Advanced Pharmacology
Midterm Exam
1. Question
A 56-year-old male with hypertension is started on lisinopril. Which of the following
is the primary mechanism of action of this drug?
A. Inhibits calcium influx in vascular smooth muscle
B. Blocks the conversion of angiotensin I to angiotensin II
C. Stimulates β2-adrenergic receptors
D. Increases sodium reabsorption in the proximal tubule
Answer: B – Lisinopril is an ACE inhibitor that blocks the conversion of angiotensin I
to angiotensin II, leading to vasodilation and decreased aldosterone secretion.
2. Question
Which of the following antibiotics is contraindicated in pregnancy due to risk of
tooth discoloration in the fetus?
A. Amoxicillin
B. Azithromycin
C. Tetracycline
D. Cephalexin
Answer: C – Tetracyclines can cause permanent discoloration of teeth and inhibit
bone growth in the fetus.
,3. Question
A patient taking warfarin has an INR of 6.5 but no bleeding. The most appropriate
next step is:
A. Continue the same dose
B. Administer vitamin K orally
C. Administer vitamin K intravenously immediately
D. Discontinue warfarin permanently
Answer: B – Oral vitamin K is recommended for INR >5 without bleeding; IV is
reserved for serious or life-threatening bleeding due to risk of anaphylaxis.
4. Question
Which drug is considered first-line for chronic asthma control?
A. Albuterol
B. Salmeterol
C. Inhaled corticosteroids
D. Theophylline
Answer: C – Inhaled corticosteroids (e.g., fluticasone) are the cornerstone of long-
term asthma control, reducing airway inflammation.
5. Question
A 45-year-old woman with hyperthyroidism is started on methimazole. Which
adverse effect requires immediate discontinuation of the drug?
A. Hair loss
B. Agranulocytosis
C. Weight gain
D. Mild skin rash
,Answer: B – Agranulocytosis is a rare but life-threatening side effect of thioamides
(methimazole, propylthiouracil).
6. Question
In older adults, benzodiazepines should be used cautiously because:
A. They cause severe hypertension
B. They may increase fall risk due to sedation and ataxia
C. They improve sleep without side effects
D. They are rapidly metabolized in the elderly
Answer: B – Older adults are more sensitive to CNS depressants, increasing fall and
fracture risk.
7. Question
Which of the following is the antidote for opioid overdose?
A. Flumazenil
B. Atropine
C. Naloxone
D. Protamine sulfate
Answer: C – Naloxone is a pure opioid antagonist that rapidly reverses respiratory
depression from opioids.
8. Question
Metoprolol lowers blood pressure primarily by:
A. Increasing cardiac output
B. Blocking β1-receptors in the heart to decrease heart rate and contractility
C. Dilating peripheral arteries
, D. Inhibiting angiotensin-converting enzyme
Answer: B – Metoprolol is a cardioselective β1-blocker that decreases cardiac
workload.
9. Question
Which antibiotic has a black box warning for risk of tendon rupture?
A. Levofloxacin
B. Amoxicillin
C. Azithromycin
D. Doxycycline
Answer: A – Fluoroquinolones (like levofloxacin) can cause tendonitis and tendon
rupture, especially in older adults.
10. Question
A patient taking simvastatin develops muscle pain and dark urine. The most likely
complication is:
A. Hepatic encephalopathy
B. Acute kidney injury from rhabdomyolysis
C. Myocardial infarction
D. Gallstones
Answer: B – Statins can cause rhabdomyolysis, leading to myoglobinuria and kidney
injury.11. Question
A patient on lithium for bipolar disorder presents with tremor, nausea, and
confusion. Serum lithium level is 2.3 mEq/L. Which electrolyte imbalance can
increase lithium toxicity?
A. Hypernatremia
Midterm Exam
1. Question
A 56-year-old male with hypertension is started on lisinopril. Which of the following
is the primary mechanism of action of this drug?
A. Inhibits calcium influx in vascular smooth muscle
B. Blocks the conversion of angiotensin I to angiotensin II
C. Stimulates β2-adrenergic receptors
D. Increases sodium reabsorption in the proximal tubule
Answer: B – Lisinopril is an ACE inhibitor that blocks the conversion of angiotensin I
to angiotensin II, leading to vasodilation and decreased aldosterone secretion.
2. Question
Which of the following antibiotics is contraindicated in pregnancy due to risk of
tooth discoloration in the fetus?
A. Amoxicillin
B. Azithromycin
C. Tetracycline
D. Cephalexin
Answer: C – Tetracyclines can cause permanent discoloration of teeth and inhibit
bone growth in the fetus.
,3. Question
A patient taking warfarin has an INR of 6.5 but no bleeding. The most appropriate
next step is:
A. Continue the same dose
B. Administer vitamin K orally
C. Administer vitamin K intravenously immediately
D. Discontinue warfarin permanently
Answer: B – Oral vitamin K is recommended for INR >5 without bleeding; IV is
reserved for serious or life-threatening bleeding due to risk of anaphylaxis.
4. Question
Which drug is considered first-line for chronic asthma control?
A. Albuterol
B. Salmeterol
C. Inhaled corticosteroids
D. Theophylline
Answer: C – Inhaled corticosteroids (e.g., fluticasone) are the cornerstone of long-
term asthma control, reducing airway inflammation.
5. Question
A 45-year-old woman with hyperthyroidism is started on methimazole. Which
adverse effect requires immediate discontinuation of the drug?
A. Hair loss
B. Agranulocytosis
C. Weight gain
D. Mild skin rash
,Answer: B – Agranulocytosis is a rare but life-threatening side effect of thioamides
(methimazole, propylthiouracil).
6. Question
In older adults, benzodiazepines should be used cautiously because:
A. They cause severe hypertension
B. They may increase fall risk due to sedation and ataxia
C. They improve sleep without side effects
D. They are rapidly metabolized in the elderly
Answer: B – Older adults are more sensitive to CNS depressants, increasing fall and
fracture risk.
7. Question
Which of the following is the antidote for opioid overdose?
A. Flumazenil
B. Atropine
C. Naloxone
D. Protamine sulfate
Answer: C – Naloxone is a pure opioid antagonist that rapidly reverses respiratory
depression from opioids.
8. Question
Metoprolol lowers blood pressure primarily by:
A. Increasing cardiac output
B. Blocking β1-receptors in the heart to decrease heart rate and contractility
C. Dilating peripheral arteries
, D. Inhibiting angiotensin-converting enzyme
Answer: B – Metoprolol is a cardioselective β1-blocker that decreases cardiac
workload.
9. Question
Which antibiotic has a black box warning for risk of tendon rupture?
A. Levofloxacin
B. Amoxicillin
C. Azithromycin
D. Doxycycline
Answer: A – Fluoroquinolones (like levofloxacin) can cause tendonitis and tendon
rupture, especially in older adults.
10. Question
A patient taking simvastatin develops muscle pain and dark urine. The most likely
complication is:
A. Hepatic encephalopathy
B. Acute kidney injury from rhabdomyolysis
C. Myocardial infarction
D. Gallstones
Answer: B – Statins can cause rhabdomyolysis, leading to myoglobinuria and kidney
injury.11. Question
A patient on lithium for bipolar disorder presents with tremor, nausea, and
confusion. Serum lithium level is 2.3 mEq/L. Which electrolyte imbalance can
increase lithium toxicity?
A. Hypernatremia
