NR568 Advanced Pharmacology
Weeks 5-8 Final Exam (Latest 2026/2027 Update)
Instructions:
Select the single best answer for each question.
1. A patient with moderate Alzheimer's disease is prescribed donepezil. What is
the primary mechanism of action of this medication?
A. N-methyl-D-aspartate (NMDA) receptor antagonist
B. Acetylcholinesterase inhibitor
C. Monoamine oxidase inhibitor
D. Dopamine precursor
Answer: B
Rationale: Donepezil is a centrally acting, reversible acetylcholinesterase inhibitor. It works
by inhibiting the breakdown of acetylcholine, thereby increasing its concentration in the
synaptic cleft to compensate for the cholinergic deficit seen in Alzheimer's disease. (A) is
the mechanism of memantine, (C) is for MAOIs, and (D) is for levodopa.
2. A 75-year-old patient on memantine for Alzheimer's disease reports increased
confusion and hallucinations. Which of the following is the most likely cause?
A. Therapeutic effect of the medication
B. Drug-drug interaction with hydrochlorothiazide
C. Renal impairment leading to drug accumulation
D. Hepatic enzyme induction
Answer: C
Rationale: Memantine is primarily excreted renally. In older adults with age-related renal
decline, drug accumulation can occur, leading to increased central nervous system (CNS)
adverse effects such as confusion and hallucinations. Dosage adjustment is required based
on creatinine clearance.
,3. A patient with Parkinson's disease is started on carbidopa-levodopa. What is the
purpose of carbidopa in this combination?
A. To cross the blood-brain barrier and act as a dopamine agonist
B. To prevent the peripheral breakdown of levodopa, allowing more to reach the brain
C. To stimulate the release of dopamine from presynaptic neurons
D. To block dopamine receptors in the periphery
Answer: B
Rationale: Carbidopa is a peripheral decarboxylase inhibitor. It does not cross the blood-
brain barrier. Its role is to inhibit the enzyme aromatic L-amino acid decarboxylase (DOPA
decarboxylase) in the periphery, which prevents the conversion of levodopa to dopamine
outside the brain. This reduces peripheral side effects (like nausea) and increases the
amount of levodopa that reaches the CNS.
4. A patient taking pramipexole for Parkinson's disease develops a new,
uncontrollable urge to gamble and make impulsive purchases. The provider should
recognize this as:
A. An idiosyncratic allergic reaction
B. A side effect of dopamine agonists, requiring a dose adjustment or medication
change
C. A sign of early-onset dementia
D. A normal psychological response to a chronic illness
Answer: B
Rationale: Dopamine agonists, such as pramipexole and ropinirole, are associated with
impulse control disorders (ICDs). These include pathological gambling, hypersexuality,
compulsive shopping, and binge eating. This is a class effect and requires assessment and
management, often dose reduction or discontinuation.
5. A patient is started on selegiline for Parkinson's disease. Which dietary
instruction is most important?
A. Avoid foods high in tyramine.
B. Increase intake of high-fiber foods.
C. Consume a high-protein meal with the medication.
D. Avoid grapefruit juice.
Answer: A
,Rationale: Selegiline is a selective monoamine oxidase type B (MAO-B) inhibitor. At
standard doses, it is selective and has a low risk of hypertensive crisis from tyramine.
However, at higher doses (or with long-term use), its selectivity is lost, and a tyramine-
restricted diet is crucial to prevent a hypertensive crisis.
6. A patient with epilepsy is transitioned from phenytoin to levetiracetam. Which
of the following is a major advantage of levetiracetam?
A. It does not require therapeutic drug monitoring.
B. It is a potent enzyme inducer.
C. It has no risk of psychiatric side effects.
D. It is highly protein-bound, leading to fewer drug interactions.
Answer: A
Rationale: Levetiracetam has a wide therapeutic index and a predictable pharmacokinetic
profile. Its clearance is primarily renal, and it does not undergo significant hepatic
metabolism or protein binding, so routine therapeutic drug monitoring is not generally
required. It also has a low potential for drug interactions as it does not induce or inhibit
CYP450 enzymes.
7. Valproic acid is known to have several severe adverse effects. Which of the
following requires immediate monitoring in a female of childbearing age?
A. Hepatotoxicity and teratogenicity
B. Nephrotoxicity and ototoxicity
C. Cardiotoxicity and pulmonary fibrosis
D. Hyperglycemia and pancreatitis
Answer: A
Rationale: Valproic acid carries a black box warning for hepatotoxicity (especially in
children under 2 and those with mitochondrial disorders) and teratogenicity. It is
associated with neural tube defects (e.g., spina bifida) and cognitive impairment in
children exposed in utero. It is highly teratogenic and should be avoided if possible in
women of childbearing potential.
, 8. Which of the following antiseizure medications is considered a pregnancy
category with the least risk of major congenital malformations?
A. Valproic acid
B. Phenytoin
C. Lamotrigine
D. Carbamazepine
Answer: C
Rationale: Among the traditional and newer antiseizure medications, lamotrigine and
levetiracetam are generally considered to have a lower risk of major congenital
malformations compared to valproic acid, phenytoin, and carbamazepine. Valproic acid
carries the highest risk.
9. A patient on phenytoin develops gingival hyperplasia. What is the primary
mechanism?
A. Direct toxic effect on the gums
B. Overexpression of inflammatory mediators leading to fibroblast proliferation
C. Increased collagen synthesis and reduced breakdown
D. Xerostomia leading to poor oral hygiene
Answer: C
Rationale: Phenytoin-induced gingival hyperplasia is characterized by an increase in
collagen synthesis and a decrease in its breakdown by fibroblasts. This results in an
accumulation of extracellular matrix in the gingival tissue.
10. A patient with chronic pain is started on duloxetine. The provider explains that
this drug is effective for both depression and neuropathic pain. What is the
mechanism of action?
A. Selective serotonin reuptake inhibition
B. Serotonin and norepinephrine reuptake inhibition
C. Voltage-gated calcium channel blockade
D. Mu-opioid receptor agonism
Answer: B
Rationale: Duloxetine is a serotonin-norepinephrine reuptake inhibitor (SNRI). By
increasing levels of both serotonin and norepinephrine in the synaptic cleft, it addresses
Weeks 5-8 Final Exam (Latest 2026/2027 Update)
Instructions:
Select the single best answer for each question.
1. A patient with moderate Alzheimer's disease is prescribed donepezil. What is
the primary mechanism of action of this medication?
A. N-methyl-D-aspartate (NMDA) receptor antagonist
B. Acetylcholinesterase inhibitor
C. Monoamine oxidase inhibitor
D. Dopamine precursor
Answer: B
Rationale: Donepezil is a centrally acting, reversible acetylcholinesterase inhibitor. It works
by inhibiting the breakdown of acetylcholine, thereby increasing its concentration in the
synaptic cleft to compensate for the cholinergic deficit seen in Alzheimer's disease. (A) is
the mechanism of memantine, (C) is for MAOIs, and (D) is for levodopa.
2. A 75-year-old patient on memantine for Alzheimer's disease reports increased
confusion and hallucinations. Which of the following is the most likely cause?
A. Therapeutic effect of the medication
B. Drug-drug interaction with hydrochlorothiazide
C. Renal impairment leading to drug accumulation
D. Hepatic enzyme induction
Answer: C
Rationale: Memantine is primarily excreted renally. In older adults with age-related renal
decline, drug accumulation can occur, leading to increased central nervous system (CNS)
adverse effects such as confusion and hallucinations. Dosage adjustment is required based
on creatinine clearance.
,3. A patient with Parkinson's disease is started on carbidopa-levodopa. What is the
purpose of carbidopa in this combination?
A. To cross the blood-brain barrier and act as a dopamine agonist
B. To prevent the peripheral breakdown of levodopa, allowing more to reach the brain
C. To stimulate the release of dopamine from presynaptic neurons
D. To block dopamine receptors in the periphery
Answer: B
Rationale: Carbidopa is a peripheral decarboxylase inhibitor. It does not cross the blood-
brain barrier. Its role is to inhibit the enzyme aromatic L-amino acid decarboxylase (DOPA
decarboxylase) in the periphery, which prevents the conversion of levodopa to dopamine
outside the brain. This reduces peripheral side effects (like nausea) and increases the
amount of levodopa that reaches the CNS.
4. A patient taking pramipexole for Parkinson's disease develops a new,
uncontrollable urge to gamble and make impulsive purchases. The provider should
recognize this as:
A. An idiosyncratic allergic reaction
B. A side effect of dopamine agonists, requiring a dose adjustment or medication
change
C. A sign of early-onset dementia
D. A normal psychological response to a chronic illness
Answer: B
Rationale: Dopamine agonists, such as pramipexole and ropinirole, are associated with
impulse control disorders (ICDs). These include pathological gambling, hypersexuality,
compulsive shopping, and binge eating. This is a class effect and requires assessment and
management, often dose reduction or discontinuation.
5. A patient is started on selegiline for Parkinson's disease. Which dietary
instruction is most important?
A. Avoid foods high in tyramine.
B. Increase intake of high-fiber foods.
C. Consume a high-protein meal with the medication.
D. Avoid grapefruit juice.
Answer: A
,Rationale: Selegiline is a selective monoamine oxidase type B (MAO-B) inhibitor. At
standard doses, it is selective and has a low risk of hypertensive crisis from tyramine.
However, at higher doses (or with long-term use), its selectivity is lost, and a tyramine-
restricted diet is crucial to prevent a hypertensive crisis.
6. A patient with epilepsy is transitioned from phenytoin to levetiracetam. Which
of the following is a major advantage of levetiracetam?
A. It does not require therapeutic drug monitoring.
B. It is a potent enzyme inducer.
C. It has no risk of psychiatric side effects.
D. It is highly protein-bound, leading to fewer drug interactions.
Answer: A
Rationale: Levetiracetam has a wide therapeutic index and a predictable pharmacokinetic
profile. Its clearance is primarily renal, and it does not undergo significant hepatic
metabolism or protein binding, so routine therapeutic drug monitoring is not generally
required. It also has a low potential for drug interactions as it does not induce or inhibit
CYP450 enzymes.
7. Valproic acid is known to have several severe adverse effects. Which of the
following requires immediate monitoring in a female of childbearing age?
A. Hepatotoxicity and teratogenicity
B. Nephrotoxicity and ototoxicity
C. Cardiotoxicity and pulmonary fibrosis
D. Hyperglycemia and pancreatitis
Answer: A
Rationale: Valproic acid carries a black box warning for hepatotoxicity (especially in
children under 2 and those with mitochondrial disorders) and teratogenicity. It is
associated with neural tube defects (e.g., spina bifida) and cognitive impairment in
children exposed in utero. It is highly teratogenic and should be avoided if possible in
women of childbearing potential.
, 8. Which of the following antiseizure medications is considered a pregnancy
category with the least risk of major congenital malformations?
A. Valproic acid
B. Phenytoin
C. Lamotrigine
D. Carbamazepine
Answer: C
Rationale: Among the traditional and newer antiseizure medications, lamotrigine and
levetiracetam are generally considered to have a lower risk of major congenital
malformations compared to valproic acid, phenytoin, and carbamazepine. Valproic acid
carries the highest risk.
9. A patient on phenytoin develops gingival hyperplasia. What is the primary
mechanism?
A. Direct toxic effect on the gums
B. Overexpression of inflammatory mediators leading to fibroblast proliferation
C. Increased collagen synthesis and reduced breakdown
D. Xerostomia leading to poor oral hygiene
Answer: C
Rationale: Phenytoin-induced gingival hyperplasia is characterized by an increase in
collagen synthesis and a decrease in its breakdown by fibroblasts. This results in an
accumulation of extracellular matrix in the gingival tissue.
10. A patient with chronic pain is started on duloxetine. The provider explains that
this drug is effective for both depression and neuropathic pain. What is the
mechanism of action?
A. Selective serotonin reuptake inhibition
B. Serotonin and norepinephrine reuptake inhibition
C. Voltage-gated calcium channel blockade
D. Mu-opioid receptor agonism
Answer: B
Rationale: Duloxetine is a serotonin-norepinephrine reuptake inhibitor (SNRI). By
increasing levels of both serotonin and norepinephrine in the synaptic cleft, it addresses
