NR565 Week 3 Quiz: Advanced Pharmacology
Exam LATEST 2026 UPDATE 100+ QUESTIONS AND
DETAILED VERIFIED ANSWERS FROM ACTUAL
EXAMS TEST GRADE A+
Question 1
A patient with type 2 diabetes and heart failure with reduced ejection fraction
(HFrEF) is prescribed empagliflozin. What is the most important mechanism by
which this medication reduces cardiovascular mortality?
A. Increased insulin secretion from pancreatic beta cells
B. Inhibition of the sodium-glucose cotransporter-2 (SGLT2), leading to osmotic
diuresis and preload reduction
C. Direct stimulation of cardiac contractility via calcium sensitization
D. Antagonism of aldosterone receptors in the distal nephron
Correct Answer: B
*Explanation: Empagliflozin is an SGLT2 inhibitor that blocks glucose and sodium
reabsorption in the proximal tubule, causing osmotic diuresis, natriuresis, and
reduced preload/afterload. This hemodynamic effect lowers cardiac wall stress
and reduces hospitalization for heart failure, independent of glycemic control.
Option A is incorrect because empagliflozin does not directly increase insulin
secretion; it works independently of insulin. Option C describes inotropic agents
like levosimendan. Option D describes mineralocorticoid receptor antagonists like
spironolactone.*
Question 2
A patient on warfarin with an INR of 4.5 and no bleeding requires a dental
extraction. What is the most appropriate immediate management step?
A. Administer vitamin K 10 mg subcutaneously
B. Withhold warfarin for 24 hours and recheck INR
C. Administer fresh frozen plasma (FFP) 2 units
D. Give prothrombin complex concentrate (PCC) 25 units/kg
,Correct Answer: B
*Explanation: For an asymptomatic elevated INR (4.5) without bleeding, the
standard approach is to withhold warfarin for 1–2 days and recheck INR; major
bleeding risk is low. Option A (vitamin K) would lower INR too aggressively, causing
warfarin resistance for days. Option C (FFP) and Option D (PCC) are reserved for
active bleeding or life-threatening elevations.*
Question 3
Which of the following antibiotics is most strongly associated with the risk of
prolonging the QT interval and precipitating torsades de pointes?
A. Doxycycline
B. Azithromycin
C. Levofloxacin
D. Amoxicillin
Correct Answer: C
Explanation: Levofloxacin (a fluoroquinolone) is known to block the hERG
potassium channel, prolonging the QT interval and increasing torsades de pointes
risk, especially with hypokalemia, bradycardia, or concurrent QT-prolonging drugs.
Azithromycin (B) has a weaker but still documented risk. Doxycycline (A) and
amoxicillin (D) are generally considered safe.
Question 4
A 68-year-old woman with chronic kidney disease (eGFR 35 mL/min) is started on
lisinopril. Two weeks later, her serum potassium rises from 4.2 to 5.9 mEq/L.
Which additional medication would most likely contribute to this adverse effect?
A. Metformin
B. Spironolactone
C. Furosemide
D. Levothyroxine
Correct Answer: B
Explanation: Spironolactone is a potassium-sparing diuretic (aldosterone
antagonist). When combined with an ACE inhibitor like lisinopril, the risk of severe
hyperkalemia is markedly increased, especially in CKD. Metformin (A) does not
,cause hyperkalemia. Furosemide (C) causes hypokalemia. Levothyroxine (D) does
not affect potassium.
Question 5
A patient with bipolar disorder is stable on lithium. Which medication if added
would most likely increase lithium levels to a toxic range?
A. Ibuprofen
B. Acetaminophen
C. Metoprolol
D. Omeprazole
Correct Answer: A
Explanation: NSAIDs (e.g., ibuprofen) reduce renal blood flow and decrease
glomerular filtration, leading to reduced lithium excretion and increased serum
lithium levels, risking toxicity. Acetaminophen (B) does not affect lithium.
Metoprolol (C) and omeprazole (D) have minimal interactions.
Question 6
A patient prescribed metformin reports gastrointestinal upset. Which strategy is
most evidence-based to improve tolerance?
A. Switch to extended-release metformin taken with the evening meal
B. Add a proton pump inhibitor daily
C. Reduce the dose by 50% for 2 weeks, then increase back
D. Change to immediate-release metformin three times daily
Correct Answer: A
Explanation: Extended-release metformin, especially taken with food (particularly
the evening meal), significantly reduces GI side effects by slowing absorption and
reducing peak gastric concentrations. Dose reduction (C) may help temporarily but
is not the preferred long-term strategy. Switching to more frequent immediate-
release (D) usually worsens GI issues.
Question 7
Which statement best describes the pharmacologic action of glucagon-like
peptide-1 receptor agonists (e.g., semaglutide)?
, A. They directly inhibit renal glucose reabsorption
B. They increase glucose-dependent insulin secretion and delay gastric emptying
C. They activate PPAR-gamma receptors to improve insulin sensitivity
D. They inhibit dipeptidyl peptidase-4 to prolong endogenous GLP-1
Correct Answer: B
*Explanation: GLP-1 receptor agonists mimic endogenous GLP-1, enhancing
glucose-dependent insulin secretion, suppressing glucagon, and slowing gastric
emptying. Option A describes SGLT2 inhibitors. Option C describes
thiazolidinediones. Option D describes DPP-4 inhibitors, not GLP-1 agonists.*
Question 8
A patient with a penicillin allergy (non-anaphylactic) requires treatment for a
methicillin-susceptible Staphylococcus aureus infection. Which cephalosporin is
most appropriate?
A. Cefepime
B. Cefazolin
C. Ceftriaxone
D. Cefixime
Correct Answer: B
*Explanation: Cefazolin (first-generation cephalosporin) is effective against MSSA.
The risk of cross-reactivity between penicillins and cephalosporins is low (~1-2%)
for non-anaphylactic allergies, and cefazolin is often used. Cefepime (A) and
ceftriaxone (C) have broader spectra. Cefixime (D) is oral and less potent against
MSSA.*
Question 9
Which medication is first-line for acute treatment of migraine in a patient without
cardiovascular risk factors?
A. Sumatriptan 50 mg oral
B. Propranolol 80 mg daily
C. Topiramate 25 mg daily
D. Amitriptyline 25 mg at bedtime
Exam LATEST 2026 UPDATE 100+ QUESTIONS AND
DETAILED VERIFIED ANSWERS FROM ACTUAL
EXAMS TEST GRADE A+
Question 1
A patient with type 2 diabetes and heart failure with reduced ejection fraction
(HFrEF) is prescribed empagliflozin. What is the most important mechanism by
which this medication reduces cardiovascular mortality?
A. Increased insulin secretion from pancreatic beta cells
B. Inhibition of the sodium-glucose cotransporter-2 (SGLT2), leading to osmotic
diuresis and preload reduction
C. Direct stimulation of cardiac contractility via calcium sensitization
D. Antagonism of aldosterone receptors in the distal nephron
Correct Answer: B
*Explanation: Empagliflozin is an SGLT2 inhibitor that blocks glucose and sodium
reabsorption in the proximal tubule, causing osmotic diuresis, natriuresis, and
reduced preload/afterload. This hemodynamic effect lowers cardiac wall stress
and reduces hospitalization for heart failure, independent of glycemic control.
Option A is incorrect because empagliflozin does not directly increase insulin
secretion; it works independently of insulin. Option C describes inotropic agents
like levosimendan. Option D describes mineralocorticoid receptor antagonists like
spironolactone.*
Question 2
A patient on warfarin with an INR of 4.5 and no bleeding requires a dental
extraction. What is the most appropriate immediate management step?
A. Administer vitamin K 10 mg subcutaneously
B. Withhold warfarin for 24 hours and recheck INR
C. Administer fresh frozen plasma (FFP) 2 units
D. Give prothrombin complex concentrate (PCC) 25 units/kg
,Correct Answer: B
*Explanation: For an asymptomatic elevated INR (4.5) without bleeding, the
standard approach is to withhold warfarin for 1–2 days and recheck INR; major
bleeding risk is low. Option A (vitamin K) would lower INR too aggressively, causing
warfarin resistance for days. Option C (FFP) and Option D (PCC) are reserved for
active bleeding or life-threatening elevations.*
Question 3
Which of the following antibiotics is most strongly associated with the risk of
prolonging the QT interval and precipitating torsades de pointes?
A. Doxycycline
B. Azithromycin
C. Levofloxacin
D. Amoxicillin
Correct Answer: C
Explanation: Levofloxacin (a fluoroquinolone) is known to block the hERG
potassium channel, prolonging the QT interval and increasing torsades de pointes
risk, especially with hypokalemia, bradycardia, or concurrent QT-prolonging drugs.
Azithromycin (B) has a weaker but still documented risk. Doxycycline (A) and
amoxicillin (D) are generally considered safe.
Question 4
A 68-year-old woman with chronic kidney disease (eGFR 35 mL/min) is started on
lisinopril. Two weeks later, her serum potassium rises from 4.2 to 5.9 mEq/L.
Which additional medication would most likely contribute to this adverse effect?
A. Metformin
B. Spironolactone
C. Furosemide
D. Levothyroxine
Correct Answer: B
Explanation: Spironolactone is a potassium-sparing diuretic (aldosterone
antagonist). When combined with an ACE inhibitor like lisinopril, the risk of severe
hyperkalemia is markedly increased, especially in CKD. Metformin (A) does not
,cause hyperkalemia. Furosemide (C) causes hypokalemia. Levothyroxine (D) does
not affect potassium.
Question 5
A patient with bipolar disorder is stable on lithium. Which medication if added
would most likely increase lithium levels to a toxic range?
A. Ibuprofen
B. Acetaminophen
C. Metoprolol
D. Omeprazole
Correct Answer: A
Explanation: NSAIDs (e.g., ibuprofen) reduce renal blood flow and decrease
glomerular filtration, leading to reduced lithium excretion and increased serum
lithium levels, risking toxicity. Acetaminophen (B) does not affect lithium.
Metoprolol (C) and omeprazole (D) have minimal interactions.
Question 6
A patient prescribed metformin reports gastrointestinal upset. Which strategy is
most evidence-based to improve tolerance?
A. Switch to extended-release metformin taken with the evening meal
B. Add a proton pump inhibitor daily
C. Reduce the dose by 50% for 2 weeks, then increase back
D. Change to immediate-release metformin three times daily
Correct Answer: A
Explanation: Extended-release metformin, especially taken with food (particularly
the evening meal), significantly reduces GI side effects by slowing absorption and
reducing peak gastric concentrations. Dose reduction (C) may help temporarily but
is not the preferred long-term strategy. Switching to more frequent immediate-
release (D) usually worsens GI issues.
Question 7
Which statement best describes the pharmacologic action of glucagon-like
peptide-1 receptor agonists (e.g., semaglutide)?
, A. They directly inhibit renal glucose reabsorption
B. They increase glucose-dependent insulin secretion and delay gastric emptying
C. They activate PPAR-gamma receptors to improve insulin sensitivity
D. They inhibit dipeptidyl peptidase-4 to prolong endogenous GLP-1
Correct Answer: B
*Explanation: GLP-1 receptor agonists mimic endogenous GLP-1, enhancing
glucose-dependent insulin secretion, suppressing glucagon, and slowing gastric
emptying. Option A describes SGLT2 inhibitors. Option C describes
thiazolidinediones. Option D describes DPP-4 inhibitors, not GLP-1 agonists.*
Question 8
A patient with a penicillin allergy (non-anaphylactic) requires treatment for a
methicillin-susceptible Staphylococcus aureus infection. Which cephalosporin is
most appropriate?
A. Cefepime
B. Cefazolin
C. Ceftriaxone
D. Cefixime
Correct Answer: B
*Explanation: Cefazolin (first-generation cephalosporin) is effective against MSSA.
The risk of cross-reactivity between penicillins and cephalosporins is low (~1-2%)
for non-anaphylactic allergies, and cefazolin is often used. Cefepime (A) and
ceftriaxone (C) have broader spectra. Cefixime (D) is oral and less potent against
MSSA.*
Question 9
Which medication is first-line for acute treatment of migraine in a patient without
cardiovascular risk factors?
A. Sumatriptan 50 mg oral
B. Propranolol 80 mg daily
C. Topiramate 25 mg daily
D. Amitriptyline 25 mg at bedtime
