NR566 Advanced Pharmacology Final Exam
2026-2027 | Family-Centered Prescribing |
Complete Study Guide | 100% Verified Answers
Total Items: 60 | Time Limit: 120 min
SECTION 1 – Foundational Principles & Lifespan Pharmacokinetics (Q1-15)
Q1 Mr. K, 75 y, CKD stage 3a (eGFR 45 mL/min/1.73 m²), newly prescribed gabapentin
300 mg TID for neuropathy. Gabapentin is 90 % renally excreted unchanged. Most
appropriate initial action?
A. Reduce dose to 300 mg at bedtime only
B. Prescribe TID and monitor renal function
C. Switch to pregabalin 150 mg BID
D. No change – not nephrotoxic
Rationale: Per 2026 Beers Criteria & package insert, gabapentin requires renal
adjustment; CrCl 30-59 → max 600 mg/day divided BID; starting 300 mg HS is safest.
Q2 Neonate 4 days old, needs ceftriaxone for sepsis. Contraindication?
A. Hyperbilirubinemia (displaces bilirubin)
B. Renal immaturity
C. Hepatic metabolism overload
,D. Gut flora depletion
Rationale: FDA boxed warning 2026: ceftriaxone-calcium precipitate & bilirubin
displacement in neonates <28 days; use cefotaxime instead.
Q3 Breast-feeding mother needs UTI antibiotic. Safest class?
A. Nitrofurantoin (compatible, low milk levels)
B. Trimethoprim-sulfamethoxazole
C. Doxycycline
D. Ciprofloxacin
Rationale: LactMed 2026: nitrofurantoin safe during breastfeeding; TMP-SMX avoid in
1st 2 months (kernicterus theoretical); doxy/cipro avoid.
Q4 (SATA) CYP2C19 ultrarapid metabolizer status impacts:
A. Clopidogrel activation ↓ efficacy
B. Omeprazole ↓ levels
C. Sertraline ↓ levels
D. Escitalopram ↓ levels
E. Phenytoin ↑ toxicity
Correct Answers: A,B,C,D
Rationale: 2C19 UM converts pro-drugs faster → lower active moiety; phenytoin is
substrate but not pro-drug → levels may fall, not rise.
, Q5 Short Answer: Why is levothyroxine absorption decreased in patients on
proton-pump inhibitors?
Model Answer: PPIs raise gastric pH >4 → ionization of thyroxine sodium → reduced
dissolution and absorption in small bowel; separate administration by ≥4 h and monitor
TSH.
Q6 8 y, 30 kg, needs amoxicillin 45 mg/kg/day for pneumonia. Daily dose?
A. 1000 mg
B. 1200 mg
C. 1350 mg (e.g., 450 mg TID)
D. 1500 mg
Rationale: 45 × 30 = 1350 mg/day; within IDSA 2026 high-dose range.
Q7 Older adult on warfarin starts amiodarone. INR 5.2 (target 2-3). Mechanism?
A. Amiodarone inhibits CYP2C9 & 3A4 → ↓ S-warfarin metabolism
B. Displaces albumin
C. Induces 2C9
D. Increases vitamin K
Rationale: Amiodarone potent 2C9 inhibitor → ↑ warfarin; reduce dose 25-50 %.
Q8 Which vaccine is live-attenuated and contraindicated in pregnancy?
A. Tdap
2026-2027 | Family-Centered Prescribing |
Complete Study Guide | 100% Verified Answers
Total Items: 60 | Time Limit: 120 min
SECTION 1 – Foundational Principles & Lifespan Pharmacokinetics (Q1-15)
Q1 Mr. K, 75 y, CKD stage 3a (eGFR 45 mL/min/1.73 m²), newly prescribed gabapentin
300 mg TID for neuropathy. Gabapentin is 90 % renally excreted unchanged. Most
appropriate initial action?
A. Reduce dose to 300 mg at bedtime only
B. Prescribe TID and monitor renal function
C. Switch to pregabalin 150 mg BID
D. No change – not nephrotoxic
Rationale: Per 2026 Beers Criteria & package insert, gabapentin requires renal
adjustment; CrCl 30-59 → max 600 mg/day divided BID; starting 300 mg HS is safest.
Q2 Neonate 4 days old, needs ceftriaxone for sepsis. Contraindication?
A. Hyperbilirubinemia (displaces bilirubin)
B. Renal immaturity
C. Hepatic metabolism overload
,D. Gut flora depletion
Rationale: FDA boxed warning 2026: ceftriaxone-calcium precipitate & bilirubin
displacement in neonates <28 days; use cefotaxime instead.
Q3 Breast-feeding mother needs UTI antibiotic. Safest class?
A. Nitrofurantoin (compatible, low milk levels)
B. Trimethoprim-sulfamethoxazole
C. Doxycycline
D. Ciprofloxacin
Rationale: LactMed 2026: nitrofurantoin safe during breastfeeding; TMP-SMX avoid in
1st 2 months (kernicterus theoretical); doxy/cipro avoid.
Q4 (SATA) CYP2C19 ultrarapid metabolizer status impacts:
A. Clopidogrel activation ↓ efficacy
B. Omeprazole ↓ levels
C. Sertraline ↓ levels
D. Escitalopram ↓ levels
E. Phenytoin ↑ toxicity
Correct Answers: A,B,C,D
Rationale: 2C19 UM converts pro-drugs faster → lower active moiety; phenytoin is
substrate but not pro-drug → levels may fall, not rise.
, Q5 Short Answer: Why is levothyroxine absorption decreased in patients on
proton-pump inhibitors?
Model Answer: PPIs raise gastric pH >4 → ionization of thyroxine sodium → reduced
dissolution and absorption in small bowel; separate administration by ≥4 h and monitor
TSH.
Q6 8 y, 30 kg, needs amoxicillin 45 mg/kg/day for pneumonia. Daily dose?
A. 1000 mg
B. 1200 mg
C. 1350 mg (e.g., 450 mg TID)
D. 1500 mg
Rationale: 45 × 30 = 1350 mg/day; within IDSA 2026 high-dose range.
Q7 Older adult on warfarin starts amiodarone. INR 5.2 (target 2-3). Mechanism?
A. Amiodarone inhibits CYP2C9 & 3A4 → ↓ S-warfarin metabolism
B. Displaces albumin
C. Induces 2C9
D. Increases vitamin K
Rationale: Amiodarone potent 2C9 inhibitor → ↑ warfarin; reduce dose 25-50 %.
Q8 Which vaccine is live-attenuated and contraindicated in pregnancy?
A. Tdap
