NU 220
Pharmacology
Proctored Final Exam
2026
(Questions & Answers)
1. Case: A patient on warfarin develops bleeding after starting an antibiotic.
Q: Which mechanism explains this interaction?
• A. Increased vitamin K absorption
• B. CYP450 inhibition
• C. Enhanced platelet aggregation
• D. Increased renal clearance
Answer: B
Rationale: Antibiotics inhibit CYP450 → reduced warfarin metabolism → bleeding risk.
2. Case: A patient with asthma is prescribed propranolol.
Q: Why is this contraindicated?
• A. Causes bronchoconstriction via β2 blockade
• B. Increases mucus secretion
• C. Stimulates β2 receptors
• D. Enhances histamine release
Answer: A
Rationale: Non-selective β-blockers worsen asthma.
3. Case: A nurse administers morphine.
Q: Which receptor mediates analgesia?
• A. NMDA
• B. Mu opioid receptor
• C. GABA
• D. Dopamine D2
Answer: B
Rationale: Mu receptor activation produces analgesia.
4. Case: A patient with hypertension is prescribed lisinopril.
Q: Which adverse effect is most common?
• A. Hypokalemia
• B. Cough
• C. Bradycardia
• D. Constipation
Answer: B
Rationale: ACE inhibitors increase bradykinin → cough.
5. Case: A patient with TB is treated with isoniazid.
Q: Which vitamin deficiency may occur?
,• A. Vitamin B6 (pyridoxine)
• B. Vitamin B12
• C. Vitamin D
• D. Vitamin K
Answer: A
Rationale: Isoniazid causes pyridoxine deficiency → neuropathy.
6. Case: A patient develops serotonin syndrome after combining SSRIs with another drug.
Q: Which drug likely contributed?
• A. Triptans
• B. Beta blockers
• C. Diuretics
• D. Antacids
Answer: A
Rationale: Triptans + SSRIs → serotonin excess.
7. Case: A patient on digoxin develops arrhythmia.
Q: Which electrolyte imbalance worsens toxicity?
• A. Hyperkalemia
• B. Hypokalemia
• C. Hypernatremia
• D. Hypocalcemia
Answer: B
Rationale: Low potassium increases digoxin binding → toxicity.
8. Case: A patient with peptic ulcer is prescribed omeprazole.
Q: Mechanism of action?
• A. Blocks H2 receptors
• B. Inhibits proton pump (H+/K+ ATPase)
• C. Neutralizes acid
• D. Stimulates mucus secretion
Answer: B
Rationale: PPIs inhibit gastric proton pump.
9. Case: A patient with schizophrenia is treated with haloperidol.
Q: Which adverse effect is most concerning?
• A. Tardive dyskinesia
• B. Hypoglycemia
• C. Constipation
• D. Hypertension
Answer: A
Rationale: Typical antipsychotics cause extrapyramidal symptoms.
10. Case: A patient with angina is prescribed nitroglycerin.
Q: Which mechanism explains relief?
• A. Coronary vasoconstriction
, • B. Venodilation reduces preload
• C. Increased heart rate
• D. Enhanced platelet aggregation
Answer: B
Rationale: Venodilation decreases cardiac workload.
11. Case: A patient with diabetes is prescribed metformin.
Q: Which adverse effect is rare but serious?
• A. Hypoglycemia
• B. Lactic acidosis
• C. Weight gain
• D. Hypertension
Answer: B
Rationale: Metformin rarely causes lactic acidosis.
12. Case: A patient with seizures is prescribed phenytoin.
Q: Which adverse effect is characteristic?
• A. Gingival hyperplasia
• B. Alopecia
• C. Constipation
• D. Hypoglycemia
Answer: A
Rationale: Phenytoin causes gingival overgrowth.
True/False (8 Questions)
13. Case: Beta-1 selective blockers are safer in asthma than non-selective ones.
Answer: True
Rationale: They avoid bronchoconstriction.
14. Case: Naloxone is an opioid agonist.
Answer: False
Rationale: Naloxone is an antagonist.
15. Case: Aminoglycosides can cause nephrotoxicity and ototoxicity.
Answer: True
Rationale: Classic adverse effects.
16. Case: Insulin glargine is a short-acting insulin.
Answer: False
Rationale: It is long-acting.
17. Case: Calcium channel blockers reduce afterload by vasodilation.
Answer: True
Rationale: They relax vascular smooth muscle.
Pharmacology
Proctored Final Exam
2026
(Questions & Answers)
1. Case: A patient on warfarin develops bleeding after starting an antibiotic.
Q: Which mechanism explains this interaction?
• A. Increased vitamin K absorption
• B. CYP450 inhibition
• C. Enhanced platelet aggregation
• D. Increased renal clearance
Answer: B
Rationale: Antibiotics inhibit CYP450 → reduced warfarin metabolism → bleeding risk.
2. Case: A patient with asthma is prescribed propranolol.
Q: Why is this contraindicated?
• A. Causes bronchoconstriction via β2 blockade
• B. Increases mucus secretion
• C. Stimulates β2 receptors
• D. Enhances histamine release
Answer: A
Rationale: Non-selective β-blockers worsen asthma.
3. Case: A nurse administers morphine.
Q: Which receptor mediates analgesia?
• A. NMDA
• B. Mu opioid receptor
• C. GABA
• D. Dopamine D2
Answer: B
Rationale: Mu receptor activation produces analgesia.
4. Case: A patient with hypertension is prescribed lisinopril.
Q: Which adverse effect is most common?
• A. Hypokalemia
• B. Cough
• C. Bradycardia
• D. Constipation
Answer: B
Rationale: ACE inhibitors increase bradykinin → cough.
5. Case: A patient with TB is treated with isoniazid.
Q: Which vitamin deficiency may occur?
,• A. Vitamin B6 (pyridoxine)
• B. Vitamin B12
• C. Vitamin D
• D. Vitamin K
Answer: A
Rationale: Isoniazid causes pyridoxine deficiency → neuropathy.
6. Case: A patient develops serotonin syndrome after combining SSRIs with another drug.
Q: Which drug likely contributed?
• A. Triptans
• B. Beta blockers
• C. Diuretics
• D. Antacids
Answer: A
Rationale: Triptans + SSRIs → serotonin excess.
7. Case: A patient on digoxin develops arrhythmia.
Q: Which electrolyte imbalance worsens toxicity?
• A. Hyperkalemia
• B. Hypokalemia
• C. Hypernatremia
• D. Hypocalcemia
Answer: B
Rationale: Low potassium increases digoxin binding → toxicity.
8. Case: A patient with peptic ulcer is prescribed omeprazole.
Q: Mechanism of action?
• A. Blocks H2 receptors
• B. Inhibits proton pump (H+/K+ ATPase)
• C. Neutralizes acid
• D. Stimulates mucus secretion
Answer: B
Rationale: PPIs inhibit gastric proton pump.
9. Case: A patient with schizophrenia is treated with haloperidol.
Q: Which adverse effect is most concerning?
• A. Tardive dyskinesia
• B. Hypoglycemia
• C. Constipation
• D. Hypertension
Answer: A
Rationale: Typical antipsychotics cause extrapyramidal symptoms.
10. Case: A patient with angina is prescribed nitroglycerin.
Q: Which mechanism explains relief?
• A. Coronary vasoconstriction
, • B. Venodilation reduces preload
• C. Increased heart rate
• D. Enhanced platelet aggregation
Answer: B
Rationale: Venodilation decreases cardiac workload.
11. Case: A patient with diabetes is prescribed metformin.
Q: Which adverse effect is rare but serious?
• A. Hypoglycemia
• B. Lactic acidosis
• C. Weight gain
• D. Hypertension
Answer: B
Rationale: Metformin rarely causes lactic acidosis.
12. Case: A patient with seizures is prescribed phenytoin.
Q: Which adverse effect is characteristic?
• A. Gingival hyperplasia
• B. Alopecia
• C. Constipation
• D. Hypoglycemia
Answer: A
Rationale: Phenytoin causes gingival overgrowth.
True/False (8 Questions)
13. Case: Beta-1 selective blockers are safer in asthma than non-selective ones.
Answer: True
Rationale: They avoid bronchoconstriction.
14. Case: Naloxone is an opioid agonist.
Answer: False
Rationale: Naloxone is an antagonist.
15. Case: Aminoglycosides can cause nephrotoxicity and ototoxicity.
Answer: True
Rationale: Classic adverse effects.
16. Case: Insulin glargine is a short-acting insulin.
Answer: False
Rationale: It is long-acting.
17. Case: Calcium channel blockers reduce afterload by vasodilation.
Answer: True
Rationale: They relax vascular smooth muscle.
