Advanced Pharmacology NSG 533 Exam
Questions with Correct Answers 2026
EP is a 38-year-
old female patient that comes in for diabetes education and management. She was diagnosed 12 year
s ago and states lately she is not able to control her diet although she continues a 1600 calorie diet wi
th appropriate daily carbohydrate intake (per dietitian prescription) and walks 40 minutes every day of
the week. She states compliance with all medications. She denies any history of hypoglycemia despite
being able to identify signs and symptoms and describe appropriate treatment strategies.
PMH: T2DM, HTN, obesity, depression, s/p thyroidectomy due to thyroid cancer
FmHx: Noncontributory
SHx: (−) Smoking, alcohol use, past marijuana use while in high school
Medications: Metformin 850 mg tid, glipizide 20 mg bid, lisinopril 20 mg daily, sertraline 100 mg daily,
multivitamin daily
Vitals: BP 128/82 mg Hg; P 72 beats/min; BMI 31 m/kg2
Laboratory test results: Na 134 mEq/L, K 5.4 mEq/L, Cl 106 mEq/L, BUN - CORRECT ANSWER -
Exenatide -
Exenatide (Bydureon) once weekly has been able to demonstrate weight loss and decrease A1C% by 0
.7% to 1.2% in clinical trials; however it is contraindicated for EP due to the self-
reported history of thyroid cancer.
Dapagliflozin -
Dapagliflozin (Farxiga) is contraindicated in this patient due to hyperkalemia which could be made wo
rse by this drug. The package insert does not indicate a specific potassium concentration cut off to no
longer use this medication; however, there are better choices in this patient.
Sitagliptin -
Sitagliptin (Januvia) is able to obtain an A1C goal of less than 7% based on clinical trials and currently
the patient does not have any cautionary objective measures to not use this medication. DPP-
IV inhibitors are weight neutral. DPP-
IV inhibitors can be used in patients taking sulfonylureas; however, it may be recommended to reduce
or stop the sulfonylurea dose.
Acarbose -
Acarbose (Precose) is not recommended for initial management and is associated with significant GI s
ide effects. More information would be needed regarding fasting and post-
prandial numbers. In addition, adding acarbose would only lower A1c by 0.8% at best and therefore w
ould not achieve the desired A1C goal of <7%
,JR is a 68-year-
old African American man with a new diagnosis of T2DM. He was classified as having prediabetes (at r
isk for developing diabetes) 5 years before the diagnosis and has a strong family history of type 2 diab
etes. JR's blood pressure was 150/92 mm Hg. His laboratory results revealed an A1C of 8.1%, normal c
holesterol panel, and normal renal/hepatic function were noted with today's laboratory test results.
Past medical history: Hypertension (diagnosed 4 y ago) Hyperlipidemia (diagnosed 2 y ago) Pancreatiti
s (idiopathic) (acute hospitalization 3 y ago)
Family history: Type 2 diabetes
Medication: HCTZ 25 mg daily, simvastatin 10 mg daily
Allergies: SMZ/TMP
Vitals: BP: 150/92 mm Hg P: 78 beats/min RR: 12 rpm Waist Circumference: 46 in Weight: 267 lb Heig
ht: 5 ′ 6 ″ BMI: 43.1 kg/m 2
Despite improvements in the past six weeks due to lifestyle changes and exercise, drug therapy is to b
e started for JR's diabet - CORRECT ANSWER -
Metformin is the drug of choice recommended for most patients with diabetes in addition to lifestyle
modifications assuming no contraindications or intolerabilities are present upon evaluation. Metformin
has also shown to provide positive weight neutral/loss effects in obese patients. It is crucial to know t
he renal status of patients commencing metformin therapy to limit the risk of lactic acidosis (JR is with
out contraindication).
Since his entry A1C is >7.5%, dual therapy is indicated. There are several potential choices. The second
step can be a dipeptidyl peptidase-4 inhibitor, it can be a glucagon-like peptide-1 (GLP-
1) receptor agonist, it can be a TZD, it can be a sulfonylurea agent, it can be a SGLT2 inhibitor, or it co
uld be basal insulin. Anything next can be tried depending on what suits the circumstance
DPP4 inhibitors are weight neutral bet relatively benign side effect profile. Sitagliptin has been associat
ed with case reports of pancreatitis, so this specific agent should be avoided. $$$
GLP-
1 analog and has data to support an A1C reduction necessary to gain glycemic control and may assist
with weight loss goals for this patient. New information suggests these agents may provide benefits in
those with ASCVD. JR has a past history of pancreatitis and GLP-
1 analogs are not recommended due to this contraindication
TZDs have data to support an A1C reduction necessary to gain glycemic control, but are associated wit
h weight gain, negative effects on lipids and increased risk of fracture. Until recently, TZDs have also b
een linked to increased CV events and use has fallen out of favor
, Sulfonylureas provide excellent A1C lowering, but are also associated with weight gain. They also have
the potential to cause hypoglycemia, so patient education is crucial. Because of his allergies to "sulfa"
, use would be contr
A patient with type 1 diabetes reports taking propranolol for hypertension. What concern does this inf
ormation present for the provider? - CORRECT ANSWER -
A patient with Type 1 DM is insulin dependent for glucose control and at high risk for hypoglycemic ep
isodes. Propanolol causes prolonged hypoglycemic episodes. Needs to switch to ACE or ARB.
A provider teaches a patient who has been diagnosed with hypothyroidism about a new prescription f
or levothyroxine. Which statement by the patient indicates a need for further teaching?
a. "I should not take heartburn medication without consulting my provider first."
b. "I should report insomnia, tremors, and an increased heart rate to my provider."
c. "If I take a multivitamin with iron, I should take it 4 hours after the levothyroxine."
d. "If I take calcium supplements, I may need to decrease my dose of levothyroxine." -
CORRECT ANSWER -
D. Calcium may reduce levothyroxine absorption. Further education is needed if the patient feels she c
an take half of a prescribed medication.
MC has undiagnosed multiple gastric ulcers. Shortly after consuming a large meal and alcohol he expe
riences significant GI distress. He takes an OTC heartburn remedy. Within a minute or two he develops
what he will later describe as "belching, nausea and a bad bloated feeling". Several of the ulcers bega
n to bleed and he becomes profoundly hypotensive from the blood loss and is taken to the ED. Endos
copy confirms multiple bleeds; the endoscopist remarks that it appears as if the lesions had been liter
ally stretched apart causing additional tissue damage. What did the patient most likely take (i.e. what
was the OTC remedy)? - CORRECT ANSWER -I would accept Alka-
Selzer. I contains NaHCO3 (as well as ASA). In the presence of HCL it Liberates CO2, that can cause gas
tric distention, belching and nausea. The reaction is fairly swift allowing little time for dissipation. Tum
s, its primary ingredient calcium carbonate which when taken cause a reaction with the stomach acid
such as production of carbon dioxide gas which can cause bloating and the stomach to stretch to tear
the ulcers open.
On your way to this examination, you experience the vulnerable feeling that an attack of acute diarrhe
a is imminent! If you stop at a drug store, which anti-
diarrheal drugs could you buy without a prescription even though it is chemically related to the strong
opioid analgesic meperidine (but acts only on the peripheral opioid receptor)? - CORRECT ANSWER -
Loperamide
Questions with Correct Answers 2026
EP is a 38-year-
old female patient that comes in for diabetes education and management. She was diagnosed 12 year
s ago and states lately she is not able to control her diet although she continues a 1600 calorie diet wi
th appropriate daily carbohydrate intake (per dietitian prescription) and walks 40 minutes every day of
the week. She states compliance with all medications. She denies any history of hypoglycemia despite
being able to identify signs and symptoms and describe appropriate treatment strategies.
PMH: T2DM, HTN, obesity, depression, s/p thyroidectomy due to thyroid cancer
FmHx: Noncontributory
SHx: (−) Smoking, alcohol use, past marijuana use while in high school
Medications: Metformin 850 mg tid, glipizide 20 mg bid, lisinopril 20 mg daily, sertraline 100 mg daily,
multivitamin daily
Vitals: BP 128/82 mg Hg; P 72 beats/min; BMI 31 m/kg2
Laboratory test results: Na 134 mEq/L, K 5.4 mEq/L, Cl 106 mEq/L, BUN - CORRECT ANSWER -
Exenatide -
Exenatide (Bydureon) once weekly has been able to demonstrate weight loss and decrease A1C% by 0
.7% to 1.2% in clinical trials; however it is contraindicated for EP due to the self-
reported history of thyroid cancer.
Dapagliflozin -
Dapagliflozin (Farxiga) is contraindicated in this patient due to hyperkalemia which could be made wo
rse by this drug. The package insert does not indicate a specific potassium concentration cut off to no
longer use this medication; however, there are better choices in this patient.
Sitagliptin -
Sitagliptin (Januvia) is able to obtain an A1C goal of less than 7% based on clinical trials and currently
the patient does not have any cautionary objective measures to not use this medication. DPP-
IV inhibitors are weight neutral. DPP-
IV inhibitors can be used in patients taking sulfonylureas; however, it may be recommended to reduce
or stop the sulfonylurea dose.
Acarbose -
Acarbose (Precose) is not recommended for initial management and is associated with significant GI s
ide effects. More information would be needed regarding fasting and post-
prandial numbers. In addition, adding acarbose would only lower A1c by 0.8% at best and therefore w
ould not achieve the desired A1C goal of <7%
,JR is a 68-year-
old African American man with a new diagnosis of T2DM. He was classified as having prediabetes (at r
isk for developing diabetes) 5 years before the diagnosis and has a strong family history of type 2 diab
etes. JR's blood pressure was 150/92 mm Hg. His laboratory results revealed an A1C of 8.1%, normal c
holesterol panel, and normal renal/hepatic function were noted with today's laboratory test results.
Past medical history: Hypertension (diagnosed 4 y ago) Hyperlipidemia (diagnosed 2 y ago) Pancreatiti
s (idiopathic) (acute hospitalization 3 y ago)
Family history: Type 2 diabetes
Medication: HCTZ 25 mg daily, simvastatin 10 mg daily
Allergies: SMZ/TMP
Vitals: BP: 150/92 mm Hg P: 78 beats/min RR: 12 rpm Waist Circumference: 46 in Weight: 267 lb Heig
ht: 5 ′ 6 ″ BMI: 43.1 kg/m 2
Despite improvements in the past six weeks due to lifestyle changes and exercise, drug therapy is to b
e started for JR's diabet - CORRECT ANSWER -
Metformin is the drug of choice recommended for most patients with diabetes in addition to lifestyle
modifications assuming no contraindications or intolerabilities are present upon evaluation. Metformin
has also shown to provide positive weight neutral/loss effects in obese patients. It is crucial to know t
he renal status of patients commencing metformin therapy to limit the risk of lactic acidosis (JR is with
out contraindication).
Since his entry A1C is >7.5%, dual therapy is indicated. There are several potential choices. The second
step can be a dipeptidyl peptidase-4 inhibitor, it can be a glucagon-like peptide-1 (GLP-
1) receptor agonist, it can be a TZD, it can be a sulfonylurea agent, it can be a SGLT2 inhibitor, or it co
uld be basal insulin. Anything next can be tried depending on what suits the circumstance
DPP4 inhibitors are weight neutral bet relatively benign side effect profile. Sitagliptin has been associat
ed with case reports of pancreatitis, so this specific agent should be avoided. $$$
GLP-
1 analog and has data to support an A1C reduction necessary to gain glycemic control and may assist
with weight loss goals for this patient. New information suggests these agents may provide benefits in
those with ASCVD. JR has a past history of pancreatitis and GLP-
1 analogs are not recommended due to this contraindication
TZDs have data to support an A1C reduction necessary to gain glycemic control, but are associated wit
h weight gain, negative effects on lipids and increased risk of fracture. Until recently, TZDs have also b
een linked to increased CV events and use has fallen out of favor
, Sulfonylureas provide excellent A1C lowering, but are also associated with weight gain. They also have
the potential to cause hypoglycemia, so patient education is crucial. Because of his allergies to "sulfa"
, use would be contr
A patient with type 1 diabetes reports taking propranolol for hypertension. What concern does this inf
ormation present for the provider? - CORRECT ANSWER -
A patient with Type 1 DM is insulin dependent for glucose control and at high risk for hypoglycemic ep
isodes. Propanolol causes prolonged hypoglycemic episodes. Needs to switch to ACE or ARB.
A provider teaches a patient who has been diagnosed with hypothyroidism about a new prescription f
or levothyroxine. Which statement by the patient indicates a need for further teaching?
a. "I should not take heartburn medication without consulting my provider first."
b. "I should report insomnia, tremors, and an increased heart rate to my provider."
c. "If I take a multivitamin with iron, I should take it 4 hours after the levothyroxine."
d. "If I take calcium supplements, I may need to decrease my dose of levothyroxine." -
CORRECT ANSWER -
D. Calcium may reduce levothyroxine absorption. Further education is needed if the patient feels she c
an take half of a prescribed medication.
MC has undiagnosed multiple gastric ulcers. Shortly after consuming a large meal and alcohol he expe
riences significant GI distress. He takes an OTC heartburn remedy. Within a minute or two he develops
what he will later describe as "belching, nausea and a bad bloated feeling". Several of the ulcers bega
n to bleed and he becomes profoundly hypotensive from the blood loss and is taken to the ED. Endos
copy confirms multiple bleeds; the endoscopist remarks that it appears as if the lesions had been liter
ally stretched apart causing additional tissue damage. What did the patient most likely take (i.e. what
was the OTC remedy)? - CORRECT ANSWER -I would accept Alka-
Selzer. I contains NaHCO3 (as well as ASA). In the presence of HCL it Liberates CO2, that can cause gas
tric distention, belching and nausea. The reaction is fairly swift allowing little time for dissipation. Tum
s, its primary ingredient calcium carbonate which when taken cause a reaction with the stomach acid
such as production of carbon dioxide gas which can cause bloating and the stomach to stretch to tear
the ulcers open.
On your way to this examination, you experience the vulnerable feeling that an attack of acute diarrhe
a is imminent! If you stop at a drug store, which anti-
diarrheal drugs could you buy without a prescription even though it is chemically related to the strong
opioid analgesic meperidine (but acts only on the peripheral opioid receptor)? - CORRECT ANSWER -
Loperamide
