APEA APEA Pharmacology Review Questions and Answers 1 — Questions and Answers
Question 1: 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?
- Metformin (Correct answer)
- Glipizide
- Sitagliptin
- Empagliflozin
Correct 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.
Question 2: Which antibiotic class requires counseling about increased risk of tendon rupture, particularly in patients over 60 taking corticosteroids?
- Fluoroquinolones (Correct answer)
- Macrolides
- Tetracyclines
- Cephalosporins
Correct answer: Fluoroquinolones
Fluoroquinolones carry a black box warning for tendinopathy and tendon rupture, with risk amplified in elderly patients on corticosteroids.
Question 3: A patient on warfarin starts taking trimethoprim-sulfamethoxazole for a UTI. The NP should anticipate which effect on the INR?
- INR will increase (Correct answer)
- INR will decrease
- INR will remain unchanged
- INR is unpredictable
Correct answer: INR will increase
TMP-SMX inhibits CYP2C9, reducing warfarin metabolism and increasing its anticoagulant effect, thereby raising the INR.
Question 4: Which antihypertensive medication is contraindicated in pregnancy due to teratogenic effects including renal dysgenesis and skull hypoplasia?
- ACE inhibitors (Correct answer)
- Calcium channel blockers
- Beta-blockers
- Alpha-methyldopa
Correct 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.
Question 5: A patient taking a statin develops new-onset muscle pain and brown urine. The NP's priority action is to:
- Stop the statin and check CK level (Correct answer)
- Continue statin and monitor symptoms
- Reduce statin dose by half
- Switch to a different statin immediately
Correct 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.
Question 6: Which medication used for osteoporosis requires the patient to remain upright for 30-60 minutes after administration to prevent esophageal injury?
- Alendronate (Correct answer)
- Raloxifene
- Teriparatide
- Denosumab
Correct answer: Alendronate
Oral bisphosphonates like alendronate can cause esophageal ulceration if they remain in contact with the esophageal mucosa, requiring upright positioning.
APEA APEA Pharmacology Review Questions and Answers 1
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?