,NSG 533 Exam 3 - Advanced Pharmacology -
Wilkes University - (2026–2027) actual (PDF)
1. A patient with partial-onset seizures is started on carbamazepine. The nurse practitioner understands
that this medication's primary mechanism of action involves:
A) Enhancement of GABA-mediated chloride influx
B) Blockade of voltage-gated sodium channels
C) Antagonism of NMDA receptors
D) Activation of dopamine D2 receptors
Correct Answer: Blockade of voltage-gated sodium channels
Rationale: Carbamazepine stabilizes neuronal membranes by blocking voltage-gated sodium channels,
reducing repetitive neuronal firing. It is a first-line agent for focal and generalized tonic-clonic seizures.
GABA enhancement is the mechanism of benzodiazepines and barbiturates. NMDA antagonism is
associated with memantine and ketamine. Dopamine D2 activation is not an anticonvulsant mechanism.
2. A patient with absence seizures is prescribed ethosuximide. Which statement correctly describes its
mechanism of action and clinical indication?
A) Blocks voltage-gated sodium channels and is effective for all seizure types
B) Blocks T-type calcium channels in thalamic neurons and is specific for absence seizures
C) Enhances GABA activity and is used for myoclonic seizures
D) Blocks NMDA receptors and is used for status epilepticus
Correct Answer: Blocks T-type calcium channels in thalamic neurons and is specific for absence seizures
Rationale: Ethosuximide selectively blocks T-type calcium channels in thalamic neurons, reducing the
abnormal oscillatory activity that underlies absence seizures. It has no efficacy against other seizure
types. Sodium channel blockade is the mechanism of carbamazepine and phenytoin. GABA
enhancement is the mechanism of benzodiazepines. NMDA blockade is not a primary anticonvulsant
mechanism.
3. A patient with bipolar disorder is started on lamotrigine. Which adverse effect is most concerning and
requires slow dose titration to minimize risk?
A) Stevens-Johnson syndrome
B) Agranulocytosis
,C) Hepatotoxicity
D) Weight gain
Correct Answer: Stevens-Johnson syndrome
Rationale: Lamotrigine carries a risk of serious rash, including Stevens-Johnson syndrome and toxic
epidermal necrolysis. Slow dose titration (starting at 25 mg daily and increasing gradually over weeks) is
essential to minimize this risk. Agranulocytosis is more associated with clozapine. Hepatotoxicity is a
concern with valproate. Weight gain is common with valproate and some antipsychotics.
4. A patient with Parkinson's disease is started on carbidopa-levodopa. Which dietary factor can
significantly affect the absorption of levodopa?
A) High-protein meals
B) High-carbohydrate meals
C) High-fat meals
D) Caffeine intake
Correct Answer: High-protein meals
Rationale: Levodopa is transported across the intestinal wall by a large neutral amino acid transporter.
High-protein meals compete for this transporter, reducing levodopa absorption and CNS penetration.
Patients should take carbidopa-levodopa at least 30-60 minutes before meals or with a low-protein
snack. Carbohydrates, fats, and caffeine do not significantly affect levodopa absorption.
5. A patient with Parkinson's disease is experiencing significant "off" episodes. Which medication can be
used as an adjunct to carbidopa-levodopa to reduce "off" time?
A) Trihexyphenidyl
B) Entacapone
C) Amantadine
D) Selegiline
Correct Answer: Entacapone
Rationale: Entacapone is a catechol-O-methyltransferase (COMT) inhibitor that prolongs the action of
levodopa by blocking its peripheral metabolism, reducing "off" time and increasing "on" time.
Trihexyphenidyl is an anticholinergic used for tremor. Amantadine is used for dyskinesias. Selegiline is a
MAO-B inhibitor used as monotherapy in early Parkinson's or as adjunctive therapy.
, 6. A patient with Parkinson's disease is started on pramipexole. Which statement correctly describes its
mechanism of action and potential adverse effect?
A) Dopamine precursor that can cause dyskinesias
B) Dopamine agonist that can cause impulse control disorders
C) COMT inhibitor that can cause hepatotoxicity
D) MAO-B inhibitor that can cause hypertensive crisis
Correct Answer: Dopamine agonist that can cause impulse control disorders
Rationale: Pramipexole is a non-ergot dopamine agonist that directly stimulates dopamine D2 receptors.
It is associated with impulse control disorders (pathological gambling, hypersexuality, compulsive
shopping) in some patients. Levodopa is the dopamine precursor. COMT inhibitors (entacapone) and
MAO-B inhibitors (selegiline) have different mechanisms and adverse effect profiles.
7. A patient with multiple sclerosis is started on interferon beta-1a. Which adverse effect is most
common and requires premedication to improve tolerability?
A) Depression
B) Flu-like symptoms
C) Hepatotoxicity
D) Cardiotoxicity
Correct Answer: Flu-like symptoms
Rationale: Interferon beta-1a commonly causes flu-like symptoms (fever, chills, myalgias, fatigue), which
are most pronounced at the start of therapy. Premedication with NSAIDs or acetaminophen and evening
dosing can improve tolerability. Depression, hepatotoxicity, and injection site reactions are also possible
but less common than flu-like symptoms.
8. A patient with multiple sclerosis is started on glatiramer acetate. Which statement correctly describes
its mechanism of action?
A) Immunomodulation by altering T-cell function and promoting regulatory T cells
B) Depletion of B lymphocytes
C) Blockade of alpha-4 integrin, preventing immune cell migration into the CNS
D) Inhibition of sphingosine-1-phosphate receptor, retaining lymphocytes in lymph nodes
Correct Answer: Immunomodulation by altering T-cell function and promoting regulatory T cells
Wilkes University - (2026–2027) actual (PDF)
1. A patient with partial-onset seizures is started on carbamazepine. The nurse practitioner understands
that this medication's primary mechanism of action involves:
A) Enhancement of GABA-mediated chloride influx
B) Blockade of voltage-gated sodium channels
C) Antagonism of NMDA receptors
D) Activation of dopamine D2 receptors
Correct Answer: Blockade of voltage-gated sodium channels
Rationale: Carbamazepine stabilizes neuronal membranes by blocking voltage-gated sodium channels,
reducing repetitive neuronal firing. It is a first-line agent for focal and generalized tonic-clonic seizures.
GABA enhancement is the mechanism of benzodiazepines and barbiturates. NMDA antagonism is
associated with memantine and ketamine. Dopamine D2 activation is not an anticonvulsant mechanism.
2. A patient with absence seizures is prescribed ethosuximide. Which statement correctly describes its
mechanism of action and clinical indication?
A) Blocks voltage-gated sodium channels and is effective for all seizure types
B) Blocks T-type calcium channels in thalamic neurons and is specific for absence seizures
C) Enhances GABA activity and is used for myoclonic seizures
D) Blocks NMDA receptors and is used for status epilepticus
Correct Answer: Blocks T-type calcium channels in thalamic neurons and is specific for absence seizures
Rationale: Ethosuximide selectively blocks T-type calcium channels in thalamic neurons, reducing the
abnormal oscillatory activity that underlies absence seizures. It has no efficacy against other seizure
types. Sodium channel blockade is the mechanism of carbamazepine and phenytoin. GABA
enhancement is the mechanism of benzodiazepines. NMDA blockade is not a primary anticonvulsant
mechanism.
3. A patient with bipolar disorder is started on lamotrigine. Which adverse effect is most concerning and
requires slow dose titration to minimize risk?
A) Stevens-Johnson syndrome
B) Agranulocytosis
,C) Hepatotoxicity
D) Weight gain
Correct Answer: Stevens-Johnson syndrome
Rationale: Lamotrigine carries a risk of serious rash, including Stevens-Johnson syndrome and toxic
epidermal necrolysis. Slow dose titration (starting at 25 mg daily and increasing gradually over weeks) is
essential to minimize this risk. Agranulocytosis is more associated with clozapine. Hepatotoxicity is a
concern with valproate. Weight gain is common with valproate and some antipsychotics.
4. A patient with Parkinson's disease is started on carbidopa-levodopa. Which dietary factor can
significantly affect the absorption of levodopa?
A) High-protein meals
B) High-carbohydrate meals
C) High-fat meals
D) Caffeine intake
Correct Answer: High-protein meals
Rationale: Levodopa is transported across the intestinal wall by a large neutral amino acid transporter.
High-protein meals compete for this transporter, reducing levodopa absorption and CNS penetration.
Patients should take carbidopa-levodopa at least 30-60 minutes before meals or with a low-protein
snack. Carbohydrates, fats, and caffeine do not significantly affect levodopa absorption.
5. A patient with Parkinson's disease is experiencing significant "off" episodes. Which medication can be
used as an adjunct to carbidopa-levodopa to reduce "off" time?
A) Trihexyphenidyl
B) Entacapone
C) Amantadine
D) Selegiline
Correct Answer: Entacapone
Rationale: Entacapone is a catechol-O-methyltransferase (COMT) inhibitor that prolongs the action of
levodopa by blocking its peripheral metabolism, reducing "off" time and increasing "on" time.
Trihexyphenidyl is an anticholinergic used for tremor. Amantadine is used for dyskinesias. Selegiline is a
MAO-B inhibitor used as monotherapy in early Parkinson's or as adjunctive therapy.
, 6. A patient with Parkinson's disease is started on pramipexole. Which statement correctly describes its
mechanism of action and potential adverse effect?
A) Dopamine precursor that can cause dyskinesias
B) Dopamine agonist that can cause impulse control disorders
C) COMT inhibitor that can cause hepatotoxicity
D) MAO-B inhibitor that can cause hypertensive crisis
Correct Answer: Dopamine agonist that can cause impulse control disorders
Rationale: Pramipexole is a non-ergot dopamine agonist that directly stimulates dopamine D2 receptors.
It is associated with impulse control disorders (pathological gambling, hypersexuality, compulsive
shopping) in some patients. Levodopa is the dopamine precursor. COMT inhibitors (entacapone) and
MAO-B inhibitors (selegiline) have different mechanisms and adverse effect profiles.
7. A patient with multiple sclerosis is started on interferon beta-1a. Which adverse effect is most
common and requires premedication to improve tolerability?
A) Depression
B) Flu-like symptoms
C) Hepatotoxicity
D) Cardiotoxicity
Correct Answer: Flu-like symptoms
Rationale: Interferon beta-1a commonly causes flu-like symptoms (fever, chills, myalgias, fatigue), which
are most pronounced at the start of therapy. Premedication with NSAIDs or acetaminophen and evening
dosing can improve tolerability. Depression, hepatotoxicity, and injection site reactions are also possible
but less common than flu-like symptoms.
8. A patient with multiple sclerosis is started on glatiramer acetate. Which statement correctly describes
its mechanism of action?
A) Immunomodulation by altering T-cell function and promoting regulatory T cells
B) Depletion of B lymphocytes
C) Blockade of alpha-4 integrin, preventing immune cell migration into the CNS
D) Inhibition of sphingosine-1-phosphate receptor, retaining lymphocytes in lymph nodes
Correct Answer: Immunomodulation by altering T-cell function and promoting regulatory T cells
