NBME Pharmacology Shelf Practice Exam Questions
And Correct Answers (Verified Answers) Plus
Rationales 2025/2026 Q&A | Instant Download Pdf
1. A 55-year-old man with angina is prescribed a drug that decreases
myocardial oxygen demand by reducing heart rate and contractility. Which
drug is most appropriate?
A) Nifedipine
B) Metoprolol
C) Nitroglycerin
D) Verapamil
Beta-blockers like metoprolol reduce heart rate and contractility, lowering
myocardial oxygen demand. Nifedipine is a vasodilator, and nitroglycerin
primarily decreases preload.
2. Which of the following antibiotics is bactericidal and inhibits cell wall
synthesis by binding penicillin-binding proteins?
A) Tetracycline
B) Ceftriaxone
C) Azithromycin
D) Clindamycin
Ceftriaxone, a cephalosporin, is bactericidal and inhibits peptidoglycan cross-
linking via penicillin-binding proteins. Tetracyclines and macrolides are
bacteriostatic.
3. A patient with schizophrenia develops tardive dyskinesia after long-term
antipsychotic therapy. Which receptor is most associated with this adverse
effect?
A) 5-HT2A
B) D2
C) H1
D) α1
Chronic blockade of D2 receptors in the nigrostriatal pathway leads to
extrapyramidal symptoms, including tardive dyskinesia.
,4. Which of the following drugs is most appropriate for treating a patient with
asthma who needs long-term prophylaxis?
A) Albuterol
B) Montelukast
C) Ipratropium
D) Epinephrine
Montelukast, a leukotriene receptor antagonist, is effective for long-term
asthma control. Albuterol is short-acting and used for acute symptoms.
5. A patient develops hemolytic anemia after taking a sulfonamide antibiotic.
Which enzyme deficiency is most likely?
A) Glucose-6-phosphate dehydrogenase
B) Glucose-6-phosphate dehydrogenase
C) Pyruvate kinase
D) Hexokinase
G6PD deficiency predisposes red blood cells to oxidative damage from drugs
like sulfonamides, causing hemolytic anemia.
6. Which of the following drugs is used to reverse opioid overdose?
A) Methadone
B) Naloxone
C) Buprenorphine
D) Fentanyl
Naloxone is a competitive opioid receptor antagonist used in opioid overdose.
7. A patient on chemotherapy develops gout due to increased uric acid. Which
drug can prevent this complication?
A) Allopurinol
B) Allopurinol
C) Febuxostat
D) Probenecid
, Allopurinol inhibits xanthine oxidase, reducing uric acid production. Febuxostat
is similar; probenecid increases uric acid excretion.
8. Which antihypertensive drug can cause a persistent dry cough in some
patients?
A) Losartan
B) Lisinopril
C) Amlodipine
D) Metoprolol
ACE inhibitors like lisinopril increase bradykinin levels, causing a dry cough.
9. A patient with status epilepticus is treated with a drug that enhances GABA-
A receptor activity. Which drug is used?
A) Phenytoin
B) Valproate
C) Lorazepam
D) Carbamazepine
Benzodiazepines, such as lorazepam, enhance GABA-A receptor-mediated
chloride influx, producing anticonvulsant effects.
10. Which class of drugs can cause gynecomastia by increasing estrogen-to-
androgen ratio?
A) Statins
B) Spironolactone
C) Loop diuretics
D) Beta-blockers
Spironolactone blocks androgen receptors and inhibits testosterone synthesis,
potentially leading to gynecomastia.
11. Which of the following is a first-line drug for Type 2 diabetes that improves
insulin sensitivity?
A) Glipizide
B) Metformin
And Correct Answers (Verified Answers) Plus
Rationales 2025/2026 Q&A | Instant Download Pdf
1. A 55-year-old man with angina is prescribed a drug that decreases
myocardial oxygen demand by reducing heart rate and contractility. Which
drug is most appropriate?
A) Nifedipine
B) Metoprolol
C) Nitroglycerin
D) Verapamil
Beta-blockers like metoprolol reduce heart rate and contractility, lowering
myocardial oxygen demand. Nifedipine is a vasodilator, and nitroglycerin
primarily decreases preload.
2. Which of the following antibiotics is bactericidal and inhibits cell wall
synthesis by binding penicillin-binding proteins?
A) Tetracycline
B) Ceftriaxone
C) Azithromycin
D) Clindamycin
Ceftriaxone, a cephalosporin, is bactericidal and inhibits peptidoglycan cross-
linking via penicillin-binding proteins. Tetracyclines and macrolides are
bacteriostatic.
3. A patient with schizophrenia develops tardive dyskinesia after long-term
antipsychotic therapy. Which receptor is most associated with this adverse
effect?
A) 5-HT2A
B) D2
C) H1
D) α1
Chronic blockade of D2 receptors in the nigrostriatal pathway leads to
extrapyramidal symptoms, including tardive dyskinesia.
,4. Which of the following drugs is most appropriate for treating a patient with
asthma who needs long-term prophylaxis?
A) Albuterol
B) Montelukast
C) Ipratropium
D) Epinephrine
Montelukast, a leukotriene receptor antagonist, is effective for long-term
asthma control. Albuterol is short-acting and used for acute symptoms.
5. A patient develops hemolytic anemia after taking a sulfonamide antibiotic.
Which enzyme deficiency is most likely?
A) Glucose-6-phosphate dehydrogenase
B) Glucose-6-phosphate dehydrogenase
C) Pyruvate kinase
D) Hexokinase
G6PD deficiency predisposes red blood cells to oxidative damage from drugs
like sulfonamides, causing hemolytic anemia.
6. Which of the following drugs is used to reverse opioid overdose?
A) Methadone
B) Naloxone
C) Buprenorphine
D) Fentanyl
Naloxone is a competitive opioid receptor antagonist used in opioid overdose.
7. A patient on chemotherapy develops gout due to increased uric acid. Which
drug can prevent this complication?
A) Allopurinol
B) Allopurinol
C) Febuxostat
D) Probenecid
, Allopurinol inhibits xanthine oxidase, reducing uric acid production. Febuxostat
is similar; probenecid increases uric acid excretion.
8. Which antihypertensive drug can cause a persistent dry cough in some
patients?
A) Losartan
B) Lisinopril
C) Amlodipine
D) Metoprolol
ACE inhibitors like lisinopril increase bradykinin levels, causing a dry cough.
9. A patient with status epilepticus is treated with a drug that enhances GABA-
A receptor activity. Which drug is used?
A) Phenytoin
B) Valproate
C) Lorazepam
D) Carbamazepine
Benzodiazepines, such as lorazepam, enhance GABA-A receptor-mediated
chloride influx, producing anticonvulsant effects.
10. Which class of drugs can cause gynecomastia by increasing estrogen-to-
androgen ratio?
A) Statins
B) Spironolactone
C) Loop diuretics
D) Beta-blockers
Spironolactone blocks androgen receptors and inhibits testosterone synthesis,
potentially leading to gynecomastia.
11. Which of the following is a first-line drug for Type 2 diabetes that improves
insulin sensitivity?
A) Glipizide
B) Metformin
