Barkley Advanced Pharmacology Review Exam | 3 Separate
50-Question Pharmacology Exams with Rationales
CARDIOVASCULAR & CENTRAL NERVOUS SYSTEM
PHARMACOLOGY
Questions 1-50
Question 1
A 65-year-old male with hypertension is started on lisinopril. He returns 2 weeks later
with a new, dry cough. What is the most likely mechanism for this adverse effect?
A) Angioedema from bradykinin accumulation
B) Bronchospasm from beta-2 receptor blockade
C) Cough from bradykinin accumulation in the airways
D) Reflex tachycardia from vasodilation
Answer: C) Cough from bradykinin accumulation in the airways
Rationale: ACE inhibitors like lisinopril prevent the breakdown of bradykinin, leading to
its accumulation. Bradykinin causes irritation of the respiratory tract, resulting in a
characteristic dry cough. This is the most common reason patients discontinue ACE
inhibitors. Angioedema, while also caused by bradykinin, is a different and more serious
adverse effect.
,Question 2
A patient with heart failure with reduced ejection fraction (HFrEF) is prescribed
carvedilol. Which of the following best describes the mechanism of action of carvedilol?
A) Beta-1 selective blocker
B) Non-selective beta-blocker with alpha-1 blocking activity
C) Beta-2 selective blocker
D) Calcium channel blocker with beta-blocking activity
Answer: B) Non-selective beta-blocker with alpha-1 blocking activity
Rationale: Carvedilol is a non-selective beta-blocker (blocks beta-1 and beta-2
receptors) with additional alpha-1 blocking activity. This unique combination results in
vasodilation in addition to beta-blockade, making it particularly effective in heart failure.
The vasodilation helps offset the peripheral vasoconstriction that can occur with pure
beta-blockers.
Question 3
A 55-year-old female with hypertension and diabetes is started on losartan. Which of
the following is a potential advantage of losartan over lisinopril?
A) Lower risk of angioedema
B) Better blood pressure control
C) Lower risk of hyperkalemia
D) Faster onset of action
Answer: A) Lower risk of angioedema
Rationale: Losartan is an angiotensin receptor blocker (ARB). Unlike ACE inhibitors,
ARBs do not affect bradykinin metabolism. Therefore, they are associated with a
,significantly lower risk of angioedema and cough compared to ACE inhibitors. Both drug
classes are comparable for blood pressure control and have similar hyperkalemia risks.
Question 4
A 62-year-old male is started on amlodipine for hypertension. Which of the following is
a common side effect of this medication?
A) Constipation
B) Peripheral edema
C) Dry cough
D) Hypoglycemia
Answer: B) Peripheral edema
Rationale: Amlodipine is a dihydropyridine calcium channel blocker that primarily
causes arterial vasodilation. Peripheral edema is the most common dose-related adverse
effect, occurring in up to 10-20% of patients. This is due to increased capillary
hydrostatic pressure from arteriolar dilation. Unlike verapamil and diltiazem, amlodipine
has minimal negative inotropic effects.
Question 5
A patient with atrial fibrillation is started on warfarin. The NP should advise the patient
to avoid which of the following foods?
A) Bananas
B) Grapefruit juice
C) Leafy green vegetables
D) Dairy products
, Answer: C) Leafy green vegetables
Rationale: Leafy green vegetables are high in vitamin K, which is a cofactor for the
synthesis of vitamin K-dependent clotting factors. Warfarin inhibits vitamin K epoxide
reductase, and increased dietary vitamin K can antagonize the anticoagulant effect,
making INR monitoring and dose adjustments challenging. Patients on warfarin should
maintain consistent vitamin K intake.
Question 6
A 70-year-old female with heart failure and atrial fibrillation is started on digoxin. Which
of the following is a sign of digoxin toxicity?
A) Tachycardia
B) Hypokalemia
C) Visual disturbances (yellow-green halos)
D) Hyperglycemia
Answer: C) Visual disturbances (yellow-green halos)
Rationale: Digoxin toxicity can cause a range of symptoms, but visual disturbances are
particularly characteristic. Patients may report seeing yellow-green halos around lights
(xanthopsia). Other signs include gastrointestinal symptoms (nausea, vomiting,
anorexia), cardiac arrhythmias (especially bradycardia and heart block), and neurologic
symptoms (confusion, fatigue).
Question 7
A 45-year-old male with bipolar disorder is started on lithium. Which laboratory test
should be monitored closely during therapy?
50-Question Pharmacology Exams with Rationales
CARDIOVASCULAR & CENTRAL NERVOUS SYSTEM
PHARMACOLOGY
Questions 1-50
Question 1
A 65-year-old male with hypertension is started on lisinopril. He returns 2 weeks later
with a new, dry cough. What is the most likely mechanism for this adverse effect?
A) Angioedema from bradykinin accumulation
B) Bronchospasm from beta-2 receptor blockade
C) Cough from bradykinin accumulation in the airways
D) Reflex tachycardia from vasodilation
Answer: C) Cough from bradykinin accumulation in the airways
Rationale: ACE inhibitors like lisinopril prevent the breakdown of bradykinin, leading to
its accumulation. Bradykinin causes irritation of the respiratory tract, resulting in a
characteristic dry cough. This is the most common reason patients discontinue ACE
inhibitors. Angioedema, while also caused by bradykinin, is a different and more serious
adverse effect.
,Question 2
A patient with heart failure with reduced ejection fraction (HFrEF) is prescribed
carvedilol. Which of the following best describes the mechanism of action of carvedilol?
A) Beta-1 selective blocker
B) Non-selective beta-blocker with alpha-1 blocking activity
C) Beta-2 selective blocker
D) Calcium channel blocker with beta-blocking activity
Answer: B) Non-selective beta-blocker with alpha-1 blocking activity
Rationale: Carvedilol is a non-selective beta-blocker (blocks beta-1 and beta-2
receptors) with additional alpha-1 blocking activity. This unique combination results in
vasodilation in addition to beta-blockade, making it particularly effective in heart failure.
The vasodilation helps offset the peripheral vasoconstriction that can occur with pure
beta-blockers.
Question 3
A 55-year-old female with hypertension and diabetes is started on losartan. Which of
the following is a potential advantage of losartan over lisinopril?
A) Lower risk of angioedema
B) Better blood pressure control
C) Lower risk of hyperkalemia
D) Faster onset of action
Answer: A) Lower risk of angioedema
Rationale: Losartan is an angiotensin receptor blocker (ARB). Unlike ACE inhibitors,
ARBs do not affect bradykinin metabolism. Therefore, they are associated with a
,significantly lower risk of angioedema and cough compared to ACE inhibitors. Both drug
classes are comparable for blood pressure control and have similar hyperkalemia risks.
Question 4
A 62-year-old male is started on amlodipine for hypertension. Which of the following is
a common side effect of this medication?
A) Constipation
B) Peripheral edema
C) Dry cough
D) Hypoglycemia
Answer: B) Peripheral edema
Rationale: Amlodipine is a dihydropyridine calcium channel blocker that primarily
causes arterial vasodilation. Peripheral edema is the most common dose-related adverse
effect, occurring in up to 10-20% of patients. This is due to increased capillary
hydrostatic pressure from arteriolar dilation. Unlike verapamil and diltiazem, amlodipine
has minimal negative inotropic effects.
Question 5
A patient with atrial fibrillation is started on warfarin. The NP should advise the patient
to avoid which of the following foods?
A) Bananas
B) Grapefruit juice
C) Leafy green vegetables
D) Dairy products
, Answer: C) Leafy green vegetables
Rationale: Leafy green vegetables are high in vitamin K, which is a cofactor for the
synthesis of vitamin K-dependent clotting factors. Warfarin inhibits vitamin K epoxide
reductase, and increased dietary vitamin K can antagonize the anticoagulant effect,
making INR monitoring and dose adjustments challenging. Patients on warfarin should
maintain consistent vitamin K intake.
Question 6
A 70-year-old female with heart failure and atrial fibrillation is started on digoxin. Which
of the following is a sign of digoxin toxicity?
A) Tachycardia
B) Hypokalemia
C) Visual disturbances (yellow-green halos)
D) Hyperglycemia
Answer: C) Visual disturbances (yellow-green halos)
Rationale: Digoxin toxicity can cause a range of symptoms, but visual disturbances are
particularly characteristic. Patients may report seeing yellow-green halos around lights
(xanthopsia). Other signs include gastrointestinal symptoms (nausea, vomiting,
anorexia), cardiac arrhythmias (especially bradycardia and heart block), and neurologic
symptoms (confusion, fatigue).
Question 7
A 45-year-old male with bipolar disorder is started on lithium. Which laboratory test
should be monitored closely during therapy?
