NR 565 Advanced Pharmacology Fundamentals

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Free NR 565 Advanced Pharmacology Fundamentals Questions

1.

Which medication is associated with decreased absorption of calcium, magnesium, and vitamin B12?

  • Metronidazole

  • Polyethylene glycol

  • Metoclopramide

  • Esomeprazole

Explanation

Correct Answer: D. Esomeprazole

Explanation of Correct Answer
Esomeprazole, a proton pump inhibitor (PPI), reduces gastric acid secretion, which is essential for the absorption of several nutrients, including calcium, magnesium, and vitamin B12. Long-term use of PPIs is associated with deficiencies in these nutrients, increasing the risk of osteoporosis, hypomagnesemia, and anemia. Metronidazole is an antibiotic, polyethylene glycol is an osmotic laxative, and metoclopramide is a prokinetic agent—none of which impair nutrient absorption in the same way as PPIs.

2.

The patient demonstrates correct understanding metronidazole when they state:

  • "I can still have my nightly glass of wine while taking this medication."

  • "Unfortunately, I can not take this medication because I am 6 weeks pregnant."

  • "Episodes of diarrhea and insomnia are the most common side effects of this medication."

  • "Metronidazole does not treat sensitive strains of H. pylori. I need a different prescription."

Explanation

Correct Answer: B. "Unfortunately, I can not take this medication because I am 6 weeks pregnant."

Explanation of Correct Answer
Metronidazole is contraindicated during the first trimester of pregnancy due to potential teratogenic risks. Patients taking metronidazole should also avoid alcohol because of the disulfiram-like reaction (flushing, nausea, vomiting). While it can cause GI upset, metallic taste, and rarely neurologic effects, diarrhea and insomnia are not the most common side effects. Metronidazole is indeed used in combination therapy to treat H. pylori, making option D incorrect.

3.

Which symptoms are most expected of a patient diagnosed with hypothyroidism?

  • shortness of breath, wheezing, fatigue

  • tachycardia, insomnia, weight loss, goiter

  • irritability, anxiety, dizziness, increased sweating

  • dry pale skin, brittle hair, fatigue, myxedema

Explanation

Correct Answer: D. dry pale skin, brittle hair, fatigue, myxedema

Explanation of Correct Answer
Hypothyroidism results from inadequate thyroid hormone production, slowing metabolic processes. Common symptoms include dry, pale skin due to reduced circulation, brittle hair from impaired protein synthesis, and fatigue caused by slowed metabolism. Myxedema, a hallmark of severe hypothyroidism, presents as swelling with thickened skin and puffiness. These features distinguish hypothyroidism from hyperthyroidism, where symptoms are typically related to increased metabolism such as weight loss, tachycardia, and heat intolerance.

4.

Which medication is best used to treat thyroid storm?

  • NSAIDs

  • Ace inhibitors

  • Levothyroxine

  • Potassium iodine

Explanation

Correct Answer:

D. Potassium iodine

Explanation of Correct Answer

Thyroid storm is a life-threatening exacerbation of hyperthyroidism characterized by fever, tachycardia, hypertension, and altered mental status. Potassium iodine is used in the acute management of thyroid storm because it rapidly inhibits the release of preformed thyroid hormone from the gland. It is typically given after antithyroid drugs like propylthiouracil or methimazole to prevent new hormone synthesis. This combination helps stabilize the patient until definitive therapies, such as radioactive iodine or surgery, can be considered.


5.

When treating for symptomatic H. Pylori the medications used should include:

  • Amoxicillin

  • Bismuth

  • Metronidazole

  • All of the above

Explanation

Correct Answer: D. All of the above

Explanation of Correct Answer
H. pylori infections are treated with combination therapy to maximize eradication and prevent resistance. Standard regimens often include amoxicillin, metronidazole (or clarithromycin), bismuth subsalicylate, and a proton pump inhibitor (PPI). Amoxicillin and metronidazole act as antibiotics to kill the bacteria, while bismuth provides a protective effect on the gastric mucosa and also has antibacterial properties. Using multiple agents improves treatment success and reduces the likelihood of recurrence.

6.

Which of the following medications is a long-acting beta agonists (LABA)?

  • Methylprednisolone

  • Budesonide

  • Salmeterol

  • Zafirlukast

Explanation

Correct Answer:

C. Salmeterol

Explanation of Correct Answer

Salmeterol is a long-acting beta agonist (LABA) that provides bronchodilation for up to 12 hours by stimulating beta-2 adrenergic receptors in the bronchial smooth muscle. LABAs are used in combination with inhaled corticosteroids for long-term asthma control and COPD management, but never as monotherapy in asthma because of the risk of severe exacerbations. Unlike short-acting beta agonists (SABAs), LABAs are for maintenance therapy rather than immediate symptom relief.


7.

Which of the following diabetic medications are most likely to cause hypoglycemia?

  • biguanides

  • thiazolidinediones (TZDs)

  • sulfonylureas

  • dipeptidyl peptidase-4 inhibitors (DPP4i)

Explanation

Explanation
Correct Answer: C. sulfonylureas
Explanation of Correct Answer
Sulfonylureas stimulate insulin secretion from pancreatic beta cells regardless of blood glucose levels, which significantly increases the risk of hypoglycemia. This risk is higher in elderly patients, those with irregular meal patterns, or those with impaired renal function. Unlike metformin, TZDs, or DPP-4 inhibitors, sulfonylureas directly increase circulating insulin, making hypoglycemia their most common and serious adverse effect, and requiring careful patient education and monitoring.
8.

What is the FDA black box warning for the use of metoclopramide (Reglan)?

  • Risk of gastrointestinal bleeding; discontinue after 6 months

  • Risk of tardive dyskinesia; discontinue after 12 weeks or if movement disorder develops

  • Risk of agranulocytosis; discontinue if WBC count decreases

  • Risk of lactic acidosis; discontinue if renal function worsens

Explanation

Correct Answer: B. Risk of tardive dyskinesia; discontinue after 12 weeks or if movement disorder develops

Explanation of Correct Answer
Metoclopramide carries a black box warning for tardive dyskinesia, a serious and potentially irreversible movement disorder. The risk increases with duration of treatment and cumulative dose. Therapy should not exceed 12 weeks, and the medication should be stopped immediately if signs of involuntary movements develop. The other options describe risks linked to different drugs, not metoclopramide.

9.

Extrapyramidal symptoms (EPS) have been associated with which of the following drugs?

  • Metoclopramide

  • Sucralfate

  • Aprepitant

  • Bisacodyl

Explanation

Correct Answer: A. Metoclopramide

Explanation of Correct Answer
Metoclopramide is a dopamine receptor antagonist used as an antiemetic and prokinetic agent. By blocking dopamine receptors in the central nervous system, particularly in the basal ganglia, it can cause extrapyramidal symptoms (EPS), including dystonia, akathisia, parkinsonism, and tardive dyskinesia. These risks increase with long-term or high-dose use. Sucralfate is a mucosal protectant, aprepitant is a neurokinin-1 receptor antagonist, and bisacodyl is a stimulant laxative—none of which are associated with EPS.

10.

The correct drug classification of Ciclesonide is

  • Methylazanthine

  • Inhaled Corticosteroid

  • Short-acting Beta Agonist

  • Leukotriene Receptor Antagonist

Explanation

Correct Answer Is:
B. Inhaled Corticosteroid
Explanation
Ciclesonide is an inhaled corticosteroid (ICS) used in the management of asthma. It works by reducing airway inflammation, decreasing mucus production, and improving overall lung function. As a prodrug, it is activated in the lungs, minimizing systemic side effects. ICS like ciclesonide are cornerstone therapies in asthma treatment, especially for patients with persistent symptoms, because they address the underlying inflammatory process rather than just providing bronchodilation.

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