1
ADVANCED PHARMACOLOGY NSG 533 EXAM NEWEST
VERSION -2025/2026- 100+ Q AND ANS MOST POPULAR EXAM
GUARANTEED SUCCESS
A provider teaches a patient who has been diagnosed with hypothyroidism about
a new prescription for levothyroxine. Which statement by the patient indicates a
need for further teaching?
a. "I should not take heartburn medication without consulting my provider first."
b. "I should report insomnia, tremors, and an increased heart rate to my provider."
c. "If I take a multivitamin with iron, I should take it 4 hours after the
levothyroxine."
d. "If I take calcium supplements, I may need to decrease my dose of
levothyroxine."
D. Calcium may reduce levothyroxine absorption. Further education is needed if
the patient feels she can take half of a prescribed medication.
What medications / foods can contribute to GERD?
-Medications: anticholinergics, barbituates, dopamine, estrogen, opioids,
progesterone, theophylline, nitrates
-Foods: cirus fruits/juices, coffee, tomatoes, spicy food, carbonated drinks
Fried/fatty foods, garlic, onions, chocolate
What is the most effective PPI or H2RA within each of these classes?
-PPI- bismuth quadruple therapy combined with proton pump inhibitors
-H2RA- Famotidine 80mg
, 2
Other products such as antacids are also available. What are some of these and
what is their place in therapy?
-Reflux symptoms <2 times a week (infrequent)
-Effective for immediate relief
-Magnesium/Aluminum Hydroxide (Maalox)- can cause constipation
-Alginic Acid
MC has undiagnosed multiple gastric ulcers. Shortly after consuming a large meal
and alcohol he experiences significant GI distress. He takes an OTC heartburn
remedy. Within a minute or two he develops what he will later describe as
"belching, nausea and a bad bloated feeling". Several of the ulcers began to bleed
and he becomes profoundly hypotensive from the blood loss and is taken to the
ED. Endoscopy confirms multiple bleeds; the endoscopist remarks that it appears
as if the lesions had been literally stretched apart causing additional tissue
damage. What did the patient most likely take (i.e. what was the OTC remedy)?
I would accept Alka-Selzer. I contains NaHCO3 (as well as ASA). In the presence of
HCL it Liberates CO2, that can cause gastric distention, belching and nausea. The
reaction is fairly swift allowing little time for dissipation. Tums, its primary
ingredient calcium carbonate which when taken cause a reaction with the
stomach acid such as production of carbon dioxide gas which can cause bloating
and the stomach to stretch to tear the ulcers open.
Medications: Metformin 850 mg tid, glipizide 20 mg bid, lisinopril 20 mg daily,
sertraline 100 mg daily, multivitamin daily
Vitals: BP 128/82 mg Hg; P 72 beats/min; BMI 31 m/kg2
Laboratory test results: Na 134 mEq/L, K 5.4 mEq/L, Cl 106 mEq/L, BUN
Exenatide - Exenatide (Bydureon) once weekly has been able to demonstrate
weight loss and decrease A1C% by 0.7% to 1.2% in clinical trials; however it is
contraindicated for EP due to the self-reported history of thyroid cancer.
, 3
Dapagliflozin - Dapagliflozin (Farxiga) is contraindicated in this patient due to
hyperkalemia which could be made worse by this drug. The package insert does
not indicate a specific potassium concentration cut off to no longer use this
medication; however, there are better choices in this patient.
Sitagliptin - Sitagliptin (Januvia) is able to obtain an A1C goal of less than 7% based
on clinical trials and currently the patient does not have any cautionary objective
measures to not use this medication. DPP-IV inhibitors are weight neutral. DPP-IV
inhibitors can be used in patients taking sulfonylureas; however, it may be
recommended to reduce or stop the sulfonylurea dose.
Acarbose - Acarbose (Precose) is not recommended for initial management and is
associated with significant GI side effects. More information would be needed
regarding fasting and post-prandial numbers. In addition, adding acarbose would
only lower A1c by 0.8% at best and therefore would not achieve the desired A1C
goal of <7%
JR is a 68-year-old African American man with a new diagnosis of T2DM. He was
classified as having prediabetes (at risk for developing diabetes) 5 years before the
diagnosis and has a strong family history of type 2 diabetes. JR's blood pressure
was 150/92 mm Hg. His laboratory results revealed an A1C of 8.1%, normal
cholesterol panel, and normal renal/hepatic function were noted with today's
laboratory test results.
Past medical history: Hypertension (diagnosed 4 y ago) Hyperlipidemia (diagnosed
2 y ago) Pancreatitis (idiopathic) (acute hospitalization 3 y ago)
Family history: Type 2 diabetes
Medication: HCTZ 25 mg daily, simvastatin 10 mg daily
Allergies: SMZ/TMP
Vitals: BP: 150/92 mm Hg P: 78 beats/min RR: 12 rpm Waist Circumference: 46 in
Weight: 267 lb Height: 5 ′ 6 ″ BMI: 43.1 kg/m 2
Despite improvements in the past six weeks due to lifestyle changes and exercise,
drug therapy is to be started for JR's diabet
, 4
Metformin is the drug of choice recommended for most patients with diabetes in
addition to lifestyle modifications assuming no contraindications or intolerabilities
are present upon evaluation. Metformin has also shown to provide positive
weight neutral/loss effects in obese patients. It is crucial to know the renal status
of patients commencing metformin therapy to limit the risk of lactic acidosis (JR is
without contraindication).
Since his entry A1C is >7.5%, dual therapy is indicated. There are several potential
choices. The second step can be a dipeptidyl peptidase-4 inhibitor, it can be a
glucagon-like peptide-1 (GLP-1) receptor agonist, it can be a TZD, it can be a
sulfonylurea agent, it can be a SGLT2 inhibitor, or it could be basal insulin.
Anything next can be tried depending on what suits the circumstance
DPP4 inhibitors are weight neutral bet relatively benign side effect profile.
Sitagliptin has been associated with case reports of pancreatitis, so this specific
agent should be avoided. $$$
GLP-1 analog and has data to support an A1C reduction necessary to gain glycemic
control and may assist with weight loss goals for this patient. New information
suggests these agents may provide benefits in those with ASCVD. JR has a past
history of pancreatitis and GLP-1 analogs are not recommended due to this
contraindication
TZDs have data to support an A1C reduction necessary to gain glycemic control,
but are associated with weight gain, negative effects on lipids and increased risk of
fracture. Until recently, TZDs have also been linked to increased CV events and use
has fallen out of favor
Sulfonylureas provide excellent A1C lowering, but are also associated with weight
gain. They also have the potential to cause hypoglycemia, so patient education is
crucial. Because of his allergies to "sulfa", use would be contr
A patient with type 1 diabetes reports taking propranolol for hypertension. What
concern does this information present for the provider?
ADVANCED PHARMACOLOGY NSG 533 EXAM NEWEST
VERSION -2025/2026- 100+ Q AND ANS MOST POPULAR EXAM
GUARANTEED SUCCESS
A provider teaches a patient who has been diagnosed with hypothyroidism about
a new prescription for levothyroxine. Which statement by the patient indicates a
need for further teaching?
a. "I should not take heartburn medication without consulting my provider first."
b. "I should report insomnia, tremors, and an increased heart rate to my provider."
c. "If I take a multivitamin with iron, I should take it 4 hours after the
levothyroxine."
d. "If I take calcium supplements, I may need to decrease my dose of
levothyroxine."
D. Calcium may reduce levothyroxine absorption. Further education is needed if
the patient feels she can take half of a prescribed medication.
What medications / foods can contribute to GERD?
-Medications: anticholinergics, barbituates, dopamine, estrogen, opioids,
progesterone, theophylline, nitrates
-Foods: cirus fruits/juices, coffee, tomatoes, spicy food, carbonated drinks
Fried/fatty foods, garlic, onions, chocolate
What is the most effective PPI or H2RA within each of these classes?
-PPI- bismuth quadruple therapy combined with proton pump inhibitors
-H2RA- Famotidine 80mg
, 2
Other products such as antacids are also available. What are some of these and
what is their place in therapy?
-Reflux symptoms <2 times a week (infrequent)
-Effective for immediate relief
-Magnesium/Aluminum Hydroxide (Maalox)- can cause constipation
-Alginic Acid
MC has undiagnosed multiple gastric ulcers. Shortly after consuming a large meal
and alcohol he experiences significant GI distress. He takes an OTC heartburn
remedy. Within a minute or two he develops what he will later describe as
"belching, nausea and a bad bloated feeling". Several of the ulcers began to bleed
and he becomes profoundly hypotensive from the blood loss and is taken to the
ED. Endoscopy confirms multiple bleeds; the endoscopist remarks that it appears
as if the lesions had been literally stretched apart causing additional tissue
damage. What did the patient most likely take (i.e. what was the OTC remedy)?
I would accept Alka-Selzer. I contains NaHCO3 (as well as ASA). In the presence of
HCL it Liberates CO2, that can cause gastric distention, belching and nausea. The
reaction is fairly swift allowing little time for dissipation. Tums, its primary
ingredient calcium carbonate which when taken cause a reaction with the
stomach acid such as production of carbon dioxide gas which can cause bloating
and the stomach to stretch to tear the ulcers open.
Medications: Metformin 850 mg tid, glipizide 20 mg bid, lisinopril 20 mg daily,
sertraline 100 mg daily, multivitamin daily
Vitals: BP 128/82 mg Hg; P 72 beats/min; BMI 31 m/kg2
Laboratory test results: Na 134 mEq/L, K 5.4 mEq/L, Cl 106 mEq/L, BUN
Exenatide - Exenatide (Bydureon) once weekly has been able to demonstrate
weight loss and decrease A1C% by 0.7% to 1.2% in clinical trials; however it is
contraindicated for EP due to the self-reported history of thyroid cancer.
, 3
Dapagliflozin - Dapagliflozin (Farxiga) is contraindicated in this patient due to
hyperkalemia which could be made worse by this drug. The package insert does
not indicate a specific potassium concentration cut off to no longer use this
medication; however, there are better choices in this patient.
Sitagliptin - Sitagliptin (Januvia) is able to obtain an A1C goal of less than 7% based
on clinical trials and currently the patient does not have any cautionary objective
measures to not use this medication. DPP-IV inhibitors are weight neutral. DPP-IV
inhibitors can be used in patients taking sulfonylureas; however, it may be
recommended to reduce or stop the sulfonylurea dose.
Acarbose - Acarbose (Precose) is not recommended for initial management and is
associated with significant GI side effects. More information would be needed
regarding fasting and post-prandial numbers. In addition, adding acarbose would
only lower A1c by 0.8% at best and therefore would not achieve the desired A1C
goal of <7%
JR is a 68-year-old African American man with a new diagnosis of T2DM. He was
classified as having prediabetes (at risk for developing diabetes) 5 years before the
diagnosis and has a strong family history of type 2 diabetes. JR's blood pressure
was 150/92 mm Hg. His laboratory results revealed an A1C of 8.1%, normal
cholesterol panel, and normal renal/hepatic function were noted with today's
laboratory test results.
Past medical history: Hypertension (diagnosed 4 y ago) Hyperlipidemia (diagnosed
2 y ago) Pancreatitis (idiopathic) (acute hospitalization 3 y ago)
Family history: Type 2 diabetes
Medication: HCTZ 25 mg daily, simvastatin 10 mg daily
Allergies: SMZ/TMP
Vitals: BP: 150/92 mm Hg P: 78 beats/min RR: 12 rpm Waist Circumference: 46 in
Weight: 267 lb Height: 5 ′ 6 ″ BMI: 43.1 kg/m 2
Despite improvements in the past six weeks due to lifestyle changes and exercise,
drug therapy is to be started for JR's diabet
, 4
Metformin is the drug of choice recommended for most patients with diabetes in
addition to lifestyle modifications assuming no contraindications or intolerabilities
are present upon evaluation. Metformin has also shown to provide positive
weight neutral/loss effects in obese patients. It is crucial to know the renal status
of patients commencing metformin therapy to limit the risk of lactic acidosis (JR is
without contraindication).
Since his entry A1C is >7.5%, dual therapy is indicated. There are several potential
choices. The second step can be a dipeptidyl peptidase-4 inhibitor, it can be a
glucagon-like peptide-1 (GLP-1) receptor agonist, it can be a TZD, it can be a
sulfonylurea agent, it can be a SGLT2 inhibitor, or it could be basal insulin.
Anything next can be tried depending on what suits the circumstance
DPP4 inhibitors are weight neutral bet relatively benign side effect profile.
Sitagliptin has been associated with case reports of pancreatitis, so this specific
agent should be avoided. $$$
GLP-1 analog and has data to support an A1C reduction necessary to gain glycemic
control and may assist with weight loss goals for this patient. New information
suggests these agents may provide benefits in those with ASCVD. JR has a past
history of pancreatitis and GLP-1 analogs are not recommended due to this
contraindication
TZDs have data to support an A1C reduction necessary to gain glycemic control,
but are associated with weight gain, negative effects on lipids and increased risk of
fracture. Until recently, TZDs have also been linked to increased CV events and use
has fallen out of favor
Sulfonylureas provide excellent A1C lowering, but are also associated with weight
gain. They also have the potential to cause hypoglycemia, so patient education is
crucial. Because of his allergies to "sulfa", use would be contr
A patient with type 1 diabetes reports taking propranolol for hypertension. What
concern does this information present for the provider?
