NR565 | NR565 Advanced Pharmacology
Fundamentals Exam 4 v2 | Questions with Correct
Answers and Expert Explanation for Each Question
| Chamberlain
1. A patient with type 2 diabetes mellitus is prescribed metformin. Which of the
following lab values would require the clinician to discontinue the medication?
A. Hemoglobin A1c of 7.5%
B. eGFR of 28 mL/min/1.73 m2
C. Serum sodium of 135 mEq/L
D. AST of 35 U/L
Correct Answer: B
Expert Explanation: Metformin is strictly contraindicated in patients with an eGFR
below 30 mL/min/1.73 m2 due to the high risk of lactic acidosis. Lactic acidosis is a
rare but life-threatening complication associated with metformin accumulation in
renal impairment. Clinicians must monitor renal function at least annually for all
patients on this therapy.
2. Which mechanism of action best describes how SGLT2 inhibitors like empagliflozin
lower blood glucose levels?
A. Increasing insulin sensitivity in peripheral tissues
,B. Inhibiting glucose reabsorption in the proximal renal tubules
C. Stimulating the pancreas to release more insulin
D. Slowing gastric emptying and increasing satiety
Correct Answer: B
Expert Explanation: SGLT2 inhibitors lower blood glucose by preventing the
kidneys from reabsorbing glucose back into the bloodstream, thereby promoting
glucose excretion in the urine. This mechanism is independent of insulin and can
also lead to modest weight loss and blood pressure reduction. Because of the
increased glucose in the urine, patients should be monitored for urinary tract and
yeast infections.
3. A patient is diagnosed with hypothyroidism and started on levothyroxine. What is
the most important instruction regarding the administration of this drug?
A. Take it on an empty stomach, 30 to 60 minutes before breakfast
B. Take it at bedtime with a glass of milk
C. Take it with a full meal to avoid GI upset
D. Take it only when symptoms of fatigue are present
Correct Answer: A
,Expert Explanation: Levothyroxine absorption is significantly decreased by food
and certain minerals like calcium and iron. To ensure consistent absorption and
therapeutic levels, it must be taken on an empty stomach with water. Patients
should wait at least 30 to 60 minutes before eating or drinking other beverages.
4. Which of the following is a potential side effect of long-term corticosteroid therapy
that a clinician must monitor?
A. Hypoglycemia
B. Weight loss
C. Osteoporosis
D. Hypotension
Correct Answer: C
Expert Explanation: Long-term use of corticosteroids like prednisone leads to
suppressed bone formation and increased bone resorption, significantly increasing
the risk of osteoporosis and fractures. Clinicians should recommend calcium and
vitamin D supplementation and potentially bisphosphonates for high-risk patients.
Other common side effects include hyperglycemia, weight gain, and hypertension.
5. A patient with T2DM is starting a GLP-1 receptor agonist. Which of the following is a
contraindication for this class of medication?
A. Personal or family history of medullary thyroid carcinoma
, B. History of hypertension
C. BMI greater than 30
D. Chronic obstructive pulmonary disease
Correct Answer: A
Expert Explanation: GLP-1 receptor agonists carry a black box warning for the risk
of thyroid C-cell tumors. They are strictly contraindicated in patients with a
personal or family history of medullary thyroid carcinoma or Multiple Endocrine
Neoplasia syndrome type 2. Patients should be educated to report any neck masses
or difficulty swallowing while on this medication.
6. When treating a patient for hyperthyroidism with propylthiouracil (PTU), which rare
but serious adverse effect requires monitoring?
A. Renal stones
B. Liver failure
C. Hyperglycemia
D. Hypokalemia
Correct Answer: B
Expert Explanation: PTU is associated with a risk of severe liver injury and acute
liver failure, which is why methimazole is often preferred except in specific cases
Fundamentals Exam 4 v2 | Questions with Correct
Answers and Expert Explanation for Each Question
| Chamberlain
1. A patient with type 2 diabetes mellitus is prescribed metformin. Which of the
following lab values would require the clinician to discontinue the medication?
A. Hemoglobin A1c of 7.5%
B. eGFR of 28 mL/min/1.73 m2
C. Serum sodium of 135 mEq/L
D. AST of 35 U/L
Correct Answer: B
Expert Explanation: Metformin is strictly contraindicated in patients with an eGFR
below 30 mL/min/1.73 m2 due to the high risk of lactic acidosis. Lactic acidosis is a
rare but life-threatening complication associated with metformin accumulation in
renal impairment. Clinicians must monitor renal function at least annually for all
patients on this therapy.
2. Which mechanism of action best describes how SGLT2 inhibitors like empagliflozin
lower blood glucose levels?
A. Increasing insulin sensitivity in peripheral tissues
,B. Inhibiting glucose reabsorption in the proximal renal tubules
C. Stimulating the pancreas to release more insulin
D. Slowing gastric emptying and increasing satiety
Correct Answer: B
Expert Explanation: SGLT2 inhibitors lower blood glucose by preventing the
kidneys from reabsorbing glucose back into the bloodstream, thereby promoting
glucose excretion in the urine. This mechanism is independent of insulin and can
also lead to modest weight loss and blood pressure reduction. Because of the
increased glucose in the urine, patients should be monitored for urinary tract and
yeast infections.
3. A patient is diagnosed with hypothyroidism and started on levothyroxine. What is
the most important instruction regarding the administration of this drug?
A. Take it on an empty stomach, 30 to 60 minutes before breakfast
B. Take it at bedtime with a glass of milk
C. Take it with a full meal to avoid GI upset
D. Take it only when symptoms of fatigue are present
Correct Answer: A
,Expert Explanation: Levothyroxine absorption is significantly decreased by food
and certain minerals like calcium and iron. To ensure consistent absorption and
therapeutic levels, it must be taken on an empty stomach with water. Patients
should wait at least 30 to 60 minutes before eating or drinking other beverages.
4. Which of the following is a potential side effect of long-term corticosteroid therapy
that a clinician must monitor?
A. Hypoglycemia
B. Weight loss
C. Osteoporosis
D. Hypotension
Correct Answer: C
Expert Explanation: Long-term use of corticosteroids like prednisone leads to
suppressed bone formation and increased bone resorption, significantly increasing
the risk of osteoporosis and fractures. Clinicians should recommend calcium and
vitamin D supplementation and potentially bisphosphonates for high-risk patients.
Other common side effects include hyperglycemia, weight gain, and hypertension.
5. A patient with T2DM is starting a GLP-1 receptor agonist. Which of the following is a
contraindication for this class of medication?
A. Personal or family history of medullary thyroid carcinoma
, B. History of hypertension
C. BMI greater than 30
D. Chronic obstructive pulmonary disease
Correct Answer: A
Expert Explanation: GLP-1 receptor agonists carry a black box warning for the risk
of thyroid C-cell tumors. They are strictly contraindicated in patients with a
personal or family history of medullary thyroid carcinoma or Multiple Endocrine
Neoplasia syndrome type 2. Patients should be educated to report any neck masses
or difficulty swallowing while on this medication.
6. When treating a patient for hyperthyroidism with propylthiouracil (PTU), which rare
but serious adverse effect requires monitoring?
A. Renal stones
B. Liver failure
C. Hyperglycemia
D. Hypokalemia
Correct Answer: B
Expert Explanation: PTU is associated with a risk of severe liver injury and acute
liver failure, which is why methimazole is often preferred except in specific cases
