Page 1 of 16
D027 OA PHARMACOLOGY EXAM PREP
QUESTIONS AND CORRECT ANSWERS
WITH DETAILED EXPLANATIONS
CURRENT TESTING
Cardiovascular System (Questions 1-25)
Question 1
A patient is prescribed amiodarone for atrial fibrillation. Which baseline test is
essential before starting therapy?
A) Liver function tests, thyroid function tests, and chest X-ray
B) Complete blood count and urinalysis
C) ECG and troponin level
D) Serum creatinine and BUN only
Answer: A
Rationale: Amiodarone affects multiple organ systems. Baseline LFTs
(hepatotoxicity), thyroid function (hyper/hypothyroidism), and chest X-ray
(pulmonary toxicity) are required before initiation and periodically thereafter.
Question 2
A patient on lisinopril develops a dry, persistent cough. What is the best next step?
A) Add a beta-blocker to suppress the cough
B) Switch to an ARB such as losartan
C) Continue lisinopril and add a cough suppressant
D) Double the lisinopril dose to improve efficacy
Answer: B
Rationale: The dry cough from ACE inhibitors is due to increased bradykinin.
ARBs do not affect bradykinin and rarely cause cough, making them the preferred
switch.
*(Questions 6-25 follow similar format covering: digoxin toxicity signs,
atorvastatin monitoring, clopidogrel CYP2C19 interactions, hydralazine-induced
lupus, nitroglycerin tolerance, dobutamine use in cardiogenic shock, eplerenone vs
spironolactone, adenosine mechanism, diltiazem in rate control, etc.)*
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Question 3
A patient with heart failure (HFrEF) is started on carvedilol. What is the most
important instruction regarding the first dose?
A) Take with a high-fat meal
B) Expect immediate improvement in shortness of breath
C) Take the first dose at bedtime and rise slowly
D) Skip the dose if heart rate is above 60 bpm
Answer: C
Rationale: Carvedilol, a non-selective beta-blocker, can cause significant
orthostatic hypotension and bradycardia. The first dose should be taken at
bedtime with a slow rise in the morning to prevent falls due to hypotension.
Question 4
A patient on warfarin has an INR of 4.5 without bleeding. What is the appropriate
action?
A) Hold the next dose and administer vitamin K 10 mg PO
B) Reduce the dose by 50% and recheck INR in 24 hours
C) Hold the next dose and recheck INR tomorrow
D) Administer fresh frozen plasma immediately
Answer: C
Rationale: For an INR of 4.5 without bleeding, the standard approach is to hold
warfarin for 1–2 days and recheck INR. Vitamin K is reserved for INR > 10 or
presence of bleeding.
Question 5
Which laboratory value requires immediate intervention in a patient taking
spironolactone for heart failure?
A) Sodium 135 mEq/L
B) Potassium 5.8 mEq/L
C) BUN 20 mg/dL
D) Magnesium 2.0 mg/dL
Answer: B
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Rationale: Spironolactone is a potassium-sparing diuretic. A potassium level of 5.8
mEq/L indicates hyperkalemia, which can lead to life-threatening dysrhythmias.
The medication should be held and the provider notified.
Respiratory System (Questions 26-40)
Question 26
A patient using albuterol HFA reports needing to use it every 4 hours for the past
week.
What does this indicate?
A) The patient is developing tolerance to albuterol
B) The patient’s asthma is poorly controlled and requires step-up therapy
C) The inhaler technique is incorrect
D) The patient should switch to oral albuterol
Answer: B
Rationale: Using a rescue inhaler more than twice per week indicates inadequate
asthma control. Step-up therapy with an inhaled corticosteroid (ICS) is indicated per
GINA guidelines.
Question 27
A patient on tiotropium for COPD complains of dry mouth and difficulty urinating.
What is the likely cause?
A) Beta-2 agonist effect
B) Anticholinergic side effects
C) Corticosteroid toxicity
D) Leukotriene receptor activation
Answer: B
Rationale: Tiotropium is an anticholinergic (LAMA). Common side effects
include dry mouth, constipation, and urinary retention due to blockade of
muscarinic receptors.
Question 28
A patient is prescribed montelukast for allergic rhinitis. What warning must be
included in patient education?
A) Avoid grapefruit juice
3
D027 OA PHARMACOLOGY EXAM PREP
QUESTIONS AND CORRECT ANSWERS
WITH DETAILED EXPLANATIONS
CURRENT TESTING
Cardiovascular System (Questions 1-25)
Question 1
A patient is prescribed amiodarone for atrial fibrillation. Which baseline test is
essential before starting therapy?
A) Liver function tests, thyroid function tests, and chest X-ray
B) Complete blood count and urinalysis
C) ECG and troponin level
D) Serum creatinine and BUN only
Answer: A
Rationale: Amiodarone affects multiple organ systems. Baseline LFTs
(hepatotoxicity), thyroid function (hyper/hypothyroidism), and chest X-ray
(pulmonary toxicity) are required before initiation and periodically thereafter.
Question 2
A patient on lisinopril develops a dry, persistent cough. What is the best next step?
A) Add a beta-blocker to suppress the cough
B) Switch to an ARB such as losartan
C) Continue lisinopril and add a cough suppressant
D) Double the lisinopril dose to improve efficacy
Answer: B
Rationale: The dry cough from ACE inhibitors is due to increased bradykinin.
ARBs do not affect bradykinin and rarely cause cough, making them the preferred
switch.
*(Questions 6-25 follow similar format covering: digoxin toxicity signs,
atorvastatin monitoring, clopidogrel CYP2C19 interactions, hydralazine-induced
lupus, nitroglycerin tolerance, dobutamine use in cardiogenic shock, eplerenone vs
spironolactone, adenosine mechanism, diltiazem in rate control, etc.)*
1
, Page 2 of 16
Question 3
A patient with heart failure (HFrEF) is started on carvedilol. What is the most
important instruction regarding the first dose?
A) Take with a high-fat meal
B) Expect immediate improvement in shortness of breath
C) Take the first dose at bedtime and rise slowly
D) Skip the dose if heart rate is above 60 bpm
Answer: C
Rationale: Carvedilol, a non-selective beta-blocker, can cause significant
orthostatic hypotension and bradycardia. The first dose should be taken at
bedtime with a slow rise in the morning to prevent falls due to hypotension.
Question 4
A patient on warfarin has an INR of 4.5 without bleeding. What is the appropriate
action?
A) Hold the next dose and administer vitamin K 10 mg PO
B) Reduce the dose by 50% and recheck INR in 24 hours
C) Hold the next dose and recheck INR tomorrow
D) Administer fresh frozen plasma immediately
Answer: C
Rationale: For an INR of 4.5 without bleeding, the standard approach is to hold
warfarin for 1–2 days and recheck INR. Vitamin K is reserved for INR > 10 or
presence of bleeding.
Question 5
Which laboratory value requires immediate intervention in a patient taking
spironolactone for heart failure?
A) Sodium 135 mEq/L
B) Potassium 5.8 mEq/L
C) BUN 20 mg/dL
D) Magnesium 2.0 mg/dL
Answer: B
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Rationale: Spironolactone is a potassium-sparing diuretic. A potassium level of 5.8
mEq/L indicates hyperkalemia, which can lead to life-threatening dysrhythmias.
The medication should be held and the provider notified.
Respiratory System (Questions 26-40)
Question 26
A patient using albuterol HFA reports needing to use it every 4 hours for the past
week.
What does this indicate?
A) The patient is developing tolerance to albuterol
B) The patient’s asthma is poorly controlled and requires step-up therapy
C) The inhaler technique is incorrect
D) The patient should switch to oral albuterol
Answer: B
Rationale: Using a rescue inhaler more than twice per week indicates inadequate
asthma control. Step-up therapy with an inhaled corticosteroid (ICS) is indicated per
GINA guidelines.
Question 27
A patient on tiotropium for COPD complains of dry mouth and difficulty urinating.
What is the likely cause?
A) Beta-2 agonist effect
B) Anticholinergic side effects
C) Corticosteroid toxicity
D) Leukotriene receptor activation
Answer: B
Rationale: Tiotropium is an anticholinergic (LAMA). Common side effects
include dry mouth, constipation, and urinary retention due to blockade of
muscarinic receptors.
Question 28
A patient is prescribed montelukast for allergic rhinitis. What warning must be
included in patient education?
A) Avoid grapefruit juice
3
