Advanced Pharmacology Final Verified Exam Updated 2025

A 64-year-old man presents with mild to moderate musculoskeletal back pain. He states that he has tried acetaminophen without relief. His medical history includes diabetes, hypertension, hyperlipidemia, gastric ulcer (resolved), and coronary artery disease. Which is the most appropriate NSAID regimen to treat this patient's pain? A. Celacoxib B. Indomethacin and omeprazole C. Naproxen and omeprazole D. Naproxen - Correct Answer-C. Naproxen and omeprazole Which statement is correct regarding the difference between acetaminophen and naproxen? A. Acetaminophen has more anti-inflammatory effects compared with naproxen. B. Acetaminophen has more Gl side effects but less effects on bleeding compared with naproxen. C. Acetaminophen has less risk for CV events compared with naproxen. D. Acetaminophen has fewer antipyretic effects than naproxen. - Correct Answer-C. Acetaminophen has less risk for CV events compared with naproxen. Which statement correctly describes the proposed mechanism of cardioprotection from low-dose aspirin? A. Aspirin preferentially inhibits COX-2 to lead to a relative reduction in thromboxane ~ levels. B. Aspirin preferentially inhibits COX-1 to lead to a relative reduction in thromboxane ~ levels. C. Aspirin preferentially inhibits COX-2 to lead to a relative reduction in prostacyclin levels. D. Aspirin preferentially inhibits COX-1 to lead a relative reduction in prostacyclin levels. - Correct Answer-B. Aspirin preferentially inhibits COX-1 to lead to a relative reduction in thromboxane ~ levels. Which statement correctly describes the pathophysiologic actions of prostaglandins at a target tissue? A. Promote vasoconstriction in the kidneys. B. Promote sodium and water retention in the kidneys. Pharm Pharm C. Decrease secretion of mucus at the lining of the stomach. D. Decrease secretion of gastric acid in the stomach - Correct Answer-D. Decrease secretion of gastric acid in the stomach Which prostaglandin agent can be used to maintain the patency of the ductus arteriosus in neonates with congenital heart problems while awaiting surgery? A. Misoprostol B. Epoprostenol C. Bimatoprost D. Alprostadil - Correct Answer-D. Alprostadil A 34-year-old woman with RA is planning for pregnancy. Which RA agents are absolutely contraindicated in pregnancy? A. Abatacept and rituximab B. Adalimumab and certolizumab C. lnfliximab and etanercept D. Methotrexate and leflunomide - Correct Answer-D. Methotrexate and leflunomide Which agent for RA competes with CD28 to prevent full T-cell activation? A. Sarilumab B. Abatacept C. Golimumab D. Adalimumab - Correct Answer-B. Abatacept Which statement correctly represents the mechanism of action of tofacitinib in the treatment of RA? A. TNF-a inhibitor B. Janus kinase inhibitor C. IL-6 receptor blocker D. Dihydrofolate reductase inhibitor - Correct Answer-B. Janus kinase inhibitor A 54-year-old man with gout is found to have an issue with renal excretion of uric acid. Which drug is an oral agent that would target the cause of his acute gout attacks? A. Allopurinol B. Febuxostat C. Probenecid D. Pegloticase - Correct Answer-C. Probencid A 64-year-old man presents with signs and symptoms of an acute gouty flare. Which strategy is the least likely to acutely improve his gout symptoms and pain? Pharm Pharm A. Naproxen B. Colchicine C. Probenecid D. Prednisone - Correct Answer-C. Probenecid A 43-year-old heavy machine operator complains of seasonal allergies. Which medication is most appropriate for the management of his allergy symptoms? A. Diphenhydramine B. Doxylamine C. Hydroxyzine D. Fexofenadine - Correct Answer-D. Fexofenadine Which statement concerning H, antihistamines is correct? A. Second-generation H1 antihistamines are relatively free of adverse effects. B. Because of the established long-term safety of first-generation H1 antihistamines, they are the first choice for allergic rhinitis. c. The motor coordination involved in driving an automobile is not affected by the use of first-generation H, antihistamines. D. H1 antihistamines can be used in the treatment of acute anaphylaxis. - Correct Answer-A. Second-generation H1 antihistamines are relatively free of adverse effects. Which histamine receptor antagonist is known to enter the central nervous system readily and cause sedation? A. Hydroxyzine B. Cetirizine C. Desloratadine D. Loratadine - Correct Answer-A. Hydroxyzine Which drug is an H,-receptor antagonist that also has serotonin receptor antagonism on the appetite center, with the ability to stimulate appetite? A. Hydroxyzine B. Loratadine C. Diphenhydramine D. Cyproheptadine - Correct Answer-D. Cyproheptadine Which drug for headache is contraindicated in patients with peripheral vascular disease? A. Ergotamine Pharm Pharm B. Aspirin C. Acetaminophen D. Naproxen - Correct Answer-A. Ergotamine A 29-year-old woman complains of migraine headaches associated with early onset vomiting. Currently, she uses ibuprofen as needed for her migraines, but it is not very effective. Which triptan would be ideal for this patient? A. Naratriptan B. Zolmitriptan C. Frovatriptan D. Almotriptan - Correct Answer-B. Zolmitriptan A 35-year-old woman is having several severe migraines per month. The migraines are usually relieved with one or two doses of triptan drugs. Which is most appropriate for prophylaxis to reduce the frequency of her migraines? A. Dihydroergotamine B. Ibuprofen C. Propranolol D. Sumatriptan - Correct Answer-C. Propranolol A 27-year-old married woman is asking about treatment options for obesity. She recently stopped taking her birth control medications, as she felt they were contributing to her weight gain. Which medication should be avoided in this patient? A. Phentermineltopiramate B. Orlistat C. Diethylpropion D. Lorcase ri n - Correct Answer-A. Phentermineltopiramate A fellow health care provider is concerned about prescribing orlistat to adolescent patients. Many of his adolescent patients are stopping the medication during the first month of treatment. Which side effect is the most likely reason the adolescents are stopping orlistat? A. Valvulopathy B. Suicidal ideation C. Drowsiness D. Flatulence - Correct Answer-D. Flatulence A 38-year-old obese man with depression is considering a weight loss medication following several failed attempts with diet and exercise. Which medication could be considered in this individual? A. Liraglutide B. Bupropion + naltrexone Pharm Pharm C. Orlistat D. Lorcaserin - Correct Answer-C. Orlistat A 12·year-old girl with asthma presents to the emergency room with complaints of cough, dyspnea, and wheezing after visiting a riding stable. Which is the most appropriate drug to rapidly reverse her bronchoconstriction? A. Inhaled fluticasone B. Inhaled beclomethasone C. Inhaled albuterol D. Intravenous propranolol - Correct Answer-C. Inhaled albuterol A 9-year-old girl has severe asthma that required three hospitalizations in the past year. She is now receiving therapy that has greatly reduced the frequency of severe attacks. Which drug is most likely responsible for this benefit? A. Inhaled albuterol B. Inhaled ipratropium C. Inhaled fluticasone D. Oral zafirlukast - Correct Answer-C. Inhaled fluticasone A 68-year·old man has COPD with moderate airway obstruction. Despite using salmeterol twice daily, he reports continued symptoms of shortness of breath with mild exertion. Which agent is an appropriate addition to his currant therapy? A. Systemic corticosteroids B. Albuterol C. Tiotropium D. Roflumilast - Correct Answer-C. Tiotropium A 58-year-old woman with COPD has been hospitalized three times in the past year for COPD exacerbations. She reports only mild symptoms between exacerbations. Her regimen for the past year has included inhaled salmeterol twice daily and inhaled tiotropium once daily. Her current FEV1 is below 60%. Which is an appropriate change in her drug therapy? A. Discontinue the tiotropium. B. Discontinue the salmeterol. C. Change the salmeterol to a combination product that includes both a LABA and an inhaled corticosteroid (for example, salmetero/fluticasone DPI). D. Add theophylline. - Correct Answer-C. Change the salmeterol to a combination product that includes both a LABA and an inhaled corticosteroid (for example, salmeterol/fluticasone DPI). Pharm Pharm A 32-year-old man with a history of opioid addiction presents with cough due to a viral upper respiratory system infection. Which is appropriate symptomatic treatment for cough in this patient? A. Guaifenesin/dextromethorphan B. Guaifenesin/codeine C. Benzonatate D. Montelukast - Correct Answer-C. Benzonatate Because of its anti-inflammatory mechanism of action, which drug requires regular administration for the treatment of asthma? A. Tiotropium B. Salmeterol C. Mometasone D. Albuterol - Correct Answer-C. Mometasone Which agent is a preferred antihistamine for the management of allergic rhinitis? A. Chlorpheniramine B. Diphenhydramine C. Phenylephrine D. Cetirizine - Correct Answer-D. Cetirizine Which medication inhibits the action of 5-lipoxygenase and consequently the action of leukotriene B4 and the cysteinylleukotrienes? A. Cromolyn B. Zafirlukast C. Zileuton D. Montelukast - Correct Answer-C. Zileuton Which statement describes appropriate inhaler technique for a dry powder inhaler? A. Inhale slowly and deeply just before and throughout actuation of the inhaler. B. Use a large-volume chamber (spacer) to decrease deposition of drug in the mouth caused by improper inhaler technique. C. Inhale quickly and deeply to optimize drug delivery to the lungs. D. Rinse mouth in a "swish-and-spif' method with water prior to inhaler use to decrease the chance of adverse events. - Correct Answer-C. Inhale quickly and deeply to optimize drug delivery to the lungs. Which category of allergic rhinitis medications is most likely to be associated with rhinitis medicamentosa (rebound nasal congestion) with prolonged use? A. Intranasal corticosteroid B. Intranasal decongestant Pharm Pharm C. Leukotriene antagonist D. Oral antihistamine - Correct Answer-B. Intranasal decongestant A 68-year-old patient with cardiac failure is diagnosed with ovarian cancer. She begins using cisplatin but becomes nauseous and suffers from severe vomiting. Which drug would be most effective to counteract the emesis in this patient without exacerbating her cardiac problem? A. Droperidol B. Dolasetron C. Prochlorperazine D. Palonosetron - Correct Answer-D. Palonosetron A 45-year-old woman complains of severe persistent heartburn and an unpleasant, acid-like taste in her mouth. The clinician suspects that she has gastroesophageal reflux disease. Which drug is most appropriate? A. An antacid such as aluminum hydroxide B. Dicyclomine C. Granisetron D. Esomeprazole - Correct Answer-D. Esomeprazole A couple celebrating their 30th wedding anniversary are given a trip to Peru to visit Machu Picchu. Because of past experiences while traveling, they ask their doctor to prescribe an agent in case they experience diarrhea. Which drug would be effective? A. Omeprazole B. Loperamide C. Famotidine D. Lubiprostone - Correct Answer-B. Loperamide A 27-year-old woman who is 34 weeks' pregnant is on bed rest and is experiencing mild constipation. Which drug is most appropriate for her? A. Castor oil B. Docusate C. Mineral oil D. Loperamide - Correct Answer-B. Docusate Which drug has been known to cause discoloration of the tongue? A. Amoxicillin B. Omeprazole C. Bismuth subsalicylate D. Lubiprostone - Correct Answer-C. Bismuth subsalicylate Pharm Pharm An elderly woman with a recent history of myocardial infarction is seeking medication to help treat her occasional heartburn. She is currently taking several medications, including aspirin, clopidogrel, simvastatin, metoprolol, and lisinopril. Which drug should be avoided in this patient? A. Calcium citrate B. Famotidine C. Omeprazole D. Ranitidine - Correct Answer-C. Omeprazole Extrapyramidal symptoms (EPS) have been associated with which drug? A. Metoclopramide B. Sucralfate C. Aprepitant D. Bisacodyl - Correct Answer-A. Metoclopramide Which agent for gastrointestinal problems is contraindicated in pregnancy? A. Calcium carbonate B. Famotidine C. Lansoprazole D. Misoprostol - Correct Answer-D. Misoprostol A patient presents with a 2-month history of crampy right lower quadrant abdominal pain. Results of endoscopy are consistent with moderate Crohn's disease involving the terminal ileum and proximal large intestine. Which drug is best to initiate in this patient at this time? A. Extended-release budesonide B. Delayed-release budesonide C. Mesalamine enema D. Ustekinumab - Correct Answer-B. Delayed-release budesonide A patient with a history of ulcerative colitis well controlled on mesalamine (Apriso) presents with epigastric pain and dark tarry stools. He is found to have a duodenal ulcer and is prescribed omeprazole for 8 weeks. At follow-up 2 weeks later, his epigastric pain and dark tarry stools are resolved. However, he reports having increased lower abdominal pain and increased stool frequency. Which change in drug therapy is appropriate at this time? A. Change esomeprazole to omeprazole due to interaction with mesalamine (Apriso). B. Discontinue esomeprazole. c. Change mesalamine {Apriso) to mesalamine (Asacol). Pharm Pharm D. Change masalamine (Apriso) to olsalazine (Dipantum). - Correct Answer-D. Change masalamine (Apriso) to olsalazine (Dipantum). A 6-year-old boy presents to his pediatrician for followup of recurrent hay fever and asthma. He usually has two to three attacks per week. For symptom control, he uses an albuterol inhaler, but his parents would like to try something more. They would like him to take something that would lessen the amount of attacks he has. Although corticosteroids would probably work best for prophylaxis, they are contraindicated in children. Which of the following drugs would decrease the amount of asthma attacks by preventing an arachidonic acid derivative from binding to its receptor? (A) Aspirin (B) Celecoxib (C) Ipratropium (D) Montelukast (E) Zileuton - Correct Answer-(D) Montelukast A 15-year-old female presents to her primary care physician complaining of runny nose and itchy eyes. She said that she first had these symptoms during the spring a few years ago, but each year, they have been bothering her more. You know there are multiple ways to interfere with the signaling that is causing her symptoms. Which of the following drugs would prevent the release of the main chemical mediator in her case? (A) Cromolyn sodium (B) Diphenhydramine (C) Ranitidine (D) Loratadine (E) Theophylline - Correct Answer-(A) Cromolyn sodium A 52-year-old overweight male steamroller operator presents to his primary care physician complaining of itchy, watery eyes and runny nose in the springtime. He says that he has had this problem for as long as he can remember but does not like going to doctors. His wife finally convinced him to come today to see what his physician might be able to do for him. What is the most appropriate treatment for this patient? (A) Albuterol (B) Diphenhydramine (C) Epinephrine (D) Hydroxyzine (E) Loratadine - Correct Answer-(E) Loratadine Intravenous atropine at low doses is commonly used by oral surgeons during surgical procedures to remove impacted wisdom teeth. The rationale behind the use of this agent in this situation likely involves which of the following beneficial effects? Pharm Pharm (A) Antispasmodic for gastrointestinal tract relaxation (B) Drying effect on the oral mucous membranes (C) Induction of tachycardia to increase cardiac output (D) Pupillary dilation to produce unresponsiveness to darkness (E) Reduction of urinary tract motility to reduce voiding during the procedure - Correct Answer-(B) Drying effect on the oral mucous membranes A 63-year-old man with glaucoma maintained on a regimen of topical medications with an exacerbation of his symptoms. He complains of difficulty with his vision in both eyes and has headaches. Which of the following drugs is the most appropriate treatment for this patient? (A) Bimatoprost (B) Latanoprost (C) Pilocarpine (D) Tetracycline (E) Travoprost - Correct Answer-(C) Pilocarpine A 39-year-old man with chronic allergic rhinitis and nasal congestion takes an over-the counter nasal spray containing oxymetazoline. Over the next few days, he has significant improvement in his symptoms. Which of the following is the most likely mechanism of action of this agent? (A) Increased nasal blood flow (B) Increased intranasal arterial pressure (C) Receptor stimulation on nasal vasculature (D) Transmembrane conductance change (E) Understimulation of inflamed nasal membranes - Correct Answer-(C) Receptor stimulation on nasal vasculature A 33-year-old man spends the morning outside gardening in the sun on a warm spring day. He develops a tension hea