NR565 / NR 565 Advanced Pharmacology Care of the Fundamentals Final Exam | Chamberlain University (2026/2027) | Verified Questions and Answers with Rationales | Get HighScore | Instant Download

GET HIGHSCORE on the NR565 Advanced Pharmacology Care of the Fundamentals Final Exam (Weeks 5-8) at Chamberlain University with this comprehensive test bank featuring verified questions and answers with detailed rationales. The NR565 final exam is non-cumulative, consisting of 100 multiple-choice questions with a 120-minute time allotment (1.2 minutes per question), covering content from Weeks 5 through 8 of the course . The exam will be available from Wednesday Week 8 at 12:01 am MT until Saturday Week 8 at 11:59 pm MT . MASTER ENDOCRINOLOGY (WEEK 5 - CHAPTERS 48-49) Type 2 Diabetes Diagnosis and Initial Management: A fasting plasma glucose of 130 mg/dL and a repeat value of 128 mg/dL meets the criteria for diabetes mellitus, as fasting plasma glucose ≥126 mg/dL on two separate occasions is diagnostic in the absence of acute stress. For a newly diagnosed patient with A1C of 7.2% and creatinine clearance 60 mL/min, the American Diabetes Association (ADA) recommends metformin as first-line pharmacologic therapy in conjunction with lifestyle modifications. Metformin is effective, safe, inexpensive, and has a low risk of hypoglycemia while also not causing weight gain . Metformin GI Side Effects and Administration: A patient on metformin reporting significant nausea and diarrhea should be instructed to take the medication with the largest meal of the day. Gastrointestinal side effects are dose-dependent and can be minimized by taking with food, starting with a low dose, and titrating slowly. The medication should not be stopped abruptly . Diagnostic Criteria for Diabetes Mellitus (SATA) : All four criteria are diagnostic for diabetes: Fasting plasma glucose ≥126 mg/dL, random plasma glucose ≥200 mg/dL with symptoms, oral glucose tolerance test ≥200 mg/dL, or hemoglobin A1C ≥6.5% . A1C Monitoring Frequency: When stable, A1C should be monitored every 6 months. When unstable (A1C of 7% or greater), A1C should be monitored every 3 months . Treatment Intensification for Elevated A1C: When a patient with type 2 diabetes has an A1C of 9.5% despite being on metformin and glipizide with eGFR 45 mL/min, the most appropriate next step is to add basal insulin (e.g., glargine) . Adding insulin earlier helps preserve beta-cell function while continuing oral agents, especially metformin . A1C Goals: General A1C goal is below 7%. For older adults with moderate comorbidities and life expectancy less than 10 years, recommended A1C goal is 7.5-8%; 8-8.5% for older patients with complex medical issues. A patient with recurrent severe hypoglycemia events should have an A1C goal of 8% . Pioglitazone (TZD) Contraindications: Pioglitazone decreases insulin resistance, increases glucose uptake by muscle/adipose tissue, and decreases glucose production by the liver. It carries a black box warning for severe heart failure due to fluid retention. Contraindications include DKA, history of bladder cancer, Type 1 DM, hematuria, hypersensitivity to drugs, and hepatic impairment . Sulfonylureas (Glipizide): Promote insulin secretion by the pancreas; significant risk of hypoglycemia. Should not be used during pregnancy or with liver or renal impairments . GLP-1 Receptor Agonists: Subcutaneous injections that cause increased insulin production, inhibit postprandial glucagon release, and increase satiety. Can be helpful in obese patients as they stimulate weight loss and suppression of appetite. Contraindications include pancreatitis, renal dysfunction, pregnancy, and personal or family history of medullary thyroid carcinoma or multiple endocrine neoplasia syndrome type 2 . SGLT2 Inhibitors (Canagliflozin, Empagliflozin) : Limit reabsorption of glucose in renal tubules, block glucose reabsorption in the proximal nephron, and increase release of glucose in urine. Due to increased glucose in urine, patients are at higher risk for UTIs and pyelonephritis. May cause weight loss. Risk for volume depletion and hypotension; can lead to diabetic ketoacidosis . DPP-4 Inhibitors: Inhibit DPP-4 activity and increase active incretin concentrations, resulting in increased insulin secretion and decreased glucagon. May cause severe and disabling joint pain that can occur at any point during treatment; may also cause angioedema and acute pancreatitis . Insulin Total Daily Dose (TDD) Calculation: TDD is calculated as patient weight in kilograms multiplied by 0.6 units. For a 70 kg patient: 70 × 0.6 = 42 units total. 50% of TDD is basal dose (long-acting - 21 units) and 50% is rapid-acting bolus/mealtime insulin (21 units) . Carbohydrate-to-Insulin Ratio (500 Rule) : 500 ÷ TDD = carb ratio. For TDD of 42: 500 ÷ 42 = 11.9 (approximately 1 unit per 12 grams of carbs). For a 50g carb meal: 50 ÷ 12 = 4.2 units of rapid-acting insulin . Insulin Lispro Administration: Lispro is a rapid-acting insulin with onset of 15-30 minutes. It should be taken within 15-30 minutes of a meal, not 30-60 minutes before . Mixing Insulins: Only NPH (intermediate-acting) can be mixed with short-acting insulin. Always draw regular (clear) before NPH (cloudy). Insulin glargine (Lantus) should NEVER be mixed with other insulins . Increased Insulin Needs: Insulin requirements increase during pregnancy (especially after first trimester), infection, stress, and adolescent growth spurts. Insulin requirements decrease during exercise and in the first trimester of pregnancy . Levothyroxine Management: Used for hypothyroidism, congenital hypothyroidism, myxedema coma, simple goiter, and primary hypothyroidism. TSH should be rechecked 6-8 weeks after initiating therapy or after any dosage change (due to 7-day half-life), then at least once a year after stabilization. The medication should be taken on an empty stomach 30-60 minutes before breakfast . Levothyroxine in Pregnancy: A pregnant patient with hypothyroidism in the first trimester typically requires an increase in levothyroxine dose and more frequent TSH monitoring, as pregnancy increases thyroid hormone requirements. Hyperthyroidism Treatment: A patient with TSH of 0.28, free T4 of 3.0, and free T3 over 650 has hyperthyroidism and should be started on methimazole, PTU (propylthiouracil), or radioactive iodine . Methimazole is first-line for hyperthyroidism, inhibiting thyroid hormone synthesis, and is preferred in pregnant/breastfeeding patients. PTU is preferred for thyroid storm. Methimazole Mechanism of Action (MOA) : Indicated as first-line drug for hyperthyroidism - inhibits thyroid hormone synthesis. Also used for reduction of Graves' disease, suppression of thyroid hormone until thyroidectomy, and treatment of thyrotoxic crisis . Radioactive Iodine Adverse Effects (Iodism) : Can lead to corrosive injury to the GI tract, brassy taste, burning sensation in mouth, soreness in gums/teeth, and severe abdominal distress . Hypothyroidism vs Hyperthyroidism Signs: Hypothyroidism signs include pale puffy face, cold dry skin, brittle hair, slowed heart rate, lethargy, fatigue, cold intolerance. Hyperthyroidism signs include elevated heart rate, nervousness, insomnia, tremors, hyperreflexia, warm moist skin, heat intolerance, increased appetite with weight loss, and exophthalmos (bulging eyes). MASTER RESPIRATORY PHARMACOLOGY (WEEK 6) Asthma Classification: A 33-year-old asthmatic with daily symptoms and night-time exacerbations 4-5 times weekly is classified as moderate-persistent asthma. Step 3 (Moderate Persistent) is defined as symptoms daily with nighttime awakenings 3-4 times per month . Mild Persistent Asthma Classification: Symptoms occurring more than twice a week but less than daily, with nighttime awakenings 3-4 times per month . Intermittent Asthma: Symptoms ≤2 days/week, SABA use ≤2 days/week, nighttime awakenings ≤2 times/month . Severe Persistent Asthma: Symptoms several times daily, nighttime awakenings once/week . Short-Acting Beta-Agonists (SABAs) : Examples include albuterol (ProAir, Ventolin, Proventil) and levalbuterol (Xopenex). They provide rapid relief of bronchospasm and are used as rescue inhalers . LABA Safety in Asthma: Long-acting beta-agonists (LABAs) such as salmeterol and formoterol should never be used without an inhaled corticosteroid (ICS) in asthma due to increased risk of severe asthma exacerbations and asthma-related death when used as monotherapy . Bronchodilators: Provide symptomatic relief in patients with asthma and COPD but do not alter the underlying inflammation. They activate beta-2 receptors causing bronchodilation and relieving bronchospasm. Tiotropium Mechanism: Tiotropium is a long-acting muscarinic antagonist (LAMA) that blocks muscarinic receptors in the bronchial smooth muscle, causing bronchodilation. It is used once daily for maintenance treatment of COPD . MASTER GASTROENTEROLOGY (WEEK 7) First-Line Therapy for Moderate to Severe GERD: Proton pump inhibitors (PPIs) are first-line therapy because they provide superior acid suppression and healing compared to H2RAs. They work by irreversibly blocking the proton pump (H+/K+ ATPase) in gastric parietal cells . GERD Treatment Goals: Reduce or eliminate symptoms, heal any esophageal lesions, manage or prevent complications (stricture, Barrett's esophagus,