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WGU D116 ADVANCED PHARMACOLOGY OA EXAM
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The WGU D116 Advanced Pharmacology course focuses on the safe and effective prescribing of medications across the lifespan , with an emphasis on pharmacokinetics, pharmacodynamics, pharmacogenetics, and evidence-based prescribing for common acute and chronic conditions. Key content areas include: Pharmacokinetics & Pharmacodynamics — Absorption, distribution, metabolism, excretion (ADME); volume of distribution; half-life; steady state; receptor theory; agonists vs. antagonists; dose-response curves; therapeutic index; drug-drug interactions . Pharmacogenetics & Pharmacogenomics — Genetic variations affecting drug metabolism (CYP450 isoenzymes: CYP2D6, CYP3A4, CYP2C9, CYP2C19); warfarin sensitivity (VKORC1, CYP2C9); clopidogrel metabolism (CYP2C19 poor metabolizers); HLA-B*5701 (abacavir hypersensitivity); pharmacogenetic testing indications. Cardiovascular Pharmacology — Antihypertensives (ACE inhibitors, ARBs, CCBs, thiazide diuretics, beta-blockers, alpha-blockers); heart failure medications (digoxin, loop diuretics, spironolactone, sacubitril/valsartan, beta-blockers); antiarrhythmics (amiodarone, lidocaine, adenosine); anticoagulants (warfarin, DOACs: apixaban, rivaroxaban, dabigatran, edoxaban; heparin, enoxaparin); antiplatelets (aspirin, clopidogrel, ticagrelor, prasugrel); lipid-lowering agents (statins, ezetimibe, PCSK inhibitors). Endocrine Pharmacology — Diabetes medications (metformin, sulfonylureas, DPP- 4 inhibitors, SGLT2 inhibitors, GLP-1 agonists, insulin types, amylin analogs); thyroid medications (levothyroxine, methimazole, propylthiouracil); corticosteroids (glucocorticoids, mineralocorticoids); adrenal insufficiency management; osteoporosis medications (bisphosphonates, denosumab, teriparatide, raloxifene, calcitonin). Neurologic & Psychiatric Pharmacology — Antidepressants (SSRIs, SNRIs, TCAs, MAOIs, atypical antidepressants); antipsychotics (first-generation and second-generation); mood
stabilizers (lithium, valproate, lamotrigine, carbamazepine); anxiolytics (benzodiazepines, buspirone); ADHD medications (stimulants: methylphenidate, amphetamines; non-stimulants: atomoxetine, guanfacine, clonidine); anti-epileptic drugs (phenytoin, carbamazepine, valproate, levetiracetam, lamotrigine, topiramate); Parkinson's disease medications (carbidopa/levodopa, dopamine agonists, MAO-B inhibitors, COMT inhibitors); migraine medications (triptans, ergots, gepants, CGRP antagonists). Pulmonary Pharmacology — Asthma and COPD medications (SABA, LABA, ICS, LAMA, SAMA, combination inhalers, leukotriene modifiers, methylxanthines, biologic agents: omalizumab, mepolizumab, dupilumab). Pain Management — Opioid analgesics (morphine, oxycodone, hydrocodone, fentanyl, hydromorphone, methadone, tramadol); non-opioid analgesics (NSAIDs, acetaminophen); adjuvant analgesics (gabapentinoids, TCAs, SNRIs); opioid tolerance, dependence, withdrawal, and reversal (naloxone, naltrexone). Infectious Disease Pharmacology — Antibiotics (penicillins, cephalosporins, carbapenems, macrolides, tetracyclines, fluoroquinolones, aminoglycosides, sulfonamides, vancomycin, metronidazole, linezolid, daptomycin); antifungals (azoles, echinocandins, amphotericin B, flucytosine, terbinafine); antivirals (acyclovir, valacyclovir, oseltamivir, remdesivir, HIV antiretrovirals); antitubercular agents (isoniazid, rifampin, pyrazinamide, ethambutol); antimicrobial stewardship, resistance mechanisms, and adverse effects. Special Populations — Pregnancy (FDA pregnancy categories, teratogenic risks, safe medications in pregnancy/lactation); pediatrics (weight-based dosing, off-label use, age- specific adverse effects); geriatrics (polypharmacy, Beers Criteria, reduced renal/hepatic function, increased sensitivity to CNS depressants, fall risk). WGU D116 ADVANCED PHARMACOLOGY OA — 2 00 RANDOMIZED SCENARIO-BASED MCQS
1. A 72-year-old male with chronic kidney disease (eGFR 35 mL/min) is prescribed apixaban for atrial fibrillation. What is the most appropriate dose adjustment? A) Apixaban 5 mg BID (no adjustment needed) B) Apixaban 2.5 mg BID C) Apixaban 5 mg daily
C) Pioglitazone D) Sitagliptin Answer: C RATIONALE: Thiazolidinediones (pioglitazone, rosiglitazone) cause fluid retention and can exacerbate or precipitate heart failure. They are contraindicated in patients with NYHA Class III- IV heart failure.
4. A patient is prescribed clopidogrel after a drug-eluting stent placement. The patient has a CYP2C19 loss-of-function polymorphism. What is the expected clinical effect? A) Increased antiplatelet effect B) Reduced antiplatelet effect (clopidogrel resistance) C) No change in antiplatelet effect D) Increased risk of bleeding Answer: B RATIONALE: Clopidogrel is a prodrug that requires activation by CYP2C19. Patients with loss-of- function CYP2C19 polymorphisms have reduced conversion to the active metabolite, leading to reduced antiplatelet effect and increased risk of stent thrombosis. 5. A 65-year-old male with hypertension is started on lisinopril 10 mg daily. Two weeks later, he develops a dry cough. What is the most appropriate next step? A) Add a calcium channel blocker B) Switch lisinopril to losartan C) Increase lisinopril to 20 mg daily
D) Add a thiazide diuretic Answer: B RATIONALE: ACE inhibitor-induced cough (due to bradykinin accumulation) is common (up to 20%). Switching to an ARB (losartan) is appropriate as ARBs do not affect bradykinin and have a lower incidence of cough.
6. A 45-year-old female with major depressive disorder is started on fluoxetine 20 mg daily. She also takes sumatriptan for migraines. What potential adverse effect should be monitored? A) Serotonin syndrome B) Hypertensive crisis C) Prolonged QT interval D) Hepatotoxicity Answer: A RATIONALE: Combining SSRIs (fluoxetine) with triptans (sumatriptan) increases the risk of serotonin syndrome due to additive serotonergic effects. Symptoms include agitation, confusion, tachycardia, hyperreflexia, and clonus. 7. A 70-year-old male with benign prostatic hyperplasia (BPH) is prescribed tamsulosin. He also takes amlodipine for hypertension. What adverse effect is most concerning with this combination? A) Hyperkalemia B) Orthostatic hypotension C) Bradycardia
Answer: D RATIONALE: Isotretinoin is highly teratogenic (pregnancy category X). Pregnancy testing is mandatory before, during, and after treatment. Additionally, monitoring of LFTs, lipids, and CBC is recommended due to potential hepatotoxicity, hyperlipidemia, and hematologic effects.
10. A 60-year-old male with type 2 diabetes is started on metformin. He has a history of heart failure. Which of the following is a contraindication to metformin use? A) Heart failure with preserved ejection fraction (HFpEF) B) Acute decompensated heart failure C) Chronic stable heart failure D) Metformin is safe in all heart failure Answer: B RATIONALE: Metformin is contraindicated in acute or unstable heart failure due to the risk of lactic acidosis secondary to tissue hypoperfusion. However, metformin is safe in stable, compensated heart failure and may even have cardiovascular benefits. 11. A patient is prescribed warfarin and is found to have a genetic variant in VKORC1. What effect does this variant have on warfarin dosing? A) Increased warfarin metabolism B) Decreased warfarin metabolism C) Increased sensitivity to warfarin (lower dose required) D) Decreased sensitivity to warfarin (higher dose required) Answer: C
RATIONALE: Polymorphisms in VKORC1 (the target enzyme of warfarin) affect the enzyme's sensitivity to warfarin. Patients with certain VKORC1 variants require lower doses of warfarin to achieve therapeutic INR.
12. A 32-year-old female with generalized anxiety disorder is prescribed buspirone. Which statement about buspirone is correct? A) It has immediate anxiolytic effects B) It has no abuse potential and is not a benzodiazepine C) It causes significant sedation D) It interacts with alcohol Answer: B RATIONALE: Buspirone is a non-benzodiazepine anxiolytic with no abuse potential and does not cause significant sedation. However, it takes 2-4 weeks to become effective and has minimal interaction with alcohol. 13. A 55-year-old male with gout is started on allopurinol. He should be counseled to watch for signs of: A) Hyperuricemia flare (acute gout attack) B) Hypoglycemia C) Hypertension D) Hyperkalemia Answer: A *RATIONALE: Initiation of allopurinol can precipitate acute gout flares due to rapid lowering of
For suppression, daily dosing is used, but acute treatment should be initiated at the first sign of symptoms.
16. A 62-year-old male with chronic kidney disease stage 4 (eGFR 25 mL/min) and type 2 diabetes has A1C 8.5% on metformin 500 mg BID and glargine 30 units at bedtime. What is the most appropriate change? A) Stop metformin B) Increase glargine C) Add glipizide D) Add sitagliptin Answer: A RATIONALE: Metformin is contraindicated when eGFR <30 mL/min due to increased risk of lactic acidosis. Metformin should be discontinued and other agents (insulin, DPP-4 inhibitors) adjusted as needed. 17. A 72-year-old female with osteoporosis is started on alendronate 70 mg weekly. She should be instructed to: A) Take with a full glass of water and remain upright for 30 minutes B) Take with food to reduce GI side effects C) Take at bedtime to avoid nausea D) Take with calcium supplements Answer: A RATIONALE: Alendronate (bisphosphonate) should be taken with a full glass of water on an
empty stomach (first thing in the morning), and the patient should remain upright for at least 30 minutes to prevent esophageal irritation and ulceration.
18. A 35-year-old female with depression is started on fluoxetine (Prozac). She is told that improvement in mood may take: A) 1-2 days B) 1-2 weeks C) 2-4 weeks D) 6-8 weeks Answer: C RATIONALE: SSRIs like fluoxetine typically take 2-4 weeks to produce noticeable improvement in depressive symptoms due to downstream neuroadaptive changes. 19. A 55-year-old male with hyperlipidemia is prescribed atorvastatin. This medication lowers cholesterol primarily by: A) Increasing bile acid excretion B) Inhibiting HMG-CoA reductase C) Decreasing intestinal cholesterol absorption D) Increasing HDL production Answer: B RATIONALE: Statins (atorvastatin) are HMG-CoA reductase inhibitors that block cholesterol synthesis in the liver, leading to increased LDL receptor expression and LDL clearance.
C) Alpha-1 selective antagonist D) Calcium channel blocker Answer: B RATIONALE: Carvedilol is a non-selective beta-adrenergic antagonist (beta-1 and beta-2) with additional alpha-1 blocking activity, which provides additional vasodilation. It improves mortality in HFrEF.
23. A 30-year-old female with bipolar disorder is started on lithium. She develops polyuria, polydipsia, and dilute urine. This is most likely due to: A) Diabetes mellitus B) Nephrogenic diabetes insipidus C) Syndrome of inappropriate antidiuretic hormone (SIADH) D) Hypercalcemia Answer: B RATIONALE: Lithium can cause nephrogenic diabetes insipidus by interfering with the action of ADH on the collecting duct, leading to polyuria, polydipsia, and dilute urine. 24. A 62-year-old male with type 2 diabetes and hypertension is prescribed lisinopril. Which adverse effect is common with ACE inhibitors? A) Hyperkalemia B) Hypokalemia C) Hypoglycemia D) Hypercalcemia
Answer: A RATIONALE: ACE inhibitors can cause hyperkalemia by reducing aldosterone secretion, leading to decreased potassium excretion. This is more common in patients with CKD or those taking potassium supplements or potassium-sparing diuretics.
25. A 28-year-old female with a urinary tract infection is prescribed trimethoprim- sulfamethoxazole (TMP-SMX). She develops a diffuse maculopapular rash, fever, and facial edema. This is most likely: A) Expected therapeutic effect B) Drug fever C) Hypersensitivity reaction (SJS/TEN early presentation) D) Photosensitivity Answer: C RATIONALE: TMP-SMX can cause severe hypersensitivity reactions including Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN), presenting with rash, fever, and mucosal involvement. Immediate discontinuation is required. 26. A 50-year-old female with osteoporosis is prescribed raloxifene. This medication is a: A) Bisphosphonate B) Selective estrogen receptor modulator (SERM) C) Calcitonin analog D) Parathyroid hormone analog Answer: B
29. A 55-year-old male with chronic kidney disease is prescribed epoetin alfa (erythropoietin). This medication is used to treat: A) Hypertension B) Anemia of chronic kidney disease C) Hyperkalemia D) Acidosis Answer: B RATIONALE: Epoetin alfa is recombinant human erythropoietin used to treat anemia in chronic kidney disease by stimulating red blood cell production. 30. A 45-year-old male with type 2 diabetes is started on empagliflozin. This medication works by: A) Increasing insulin secretion B) Decreasing hepatic glucose production C) Inhibiting SGLT2 in the kidney, increasing glucose excretion in urine D) Increasing peripheral glucose uptake Answer: C RATIONALE: Empagliflozin is an SGLT2 inhibitor that blocks glucose reabsorption in the proximal tubule, causing glucosuria and lowering blood glucose. It also has cardiovascular and renal protective effects. 31. A 62-year-old female with osteoporosis is started on teriparatide. This medication is a: A) Bisphosphonate
B) Parathyroid hormone analog C) SERM D) Calcium supplement Answer: B RATIONALE: Teriparatide is recombinant human parathyroid hormone (1-34) that stimulates new bone formation; used for severe osteoporosis.
32. A 55-year-old male with chronic obstructive pulmonary disease is prescribed theophylline. The mechanism of action of theophylline is: A) Bronchodilation via beta-2 agonism B) Phosphodiesterase inhibition and adenosine antagonism C) Muscarinic receptor blockade D) Leukotriene receptor antagonism Answer: B RATIONALE: Theophylline is a methylxanthine bronchodilator that works by inhibiting phosphodiesterase (increasing cAMP) and antagonizing adenosine receptors. 33. A 28-year-old female with acne is started on doxycycline. She should be counseled to: A) Take with dairy products for better absorption B) Avoid sun exposure due to photosensitivity C) Take on an empty stomach only D) Monitor for bradycardia Answer: B
36. A 68-year-old male with heart failure is prescribed metoprolol succinate. The cardioselectivity of this beta-blocker at low doses is beneficial because it: A) Blocks beta-2 receptors in the lungs B) Spares beta-2 receptors, minimizing bronchospasm risk C) Increases heart rate D) Blocks alpha receptors Answer: B RATIONALE: Metoprolol succinate is beta-1 selective (cardioselective) at low doses, meaning it has less effect on beta-2 receptors in the lungs (reducing bronchospasm risk). 37. A 52-year-old female with osteoporosis is prescribed denosumab. This medication is a: A) Bisphosphonate B) Monoclonal antibody against RANKL C) SERM D) PTH analog Answer: B RATIONALE: Denosumab is a monoclonal antibody that inhibits RANKL, decreasing osteoclast activity and bone resorption. 38. A 25-year-old male with schizophrenia is started on clozapine. Clozapine is effective for treatment-resistant schizophrenia but requires monitoring for: A) Weight loss B) Agranulocytosis (absolute neutrophil count)
C) Hypercalcemia D) Tachycardia Answer: B RATIONALE: Clozapine carries a black box warning for agranulocytosis; absolute neutrophil count must be monitored regularly (weekly initially).
39. A 62-year-old female with type 2 diabetes is started on glipizide. A major adverse effect of sulfonylureas is: A) Weight loss B) Hypoglycemia C) Lactic acidosis D) Hyperkalemia Answer: B RATIONALE: Sulfonylureas (glipizide) stimulate insulin release from the pancreas and are associated with a significant risk of hypoglycemia, especially in older adults. 40. A 55-year-old male with chronic hepatitis C infection is being treated with direct-acting antivirals. A sustained virologic response (SVR) is defined as: A) Undetectable HCV RNA 12 weeks after completing treatment B) Normal liver enzymes during treatment C) Negative HCV antibody test D) Resolution of symptoms Answer: A
