kg2
kr kr kr kr kr kr kr kr kr kr
Laboratory test results: Na 134 mEq/L, K 5.4 mEq/L, Cl 106 mEq/L, BUN Exenatide -kr kr kr kr kr kr kr kr kr kr kr kr kr
Exenatide (Bydureon) once weekly has been able to demonstrate weight loss and decrease A1C% b
kr kr kr kr kr kr kr kr kr kr kr kr kr kr kr
y 0.7% to 1.2% in clinical trials; however it is contraindicated for EP due to the self-
kr kr kr kr kr kr kr kr kr kr kr kr kr kr kr kr
reported history of thyroid cancer. kr kr kr kr
Dapagliflozin - kr
Dapagliflozin (Farxiga) is contraindicated in this patient due to hyperkalemia which could be made
kr kr kr kr kr kr kr kr kr kr kr kr kr kr kr
worse by this drug. The package insert does not indicate a specific potassium concentration cut off t
kr kr kr kr kr kr kr kr kr kr kr kr kr kr kr kr
o no longer use this medication; however, there are better choices in this patient.
kr kr kr kr kr kr kr kr kr kr kr kr kr
Sitagliptin - kr
Sitagliptin (Januvia) is able to obtain an A1C goal of less than 7% based on clinical trials and currentl
kr kr kr kr kr kr kr kr kr kr kr kr kr kr kr kr kr kr kr
y the patient does not have any cautionary objective measures to not use this medication. DPP-
kr kr kr kr kr kr kr kr kr kr kr kr kr kr kr
IV inhibitors are weight neutral. DPP-
kr kr kr kr kr
IV inhibitors can be used in patients taking sulfonylureas; however, it may be recommended to redu
kr kr kr kr kr kr kr kr kr kr kr kr kr kr kr
ce or stop the sulfonylurea dose.
kr kr kr kr kr
Acarbose - kr
Acarbose (Precose) is not recommended for initial management and is associated with significant
kr kr kr kr kr kr kr kr kr kr kr kr kr kr
GI side effects. More information would be needed regarding fasting and post-
kr kr kr kr kr kr kr kr kr kr kr
prandial numbers. In addition, adding acarbose would only lower A1c by 0.8% at best and therefore
kr kr kr kr kr kr kr kr kr kr kr kr kr kr kr k
would not achieve the desired A1C goal of <7%
r kr kr kr kr kr kr kr kr
, JR is a 68-year- kr kr kr
old African American man with a new diagnosis of T2DM. He was classified as having prediabetes (a
kr kr kr kr kr kr kr kr kr kr kr kr kr kr kr kr
t risk for developing diabetes) 5 years before the diagnosis and has a strong family history of type 2
kr kr kr kr kr kr kr kr kr kr kr kr kr kr kr kr kr kr kr
diabetes. JR's blood pressure was 150/92 mm Hg. His laboratory results revealed an A1C of 8.1%, n
kr kr kr kr kr kr kr kr kr kr kr kr kr kr kr kr
ormal cholesterol panel, and normal renal/hepatic function were noted with today's laboratory tes
kr kr kr kr kr kr kr kr kr kr kr kr
t results.
kr
Past medical history: Hypertension (diagnosed 4 y ago) Hyperlipidemia (diagnosed 2 y ago) Pancrea
kr kr kr kr kr kr kr kr kr kr kr kr kr
titis (idiopathic) (acute hospitalization 3 y ago)
kr kr kr kr kr kr
Family history: Type 2 diabetes kr kr kr kr
Medication: HCTZ 25 mg daily, simvastatin 10 mg daily kr kr kr kr kr kr kr kr
Allergies: SMZ/TMP kr
Vitals: BP: 150/92 mm Hg P: 78 beats/min RR: 12 rpm Waist Circumference: 46 in Weight: 267 lb Hei
kr kr kr kr kr kr kr kr kr kr kr kr kr kr kr kr kr kr
ght: 5 ′ 6 ″ BMI: 43.1 kg/m 2 kr kr kr kr kr kr kr kr
Despite improvements in the past six weeks due to lifestyle changes and exercise, drug therapy is to
kr kr kr kr kr kr kr kr kr kr kr kr kr kr kr kr k
be started for JR's diabet
r kr kr kr kr
Metformin is the drug of choice recommended for most patients with diabetes in addition t kr kr kr kr kr kr kr kr kr kr kr kr kr kr
o lifestyle modifications assuming no contraindications or intolerabilities are present upon evaluati
kr kr kr kr kr kr kr kr kr kr kr
on. Metformin has also shown to provide positive weight neutral/loss effects in obese patients. It is
kr kr kr kr kr kr kr kr kr kr kr kr kr kr kr kr
crucial to know the renal status of patients commencing metformin therapy to limit the risk of lactic
kr kr kr kr kr kr kr kr kr kr kr kr kr kr kr kr k
acidosis (JR is without contraindication).
r kr kr kr kr
Since his entry A1C is >7.5%, dual therapy is indicated. There are several potential choices. The seco
kr kr kr kr kr kr kr kr kr kr kr kr kr kr kr kr
nd step can be a dipeptidyl peptidase-4 inhibitor, it can be a glucagon-like peptide-1 (GLP-
kr kr kr kr kr kr kr kr kr kr kr kr kr kr
1) receptor agonist, it can be a TZD, it can be a sulfonylurea agent, it can be a SGLT2 inhibitor, or it co
kr kr kr kr kr kr kr kr kr kr kr kr kr kr kr kr kr kr kr kr kr kr
uld be basal insulin. Anything next can be tried depending on what suits the circumstance
kr kr kr kr kr kr kr kr kr kr kr kr kr kr
DPP4 inhibitors are weight neutral bet relatively benign side effect profile. Sitagliptin has been asso
kr kr kr kr kr kr kr kr kr kr kr kr kr kr
ciated with case reports of pancreatitis, so this specific agent should be avoided. $$$
kr kr kr kr kr kr kr kr kr kr kr kr kr
GLP-
1 analog and has data to support an A1C reduction necessary to gain glycemic control and may assis
kr kr kr kr kr kr kr kr kr kr kr kr kr kr kr kr kr
t with weight loss goals for this patient. New information suggests these agents may provide benefi
kr kr kr kr kr kr kr kr kr kr kr kr kr kr kr
ts in those with ASCVD. JR has a past history of pancreatitis and GLP-
kr kr kr kr kr kr kr kr kr kr kr kr kr
1 analogs are not recommended due to this contraindication
kr kr kr kr kr kr kr kr
