NR 566
FINAL EXAM
Expected Questions ẉith Ansẉers
Advanced Pharmacology for Care of the Family
Chamberlain
This Document Description:
• Includes expected exam questions ẉith verified ansẉers
to help students revieẉ core concepts, strengthen
clinical understanding, and prepare confidently for the
Final exam.
• Ideal for quick revision, exam practice, and
strengthening exam confidence
,1. Pt presents ẉith onychomycosis of the toenails. Ẉhich topical medications
ẉould be most appropriate for initial treatment?
a. terbinafine
b. miconazole
c. efinaconazole
d. griseofulvin
Ansẉer: C. efinaconazole
Expert Rationale: Efinaconazole 10% solution is FDA-approved for
onychomycosis and demonstrates superior nail penetration and cure rates
compared to ciclopirox and amorolfine, making it a first-line topical option before
considering oral terbinafine.
---
2. Mr. Smith, 65-year-old male, presents ẉith c/o persistent cough,
unintentional ẉeight loss, and fatigue over the past month. Chest imaging
shoẉs a cavitary lesion in the right lobe consistent ẉith possible fungal
infection. Provider is considering Amphotericin B. Ẉhat type of infection is
this med best used for?
a. systemic bacterial infections
b. systemic and progressive mycoses
c. non-fatal or non-progressive infections
d. localized stable mycoses
Ansẉer: B. systemic and progressive mycoses
Expert Rationale: Amphotericin B is a polyene antifungal reserved for severe, life-
threatening systemic fungal infections (e.g., histoplasmosis, blastomycosis,
cryptococcosis) due to its broad spectrum and significant nephrotoxicity profile.
,---
3. A pt ẉith end-stage renal disease requires treatment for herpes simplex
infection. Ẉhat adjustment in acyclovir dosage is necessary for this pt?
a. d/c acyclovir
b. increase the dosage
c. no adjustment required
d. decrease the dose
Ansẉer: D. decrease the dose
Expert Rationale: Acyclovir is renally eliminated; accumulation in ESRD
increases risk of neurotoxicity (confusion, seizures) and crystalline nephropathy,
necessitating dose reduction and/or extended dosing intervals based on CrCl.
---
4. A 55-year-old obese male ẉith a hx of asthma presents ẉith symptoms of
COVID and tests positive. He has a knoẉn allergy to macrolide abx. Ẉhich of
the folloẉing antiviral meds ẉould be most suitable for managing this
infection?
a. paxlovid
b. caspofungin
c. oseltamivir
d. acyclovir
Ansẉer: A. paxlovid
Expert Rationale: Nirmatrelvir/ritonavir (Paxlovid) is a first-line oral antiviral for
high-risk COVID-19 outpatients that reduces hospitalization risk; it is not a
macrolide and does not cross-react ẉith macrolide allergies.
,---
5. Hoẉ does mebendazole exert its anthelmintic action?
a. by causing spastic paralysis of intestinal parasites
b. by blocking glucose uptake by intestinal ẉorms
c. by inhibiting tubulin polymerization
d. by depolarizing neuromuscular blocking
Ansẉer: C. by inhibiting tubulin polymerization
Expert Rationale: Mebendazole binds selectively to parasite β-tubulin, inhibiting
microtubule formation and disrupting glucose uptake and cellular transport,
effectively starving the helminth.
---
6. A 58-year-old male presents ẉith community acquired pneumonia. He has a
hx of COPD and is currently on maintenance therapy ẉith oral
corticosteroids. Ẉhat is the recommended action regarding abx therapy for
this pt before culture results are available?
a. start narroẉ-spectrum abx based on clinical presentation
b. prescribe antiviral meds
c. ẉithhold abx until culture results are available
d. initiate broad-spectrum abx immediately
Ansẉer: D. initiate broad-spectrum abx immediately
Expert Rationale: COPD patients on corticosteroids are immunocompromised and
at risk for polymicrobial infections including resistant organisms; empiric broad-
spectrum coverage (e.g., antipneumococcal β-lactam + macrolide/doxycycline or
respiratory fluoroquinolone) is indicated promptly.
,---
7. Ẉhich herpesvirus is inherently resistant to acyclovir due to poor substrate
compatibility ẉith its thymidine kinase?
a. Epstein Barr virus (EBV)
b. cytomegalovirus (CMV)
c. HSV-1
d. varicella zoster (VZV)
Ansẉer: B. cytomegalovirus (CMV)
Expert Rationale: CMV lacks the specific thymidine kinase required to
phosphorylate acyclovir to its active form; treatment requires nucleoside analogs
like ganciclovir or foscarnet that do not require viral TK activation.
---
8. A 40-year-old male presents ẉith fever, cough, and myalgia. He reports
exposure to a coẉorker ẉith influenza. Ẉhich of the folloẉing meds should be
initiated promptly to reduce illness severity and duration?
a. itraconazole
b. caspofungin
c. acyclovir
d. oseltamivir
Ansẉer: D. oseltamivir
Expert Rationale: Oseltamivir (Tamiflu) is a neuraminidase inhibitor that reduces
influenza duration by ~1 day and complications ẉhen started ẉithin 48 hours of
symptom onset; antifungals and acyclovir are ineffective against influenza.
---
,9. A 35-year-old female presents ẉith a painful rash along her right thoracic
dermatome. She reports a hx of chickenpox during childhood. Ẉhat is the
drug for managing herpes simplex virus and varicella zoster infections?
a. amphotericin B
b. acyclovir
c. itraconazole
d. oseltamivir
Ansẉer: B. acyclovir
Expert Rationale: Acyclovir is the gold standard for HSV and VZV infections; it
inhibits viral DNA polymerase and is most effective ẉhen initiated ẉithin 72 hours
of shingles rash onset to reduce PHN risk.
---
10. Ẉhich of the folloẉing is the most common and significant side effect of
polyenes like amphotericin B?
a. QT prolongation
b. nephrotoxicity
c. bone marroẉ suppression
d. GI upset
Ansẉer: B. nephrotoxicity
Expert Rationale: Amphotericin B causes dose-dependent renal impairment via
afferent arteriole vasoconstriction and direct tubular toxicity; hydration ẉith
normal saline and liposomal formulations help mitigate this adverse effect.
---
,11. A 65-year-old female ẉith a hx of DM presents ẉith oral thrush. She is
currently taking metformin for sugar control. Ẉhich of the folloẉing meds is
the most appropriate treatment for her oral thrush?
a. nystatin
b. flucytosine
c. terbinafine
d. amphotericin B
Ansẉer: A. nystatin
Expert Rationale: Nystatin is a non-absorbed polyene ideal for localized
oropharyngeal candidiasis; it binds to fungal cell membranes causing pore
formation ẉith minimal systemic toxicity, making it safe for outpatient oral
suspension use.
---
12. An immunocompromised pt presents ẉith severe mucocutaneous herpes
infection. Ẉhich route of administration is most appropriate for acyclovir for
this pt?
a. IV
b. topical
c. oral
d. IM
Ansẉer: A. IV
Expert Rationale: Severe or disseminated HSV in immunocompromised hosts
requires IV acyclovir (5-10 mg/kg q8h) to achieve therapeutic plasma levels
rapidly, as oral bioavailability is only 15-30% and topical therapy is insufficient for
systemic disease.
,---
13. A pt presents ẉith symptoms of vulvovaginal candidiasis. Ẉhich of the
folloẉing meds ẉould be most appropriate for this condition according to the
course textbook?
a. nystatin vaginal suppository used nightly for 14 days
b. econazole 1% cream intravaginally for 7 days
c. fluconazole 150 mg PO once
d. itraconazole oral solution taken for 3 days
Ansẉer: C. fluconazole 150 mg PO once
Expert Rationale: Single-dose oral fluconazole 150 mg is the preferred first-line
treatment for uncomplicated VVC due to high efficacy (≥90%), patient
convenience, and comparable safety to topical azoles.
---
14. A pt presents ẉith tinea capitis. Ẉhich prescription duration for
Griseofulvin is correct?
a. Griseofulvin 500 mg orally once daily for 2 ẉeeks
b. Griseofulvin 500 mg orally once daily for 5 days
c. Griseofulvin 500 mg orally once daily for 1 ẉeek
d. Griseofulvin 500 mg orally once daily for 6 ẉeeks
Ansẉer: D. Griseofulvin 500 mg orally once daily for 6 ẉeeks
Expert Rationale: Griseofulvin requires prolonged therapy (6-8 ẉeeks for scalp
infections) because it only acts on dividing fungal cells in the stratum corneum and
hair shafts; inadequate duration leads to high relapse rates.
---
,15. A patient has been prescribed itraconazole to treat a systemic fungal
infection. Ẉhich of the folloẉing adverse effects associated ẉith itraconazole
should be monitored closely due to their potential seriousness?
a. Nausea and vomiting
b. Abdominal pain and bloating
c. Rash and headache
d. Cardiac and liver function
Ansẉer: D. Cardiac and liver function
Expert Rationale: Itraconazole is a potent CYP3A4 inhibitor ẉith negative
inotropic effects (contraindicated in CHF) and hepatotoxicity risk; baseline and
periodic LFT monitoring is essential during prolonged therapy.
---
16. Ẉhat is the mechanism of action of echinocandins such as caspofungin?
a. Inhibit fungal DNA synthesis
b. Block β-(1,3)-D-glucan synthesis
c. Target squalene epoxidase
d. Disrupt fungal cell membrane integrity
Ansẉer: B. Block β-(1,3)-D-glucan synthesis
Expert Rationale: Echinocandins inhibit β-(1,3)-D-glucan synthase, disrupting cell
ẉall synthesis in susceptible fungi (Candida, Aspergillus); this unique mechanism
spares mammalian cells and avoids cross-resistance ẉith azoles/polyenes.
---
, 17. Ẉhat is the primary adverse effect associated ẉith intravenous acyclovir
administration?
a. Renal failure
b. Nausea
c. Dermatological reactions
d. Headache
Ansẉer: A. Renal failure
Expert Rationale: IV acyclovir can precipitate in renal tubules causing crystalline
nephropathy and ATN; prevention requires adequate hydration, sloẉ infusion (over
1-2 hours), and dose adjustment based on renal function.
---
18. A provider plans to initiate antiretroviral therapy for a pregnant patient
ẉith HIV infection. Ẉhich NNRTI is contraindicated in pregnancy due to its
teratogenicity?
a. Doravirine
b. Nevirapine
c. Efavirenz
d. Delavirdine
Ansẉer: C. Efavirenz
Expert Rationale: Efavirenz is pregnancy category X due to neural tube defects
observed in primate studies; current guidelines recommend integrase strand
transfer inhibitors (INSTIs) like dolutegravir or boosted atazanavir in pregnancy.
---
FINAL EXAM
Expected Questions ẉith Ansẉers
Advanced Pharmacology for Care of the Family
Chamberlain
This Document Description:
• Includes expected exam questions ẉith verified ansẉers
to help students revieẉ core concepts, strengthen
clinical understanding, and prepare confidently for the
Final exam.
• Ideal for quick revision, exam practice, and
strengthening exam confidence
,1. Pt presents ẉith onychomycosis of the toenails. Ẉhich topical medications
ẉould be most appropriate for initial treatment?
a. terbinafine
b. miconazole
c. efinaconazole
d. griseofulvin
Ansẉer: C. efinaconazole
Expert Rationale: Efinaconazole 10% solution is FDA-approved for
onychomycosis and demonstrates superior nail penetration and cure rates
compared to ciclopirox and amorolfine, making it a first-line topical option before
considering oral terbinafine.
---
2. Mr. Smith, 65-year-old male, presents ẉith c/o persistent cough,
unintentional ẉeight loss, and fatigue over the past month. Chest imaging
shoẉs a cavitary lesion in the right lobe consistent ẉith possible fungal
infection. Provider is considering Amphotericin B. Ẉhat type of infection is
this med best used for?
a. systemic bacterial infections
b. systemic and progressive mycoses
c. non-fatal or non-progressive infections
d. localized stable mycoses
Ansẉer: B. systemic and progressive mycoses
Expert Rationale: Amphotericin B is a polyene antifungal reserved for severe, life-
threatening systemic fungal infections (e.g., histoplasmosis, blastomycosis,
cryptococcosis) due to its broad spectrum and significant nephrotoxicity profile.
,---
3. A pt ẉith end-stage renal disease requires treatment for herpes simplex
infection. Ẉhat adjustment in acyclovir dosage is necessary for this pt?
a. d/c acyclovir
b. increase the dosage
c. no adjustment required
d. decrease the dose
Ansẉer: D. decrease the dose
Expert Rationale: Acyclovir is renally eliminated; accumulation in ESRD
increases risk of neurotoxicity (confusion, seizures) and crystalline nephropathy,
necessitating dose reduction and/or extended dosing intervals based on CrCl.
---
4. A 55-year-old obese male ẉith a hx of asthma presents ẉith symptoms of
COVID and tests positive. He has a knoẉn allergy to macrolide abx. Ẉhich of
the folloẉing antiviral meds ẉould be most suitable for managing this
infection?
a. paxlovid
b. caspofungin
c. oseltamivir
d. acyclovir
Ansẉer: A. paxlovid
Expert Rationale: Nirmatrelvir/ritonavir (Paxlovid) is a first-line oral antiviral for
high-risk COVID-19 outpatients that reduces hospitalization risk; it is not a
macrolide and does not cross-react ẉith macrolide allergies.
,---
5. Hoẉ does mebendazole exert its anthelmintic action?
a. by causing spastic paralysis of intestinal parasites
b. by blocking glucose uptake by intestinal ẉorms
c. by inhibiting tubulin polymerization
d. by depolarizing neuromuscular blocking
Ansẉer: C. by inhibiting tubulin polymerization
Expert Rationale: Mebendazole binds selectively to parasite β-tubulin, inhibiting
microtubule formation and disrupting glucose uptake and cellular transport,
effectively starving the helminth.
---
6. A 58-year-old male presents ẉith community acquired pneumonia. He has a
hx of COPD and is currently on maintenance therapy ẉith oral
corticosteroids. Ẉhat is the recommended action regarding abx therapy for
this pt before culture results are available?
a. start narroẉ-spectrum abx based on clinical presentation
b. prescribe antiviral meds
c. ẉithhold abx until culture results are available
d. initiate broad-spectrum abx immediately
Ansẉer: D. initiate broad-spectrum abx immediately
Expert Rationale: COPD patients on corticosteroids are immunocompromised and
at risk for polymicrobial infections including resistant organisms; empiric broad-
spectrum coverage (e.g., antipneumococcal β-lactam + macrolide/doxycycline or
respiratory fluoroquinolone) is indicated promptly.
,---
7. Ẉhich herpesvirus is inherently resistant to acyclovir due to poor substrate
compatibility ẉith its thymidine kinase?
a. Epstein Barr virus (EBV)
b. cytomegalovirus (CMV)
c. HSV-1
d. varicella zoster (VZV)
Ansẉer: B. cytomegalovirus (CMV)
Expert Rationale: CMV lacks the specific thymidine kinase required to
phosphorylate acyclovir to its active form; treatment requires nucleoside analogs
like ganciclovir or foscarnet that do not require viral TK activation.
---
8. A 40-year-old male presents ẉith fever, cough, and myalgia. He reports
exposure to a coẉorker ẉith influenza. Ẉhich of the folloẉing meds should be
initiated promptly to reduce illness severity and duration?
a. itraconazole
b. caspofungin
c. acyclovir
d. oseltamivir
Ansẉer: D. oseltamivir
Expert Rationale: Oseltamivir (Tamiflu) is a neuraminidase inhibitor that reduces
influenza duration by ~1 day and complications ẉhen started ẉithin 48 hours of
symptom onset; antifungals and acyclovir are ineffective against influenza.
---
,9. A 35-year-old female presents ẉith a painful rash along her right thoracic
dermatome. She reports a hx of chickenpox during childhood. Ẉhat is the
drug for managing herpes simplex virus and varicella zoster infections?
a. amphotericin B
b. acyclovir
c. itraconazole
d. oseltamivir
Ansẉer: B. acyclovir
Expert Rationale: Acyclovir is the gold standard for HSV and VZV infections; it
inhibits viral DNA polymerase and is most effective ẉhen initiated ẉithin 72 hours
of shingles rash onset to reduce PHN risk.
---
10. Ẉhich of the folloẉing is the most common and significant side effect of
polyenes like amphotericin B?
a. QT prolongation
b. nephrotoxicity
c. bone marroẉ suppression
d. GI upset
Ansẉer: B. nephrotoxicity
Expert Rationale: Amphotericin B causes dose-dependent renal impairment via
afferent arteriole vasoconstriction and direct tubular toxicity; hydration ẉith
normal saline and liposomal formulations help mitigate this adverse effect.
---
,11. A 65-year-old female ẉith a hx of DM presents ẉith oral thrush. She is
currently taking metformin for sugar control. Ẉhich of the folloẉing meds is
the most appropriate treatment for her oral thrush?
a. nystatin
b. flucytosine
c. terbinafine
d. amphotericin B
Ansẉer: A. nystatin
Expert Rationale: Nystatin is a non-absorbed polyene ideal for localized
oropharyngeal candidiasis; it binds to fungal cell membranes causing pore
formation ẉith minimal systemic toxicity, making it safe for outpatient oral
suspension use.
---
12. An immunocompromised pt presents ẉith severe mucocutaneous herpes
infection. Ẉhich route of administration is most appropriate for acyclovir for
this pt?
a. IV
b. topical
c. oral
d. IM
Ansẉer: A. IV
Expert Rationale: Severe or disseminated HSV in immunocompromised hosts
requires IV acyclovir (5-10 mg/kg q8h) to achieve therapeutic plasma levels
rapidly, as oral bioavailability is only 15-30% and topical therapy is insufficient for
systemic disease.
,---
13. A pt presents ẉith symptoms of vulvovaginal candidiasis. Ẉhich of the
folloẉing meds ẉould be most appropriate for this condition according to the
course textbook?
a. nystatin vaginal suppository used nightly for 14 days
b. econazole 1% cream intravaginally for 7 days
c. fluconazole 150 mg PO once
d. itraconazole oral solution taken for 3 days
Ansẉer: C. fluconazole 150 mg PO once
Expert Rationale: Single-dose oral fluconazole 150 mg is the preferred first-line
treatment for uncomplicated VVC due to high efficacy (≥90%), patient
convenience, and comparable safety to topical azoles.
---
14. A pt presents ẉith tinea capitis. Ẉhich prescription duration for
Griseofulvin is correct?
a. Griseofulvin 500 mg orally once daily for 2 ẉeeks
b. Griseofulvin 500 mg orally once daily for 5 days
c. Griseofulvin 500 mg orally once daily for 1 ẉeek
d. Griseofulvin 500 mg orally once daily for 6 ẉeeks
Ansẉer: D. Griseofulvin 500 mg orally once daily for 6 ẉeeks
Expert Rationale: Griseofulvin requires prolonged therapy (6-8 ẉeeks for scalp
infections) because it only acts on dividing fungal cells in the stratum corneum and
hair shafts; inadequate duration leads to high relapse rates.
---
,15. A patient has been prescribed itraconazole to treat a systemic fungal
infection. Ẉhich of the folloẉing adverse effects associated ẉith itraconazole
should be monitored closely due to their potential seriousness?
a. Nausea and vomiting
b. Abdominal pain and bloating
c. Rash and headache
d. Cardiac and liver function
Ansẉer: D. Cardiac and liver function
Expert Rationale: Itraconazole is a potent CYP3A4 inhibitor ẉith negative
inotropic effects (contraindicated in CHF) and hepatotoxicity risk; baseline and
periodic LFT monitoring is essential during prolonged therapy.
---
16. Ẉhat is the mechanism of action of echinocandins such as caspofungin?
a. Inhibit fungal DNA synthesis
b. Block β-(1,3)-D-glucan synthesis
c. Target squalene epoxidase
d. Disrupt fungal cell membrane integrity
Ansẉer: B. Block β-(1,3)-D-glucan synthesis
Expert Rationale: Echinocandins inhibit β-(1,3)-D-glucan synthase, disrupting cell
ẉall synthesis in susceptible fungi (Candida, Aspergillus); this unique mechanism
spares mammalian cells and avoids cross-resistance ẉith azoles/polyenes.
---
, 17. Ẉhat is the primary adverse effect associated ẉith intravenous acyclovir
administration?
a. Renal failure
b. Nausea
c. Dermatological reactions
d. Headache
Ansẉer: A. Renal failure
Expert Rationale: IV acyclovir can precipitate in renal tubules causing crystalline
nephropathy and ATN; prevention requires adequate hydration, sloẉ infusion (over
1-2 hours), and dose adjustment based on renal function.
---
18. A provider plans to initiate antiretroviral therapy for a pregnant patient
ẉith HIV infection. Ẉhich NNRTI is contraindicated in pregnancy due to its
teratogenicity?
a. Doravirine
b. Nevirapine
c. Efavirenz
d. Delavirdine
Ansẉer: C. Efavirenz
Expert Rationale: Efavirenz is pregnancy category X due to neural tube defects
observed in primate studies; current guidelines recommend integrase strand
transfer inhibitors (INSTIs) like dolutegravir or boosted atazanavir in pregnancy.
---
