WGU D116 ADVANCED
PHARMACOLOGY FINAL OA EXAM
Actual & Exam | Latest 2025-2026
Question 1
A 68-year-old male with a history of heart failure (EF 35%) is started on
carvedilol. Which of the following best describes the mechanism of action of
carvedilol in this patient?
A. Selective beta-1 blockade
B. Non-selective beta blockade with alpha-1 blockade
C. Pure alpha-1 blockade
D. Beta-2 selective agonism
B. Non-selective beta blockade with alpha-1 blockade
• Carvedilol is a non-selective beta-blocker (beta-1 and beta-2) with additional
alpha-1 blocking effects, which reduces afterload and preload, beneficial in
heart failure.
Question 2
A 45-year-old woman presents with new-onset atrial fibrillation with rapid
ventricular response. She has a history of asthma. Which medication is most
appropriate for rate control?
A. Metoprolol
B. Atenolol
C. Diltiazem
D. Propranolol
C. Diltiazem
• Non-dihydropyridine calcium channel blockers like diltiazem are preferred
in patients with asthma due to lower risk of bronchospasm compared to beta-
blockers.
,Question 3
A 72-year-old male on warfarin for atrial fibrillation has an INR of 4.5 without
bleeding. Which of the following is the most appropriate management?
A. Hold warfarin and give vitamin K 10 mg subcutaneously
B. Hold warfarin and give fresh frozen plasma
C. Hold warfarin and monitor INR
D. Give vitamin K 2.5 mg orally and hold warfarin
D. Give vitamin K 2.5 mg orally and hold warfarin
• For INR 4.5–10 without bleeding, oral vitamin K (1–2.5 mg) and holding
warfarin is recommended per ACCP guidelines.
Question 4
A 34-year-old woman with major depressive disorder is started on fluoxetine. She
asks when she will begin to feel better. Which response is most accurate?
A. 1–2 days
B. 1–2 weeks
C. 4–6 weeks
D. 8–12 weeks
C. 4–6 weeks
• SSRIs like fluoxetine typically require 4–6 weeks for full antidepressant
effect, though some early improvement may occur.
Question 5
A 60-year-old male with gout is prescribed allopurinol. He has a history of HLA-
B*5801 positivity. What is the greatest risk?
A. Stevens-Johnson syndrome
B. Nephrolithiasis
C. Acute gout flare
D. Hepatotoxicity
A. Stevens-Johnson syndrome
, • HLA-B*5801 is strongly associated with severe cutaneous adverse reactions
(SCARs) including Stevens-Johnson syndrome and toxic epidermal
necrolysis with allopurinol.
Question 6
A 28-year-old pregnant woman at 32 weeks gestation is diagnosed with
uncomplicated urinary tract infection. Which antibiotic is most appropriate?
A. Ciprofloxacin
B. Doxycycline
C. Nitrofurantoin
D. Trimethoprim-sulfamethoxazole
C. Nitrofurantoin
• Nitrofurantoin is pregnancy category B and commonly used for
uncomplicated UTI in pregnancy, avoiding fluoroquinolones and
tetracyclines.
Question 7
A 55-year-old male with cirrhosis and ascites develops spontaneous bacterial
peritonitis. Which antibiotic regimen provides adequate coverage for both gram-
negative rods and anaerobes?
A. Cefepime alone
B. Ceftriaxone alone
C. Piperacillin/tazobactam
D. Aztreonam alone
C. Piperacillin/tazobactam
• Piperacillin/tazobactam covers gram-negative rods (including Pseudomonas)
and anaerobes such as Bacteroides fragilis, appropriate for SBP.
Question 8
, A 70-year-old female is started on digoxin for heart failure with reduced ejection
fraction. Which electrolyte abnormality increases the risk of digoxin toxicity?
A. Hyperkalemia
B. Hypokalemia
C. Hypermagnesemia
D. Hypercalcemia
B. Hypokalemia
• Hypokalemia increases digoxin binding to cardiac sodium-potassium
ATPase, significantly increasing risk of toxicity and arrhythmias.
Question 9
A 42-year-old male with HIV (CD4 count 120) is started on trimethoprim-
sulfamethoxazole for Pneumocystis jirovecii pneumonia prophylaxis. He develops
fever, rash, and transaminitis. What is the most appropriate next step?
A. Continue TMP-SMX and add antihistamines
B. Desensitize to TMP-SMX
C. Switch to atovaquone
D. Switch to dapsone without further testing
C. Switch to atovaquone
• Atovaquone is an alternative for PJP prophylaxis in patients with mild to
moderate sulfa allergy. Dapsone requires G6PD testing.
Question 10
A 65-year-old male with type 2 diabetes and CKD stage 4 is started on
empagliflozin. What is the primary mechanism of action?
A. Increases insulin secretion
B. Decreases hepatic gluconeogenesis
C. Inhibits SGLT2 in proximal tubule
D. Activates PPAR-gamma
C. Inhibits SGLT2 in proximal tubule
PHARMACOLOGY FINAL OA EXAM
Actual & Exam | Latest 2025-2026
Question 1
A 68-year-old male with a history of heart failure (EF 35%) is started on
carvedilol. Which of the following best describes the mechanism of action of
carvedilol in this patient?
A. Selective beta-1 blockade
B. Non-selective beta blockade with alpha-1 blockade
C. Pure alpha-1 blockade
D. Beta-2 selective agonism
B. Non-selective beta blockade with alpha-1 blockade
• Carvedilol is a non-selective beta-blocker (beta-1 and beta-2) with additional
alpha-1 blocking effects, which reduces afterload and preload, beneficial in
heart failure.
Question 2
A 45-year-old woman presents with new-onset atrial fibrillation with rapid
ventricular response. She has a history of asthma. Which medication is most
appropriate for rate control?
A. Metoprolol
B. Atenolol
C. Diltiazem
D. Propranolol
C. Diltiazem
• Non-dihydropyridine calcium channel blockers like diltiazem are preferred
in patients with asthma due to lower risk of bronchospasm compared to beta-
blockers.
,Question 3
A 72-year-old male on warfarin for atrial fibrillation has an INR of 4.5 without
bleeding. Which of the following is the most appropriate management?
A. Hold warfarin and give vitamin K 10 mg subcutaneously
B. Hold warfarin and give fresh frozen plasma
C. Hold warfarin and monitor INR
D. Give vitamin K 2.5 mg orally and hold warfarin
D. Give vitamin K 2.5 mg orally and hold warfarin
• For INR 4.5–10 without bleeding, oral vitamin K (1–2.5 mg) and holding
warfarin is recommended per ACCP guidelines.
Question 4
A 34-year-old woman with major depressive disorder is started on fluoxetine. She
asks when she will begin to feel better. Which response is most accurate?
A. 1–2 days
B. 1–2 weeks
C. 4–6 weeks
D. 8–12 weeks
C. 4–6 weeks
• SSRIs like fluoxetine typically require 4–6 weeks for full antidepressant
effect, though some early improvement may occur.
Question 5
A 60-year-old male with gout is prescribed allopurinol. He has a history of HLA-
B*5801 positivity. What is the greatest risk?
A. Stevens-Johnson syndrome
B. Nephrolithiasis
C. Acute gout flare
D. Hepatotoxicity
A. Stevens-Johnson syndrome
, • HLA-B*5801 is strongly associated with severe cutaneous adverse reactions
(SCARs) including Stevens-Johnson syndrome and toxic epidermal
necrolysis with allopurinol.
Question 6
A 28-year-old pregnant woman at 32 weeks gestation is diagnosed with
uncomplicated urinary tract infection. Which antibiotic is most appropriate?
A. Ciprofloxacin
B. Doxycycline
C. Nitrofurantoin
D. Trimethoprim-sulfamethoxazole
C. Nitrofurantoin
• Nitrofurantoin is pregnancy category B and commonly used for
uncomplicated UTI in pregnancy, avoiding fluoroquinolones and
tetracyclines.
Question 7
A 55-year-old male with cirrhosis and ascites develops spontaneous bacterial
peritonitis. Which antibiotic regimen provides adequate coverage for both gram-
negative rods and anaerobes?
A. Cefepime alone
B. Ceftriaxone alone
C. Piperacillin/tazobactam
D. Aztreonam alone
C. Piperacillin/tazobactam
• Piperacillin/tazobactam covers gram-negative rods (including Pseudomonas)
and anaerobes such as Bacteroides fragilis, appropriate for SBP.
Question 8
, A 70-year-old female is started on digoxin for heart failure with reduced ejection
fraction. Which electrolyte abnormality increases the risk of digoxin toxicity?
A. Hyperkalemia
B. Hypokalemia
C. Hypermagnesemia
D. Hypercalcemia
B. Hypokalemia
• Hypokalemia increases digoxin binding to cardiac sodium-potassium
ATPase, significantly increasing risk of toxicity and arrhythmias.
Question 9
A 42-year-old male with HIV (CD4 count 120) is started on trimethoprim-
sulfamethoxazole for Pneumocystis jirovecii pneumonia prophylaxis. He develops
fever, rash, and transaminitis. What is the most appropriate next step?
A. Continue TMP-SMX and add antihistamines
B. Desensitize to TMP-SMX
C. Switch to atovaquone
D. Switch to dapsone without further testing
C. Switch to atovaquone
• Atovaquone is an alternative for PJP prophylaxis in patients with mild to
moderate sulfa allergy. Dapsone requires G6PD testing.
Question 10
A 65-year-old male with type 2 diabetes and CKD stage 4 is started on
empagliflozin. What is the primary mechanism of action?
A. Increases insulin secretion
B. Decreases hepatic gluconeogenesis
C. Inhibits SGLT2 in proximal tubule
D. Activates PPAR-gamma
C. Inhibits SGLT2 in proximal tubule
