NR 566 MIDTERM EXAM 2 LATEST VERSIONS 2026 |
Advanced Pharmacology for Care of Family | Exam Review |
A Grade | Pass Guaranteed - A+ Graded
VERSION A
SECTION 1: FOUNDATIONAL PHARMACOLOGY PRINCIPLES
Q1. A 68-year-old patient with hypertension and osteoarthritis is prescribed celecoxib
for pain management. Which CYP450 enzyme is primarily responsible for metabolizing
celecoxib, and which concurrent medication would significantly increase celecoxib
plasma levels?
A. CYP2D6; fluoxetine
B. CYP2C9; fluconazole
C. CYP2C9; fluconazole [CORRECT]
D. CYP2D6; fluconazole
Rationale: For the NR 566 midterm exam (Version A), remember that celecoxib is
primarily metabolized by CYP2C9, not CYP2D6. Fluconazole is a potent inhibitor of
,CYP2C9 and would significantly increase celecoxib levels. Fluoxetine is a CYP2D6
inhibitor and would not significantly affect celecoxib. That’s correct because in family
practice, understanding CYP450 interactions is critical for preventing adverse drug
events.
Correct Answer: C
Q2. A patient on chronic warfarin therapy for atrial fibrillation is started on amiodarone
for newly diagnosed ventricular tachycardia. What is the primary mechanism by which
amiodarone increases warfarin effect, and what is the appropriate management?
A. Amiodarone inhibits CYP3A4 and decreasing warfarin metabolism
B. Amiodarone inhibits CYP2C9 and CYP3A4; reduce warfarin dose by 30–50% and
monitor INR frequently [CORRECT]
C. Amiodarone induces CYP2C9; increase warfarin dose
D. Amiodarone inhibits CYP2C9 and CYP3A4; no dose change needed
Rationale: For the NR 566 midterm exam (Version A), remember that amiodarone is
both a CYP2C9 and CYP3A4 inhibitor of warfarin metabolism. This significantly
increases INR and bleeding risk. Current guidelines recommend reducing warfarin dose
by 30–50% and monitoring INR frequently (initially daily) when starting amiodarone. A
common midterm trap is confusing amiodarone as an inducer rather than a potent
inhibitor.
,Correct Answer: B
Q3. A 72-year-old patient with insomnia has been taking diphenhydramine 50 mg nightly
for three weeks. Which Beers criteria concern makes this medication inappropriate in
older adults?
A. Anticholinergic effects including confusion, urinary retention, and falls
B. Anticholinergic effects including confusion, urinary retention, and falls [CORRECT]
C. Sedation only; minimal concern in older adults
D. Respiratory depression and physical dependence
Rationale: For the NR 566 midterm exam (Version A), remember that diphenhydramine
is a first-generation antihistamine with significant anticholinergic properties. The Beers
criteria specifically identifies diphenhydramine as potentially inappropriate in older
adults due to risks of confusion, urinary retention, constipation, and falls. That’s correct
because in family practice, we should recommend alternatives such as melatonin,
trazodone, or non-pharmacologic sleep hygiene for older adults.
Correct Answer: B
, Q4. A patient newly diagnosed with Type 2 diabetes has an eGFR of 45 mL/min/1.73m².
Metformin is prescribed at 500 mg twice daily. What is the most important monitoring
parameter for this patient?
A. Hemoglobin A1c every 6 months
B. Vitamin B12 levels annually
C. Renal function and vitamin B12 levels; hold metformin if eGFR drops below 30
[CORRECT]
D. Liver function tests every 3 months
Rationale: For the NR 566 midterm exam (Version A), remember that metformin is
contraindicated if eGFR falls below 30 mL/min/1.73m², and caution is advised between
30–45. The most important monitoring includes renal function to determine when
metformin should be held, and vitamin B12 levels for long-term deficiency. A common
midterm trap is focusing only on HbA1c without considering renal safety parameters.
Correct Answer: C
Q5. A 55-year-old African American patient with newly diagnosed hypertension and no
comorbidities. According to current guidelines, which medication class is the most
appropriate first-line therapy?
A. ACE inhibitor
Advanced Pharmacology for Care of Family | Exam Review |
A Grade | Pass Guaranteed - A+ Graded
VERSION A
SECTION 1: FOUNDATIONAL PHARMACOLOGY PRINCIPLES
Q1. A 68-year-old patient with hypertension and osteoarthritis is prescribed celecoxib
for pain management. Which CYP450 enzyme is primarily responsible for metabolizing
celecoxib, and which concurrent medication would significantly increase celecoxib
plasma levels?
A. CYP2D6; fluoxetine
B. CYP2C9; fluconazole
C. CYP2C9; fluconazole [CORRECT]
D. CYP2D6; fluconazole
Rationale: For the NR 566 midterm exam (Version A), remember that celecoxib is
primarily metabolized by CYP2C9, not CYP2D6. Fluconazole is a potent inhibitor of
,CYP2C9 and would significantly increase celecoxib levels. Fluoxetine is a CYP2D6
inhibitor and would not significantly affect celecoxib. That’s correct because in family
practice, understanding CYP450 interactions is critical for preventing adverse drug
events.
Correct Answer: C
Q2. A patient on chronic warfarin therapy for atrial fibrillation is started on amiodarone
for newly diagnosed ventricular tachycardia. What is the primary mechanism by which
amiodarone increases warfarin effect, and what is the appropriate management?
A. Amiodarone inhibits CYP3A4 and decreasing warfarin metabolism
B. Amiodarone inhibits CYP2C9 and CYP3A4; reduce warfarin dose by 30–50% and
monitor INR frequently [CORRECT]
C. Amiodarone induces CYP2C9; increase warfarin dose
D. Amiodarone inhibits CYP2C9 and CYP3A4; no dose change needed
Rationale: For the NR 566 midterm exam (Version A), remember that amiodarone is
both a CYP2C9 and CYP3A4 inhibitor of warfarin metabolism. This significantly
increases INR and bleeding risk. Current guidelines recommend reducing warfarin dose
by 30–50% and monitoring INR frequently (initially daily) when starting amiodarone. A
common midterm trap is confusing amiodarone as an inducer rather than a potent
inhibitor.
,Correct Answer: B
Q3. A 72-year-old patient with insomnia has been taking diphenhydramine 50 mg nightly
for three weeks. Which Beers criteria concern makes this medication inappropriate in
older adults?
A. Anticholinergic effects including confusion, urinary retention, and falls
B. Anticholinergic effects including confusion, urinary retention, and falls [CORRECT]
C. Sedation only; minimal concern in older adults
D. Respiratory depression and physical dependence
Rationale: For the NR 566 midterm exam (Version A), remember that diphenhydramine
is a first-generation antihistamine with significant anticholinergic properties. The Beers
criteria specifically identifies diphenhydramine as potentially inappropriate in older
adults due to risks of confusion, urinary retention, constipation, and falls. That’s correct
because in family practice, we should recommend alternatives such as melatonin,
trazodone, or non-pharmacologic sleep hygiene for older adults.
Correct Answer: B
, Q4. A patient newly diagnosed with Type 2 diabetes has an eGFR of 45 mL/min/1.73m².
Metformin is prescribed at 500 mg twice daily. What is the most important monitoring
parameter for this patient?
A. Hemoglobin A1c every 6 months
B. Vitamin B12 levels annually
C. Renal function and vitamin B12 levels; hold metformin if eGFR drops below 30
[CORRECT]
D. Liver function tests every 3 months
Rationale: For the NR 566 midterm exam (Version A), remember that metformin is
contraindicated if eGFR falls below 30 mL/min/1.73m², and caution is advised between
30–45. The most important monitoring includes renal function to determine when
metformin should be held, and vitamin B12 levels for long-term deficiency. A common
midterm trap is focusing only on HbA1c without considering renal safety parameters.
Correct Answer: C
Q5. A 55-year-old African American patient with newly diagnosed hypertension and no
comorbidities. According to current guidelines, which medication class is the most
appropriate first-line therapy?
A. ACE inhibitor
