CLINICAL PHARMACOLOGY EXAM 3 COMPLETE QUESTIONS WITH
ANSWERS 100% VERIFIED 2025 LATEST UPDATED ALREADY
GRADED A+
Question 1
A patient with heart failure and a history of angioedema is prescribed an antihypertensive.
Which class of medication is strictly contraindicated due to the high risk of recurrent
angioedema?
A) Calcium Channel Blockers (e.g., Amlodipine)
B) Angiotensin-Converting Enzyme (ACE) Inhibitors (e.g., Lisinopril)
C) Beta-Adrenergic Blockers (e.g., Metoprolol)
D) Loop Diuretics (e.g., Furosemide)
E) Thiazide Diuretics (e.g., Hydrochlorothiazide)
Correct Answer: B) Angiotensin-Converting Enzyme (ACE) Inhibitors (e.g., Lisinopril)
Rationale: ACE inhibitors prevent the breakdown of bradykinin. Elevated bradykinin
levels are responsible for the dry cough and the potentially life-threatening angioedema
associated with this class. If a patient has a history of angioedema (swelling of the lips,
tongue, or face), ACE inhibitors are contraindicated. Angiotensin II Receptor Blockers
(ARBs) are often used as an alternative, though cross-reactivity can occasionally occur.
Question 2
A patient taking Digoxin (Lanoxin) for heart failure reports nausea, vomiting, and seeing
"yellow-green halos" around lights. The nurse checks the heart rate and finds it to be 48
bpm. What is the most likely clinical interpretation?
A) The patient is experiencing an allergic reaction to Digoxin.
B) These are normal side effects of loading doses.
C) The patient has developed Digoxin Toxicity.
D) The patient is experiencing worsening heart failure symptoms.
E) The patient has hypokalemia but normal drug levels.
Correct Answer: C) The patient has developed Digoxin Toxicity.
Rationale: Digoxin has a narrow therapeutic index (0.5–2.0 ng/mL). Classic signs of toxicity
include gastrointestinal distress (anorexia, nausea, vomiting), neurological disturbances
(fatigue), and visual changes (yellow/green halos or blurred vision). Bradycardia (HR < 60)
and arrhythmias are serious cardiac manifestations. Hypokalemia often precipitates this
toxicity.
Question 3
A patient with atrial fibrillation is prescribed Warfarin (Coumadin). Which laboratory
value must be monitored to adjust the dosing, and what is the typical therapeutic target?
,[Type here]
A) aPTT; target 1.5–2.5 times control.
B) INR; target 2.0–3.0.
C) Serum Potassium; target 3.5–5.0 mEq/L.
D) Platelet count; target >150,000.
E) Serum Creatinine; target <1.2 mg/dL.
Correct Answer: B) INR; target 2.0–3.0.
Rationale: Warfarin effects are monitored using the Prothrombin Time (PT) and the
International Normalized Ratio (INR). For most conditions like atrial fibrillation or
DVT/PE, the target INR is between 2.0 and 3.0. The aPTT is used to monitor
Unfractionated Heparin.
Question 4
Which class of diuretics is most potent and effective for rapid diuresis in patients with
severe renal impairment or acute pulmonary edema?
A) Thiazide Diuretics (e.g., Hydrochlorothiazide)
B) Potassium-Sparing Diuretics (e.g., Spironolactone)
C) Loop Diuretics (e.g., Furosemide)
D) Osmotic Diuretics (e.g., Mannitol)
E) Carbonic Anhydrase Inhibitors (e.g., Acetazolamide)
Correct Answer: C) Loop Diuretics (e.g., Furosemide)
Rationale: Loop diuretics act on the thick ascending limb of the Loop of Henle, blocking
the Na+/K+/2Cl- cotransporter. This site accounts for the reabsorption of a large
percentage of sodium (20-25%), making loop diuretics the most potent class ("high ceiling"
diuretics). They remain effective even when the Glomerular Filtration Rate (GFR) is low.
Question 5
A patient prescribed a non-selective Beta-Blocker (e.g., Propranolol) for hypertension
presents with a new onset of wheezing and shortness of breath. What is the
pharmacological explanation for this adverse effect?
A) Blockade of Beta-1 receptors decreases heart rate excessively.
B) Blockade of Beta-2 receptors in the lungs causes bronchoconstriction.
C) Stimulation of Alpha-1 receptors causes smooth muscle contraction.
D) The drug causes fluid retention in the lungs.
E) Anaphylaxis due to sulfa moiety.
Correct Answer: B) Blockade of Beta-2 receptors in the lungs causes bronchoconstriction.
Rationale: Non-selective beta-blockers antagonize both Beta-1 (heart) and Beta-2
(lungs/vessels) receptors. Beta-2 activation normally causes bronchodilation. Blocking
,[Type here]
Beta-2 receptors can lead to bronchoconstriction, which can precipitate an asthma attack
or respiratory distress in susceptible patients (COPD/Asthma). Cardioselective beta-
blockers (e.g., Metoprolol, Atenolol) primarily target Beta-1.
Question 6
Which antihypertensive medication works by blocking the influx of calcium ions into
vascular smooth muscle and cardiac cells, leading to vasodilation and decreased heart rate?
A) Lisinopril
B) Losartan
C) Verapamil
D) Clonidine
E) Hydralazine
Correct Answer: C) Verapamil
Rationale: Verapamil is a Non-Dihydropyridine Calcium Channel Blocker (CCB). It
inhibits calcium ion channels in vascular smooth muscle (causing vasodilation) and the
myocardium/conduction system (decreasing heart rate and contractility). Dihydropyridine
CCBs (like Amlodipine) focus mainly on vasodilation with less effect on the heart rate.
Question 7
A patient is taking Spironolactone (Aldactone). Which laboratory abnormality should the
clinician monitor for most closely?
A) Hypokalemia
B) Hypernatremia
C) Hyperkalemia
D) Hypocalcemia
E) Hyperglycemia
Correct Answer: C) Hyperkalemia
Rationale: Spironolactone is a potassium-sparing diuretic and aldosterone antagonist. By
blocking aldosterone in the distal tubule, it promotes sodium and water excretion while
retaining potassium. This carries a significant risk of hyperkalemia, especially if combined
with ACE inhibitors or potassium supplements.
Question 8
A patient with stable angina is prescribed Nitroglycerin sublingual tablets. What
instructions should be provided regarding the administration of this medication for acute
chest pain?
, [Type here]
A) Swallow the tablet immediately with a full glass of water.
B) Chew the tablet thoroughly before swallowing.
C) Place one tablet under the tongue; repeat every 5 minutes for up to 3 doses if pain persists.
Call 911 if pain persists after the first dose (or per specific protocol).
D) Take one tablet every morning to prevent attacks.
E) Dissolve the tablet in juice and drink slowly.
Correct Answer: C) Place one tablet under the tongue; repeat every 5 minutes for up to 3
doses if pain persists. Call 911 if pain persists after the first dose (or per specific protocol).
Rationale: Sublingual nitroglycerin bypasses the "first-pass effect" of the liver, allowing for
rapid absorption into the systemic circulation to treat acute angina. The standard protocol
is usually 1 tablet every 5 minutes x 3 doses. However, modern guidelines emphasize calling
emergency services if pain does not improve after the first dose.
Question 9
Which lipid-lowering agent is associated with the rare but serious adverse effect of
rhabdomyolysis (muscle breakdown)?
A) Cholestyramine (Bile Acid Sequestrant)
B) Atorvastatin (HMG-CoA Reductase Inhibitor)
C) Ezetimibe (Cholesterol Absorption Inhibitor)
D) Niacin (Nicotinic Acid)
E) Omega-3 Fatty Acids
Correct Answer: B) Atorvastatin (HMG-CoA Reductase Inhibitor)
Rationale: Statins (HMG-CoA reductase inhibitors) can cause myopathy, presenting as
muscle pain and weakness. In severe cases, this can progress to rhabdomyolysis, leading to
the release of myoglobin which causes acute kidney injury. Patients are instructed to report
unexplained muscle pain immediately.
Question 10
What is the specific antidote used to reverse the effects of Unfractionated Heparin in the
event of severe bleeding?
A) Vitamin K (Phytonadione)
B) Protamine Sulfate
C) Aminocaproic Acid
D) Idarucizumab
E) Flumazenil
Correct Answer: B) Protamine Sulfate
Rationale: Protamine Sulfate is a highly cationic peptide that binds to the negatively
ANSWERS 100% VERIFIED 2025 LATEST UPDATED ALREADY
GRADED A+
Question 1
A patient with heart failure and a history of angioedema is prescribed an antihypertensive.
Which class of medication is strictly contraindicated due to the high risk of recurrent
angioedema?
A) Calcium Channel Blockers (e.g., Amlodipine)
B) Angiotensin-Converting Enzyme (ACE) Inhibitors (e.g., Lisinopril)
C) Beta-Adrenergic Blockers (e.g., Metoprolol)
D) Loop Diuretics (e.g., Furosemide)
E) Thiazide Diuretics (e.g., Hydrochlorothiazide)
Correct Answer: B) Angiotensin-Converting Enzyme (ACE) Inhibitors (e.g., Lisinopril)
Rationale: ACE inhibitors prevent the breakdown of bradykinin. Elevated bradykinin
levels are responsible for the dry cough and the potentially life-threatening angioedema
associated with this class. If a patient has a history of angioedema (swelling of the lips,
tongue, or face), ACE inhibitors are contraindicated. Angiotensin II Receptor Blockers
(ARBs) are often used as an alternative, though cross-reactivity can occasionally occur.
Question 2
A patient taking Digoxin (Lanoxin) for heart failure reports nausea, vomiting, and seeing
"yellow-green halos" around lights. The nurse checks the heart rate and finds it to be 48
bpm. What is the most likely clinical interpretation?
A) The patient is experiencing an allergic reaction to Digoxin.
B) These are normal side effects of loading doses.
C) The patient has developed Digoxin Toxicity.
D) The patient is experiencing worsening heart failure symptoms.
E) The patient has hypokalemia but normal drug levels.
Correct Answer: C) The patient has developed Digoxin Toxicity.
Rationale: Digoxin has a narrow therapeutic index (0.5–2.0 ng/mL). Classic signs of toxicity
include gastrointestinal distress (anorexia, nausea, vomiting), neurological disturbances
(fatigue), and visual changes (yellow/green halos or blurred vision). Bradycardia (HR < 60)
and arrhythmias are serious cardiac manifestations. Hypokalemia often precipitates this
toxicity.
Question 3
A patient with atrial fibrillation is prescribed Warfarin (Coumadin). Which laboratory
value must be monitored to adjust the dosing, and what is the typical therapeutic target?
,[Type here]
A) aPTT; target 1.5–2.5 times control.
B) INR; target 2.0–3.0.
C) Serum Potassium; target 3.5–5.0 mEq/L.
D) Platelet count; target >150,000.
E) Serum Creatinine; target <1.2 mg/dL.
Correct Answer: B) INR; target 2.0–3.0.
Rationale: Warfarin effects are monitored using the Prothrombin Time (PT) and the
International Normalized Ratio (INR). For most conditions like atrial fibrillation or
DVT/PE, the target INR is between 2.0 and 3.0. The aPTT is used to monitor
Unfractionated Heparin.
Question 4
Which class of diuretics is most potent and effective for rapid diuresis in patients with
severe renal impairment or acute pulmonary edema?
A) Thiazide Diuretics (e.g., Hydrochlorothiazide)
B) Potassium-Sparing Diuretics (e.g., Spironolactone)
C) Loop Diuretics (e.g., Furosemide)
D) Osmotic Diuretics (e.g., Mannitol)
E) Carbonic Anhydrase Inhibitors (e.g., Acetazolamide)
Correct Answer: C) Loop Diuretics (e.g., Furosemide)
Rationale: Loop diuretics act on the thick ascending limb of the Loop of Henle, blocking
the Na+/K+/2Cl- cotransporter. This site accounts for the reabsorption of a large
percentage of sodium (20-25%), making loop diuretics the most potent class ("high ceiling"
diuretics). They remain effective even when the Glomerular Filtration Rate (GFR) is low.
Question 5
A patient prescribed a non-selective Beta-Blocker (e.g., Propranolol) for hypertension
presents with a new onset of wheezing and shortness of breath. What is the
pharmacological explanation for this adverse effect?
A) Blockade of Beta-1 receptors decreases heart rate excessively.
B) Blockade of Beta-2 receptors in the lungs causes bronchoconstriction.
C) Stimulation of Alpha-1 receptors causes smooth muscle contraction.
D) The drug causes fluid retention in the lungs.
E) Anaphylaxis due to sulfa moiety.
Correct Answer: B) Blockade of Beta-2 receptors in the lungs causes bronchoconstriction.
Rationale: Non-selective beta-blockers antagonize both Beta-1 (heart) and Beta-2
(lungs/vessels) receptors. Beta-2 activation normally causes bronchodilation. Blocking
,[Type here]
Beta-2 receptors can lead to bronchoconstriction, which can precipitate an asthma attack
or respiratory distress in susceptible patients (COPD/Asthma). Cardioselective beta-
blockers (e.g., Metoprolol, Atenolol) primarily target Beta-1.
Question 6
Which antihypertensive medication works by blocking the influx of calcium ions into
vascular smooth muscle and cardiac cells, leading to vasodilation and decreased heart rate?
A) Lisinopril
B) Losartan
C) Verapamil
D) Clonidine
E) Hydralazine
Correct Answer: C) Verapamil
Rationale: Verapamil is a Non-Dihydropyridine Calcium Channel Blocker (CCB). It
inhibits calcium ion channels in vascular smooth muscle (causing vasodilation) and the
myocardium/conduction system (decreasing heart rate and contractility). Dihydropyridine
CCBs (like Amlodipine) focus mainly on vasodilation with less effect on the heart rate.
Question 7
A patient is taking Spironolactone (Aldactone). Which laboratory abnormality should the
clinician monitor for most closely?
A) Hypokalemia
B) Hypernatremia
C) Hyperkalemia
D) Hypocalcemia
E) Hyperglycemia
Correct Answer: C) Hyperkalemia
Rationale: Spironolactone is a potassium-sparing diuretic and aldosterone antagonist. By
blocking aldosterone in the distal tubule, it promotes sodium and water excretion while
retaining potassium. This carries a significant risk of hyperkalemia, especially if combined
with ACE inhibitors or potassium supplements.
Question 8
A patient with stable angina is prescribed Nitroglycerin sublingual tablets. What
instructions should be provided regarding the administration of this medication for acute
chest pain?
, [Type here]
A) Swallow the tablet immediately with a full glass of water.
B) Chew the tablet thoroughly before swallowing.
C) Place one tablet under the tongue; repeat every 5 minutes for up to 3 doses if pain persists.
Call 911 if pain persists after the first dose (or per specific protocol).
D) Take one tablet every morning to prevent attacks.
E) Dissolve the tablet in juice and drink slowly.
Correct Answer: C) Place one tablet under the tongue; repeat every 5 minutes for up to 3
doses if pain persists. Call 911 if pain persists after the first dose (or per specific protocol).
Rationale: Sublingual nitroglycerin bypasses the "first-pass effect" of the liver, allowing for
rapid absorption into the systemic circulation to treat acute angina. The standard protocol
is usually 1 tablet every 5 minutes x 3 doses. However, modern guidelines emphasize calling
emergency services if pain does not improve after the first dose.
Question 9
Which lipid-lowering agent is associated with the rare but serious adverse effect of
rhabdomyolysis (muscle breakdown)?
A) Cholestyramine (Bile Acid Sequestrant)
B) Atorvastatin (HMG-CoA Reductase Inhibitor)
C) Ezetimibe (Cholesterol Absorption Inhibitor)
D) Niacin (Nicotinic Acid)
E) Omega-3 Fatty Acids
Correct Answer: B) Atorvastatin (HMG-CoA Reductase Inhibitor)
Rationale: Statins (HMG-CoA reductase inhibitors) can cause myopathy, presenting as
muscle pain and weakness. In severe cases, this can progress to rhabdomyolysis, leading to
the release of myoglobin which causes acute kidney injury. Patients are instructed to report
unexplained muscle pain immediately.
Question 10
What is the specific antidote used to reverse the effects of Unfractionated Heparin in the
event of severe bleeding?
A) Vitamin K (Phytonadione)
B) Protamine Sulfate
C) Aminocaproic Acid
D) Idarucizumab
E) Flumazenil
Correct Answer: B) Protamine Sulfate
Rationale: Protamine Sulfate is a highly cationic peptide that binds to the negatively
