Chamberlain NR 565 Midterm Exam –
Advanced Pharmacology Questions and
Ansẉers with
Expert-Verified Explanation 2026\2027
update
This Exam contains:
Guarantee passing score
Questions and Ansẉers
format set of multiple-choice
, Expert-Verified Explanation
Verified ẉith trusted textbooks
───────────────────────────────────────────────────────
─
1. A 72-year-old patient with heart failure is prescribed digoxin. Which age-
related change requires a lower initial dose?
A. Increased glomerular filtration rate
B. Decreased lean body mass and renal clearance
C. Increased hepatic blood flow
D. Enhanced drug-receptor sensitivity
Correct answer: B
Expert-Explanation In older adults, decreased renal clearance (reduced GFR) and
decreased lean body mass reduce the volume of distribution for digoxin,
leading to higher serum concentrations. Digoxin toxicity risk is increased. The
starting dose should be reduced (e.g., 0.125 mg daily instead of 0.25 mg).
Monitoring of renal function and digoxin levels is essential.
2. A patient with type 2 diabetes has a creatinine clearance of 35 mL/min.
Which medication requires dose adjustment?
A. Metformin
B. Glipizide
C. Pioglitazone
D. Sitagliptin
Correct answer: A
Expert-Explanation Metformin is contraindicated in patients with eGFR <30
mL/min and requires dose adjustment at 30-45 mL/min due to risk of lactic
acidosis. Glipizide is safe (hepatic metabolism). Pioglitazone is not renally
excreted. Sitagliptin requires dose adjustment (50% dose reduction at eGFR 30-
50, 75% reduction <30). However, metformin has the most significant black box
warning for lactic acidosis in renal impairment.
,3. A patient taking warfarin has an INR of 4.5 without bleeding. What is the
appropriate management?
A. Administer vitamin K 10 mg orally
B. Hold warfarin and monitor INR
C. Administer fresh frozen plasma
D. Increase warfarin dose
Correct answer: B
Expert-Explanation For asymptomatic INR 4.5-9.0, guidelines recommend
holding warfarin and monitoring INR. Vitamin K (1-2.5 mg oral) is given if
bleeding risk is high. Vitamin K 10 mg is for serious bleeding. Fresh frozen
plasma is for life-threatening bleeding. Increasing warfarin would worsen INR.
4. A patient is prescribed atorvastatin and gemfibrozil. What adverse effect
requires monitoring?
A. Rhabdomyolysis
B. Hepatotoxicity
C. Nephrotoxicity
D. Hyperglycemia
Correct answer: A
Expert-Explanation Combining a statin (atorvastatin) with a fibrate (gemfibrozil)
increases the risk of myopathy and rhabdomyolysis, especially with gemfibrozil
(compared to fenofibrate). Muscle pain, weakness, and dark urine should be
reported. Creatine kinase (CK) should be monitored. Alternative: fenofibrate has
lower risk.
5. A patient with epilepsy is switching from phenytoin to levetiracetam. What is
true about levetiracetam?
A. Requires therapeutic drug monitoring
B. Has significant drug interactions
C. Is renally excreted and requires dose adjustment
D. Causes gingival hyperplasia
Correct answer: C
Expert-Explanation Levetiracetam is primarily renally excreted; dose adjustment
is needed for CrCl <80 mL/min. It has no significant drug interactions and does
not require routine drug monitoring. Gingival hyperplasia is associated with
phenytoin.
, 6. A 25-year-old woman with migraines with aura requests contraception. Which
method is contraindicated?
A. Copper IUD
B. Progestin-only pill
C. Combined oral contraceptive (COC)
D. Etonogestrel implant
Correct answer: C
Expert-Explanation Combined oral contraceptives (estrogen-containing) increase
the risk of ischemic stroke in women with migraines with aura. Progestin-only
methods (pill, implant, injection, LNG-IUD) and copper IUD are safe alternatives.
7. A patient on lithium has a level of 1.8 mEq/L (normal 0.6-1.2). She reports
nausea, tremor, and confusion. What is the most appropriate action?
A. Increase lithium dose
B. Hold lithium and assess renal function
C. Add haloperidol
D. Continue current dose
Correct answer: B
Expert-Explanation Lithium level >1.5 with symptoms indicates toxicity. Hold
lithium, check renal function, electrolytes, and consider IV fluids for hydration.
Severe toxicity (level >2.5, seizures) requires hemodialysis.
8. A patient with heart failure (HFrEF) is prescribed sacubitril/valsartan
(Entresto). What is a contraindication?
A. History of angioedema with ACE inhibitor
B. eGFR 45 mL/min
C. Serum potassium 4.2 mEq/L
D. Concurrent beta-blocker use
Correct answer: A
Expert-Explanation Sacubitril/valsartan is contraindicated within 36 hours of an
ACE inhibitor due to risk of angioedema. It is also contraindicated in patients
with a history of angioedema with ACE/ARB. It can be used with beta-blockers
and in mild-moderate renal impairment.
9. A patient is prescribed amoxicillin for otitis media. What is the mechanism of
action?
A. Inhibition of protein synthesis
Advanced Pharmacology Questions and
Ansẉers with
Expert-Verified Explanation 2026\2027
update
This Exam contains:
Guarantee passing score
Questions and Ansẉers
format set of multiple-choice
, Expert-Verified Explanation
Verified ẉith trusted textbooks
───────────────────────────────────────────────────────
─
1. A 72-year-old patient with heart failure is prescribed digoxin. Which age-
related change requires a lower initial dose?
A. Increased glomerular filtration rate
B. Decreased lean body mass and renal clearance
C. Increased hepatic blood flow
D. Enhanced drug-receptor sensitivity
Correct answer: B
Expert-Explanation In older adults, decreased renal clearance (reduced GFR) and
decreased lean body mass reduce the volume of distribution for digoxin,
leading to higher serum concentrations. Digoxin toxicity risk is increased. The
starting dose should be reduced (e.g., 0.125 mg daily instead of 0.25 mg).
Monitoring of renal function and digoxin levels is essential.
2. A patient with type 2 diabetes has a creatinine clearance of 35 mL/min.
Which medication requires dose adjustment?
A. Metformin
B. Glipizide
C. Pioglitazone
D. Sitagliptin
Correct answer: A
Expert-Explanation Metformin is contraindicated in patients with eGFR <30
mL/min and requires dose adjustment at 30-45 mL/min due to risk of lactic
acidosis. Glipizide is safe (hepatic metabolism). Pioglitazone is not renally
excreted. Sitagliptin requires dose adjustment (50% dose reduction at eGFR 30-
50, 75% reduction <30). However, metformin has the most significant black box
warning for lactic acidosis in renal impairment.
,3. A patient taking warfarin has an INR of 4.5 without bleeding. What is the
appropriate management?
A. Administer vitamin K 10 mg orally
B. Hold warfarin and monitor INR
C. Administer fresh frozen plasma
D. Increase warfarin dose
Correct answer: B
Expert-Explanation For asymptomatic INR 4.5-9.0, guidelines recommend
holding warfarin and monitoring INR. Vitamin K (1-2.5 mg oral) is given if
bleeding risk is high. Vitamin K 10 mg is for serious bleeding. Fresh frozen
plasma is for life-threatening bleeding. Increasing warfarin would worsen INR.
4. A patient is prescribed atorvastatin and gemfibrozil. What adverse effect
requires monitoring?
A. Rhabdomyolysis
B. Hepatotoxicity
C. Nephrotoxicity
D. Hyperglycemia
Correct answer: A
Expert-Explanation Combining a statin (atorvastatin) with a fibrate (gemfibrozil)
increases the risk of myopathy and rhabdomyolysis, especially with gemfibrozil
(compared to fenofibrate). Muscle pain, weakness, and dark urine should be
reported. Creatine kinase (CK) should be monitored. Alternative: fenofibrate has
lower risk.
5. A patient with epilepsy is switching from phenytoin to levetiracetam. What is
true about levetiracetam?
A. Requires therapeutic drug monitoring
B. Has significant drug interactions
C. Is renally excreted and requires dose adjustment
D. Causes gingival hyperplasia
Correct answer: C
Expert-Explanation Levetiracetam is primarily renally excreted; dose adjustment
is needed for CrCl <80 mL/min. It has no significant drug interactions and does
not require routine drug monitoring. Gingival hyperplasia is associated with
phenytoin.
, 6. A 25-year-old woman with migraines with aura requests contraception. Which
method is contraindicated?
A. Copper IUD
B. Progestin-only pill
C. Combined oral contraceptive (COC)
D. Etonogestrel implant
Correct answer: C
Expert-Explanation Combined oral contraceptives (estrogen-containing) increase
the risk of ischemic stroke in women with migraines with aura. Progestin-only
methods (pill, implant, injection, LNG-IUD) and copper IUD are safe alternatives.
7. A patient on lithium has a level of 1.8 mEq/L (normal 0.6-1.2). She reports
nausea, tremor, and confusion. What is the most appropriate action?
A. Increase lithium dose
B. Hold lithium and assess renal function
C. Add haloperidol
D. Continue current dose
Correct answer: B
Expert-Explanation Lithium level >1.5 with symptoms indicates toxicity. Hold
lithium, check renal function, electrolytes, and consider IV fluids for hydration.
Severe toxicity (level >2.5, seizures) requires hemodialysis.
8. A patient with heart failure (HFrEF) is prescribed sacubitril/valsartan
(Entresto). What is a contraindication?
A. History of angioedema with ACE inhibitor
B. eGFR 45 mL/min
C. Serum potassium 4.2 mEq/L
D. Concurrent beta-blocker use
Correct answer: A
Expert-Explanation Sacubitril/valsartan is contraindicated within 36 hours of an
ACE inhibitor due to risk of angioedema. It is also contraindicated in patients
with a history of angioedema with ACE/ARB. It can be used with beta-blockers
and in mild-moderate renal impairment.
9. A patient is prescribed amoxicillin for otitis media. What is the mechanism of
action?
A. Inhibition of protein synthesis
