APEA Pharmacology Exam Questions and Answers
|Fall 2025/2026 Update | 100% Correct Latest
QUESTION 1
A patient receiving lisinopril reports a persistent dry cough. Which mechanism best explains this
adverse effect?
A. Increased dopamine receptor blockade
B. Accumulation of bradykinin
C. Antagonism of beta-adrenergic receptors
D. Sodium retention
CORRECT ANSWER: B
RATIONALE: ACE inhibitors such as lisinopril decrease the degradation of bradykinin, leading to
its accumulation in the lungs and resulting in a dry, nonproductive cough. Beta-blockade and
sodium retention are unrelated mechanisms.
QUESTION 2
Which of the following antibiotics poses a risk for tendon rupture, particularly in older adults or
those on corticosteroids?
A. Ceftriaxone
B. Azithromycin
C. Ciprofloxacin
D. Doxycycline
CORRECT ANSWER: C
RATIONALE: Fluoroquinolones like ciprofloxacin interfere with collagen synthesis and can
predispose to tendon rupture, especially in high-risk populations.
QUESTION 3
What is the primary mechanism of action of metformin?
A. Direct stimulation of insulin release from pancreatic beta cells
B. Decreased hepatic glucose production and increased insulin sensitivity
,C. Delay of intestinal carbohydrate absorption
D. Inhibition of SGLT2 glucose reabsorption in the kidney
CORRECT ANSWER: B
RATIONALE: Metformin primarily decreases hepatic gluconeogenesis and improves peripheral
insulin sensitivity. It does not cause insulin secretion and thus rarely leads to hypoglycemia.
QUESTION 4
Which drug class should be avoided in patients taking nitrates due to the risk of severe
hypotension?
A. Alpha-blockers
B. PDE-5 inhibitors
C. Beta-blockers
D. Calcium channel blockers
CORRECT ANSWER: B
RATIONALE: PDE-5 inhibitors (e.g., sildenafil) potentiate nitric oxide-mediated vasodilation, and
concurrent use with nitrates can cause life-threatening hypotension.
QUESTION 5
A 70-year-old male with heart failure is initiated on digoxin. What is an early clinical sign of
digoxin toxicity?
A. Bradycardia and visual disturbances
B. Diarrhea with hypertension
C. Hypoglycemia and tremor
D. Ataxia with hyperreflexia
CORRECT ANSWER: A
RATIONALE: Early digoxin toxicity manifests as bradycardia, nausea, vomiting, and characteristic
visual disturbances (e.g., xanthopsia or yellow-tinged vision).
QUESTION 6
Which of the following antibiotics requires therapeutic drug monitoring due to potential
nephrotoxicity and ototoxicity?
A. Piperacillin-tazobactam
,B. Erythromycin
C. Gentamicin
D. Cefdinir
CORRECT ANSWER: C
RATIONALE: Aminoglycosides like gentamicin have a narrow therapeutic index; serum levels
must be monitored to prevent renal and auditory toxicity.
QUESTION 7
What is the primary adverse effect associated with long-term corticosteroid therapy?
A. Hypoglycemia
B. Osteoporosis
C. Bradycardia
D. Hypotension
CORRECT ANSWER: B
RATIONALE: Chronic corticosteroid use leads to bone resorption, decreased osteoblast activity,
and calcium loss, culminating in osteoporosis.
QUESTION 8
A patient on warfarin is started on trimethoprim-sulfamethoxazole. What is the likely
interaction?
A. Decreased warfarin levels
B. Increased INR and bleeding risk
C. Reduced INR due to hepatic enzyme induction
D. No clinically significant effect
CORRECT ANSWER: B
RATIONALE: TMP-SMX inhibits warfarin metabolism via CYP2C9 inhibition, increasing plasma
concentrations and INR, heightening bleeding risk.
QUESTION 9
What is a unique feature of clopidogrel therapy compared to aspirin?
A. It acts on cyclooxygenase to inhibit platelet aggregation
B. It irreversibly blocks P2Y12 ADP receptors on platelets
, C. It increases thromboxane A2 synthesis
D. It has a faster onset of antiplatelet action
CORRECT ANSWER: B
RATIONALE: Clopidogrel inhibits platelet aggregation by irreversibly binding P2Y12 receptors,
whereas aspirin inhibits COX-1 mediated thromboxane A2 production.
QUESTION 10
Which of the following insulin preparations has the longest duration of action?
A. Insulin aspart
B. NPH insulin
C. Insulin glargine
D. Regular insulin
CORRECT ANSWER: C
RATIONALE: Insulin glargine is a long-acting formulation providing basal coverage with minimal
peaks, typically lasting up to 24 hours.
QUESTION 11
In patients taking lithium, which medication class should generally be avoided due to the risk of
increased lithium levels and toxicity?
A. ACE inhibitors
B. Calcium channel blockers
C. Beta-blockers
D. H2 receptor antagonists
CORRECT ANSWER: A
RATIONALE: ACE inhibitors decrease renal clearance of lithium, raising serum concentrations and
predisposing to toxicity characterized by tremor, ataxia, and confusion.
QUESTION 12
Which antihypertensive drug is contraindicated in pregnancy?
A. Methyldopa
B. Labetalol
C. Losartan
D. Hydralazine
|Fall 2025/2026 Update | 100% Correct Latest
QUESTION 1
A patient receiving lisinopril reports a persistent dry cough. Which mechanism best explains this
adverse effect?
A. Increased dopamine receptor blockade
B. Accumulation of bradykinin
C. Antagonism of beta-adrenergic receptors
D. Sodium retention
CORRECT ANSWER: B
RATIONALE: ACE inhibitors such as lisinopril decrease the degradation of bradykinin, leading to
its accumulation in the lungs and resulting in a dry, nonproductive cough. Beta-blockade and
sodium retention are unrelated mechanisms.
QUESTION 2
Which of the following antibiotics poses a risk for tendon rupture, particularly in older adults or
those on corticosteroids?
A. Ceftriaxone
B. Azithromycin
C. Ciprofloxacin
D. Doxycycline
CORRECT ANSWER: C
RATIONALE: Fluoroquinolones like ciprofloxacin interfere with collagen synthesis and can
predispose to tendon rupture, especially in high-risk populations.
QUESTION 3
What is the primary mechanism of action of metformin?
A. Direct stimulation of insulin release from pancreatic beta cells
B. Decreased hepatic glucose production and increased insulin sensitivity
,C. Delay of intestinal carbohydrate absorption
D. Inhibition of SGLT2 glucose reabsorption in the kidney
CORRECT ANSWER: B
RATIONALE: Metformin primarily decreases hepatic gluconeogenesis and improves peripheral
insulin sensitivity. It does not cause insulin secretion and thus rarely leads to hypoglycemia.
QUESTION 4
Which drug class should be avoided in patients taking nitrates due to the risk of severe
hypotension?
A. Alpha-blockers
B. PDE-5 inhibitors
C. Beta-blockers
D. Calcium channel blockers
CORRECT ANSWER: B
RATIONALE: PDE-5 inhibitors (e.g., sildenafil) potentiate nitric oxide-mediated vasodilation, and
concurrent use with nitrates can cause life-threatening hypotension.
QUESTION 5
A 70-year-old male with heart failure is initiated on digoxin. What is an early clinical sign of
digoxin toxicity?
A. Bradycardia and visual disturbances
B. Diarrhea with hypertension
C. Hypoglycemia and tremor
D. Ataxia with hyperreflexia
CORRECT ANSWER: A
RATIONALE: Early digoxin toxicity manifests as bradycardia, nausea, vomiting, and characteristic
visual disturbances (e.g., xanthopsia or yellow-tinged vision).
QUESTION 6
Which of the following antibiotics requires therapeutic drug monitoring due to potential
nephrotoxicity and ototoxicity?
A. Piperacillin-tazobactam
,B. Erythromycin
C. Gentamicin
D. Cefdinir
CORRECT ANSWER: C
RATIONALE: Aminoglycosides like gentamicin have a narrow therapeutic index; serum levels
must be monitored to prevent renal and auditory toxicity.
QUESTION 7
What is the primary adverse effect associated with long-term corticosteroid therapy?
A. Hypoglycemia
B. Osteoporosis
C. Bradycardia
D. Hypotension
CORRECT ANSWER: B
RATIONALE: Chronic corticosteroid use leads to bone resorption, decreased osteoblast activity,
and calcium loss, culminating in osteoporosis.
QUESTION 8
A patient on warfarin is started on trimethoprim-sulfamethoxazole. What is the likely
interaction?
A. Decreased warfarin levels
B. Increased INR and bleeding risk
C. Reduced INR due to hepatic enzyme induction
D. No clinically significant effect
CORRECT ANSWER: B
RATIONALE: TMP-SMX inhibits warfarin metabolism via CYP2C9 inhibition, increasing plasma
concentrations and INR, heightening bleeding risk.
QUESTION 9
What is a unique feature of clopidogrel therapy compared to aspirin?
A. It acts on cyclooxygenase to inhibit platelet aggregation
B. It irreversibly blocks P2Y12 ADP receptors on platelets
, C. It increases thromboxane A2 synthesis
D. It has a faster onset of antiplatelet action
CORRECT ANSWER: B
RATIONALE: Clopidogrel inhibits platelet aggregation by irreversibly binding P2Y12 receptors,
whereas aspirin inhibits COX-1 mediated thromboxane A2 production.
QUESTION 10
Which of the following insulin preparations has the longest duration of action?
A. Insulin aspart
B. NPH insulin
C. Insulin glargine
D. Regular insulin
CORRECT ANSWER: C
RATIONALE: Insulin glargine is a long-acting formulation providing basal coverage with minimal
peaks, typically lasting up to 24 hours.
QUESTION 11
In patients taking lithium, which medication class should generally be avoided due to the risk of
increased lithium levels and toxicity?
A. ACE inhibitors
B. Calcium channel blockers
C. Beta-blockers
D. H2 receptor antagonists
CORRECT ANSWER: A
RATIONALE: ACE inhibitors decrease renal clearance of lithium, raising serum concentrations and
predisposing to toxicity characterized by tremor, ataxia, and confusion.
QUESTION 12
Which antihypertensive drug is contraindicated in pregnancy?
A. Methyldopa
B. Labetalol
C. Losartan
D. Hydralazine
