APEA Pharmacology Review Questions and Answers Flashcards

A patient with type 2 diabetes and CKD stage 3 needs a second oral antidiabetic agent. Which medication should be avoided due to risk of lactic acidosis?

Answer: Metformin

Metformin is contraindicated when eGFR falls below 30 mL/min and should be used cautiously below 45 mL/min due to lactic acidosis risk.

Which antibiotic class requires counseling about increased risk of tendon rupture, particularly in patients over 60 taking corticosteroids?

Answer: Fluoroquinolones

Fluoroquinolones carry a black box warning for tendinopathy and tendon rupture, with risk amplified in elderly patients on corticosteroids.

A patient on warfarin starts taking trimethoprim-sulfamethoxazole for a UTI. The NP should anticipate which effect on the INR?

Answer: INR will increase

TMP-SMX inhibits CYP2C9, reducing warfarin metabolism and increasing its anticoagulant effect, thereby raising the INR.

Which antihypertensive medication is contraindicated in pregnancy due to teratogenic effects including renal dysgenesis and skull hypoplasia?

Answer: ACE inhibitors

ACE inhibitors are absolutely contraindicated in pregnancy (FDA category D/X in 2nd-3rd trimester) due to fetal renal toxicity and hypotension.

A patient taking a statin develops new-onset muscle pain and brown urine. The NP's priority action is to:

Answer: Stop the statin and check CK level

Myalgias with dark urine suggest rhabdomyolysis, a rare but serious statin complication; the statin must be stopped and CK checked urgently.

Which medication used for osteoporosis requires the patient to remain upright for 30-60 minutes after administration to prevent esophageal injury?

Answer: Alendronate

Oral bisphosphonates like alendronate can cause esophageal ulceration if they remain in contact with the esophageal mucosa, requiring upright positioning.