NURS 676 ADVANCED PHARMACOLOGY
MIDTERM EXAMINATION TEST 2026 COMPLETE
QUESTIONS AND SOLUTIONS GRADED A+
◉ Chapter 28
Beta Blockers and Diabetes Mellitus. Answer: beta blockers decrease
insulin secretion and may mask the signs of hypoglycemia.
The one sign that is not masked is diaphoresis, and patients with
diabetes who are taking these drugs should be taught to test their
blood glucose levels in the event of a diaphoretic episode.
◉ Chapter 36
Treatment for Stage A Heart Failure. Answer: initial focus is on
reversing underlying pathologies.
-lifestyle modification and avoidance of behaviors that may increase
risk: smoking, poor diet, obesity, sedentary lifestyle, alcohol or drugs
Drug therapy: ACE inhibitors recommended for patients with a
history of atherosclerotic vascular disease, diabetes mellitus, HTN.
Definitely start ACE inhibitor and possibly add a BB
BB are also recommended to control HTN and prevent HF
,◉ Treatment of Stage B heart failure. Answer: Drug therapy is ACE
inhibitor and beta blocker.
If patient was already on a BB for HTN or angina, provider can leave
them on the same med or switch it to a diff one
◉ Treatment of Stage C heart failure. Answer: This is the first stage
to be symptomatic
*most of HF patients are at this stage
* all of the Class I recommendations for stage A and B are
appropriate here ** in addition moderate sodium restriction along
with daily weight monitoring are indicated to facilitate the most
effective use of drugs
-Combination of 3 to 4 types of drugs: ACE inhibitors, BB's, cardiac
glycosides (digoxin), and a diuretic
◉ Stage C patients who remain symptomatic despite optimal
treatment therapy. Answer: patients who remain symptomatic
despite therapy with ACE inhibitors and beta blockers it is
recommended to start aldosterone antagonists (spironolactone) per
the NICE guidelines
◉ Dosing of diuretics. Answer: goal with dosing is to increase the
urine output and promote weight loss of 0.5 to 1 kg daily
,concurrent administration of NSAIDs can affect absorption of
diuretics
**is symptoms seem resistant to to standard doses of diuretic check
creatinine clearance
◉ Digoxin indications. Answer: used in patients with reduced
systolic dysfunction (ejection fraction <40%) while receiving
standard therapy with a BB and ACE inhibitor.
The decision to begin patient on digoxin should only be made when
there is clear evidence of systolic dysfunction
◉ Treatment for Stage D Heart failure. Answer: these are patients
with refractory end-stage HF
-marked symptoms even at rest despite maximal medical therapy
-ACE inhibitors and BB's in small doses
these drugs are contraindicated if systolic BP is <80 or who show
signs of peripheral hypoperfusion
-referral to cardiac transplantation and heart failure program
-infusions of vasoactive and positive inotropic agents are not
recommended for these patients
, ◉ Patients with HF with preserved Ejection Fraction (HF-pEF).
Answer: -half of the population have HF-pEF
limited evidence to show benefit of ACE inhibitors and BB's
-main underlying causes of HF-pEF include HTN and CAD, treatment
should target these causes
**As with all HF patients diuretics should be given in the presence of
volume overload to improve symptoms
**ACE inhibitors should be considered in diabetic patients and one
additional risk factor or those with symptomatic atherosclerotic
cardiovascular disease
**Beta blockers should be used in all patients with prior MI or AFib
requiring control of ventricular rate
◉ First line drugs of choice for heart failure. Answer: ACE inhibitor,
Beta blockers, diuretic
◉ MOA of ACE inhibitors that benefit heart failure. Answer: ACEIs
affect both preload and afterload through their vasodilating effects
-decrease the incidence of remodeling by reducing the local
generation and action of angiotensin II in heart muscle
-prevent neurohormonal counterregulatory mechanisms that
worsen HF through their action on the R-A-A system
MIDTERM EXAMINATION TEST 2026 COMPLETE
QUESTIONS AND SOLUTIONS GRADED A+
◉ Chapter 28
Beta Blockers and Diabetes Mellitus. Answer: beta blockers decrease
insulin secretion and may mask the signs of hypoglycemia.
The one sign that is not masked is diaphoresis, and patients with
diabetes who are taking these drugs should be taught to test their
blood glucose levels in the event of a diaphoretic episode.
◉ Chapter 36
Treatment for Stage A Heart Failure. Answer: initial focus is on
reversing underlying pathologies.
-lifestyle modification and avoidance of behaviors that may increase
risk: smoking, poor diet, obesity, sedentary lifestyle, alcohol or drugs
Drug therapy: ACE inhibitors recommended for patients with a
history of atherosclerotic vascular disease, diabetes mellitus, HTN.
Definitely start ACE inhibitor and possibly add a BB
BB are also recommended to control HTN and prevent HF
,◉ Treatment of Stage B heart failure. Answer: Drug therapy is ACE
inhibitor and beta blocker.
If patient was already on a BB for HTN or angina, provider can leave
them on the same med or switch it to a diff one
◉ Treatment of Stage C heart failure. Answer: This is the first stage
to be symptomatic
*most of HF patients are at this stage
* all of the Class I recommendations for stage A and B are
appropriate here ** in addition moderate sodium restriction along
with daily weight monitoring are indicated to facilitate the most
effective use of drugs
-Combination of 3 to 4 types of drugs: ACE inhibitors, BB's, cardiac
glycosides (digoxin), and a diuretic
◉ Stage C patients who remain symptomatic despite optimal
treatment therapy. Answer: patients who remain symptomatic
despite therapy with ACE inhibitors and beta blockers it is
recommended to start aldosterone antagonists (spironolactone) per
the NICE guidelines
◉ Dosing of diuretics. Answer: goal with dosing is to increase the
urine output and promote weight loss of 0.5 to 1 kg daily
,concurrent administration of NSAIDs can affect absorption of
diuretics
**is symptoms seem resistant to to standard doses of diuretic check
creatinine clearance
◉ Digoxin indications. Answer: used in patients with reduced
systolic dysfunction (ejection fraction <40%) while receiving
standard therapy with a BB and ACE inhibitor.
The decision to begin patient on digoxin should only be made when
there is clear evidence of systolic dysfunction
◉ Treatment for Stage D Heart failure. Answer: these are patients
with refractory end-stage HF
-marked symptoms even at rest despite maximal medical therapy
-ACE inhibitors and BB's in small doses
these drugs are contraindicated if systolic BP is <80 or who show
signs of peripheral hypoperfusion
-referral to cardiac transplantation and heart failure program
-infusions of vasoactive and positive inotropic agents are not
recommended for these patients
, ◉ Patients with HF with preserved Ejection Fraction (HF-pEF).
Answer: -half of the population have HF-pEF
limited evidence to show benefit of ACE inhibitors and BB's
-main underlying causes of HF-pEF include HTN and CAD, treatment
should target these causes
**As with all HF patients diuretics should be given in the presence of
volume overload to improve symptoms
**ACE inhibitors should be considered in diabetic patients and one
additional risk factor or those with symptomatic atherosclerotic
cardiovascular disease
**Beta blockers should be used in all patients with prior MI or AFib
requiring control of ventricular rate
◉ First line drugs of choice for heart failure. Answer: ACE inhibitor,
Beta blockers, diuretic
◉ MOA of ACE inhibitors that benefit heart failure. Answer: ACEIs
affect both preload and afterload through their vasodilating effects
-decrease the incidence of remodeling by reducing the local
generation and action of angiotensin II in heart muscle
-prevent neurohormonal counterregulatory mechanisms that
worsen HF through their action on the R-A-A system
