NSG 533 – ADVANCED PHARMACOLOGY EXAM | WILKES
UNIVERSITY | 2025/2026 | VERIFIED STUDY GUIDE WITH
CORRECT COVERAGE
EP is a 38-year-old female patient that comes in for diabetes education and management. She was
diagnosed 12 years ago and states lately she is not able to control her diet although she continues a 1600
calorie diet with 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 ANSWERS-
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 worse 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 side 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 would 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 risk for developing diabetes) 5 years before the diagnosis and has a strong family history
of type 2 diabetes. JR's blood pressure was 150/92 mm Hg. His laboratory results revealed an A1C of
,8.1%, normal cholesterol 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) Pancreatitis
(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 Height:
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 be
started for JR's diabet - CORRECT ANSWERS-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 the renal status of patients commencing
metformin therapy to limit the risk of lactic acidosis (JR is without 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 could 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
associated 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 with
weight gain, negative effects on lipids and increased risk of fracture. Until recently, TZDs have also been
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
information present for the provider? - CORRECT ANSWERS-A patient with Type 1 DM is
, insulin dependent for glucose control and at high risk for hypoglycemic episodes. 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 for
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
ANSWERS-D. Calcium may reduce levothyroxine absorption. Further education is needed if the
patient feels she can take half of a prescribed medication.
MC has undiagnosed multiple gastric ulcers. Shortly after consuming a large meal and alcohol he
experiences 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 began to bleed and he becomes profoundly hypotensive from the blood loss and is taken to the
ED. Endoscopy confirms multiple bleeds; the endoscopist remarks that it appears as if the lesions had
been literally stretched apart causing additional tissue damage. What did the patient most likely take (i.e.
what was the OTC remedy)? - CORRECT ANSWERS-I would accept Alka-Selzer. I contains
NaHCO3 (as well as ASA). In the presence of HCL it Liberates CO2, that can cause gastric distention,
belching and nausea. The reaction is fairly swift allowing little time for dissipation. Tums, 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 diarrhea
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 ANSWERS-Loperamide
JA has multiple medical problems and is taking several drugs including theophylline, warfarin and
phenytoin. His conditions were well controlled, but recently he started to experience some GI distress for
which of his "well intentioned friends" gave him some medication. He presents to you with toxic effects
of all his other medications and plasma levels of those medications elevated. What was most likely the
medication he took? - CORRECT ANSWERS-Cimetidine
UNIVERSITY | 2025/2026 | VERIFIED STUDY GUIDE WITH
CORRECT COVERAGE
EP is a 38-year-old female patient that comes in for diabetes education and management. She was
diagnosed 12 years ago and states lately she is not able to control her diet although she continues a 1600
calorie diet with 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 ANSWERS-
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 worse 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 side 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 would 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 risk for developing diabetes) 5 years before the diagnosis and has a strong family history
of type 2 diabetes. JR's blood pressure was 150/92 mm Hg. His laboratory results revealed an A1C of
,8.1%, normal cholesterol 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) Pancreatitis
(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 Height:
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 be
started for JR's diabet - CORRECT ANSWERS-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 the renal status of patients commencing
metformin therapy to limit the risk of lactic acidosis (JR is without 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 could 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
associated 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 with
weight gain, negative effects on lipids and increased risk of fracture. Until recently, TZDs have also been
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
information present for the provider? - CORRECT ANSWERS-A patient with Type 1 DM is
, insulin dependent for glucose control and at high risk for hypoglycemic episodes. 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 for
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
ANSWERS-D. Calcium may reduce levothyroxine absorption. Further education is needed if the
patient feels she can take half of a prescribed medication.
MC has undiagnosed multiple gastric ulcers. Shortly after consuming a large meal and alcohol he
experiences 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 began to bleed and he becomes profoundly hypotensive from the blood loss and is taken to the
ED. Endoscopy confirms multiple bleeds; the endoscopist remarks that it appears as if the lesions had
been literally stretched apart causing additional tissue damage. What did the patient most likely take (i.e.
what was the OTC remedy)? - CORRECT ANSWERS-I would accept Alka-Selzer. I contains
NaHCO3 (as well as ASA). In the presence of HCL it Liberates CO2, that can cause gastric distention,
belching and nausea. The reaction is fairly swift allowing little time for dissipation. Tums, 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 diarrhea
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 ANSWERS-Loperamide
JA has multiple medical problems and is taking several drugs including theophylline, warfarin and
phenytoin. His conditions were well controlled, but recently he started to experience some GI distress for
which of his "well intentioned friends" gave him some medication. He presents to you with toxic effects
of all his other medications and plasma levels of those medications elevated. What was most likely the
medication he took? - CORRECT ANSWERS-Cimetidine
