D345 — Pharmacology
MRAHP · 543D
RX
PHARM Drug Reactions, Psychopharmacology & Toxicology
D345 SAFE PRESCRIBING · EVIDENCE-BASED PRACTICE
D345 — Pharmacology: DRESS, Drug Reactions &
Psychopharmacology
CO M P L E T E Q U E ST I O N S & V E R I F I E D A N S W E RS | A DVA N C E D P H A R M ACO LO G Y E X A M
INSTITUTION Nursing / Pharmacy Program — COURSE CODE D345
D345
PROGRAM Advanced Pharmacology & ACADEMIC YEAR
Therapeutics
EXAM TITLE D345 — Pharmacology: DRESS, TOTAL QUESTIONS 72 Questions
Drug Reactions &
Psychopharmacology | Complete
Questions & Verified Answers
COURSE TITLE Advanced Pharmacology — Drug FORMAT Multiple Choice — Select the
Reactions & Psychopharmacology Single Best Answer
EXAMINATION INSTRUCTIONS
▸ Select the single best answer for each question.
▸ Questions cover severe drug reactions (DRESS, TEN, SJS), psychopharmacology, substance abuse
disorders, and cytochrome P450 interactions.
▸ Correct answers and detailed clinical rationales appear below each question.
▸ All pharmacological data reflects current evidence-based clinical guidelines. Verify dosages with current
prescribing references.
, SECTION I — ADVANCED PHARMACOLOGY: DRUG
Questions 1 – 72
REACTIONS & PSYCHOPHARMACOLOGY
1. DRESS stands for ______.
A. Drug Reaction with Epidermal Skin Symptoms
B. Drug Reaction with Eosinophilia and Systemic Symptoms
C. Dermal Reaction with Eosinophilia and Systemic Symptoms
D. Drug Rash with Eosinophilia and Skin Symptoms
CORRECT ANSWER B — Drug Reaction with Eosinophilia and Systemic Symptoms
RATIONALE DRESS (Drug Reaction with Eosinophilia and Systemic Symptoms) is a severe,
potentially life-threatening hypersensitivity reaction characterized by rash, fever,
lymphadenopathy, eosinophilia, and multi-organ involvement. It typically
appears 2-8 weeks after initiating the triggering medication. Key causative
agents include aromatic anticonvulsants (phenytoin, phenobarbital),
lamotrigine, allopurinol, minocycline, and abacavir. Prompt recognition and
discontinuation of the offending drug are critical.
2. Symptoms of DRESS syndrome usually appear ______ after first starting the triggering
medication.
A. 1-3 days
B. 2-8 weeks
C. 6-12 months
D. Within 24 hours
CORRECT ANSWER B — 2-8 weeks
RATIONALE DRESS syndrome has a characteristic delayed onset of 2-8 weeks after initiation
of the causative drug, distinguishing it from immediate hypersensitivity
reactions. This delayed presentation can make diagnosis challenging, as
patients may not associate symptoms with a medication started weeks earlier.
The latency period reflects the time required for T-cell mediated immune
activation and clonal expansion. Earlier onset may occur with rechallenge.
,3. Common features of DRESS syndrome include all of the following except ______.
A. Rash and fever
B. Lymphadenopathy and eosinophilia
C. Leukocytosis and abnormal LFTs
D. Bradycardia and hypotension
CORRECT ANSWER D — Bradycardia and hypotension
RATIONALE The classic features of DRESS include rash (often morbilliform), fever,
lymphadenopathy, eosinophilia, leukocytosis, and abnormal liver function tests.
Bradycardia and hypotension are not characteristic features — cardiovascular
involvement in DRESS more commonly manifests as myocarditis or pericarditis.
Multi-organ involvement can include hepatitis, pneumonitis, myocarditis,
pericarditis, nephritis, and colitis. The acronym helps remember key features:
Drug Reaction with Eosinophilia and Systemic Symptoms.
4. Possible organ involvement in DRESS syndrome includes all of the following except
______.
A. Hepatitis and pneumonitis
B. Myocarditis and pericarditis
C. Nephritis and colitis
D. Pancreatitis and cholecystitis
CORRECT ANSWER D — Pancreatitis and cholecystitis
RATIONALE DRESS syndrome can affect multiple organ systems including the liver
(hepatitis), lungs (pneumonitis), heart (myocarditis, pericarditis), kidneys
(nephritis), and colon (colitis). Pancreatitis and cholecystitis are not typically
associated with DRESS syndrome. The multi-organ involvement distinguishes
DRESS from less severe drug eruptions and contributes to its 10% mortality rate.
Liver involvement is the most common visceral manifestation.
, 5. Which two drugs are the predominant causers of DRESS syndrome?
A. Ibuprofen and naproxen
B. Phenytoin and phenobarbital
C. Metformin and glyburide
D. Lisinopril and metoprolol
CORRECT ANSWER B — Phenytoin and phenobarbital
RATIONALE Aromatic anticonvulsants — particularly phenytoin and phenobarbital — are the
most frequently implicated drugs in DRESS syndrome. Other causative agents
include lamotrigine (Lamictal), allopurinol, minocycline, and abacavir. The
aromatic ring structure of these anticonvulsants is metabolized to reactive arene
oxide intermediates that can trigger the immune cascade. Cross-reactivity
among aromatic anticonvulsants is common, so carbamazepine should also be
avoided in affected patients.
6. Besides phenytoin and phenobarbital, which of the following drugs can also cause
DRESS syndrome?
A. Aspirin, acetaminophen, and ibuprofen
B. Lamictal, Allopurinol, Minocycline, and Abacavir
C. Amoxicillin, azithromycin, and ciprofloxacin
D. Atorvastatin, omeprazole, and metformin
CORRECT ANSWER B — Lamictal, Allopurinol, Minocycline, and Abacavir
RATIONALE Lamotrigine (Lamictal), allopurinol, minocycline, and abacavir are well-
documented causes of DRESS syndrome in addition to the aromatic
anticonvulsants. Abacavir-induced DRESS is associated with the HLA-B*5701
allele — genetic screening is recommended before initiating abacavir therapy.
Allopurinol-induced DRESS is more common in patients with renal impairment.
The risk with lamotrigine increases with rapid dose titration and concurrent
valproate use.
MRAHP · 543D
RX
PHARM Drug Reactions, Psychopharmacology & Toxicology
D345 SAFE PRESCRIBING · EVIDENCE-BASED PRACTICE
D345 — Pharmacology: DRESS, Drug Reactions &
Psychopharmacology
CO M P L E T E Q U E ST I O N S & V E R I F I E D A N S W E RS | A DVA N C E D P H A R M ACO LO G Y E X A M
INSTITUTION Nursing / Pharmacy Program — COURSE CODE D345
D345
PROGRAM Advanced Pharmacology & ACADEMIC YEAR
Therapeutics
EXAM TITLE D345 — Pharmacology: DRESS, TOTAL QUESTIONS 72 Questions
Drug Reactions &
Psychopharmacology | Complete
Questions & Verified Answers
COURSE TITLE Advanced Pharmacology — Drug FORMAT Multiple Choice — Select the
Reactions & Psychopharmacology Single Best Answer
EXAMINATION INSTRUCTIONS
▸ Select the single best answer for each question.
▸ Questions cover severe drug reactions (DRESS, TEN, SJS), psychopharmacology, substance abuse
disorders, and cytochrome P450 interactions.
▸ Correct answers and detailed clinical rationales appear below each question.
▸ All pharmacological data reflects current evidence-based clinical guidelines. Verify dosages with current
prescribing references.
, SECTION I — ADVANCED PHARMACOLOGY: DRUG
Questions 1 – 72
REACTIONS & PSYCHOPHARMACOLOGY
1. DRESS stands for ______.
A. Drug Reaction with Epidermal Skin Symptoms
B. Drug Reaction with Eosinophilia and Systemic Symptoms
C. Dermal Reaction with Eosinophilia and Systemic Symptoms
D. Drug Rash with Eosinophilia and Skin Symptoms
CORRECT ANSWER B — Drug Reaction with Eosinophilia and Systemic Symptoms
RATIONALE DRESS (Drug Reaction with Eosinophilia and Systemic Symptoms) is a severe,
potentially life-threatening hypersensitivity reaction characterized by rash, fever,
lymphadenopathy, eosinophilia, and multi-organ involvement. It typically
appears 2-8 weeks after initiating the triggering medication. Key causative
agents include aromatic anticonvulsants (phenytoin, phenobarbital),
lamotrigine, allopurinol, minocycline, and abacavir. Prompt recognition and
discontinuation of the offending drug are critical.
2. Symptoms of DRESS syndrome usually appear ______ after first starting the triggering
medication.
A. 1-3 days
B. 2-8 weeks
C. 6-12 months
D. Within 24 hours
CORRECT ANSWER B — 2-8 weeks
RATIONALE DRESS syndrome has a characteristic delayed onset of 2-8 weeks after initiation
of the causative drug, distinguishing it from immediate hypersensitivity
reactions. This delayed presentation can make diagnosis challenging, as
patients may not associate symptoms with a medication started weeks earlier.
The latency period reflects the time required for T-cell mediated immune
activation and clonal expansion. Earlier onset may occur with rechallenge.
,3. Common features of DRESS syndrome include all of the following except ______.
A. Rash and fever
B. Lymphadenopathy and eosinophilia
C. Leukocytosis and abnormal LFTs
D. Bradycardia and hypotension
CORRECT ANSWER D — Bradycardia and hypotension
RATIONALE The classic features of DRESS include rash (often morbilliform), fever,
lymphadenopathy, eosinophilia, leukocytosis, and abnormal liver function tests.
Bradycardia and hypotension are not characteristic features — cardiovascular
involvement in DRESS more commonly manifests as myocarditis or pericarditis.
Multi-organ involvement can include hepatitis, pneumonitis, myocarditis,
pericarditis, nephritis, and colitis. The acronym helps remember key features:
Drug Reaction with Eosinophilia and Systemic Symptoms.
4. Possible organ involvement in DRESS syndrome includes all of the following except
______.
A. Hepatitis and pneumonitis
B. Myocarditis and pericarditis
C. Nephritis and colitis
D. Pancreatitis and cholecystitis
CORRECT ANSWER D — Pancreatitis and cholecystitis
RATIONALE DRESS syndrome can affect multiple organ systems including the liver
(hepatitis), lungs (pneumonitis), heart (myocarditis, pericarditis), kidneys
(nephritis), and colon (colitis). Pancreatitis and cholecystitis are not typically
associated with DRESS syndrome. The multi-organ involvement distinguishes
DRESS from less severe drug eruptions and contributes to its 10% mortality rate.
Liver involvement is the most common visceral manifestation.
, 5. Which two drugs are the predominant causers of DRESS syndrome?
A. Ibuprofen and naproxen
B. Phenytoin and phenobarbital
C. Metformin and glyburide
D. Lisinopril and metoprolol
CORRECT ANSWER B — Phenytoin and phenobarbital
RATIONALE Aromatic anticonvulsants — particularly phenytoin and phenobarbital — are the
most frequently implicated drugs in DRESS syndrome. Other causative agents
include lamotrigine (Lamictal), allopurinol, minocycline, and abacavir. The
aromatic ring structure of these anticonvulsants is metabolized to reactive arene
oxide intermediates that can trigger the immune cascade. Cross-reactivity
among aromatic anticonvulsants is common, so carbamazepine should also be
avoided in affected patients.
6. Besides phenytoin and phenobarbital, which of the following drugs can also cause
DRESS syndrome?
A. Aspirin, acetaminophen, and ibuprofen
B. Lamictal, Allopurinol, Minocycline, and Abacavir
C. Amoxicillin, azithromycin, and ciprofloxacin
D. Atorvastatin, omeprazole, and metformin
CORRECT ANSWER B — Lamictal, Allopurinol, Minocycline, and Abacavir
RATIONALE Lamotrigine (Lamictal), allopurinol, minocycline, and abacavir are well-
documented causes of DRESS syndrome in addition to the aromatic
anticonvulsants. Abacavir-induced DRESS is associated with the HLA-B*5701
allele — genetic screening is recommended before initiating abacavir therapy.
Allopurinol-induced DRESS is more common in patients with renal impairment.
The risk with lamotrigine increases with rapid dose titration and concurrent
valproate use.
