1|Page --NU 578 Exam 3—smart studies!!!
NU 578 Exam 3 2026–2027 Latest Update |
Comprehensive Practice 250 + Questions, Detailed
Answer Explanations, Complete Study Review &
Exam Preparation Guide PDF
WHAT YOU WILL GET:
SUMMARY OF THE WHOLE QUESTIONS
COVERED
MULTICHOICES QUESTIONS
DETAILED AND WELL-ELABORATED RATIONALES
250 QUESTIONS WITH 100%CORRECT RESPONSES
Quick Summary Study Notes
MIGRAINE PROPHYLAXIS
1st line: Propranolol (80240mg daily) most common
Other betablockers: Timolol, atenolol, metoprolol, nadolol
Antiepileptics: Divalproex, topiramate (monitor bicarbonate)
TCAs: Amitriptyline 25150mg at HS (anticholinergic SE)
Menstrual: Estrogen gel/patch
PARKINSON'S DISEASE
Cause: Loss of dopamine neurons in substantia nigra
Motor symptoms: Tremor, rigidity, postural instability, bradykinesia
Nonmotor: Depression, dementia, sleep disturbances, autonomic dysfunction
Most effective drug: Levodopacarbidopa
MAOB inhibitors: Selegiline, rasagiline (1st line for mild)
Dopamine agonists: Pramipexole, ropinirole (lower dyskinesia risk)
For dyskinesias: Amantadine (only drug recommended)
For "off times": Entacapone (COMT inhibitor), rasagiline
,2|Page --NU 578 Exam 3—smart studies!!!
Anticholinergics: Trihexyphenidyl, benztropine (AVOID in elderly/cognitive impairment)
ANTIPSYCHOTICS
1st generation (haloperidol): High EPS, tardive dyskinesia risk
2nd generation (olanzapine, risperidone, quetiapine): Lower EPS, HIGHER metabolic effects (weight gain,
diabetes)
Clozapine: Requires CBC monitoring (agranulocytosis risk)
EPS treatment: Benztropine, diphenhydramine
Tardive dyskinesia: Valbenazine (VMAT2 inhibitor)
Neuroleptic malignant syndrome: Dantrolene + bromocriptine
LITHIUM (BIPOLAR)
Trough level: Draw 12hrs after last dose (before morning dose)
Monitor: Thyroid, renal function, serum levels
Avoid: NSAIDs (increase lithium levels), dehydration, lowsodium diets
Toxicity signs: Coarse tremor, ataxia, confusion, nausea
OPIOIDS
Heroin: High lipid solubility → rapid BBB crossing
Abuse risk in HC providers: Due to drug access
Meperidine preferred by abusers: Less pupillary constriction, constipation, urinary retention
Antidote: Naloxone
Buprenorphine: Partial agonist, ceiling effect, lower abuse potential
BENZODIAZEPINES
MOA: Enhance GABAA receptor activity
Use: Shortterm anxiety, insomnia, conscious sedation
Antidote: Flumazenil
Risk: Tolerance, dependence, respiratory depression
ANTIDEPRESSANTS
SSRIs (fluoxetine, sertraline): Block serotonin reuptake; SE: GI upset, sexual dysfunction
TCAs (amitriptyline): Anticholinergic SE; monitor for cardiac effects
MAOIs: Avoid tyraminerich foods (aged cheese) → hypertensive crisis
CNS BASICS
BBB: Lipidsoluble drugs cross; proteinbound/ionized drugs don't
Infants: More sensitive (BBB not fully developed)
,3|Page --NU 578 Exam 3—smart studies!!!
Tolerance: Decreased response with prolonged use
Physical dependence: Withdrawal on abrupt discontinuation
KEY RECEPTORS
Dopamine movement, motivation
GABA inhibitory (benzodiazepines enhance)
Acetylcholine muscarinic & nicotinic
Norepinephrine sympathetic
Comprehensive Practice Questions & Study Review
Question 1
A 45yearold female patient with a history of episodic migraines (45 per month) has failed trials of NSAIDs and
triptans for acute treatment. She has no contraindications to betablockers. Which medication would be the most
appropriate firstline choice for migraine prophylaxis in this patient?
A) Topiramate
B) Amitriptyline
C) Propranolol
D) Divalproex
Correct Answer: C) Propranolol
Propranolol is the most commonly used firstline betablocker for migraine prevention with benefits developing over
several weeks at doses of 80240mg daily.
Question 2
A 52yearold male with Parkinson's disease has been experiencing significant "off times" where his
levodopacarbidopa therapy provides inadequate symptom control. Which medication combination has the strongest
evidence for reducing these off periods?
A) Amantadine and trihexyphenidyl
B) Entacapone and rasagiline
C) Selegiline and benztropine
D) Bromocriptine and pergolide
Correct Answer: B) Entacapone and rasagiline
Entacapone as a COMT inhibitor and rasagiline as an MAOB inhibitor both demonstrate strong efficacy in reducing
off times in Parkinson's patients experiencing motor fluctuations.
Question 3
A 28yearold patient with schizophrenia has been prescribed haloperidol and is now exhibiting involuntary, repetitive
movements of the tongue and facial muscles. What is this patient most likely experiencing?
A) Neuroleptic malignant syndrome
B) Acute dystonia
C) Tardive dyskinesia
D) Parkinsonism
, 4|Page --NU 578 Exam 3—smart studies!!!
Correct Answer: C) Tardive dyskinesia
Tardive dyskinesia is characterized by involuntary choreoathetoid movements typically involving the
oralbuccallingual region and occurs as a late complication of antipsychotic therapy, particularly with
firstgeneration agents.
Question 4
A patient with bipolar disorder is prescribed lithium carbonate. When should serum lithium levels be drawn to
ensure accurate trough monitoring?
A) 2 hours after the morning dose
B) Immediately before the morning dose
C) 4 hours after the evening dose
D) At any time during the day
Correct Answer: B) Immediately before the morning dose
Lithium trough levels should be drawn 12 hours after the last dose, typically immediately before the morning dose,
to accurately assess steadystate concentrations and guide dosing adjustments.
Question 5
A 62yearold patient with Parkinson's disease experiences druginduced dyskinesias from chronic levodopa therapy.
Which medication is specifically recommended for managing these involuntary movements?
A) Entacapone
B) Rasagiline
C) Amantadine
D) Pramipexole
Correct Answer: C) Amantadine
Amantadine is the only drug specifically recommended for treating levodopainduced dyskinesias, functioning as a
dopaminereleasing agent that helps modulate abnormal involuntary movements.
Question 6
A patient who abuses opioids reports that the initial sensation following intravenous heroin use is an intense
"orgasmlike" feeling lasting approximately 45 seconds. What is this phenomenon correctly termed?
A) The rush or kick
B) The high or peak
C) The plateau effect
D) The comedown phase
Correct Answer: A) The rush or kick
The "rush" or "kick" is the initial intense sensation occurring approximately 78 seconds after IV heroin
administration, resulting from the drug's high lipid solubility and rapid bloodbrain barrier penetration.
Question 7
A 35yearold patient with generalized anxiety disorder is prescribed a benzodiazepine for shortterm management.
Which adverse effect is the most concerning and should prompt immediate discontinuation of therapy?
NU 578 Exam 3 2026–2027 Latest Update |
Comprehensive Practice 250 + Questions, Detailed
Answer Explanations, Complete Study Review &
Exam Preparation Guide PDF
WHAT YOU WILL GET:
SUMMARY OF THE WHOLE QUESTIONS
COVERED
MULTICHOICES QUESTIONS
DETAILED AND WELL-ELABORATED RATIONALES
250 QUESTIONS WITH 100%CORRECT RESPONSES
Quick Summary Study Notes
MIGRAINE PROPHYLAXIS
1st line: Propranolol (80240mg daily) most common
Other betablockers: Timolol, atenolol, metoprolol, nadolol
Antiepileptics: Divalproex, topiramate (monitor bicarbonate)
TCAs: Amitriptyline 25150mg at HS (anticholinergic SE)
Menstrual: Estrogen gel/patch
PARKINSON'S DISEASE
Cause: Loss of dopamine neurons in substantia nigra
Motor symptoms: Tremor, rigidity, postural instability, bradykinesia
Nonmotor: Depression, dementia, sleep disturbances, autonomic dysfunction
Most effective drug: Levodopacarbidopa
MAOB inhibitors: Selegiline, rasagiline (1st line for mild)
Dopamine agonists: Pramipexole, ropinirole (lower dyskinesia risk)
For dyskinesias: Amantadine (only drug recommended)
For "off times": Entacapone (COMT inhibitor), rasagiline
,2|Page --NU 578 Exam 3—smart studies!!!
Anticholinergics: Trihexyphenidyl, benztropine (AVOID in elderly/cognitive impairment)
ANTIPSYCHOTICS
1st generation (haloperidol): High EPS, tardive dyskinesia risk
2nd generation (olanzapine, risperidone, quetiapine): Lower EPS, HIGHER metabolic effects (weight gain,
diabetes)
Clozapine: Requires CBC monitoring (agranulocytosis risk)
EPS treatment: Benztropine, diphenhydramine
Tardive dyskinesia: Valbenazine (VMAT2 inhibitor)
Neuroleptic malignant syndrome: Dantrolene + bromocriptine
LITHIUM (BIPOLAR)
Trough level: Draw 12hrs after last dose (before morning dose)
Monitor: Thyroid, renal function, serum levels
Avoid: NSAIDs (increase lithium levels), dehydration, lowsodium diets
Toxicity signs: Coarse tremor, ataxia, confusion, nausea
OPIOIDS
Heroin: High lipid solubility → rapid BBB crossing
Abuse risk in HC providers: Due to drug access
Meperidine preferred by abusers: Less pupillary constriction, constipation, urinary retention
Antidote: Naloxone
Buprenorphine: Partial agonist, ceiling effect, lower abuse potential
BENZODIAZEPINES
MOA: Enhance GABAA receptor activity
Use: Shortterm anxiety, insomnia, conscious sedation
Antidote: Flumazenil
Risk: Tolerance, dependence, respiratory depression
ANTIDEPRESSANTS
SSRIs (fluoxetine, sertraline): Block serotonin reuptake; SE: GI upset, sexual dysfunction
TCAs (amitriptyline): Anticholinergic SE; monitor for cardiac effects
MAOIs: Avoid tyraminerich foods (aged cheese) → hypertensive crisis
CNS BASICS
BBB: Lipidsoluble drugs cross; proteinbound/ionized drugs don't
Infants: More sensitive (BBB not fully developed)
,3|Page --NU 578 Exam 3—smart studies!!!
Tolerance: Decreased response with prolonged use
Physical dependence: Withdrawal on abrupt discontinuation
KEY RECEPTORS
Dopamine movement, motivation
GABA inhibitory (benzodiazepines enhance)
Acetylcholine muscarinic & nicotinic
Norepinephrine sympathetic
Comprehensive Practice Questions & Study Review
Question 1
A 45yearold female patient with a history of episodic migraines (45 per month) has failed trials of NSAIDs and
triptans for acute treatment. She has no contraindications to betablockers. Which medication would be the most
appropriate firstline choice for migraine prophylaxis in this patient?
A) Topiramate
B) Amitriptyline
C) Propranolol
D) Divalproex
Correct Answer: C) Propranolol
Propranolol is the most commonly used firstline betablocker for migraine prevention with benefits developing over
several weeks at doses of 80240mg daily.
Question 2
A 52yearold male with Parkinson's disease has been experiencing significant "off times" where his
levodopacarbidopa therapy provides inadequate symptom control. Which medication combination has the strongest
evidence for reducing these off periods?
A) Amantadine and trihexyphenidyl
B) Entacapone and rasagiline
C) Selegiline and benztropine
D) Bromocriptine and pergolide
Correct Answer: B) Entacapone and rasagiline
Entacapone as a COMT inhibitor and rasagiline as an MAOB inhibitor both demonstrate strong efficacy in reducing
off times in Parkinson's patients experiencing motor fluctuations.
Question 3
A 28yearold patient with schizophrenia has been prescribed haloperidol and is now exhibiting involuntary, repetitive
movements of the tongue and facial muscles. What is this patient most likely experiencing?
A) Neuroleptic malignant syndrome
B) Acute dystonia
C) Tardive dyskinesia
D) Parkinsonism
, 4|Page --NU 578 Exam 3—smart studies!!!
Correct Answer: C) Tardive dyskinesia
Tardive dyskinesia is characterized by involuntary choreoathetoid movements typically involving the
oralbuccallingual region and occurs as a late complication of antipsychotic therapy, particularly with
firstgeneration agents.
Question 4
A patient with bipolar disorder is prescribed lithium carbonate. When should serum lithium levels be drawn to
ensure accurate trough monitoring?
A) 2 hours after the morning dose
B) Immediately before the morning dose
C) 4 hours after the evening dose
D) At any time during the day
Correct Answer: B) Immediately before the morning dose
Lithium trough levels should be drawn 12 hours after the last dose, typically immediately before the morning dose,
to accurately assess steadystate concentrations and guide dosing adjustments.
Question 5
A 62yearold patient with Parkinson's disease experiences druginduced dyskinesias from chronic levodopa therapy.
Which medication is specifically recommended for managing these involuntary movements?
A) Entacapone
B) Rasagiline
C) Amantadine
D) Pramipexole
Correct Answer: C) Amantadine
Amantadine is the only drug specifically recommended for treating levodopainduced dyskinesias, functioning as a
dopaminereleasing agent that helps modulate abnormal involuntary movements.
Question 6
A patient who abuses opioids reports that the initial sensation following intravenous heroin use is an intense
"orgasmlike" feeling lasting approximately 45 seconds. What is this phenomenon correctly termed?
A) The rush or kick
B) The high or peak
C) The plateau effect
D) The comedown phase
Correct Answer: A) The rush or kick
The "rush" or "kick" is the initial intense sensation occurring approximately 78 seconds after IV heroin
administration, resulting from the drug's high lipid solubility and rapid bloodbrain barrier penetration.
Question 7
A 35yearold patient with generalized anxiety disorder is prescribed a benzodiazepine for shortterm management.
Which adverse effect is the most concerning and should prompt immediate discontinuation of therapy?
