Advanced Pharmacology Practice Exam — Set 2 2026
### 200 Additional Practice Questions with Answers & Rationales
*A general NP/graduate-level pharmacology review, covering topics not
repeated from Set 1 (150Q). Not affiliated with or copied from any
specific university's proctored exam.*
---
## Section 1: Toxicology & Antidotes (Q1–20)
**1.** The antidote for benzodiazepine overdose is:
A) Naloxone
B) Flumazenil
C) N-acetylcysteine
D) Physostigmine
**Answer: B** — Flumazenil competitively antagonizes benzodiazepine
binding at the GABA-A receptor.
**2.** Flumazenil should be used cautiously in patients with:
A) Isolated benzodiazepine overdose
B) Chronic benzodiazepine use/dependence (seizure risk) or co-ingestion
with pro-convulsant drugs
C) Mild sedation only
D) No significant risk in any patient
**Answer: B** — Reversing benzodiazepine effect abruptly in dependent
patients or with certain co-ingestants can precipitate seizures.
**3.** The antidote for iron toxicity is:
A) Deferoxamine
B) Penicillamine
C) Dimercaprol
D) Calcium EDTA
**Answer: A** — Deferoxamine chelates free iron, enhancing its excretion.
**4.** Which antidote is used for lead poisoning?
A) Deferoxamine
B) Succimer (DMSA) or EDTA/dimercaprol depending on severity
C) Naloxone
D) Fomepizole
**Answer: B** — Chelating agents like succimer, EDTA, or dimercaprol are
used depending on lead level and severity.
**5.** Fomepizole is the antidote of choice for:
A) Acetaminophen overdose
B) Methanol and ethylene glycol poisoning
C) Iron overdose
D) Organophosphate poisoning
,**Answer: B** — Fomepizole inhibits alcohol dehydrogenase, preventing
formation of toxic metabolites from methanol/ethylene glycol.
**6.** The antidote for organophosphate (cholinesterase inhibitor)
poisoning includes:
A) Atropine and pralidoxime
B) Naloxone
C) Flumazenil
D) Vitamin K
**Answer: A** — Atropine blocks muscarinic effects; pralidoxime
reactivates acetylcholinesterase.
**7.** Which toxidrome is characterized by SLUDGE symptoms (salivation,
lacrimation, urination, defecation, GI distress, emesis)?
A) Anticholinergic toxicity
B) Cholinergic toxicity (e.g., organophosphates)
C) Sympathomimetic toxicity
D) Opioid toxicity
**Answer: B** — Excess acetylcholine activity produces the classic SLUDGE
cholinergic presentation.
**8.** Anticholinergic toxicity classically presents as:
A) "Wet" and bradycardic
B) "Dry as a bone, red as a beet, mad as a hatter, blind as a bat, hot as
a hare"
C) Pinpoint pupils and respiratory depression
D) Hypersalivation and diarrhea
**Answer: B** — This mnemonic describes anticholinergic toxidrome: dry
skin/mouth, flushing, delirium, mydriasis, hyperthermia.
**9.** The antidote for warfarin-induced bleeding (severe) is:
A) Protamine sulfate
B) Vitamin K and/or prothrombin complex concentrate
C) Fresh frozen plasma alone in all cases
D) Naloxone
**Answer: B** — Vitamin K reverses warfarin's effect on clotting factor
synthesis; PCC provides rapid factor replacement in severe bleeding.
**10.** Protamine sulfate is used to reverse the effects of:
A) Warfarin
B) Heparin (unfractionated)
C) Apixaban
D) Aspirin
**Answer: B** — Protamine binds and neutralizes heparin's anticoagulant
activity.
**11.** Idarucizumab is a reversal agent specific to:
A) Warfarin
B) Dabigatran
,C) Apixaban
D) Heparin
**Answer: B** — Idarucizumab is a monoclonal antibody fragment that
specifically binds and reverses dabigatran.
**12.** Activated charcoal is most effective when administered:
A) More than 12 hours after ingestion
B) Within approximately 1 hour of ingestion of most toxins (with
exceptions)
C) Only for alcohol ingestion
D) Regardless of timing
**Answer: B** — Efficacy diminishes significantly with time; it's most
useful shortly after ingestion and is not effective for all substances
(e.g., alcohols, metals).
**13.** Activated charcoal is NOT effective for which type of ingestion?
A) Acetaminophen
B) Heavy metals (e.g., iron, lithium) and alcohols
C) Most oral medications
D) Aspirin
**Answer: B** — Charcoal does not effectively bind small ions like
iron/lithium or alcohols.
**14.** Digoxin immune Fab (DigiFab) is used for:
A) Digoxin toxicity with life-threatening arrhythmias or severe
hyperkalemia
B) Warfarin overdose
C) Beta-blocker overdose
D) Calcium channel blocker overdose
**Answer: A** — DigiFab binds free digoxin, rapidly reducing active drug
levels in severe toxicity.
**15.** High-dose insulin/dextrose therapy is a treatment strategy for
toxicity from:
A) Opioids
B) Calcium channel blocker and beta-blocker overdose
C) Acetaminophen
D) Benzodiazepines
**Answer: B** — High-dose insulin improves cardiac contractility in
CCB/beta-blocker overdose through metabolic and inotropic effects.
**16.** Intravenous lipid emulsion therapy is primarily used for toxicity
from:
A) Local anesthetic systemic toxicity (e.g., bupivacaine) and certain
lipophilic drug overdoses
B) Acetaminophen overdose
C) Iron overdose
D) Aspirin overdose
, **Answer: A** — Lipid emulsion acts as a "lipid sink," particularly
useful in local anesthetic cardiotoxicity.
**17.** Salicylate (aspirin) toxicity classically causes which acid-base
disturbance?
A) Pure metabolic acidosis
B) Mixed respiratory alkalosis and metabolic acidosis
C) Pure respiratory acidosis
D) Metabolic alkalosis only
**Answer: B** — Early respiratory alkalosis (direct respiratory center
stimulation) followed by metabolic acidosis is classic for salicylate
toxicity.
**18.** Sodium bicarbonate is used in salicylate toxicity to:
A) Directly neutralize the drug
B) Alkalinize the urine, enhancing salicylate excretion (ion trapping)
C) Treat hyperkalemia only
D) Reverse CNS depression
**Answer: B** — Urinary alkalinization increases the ionized (trapped)
form of salicylate in urine, enhancing renal elimination.
**19.** Which lab value is most important to trend in suspected
acetaminophen overdose to guide treatment via a nomogram?
A) Serum sodium
B) Serum acetaminophen level (timed from ingestion) plotted on the
Rumack-Matthew nomogram
C) Serum potassium
D) Hemoglobin
**Answer: B** — The Rumack-Matthew nomogram uses acetaminophen level and
time since ingestion to guide NAC treatment decisions.
**20.** Methemoglobinemia (e.g., from certain local anesthetics like
benzocaine) is treated with:
A) Naloxone
B) Methylene blue
C) Flumazenil
D) Deferoxamine
**Answer: B** — Methylene blue helps reduce methemoglobin back to
functional hemoglobin.
---
## Section 2: Vaccines & Immunizations (Q21–40)
**21.** Live attenuated vaccines are generally contraindicated in:
A) Healthy adults
B) Pregnant women and significantly immunocompromised patients
C) School-age children
D) Healthcare workers
### 200 Additional Practice Questions with Answers & Rationales
*A general NP/graduate-level pharmacology review, covering topics not
repeated from Set 1 (150Q). Not affiliated with or copied from any
specific university's proctored exam.*
---
## Section 1: Toxicology & Antidotes (Q1–20)
**1.** The antidote for benzodiazepine overdose is:
A) Naloxone
B) Flumazenil
C) N-acetylcysteine
D) Physostigmine
**Answer: B** — Flumazenil competitively antagonizes benzodiazepine
binding at the GABA-A receptor.
**2.** Flumazenil should be used cautiously in patients with:
A) Isolated benzodiazepine overdose
B) Chronic benzodiazepine use/dependence (seizure risk) or co-ingestion
with pro-convulsant drugs
C) Mild sedation only
D) No significant risk in any patient
**Answer: B** — Reversing benzodiazepine effect abruptly in dependent
patients or with certain co-ingestants can precipitate seizures.
**3.** The antidote for iron toxicity is:
A) Deferoxamine
B) Penicillamine
C) Dimercaprol
D) Calcium EDTA
**Answer: A** — Deferoxamine chelates free iron, enhancing its excretion.
**4.** Which antidote is used for lead poisoning?
A) Deferoxamine
B) Succimer (DMSA) or EDTA/dimercaprol depending on severity
C) Naloxone
D) Fomepizole
**Answer: B** — Chelating agents like succimer, EDTA, or dimercaprol are
used depending on lead level and severity.
**5.** Fomepizole is the antidote of choice for:
A) Acetaminophen overdose
B) Methanol and ethylene glycol poisoning
C) Iron overdose
D) Organophosphate poisoning
,**Answer: B** — Fomepizole inhibits alcohol dehydrogenase, preventing
formation of toxic metabolites from methanol/ethylene glycol.
**6.** The antidote for organophosphate (cholinesterase inhibitor)
poisoning includes:
A) Atropine and pralidoxime
B) Naloxone
C) Flumazenil
D) Vitamin K
**Answer: A** — Atropine blocks muscarinic effects; pralidoxime
reactivates acetylcholinesterase.
**7.** Which toxidrome is characterized by SLUDGE symptoms (salivation,
lacrimation, urination, defecation, GI distress, emesis)?
A) Anticholinergic toxicity
B) Cholinergic toxicity (e.g., organophosphates)
C) Sympathomimetic toxicity
D) Opioid toxicity
**Answer: B** — Excess acetylcholine activity produces the classic SLUDGE
cholinergic presentation.
**8.** Anticholinergic toxicity classically presents as:
A) "Wet" and bradycardic
B) "Dry as a bone, red as a beet, mad as a hatter, blind as a bat, hot as
a hare"
C) Pinpoint pupils and respiratory depression
D) Hypersalivation and diarrhea
**Answer: B** — This mnemonic describes anticholinergic toxidrome: dry
skin/mouth, flushing, delirium, mydriasis, hyperthermia.
**9.** The antidote for warfarin-induced bleeding (severe) is:
A) Protamine sulfate
B) Vitamin K and/or prothrombin complex concentrate
C) Fresh frozen plasma alone in all cases
D) Naloxone
**Answer: B** — Vitamin K reverses warfarin's effect on clotting factor
synthesis; PCC provides rapid factor replacement in severe bleeding.
**10.** Protamine sulfate is used to reverse the effects of:
A) Warfarin
B) Heparin (unfractionated)
C) Apixaban
D) Aspirin
**Answer: B** — Protamine binds and neutralizes heparin's anticoagulant
activity.
**11.** Idarucizumab is a reversal agent specific to:
A) Warfarin
B) Dabigatran
,C) Apixaban
D) Heparin
**Answer: B** — Idarucizumab is a monoclonal antibody fragment that
specifically binds and reverses dabigatran.
**12.** Activated charcoal is most effective when administered:
A) More than 12 hours after ingestion
B) Within approximately 1 hour of ingestion of most toxins (with
exceptions)
C) Only for alcohol ingestion
D) Regardless of timing
**Answer: B** — Efficacy diminishes significantly with time; it's most
useful shortly after ingestion and is not effective for all substances
(e.g., alcohols, metals).
**13.** Activated charcoal is NOT effective for which type of ingestion?
A) Acetaminophen
B) Heavy metals (e.g., iron, lithium) and alcohols
C) Most oral medications
D) Aspirin
**Answer: B** — Charcoal does not effectively bind small ions like
iron/lithium or alcohols.
**14.** Digoxin immune Fab (DigiFab) is used for:
A) Digoxin toxicity with life-threatening arrhythmias or severe
hyperkalemia
B) Warfarin overdose
C) Beta-blocker overdose
D) Calcium channel blocker overdose
**Answer: A** — DigiFab binds free digoxin, rapidly reducing active drug
levels in severe toxicity.
**15.** High-dose insulin/dextrose therapy is a treatment strategy for
toxicity from:
A) Opioids
B) Calcium channel blocker and beta-blocker overdose
C) Acetaminophen
D) Benzodiazepines
**Answer: B** — High-dose insulin improves cardiac contractility in
CCB/beta-blocker overdose through metabolic and inotropic effects.
**16.** Intravenous lipid emulsion therapy is primarily used for toxicity
from:
A) Local anesthetic systemic toxicity (e.g., bupivacaine) and certain
lipophilic drug overdoses
B) Acetaminophen overdose
C) Iron overdose
D) Aspirin overdose
, **Answer: A** — Lipid emulsion acts as a "lipid sink," particularly
useful in local anesthetic cardiotoxicity.
**17.** Salicylate (aspirin) toxicity classically causes which acid-base
disturbance?
A) Pure metabolic acidosis
B) Mixed respiratory alkalosis and metabolic acidosis
C) Pure respiratory acidosis
D) Metabolic alkalosis only
**Answer: B** — Early respiratory alkalosis (direct respiratory center
stimulation) followed by metabolic acidosis is classic for salicylate
toxicity.
**18.** Sodium bicarbonate is used in salicylate toxicity to:
A) Directly neutralize the drug
B) Alkalinize the urine, enhancing salicylate excretion (ion trapping)
C) Treat hyperkalemia only
D) Reverse CNS depression
**Answer: B** — Urinary alkalinization increases the ionized (trapped)
form of salicylate in urine, enhancing renal elimination.
**19.** Which lab value is most important to trend in suspected
acetaminophen overdose to guide treatment via a nomogram?
A) Serum sodium
B) Serum acetaminophen level (timed from ingestion) plotted on the
Rumack-Matthew nomogram
C) Serum potassium
D) Hemoglobin
**Answer: B** — The Rumack-Matthew nomogram uses acetaminophen level and
time since ingestion to guide NAC treatment decisions.
**20.** Methemoglobinemia (e.g., from certain local anesthetics like
benzocaine) is treated with:
A) Naloxone
B) Methylene blue
C) Flumazenil
D) Deferoxamine
**Answer: B** — Methylene blue helps reduce methemoglobin back to
functional hemoglobin.
---
## Section 2: Vaccines & Immunizations (Q21–40)
**21.** Live attenuated vaccines are generally contraindicated in:
A) Healthy adults
B) Pregnant women and significantly immunocompromised patients
C) School-age children
D) Healthcare workers
