Advanced Pharmacology Final
A 64-year-old man presents with mild to moderate musculoskeletal
back pain. He states that he has tried acetaminophen without relief. His medical history includes
diabetes, hypertension, hyperlipidemia, gastric ulcer (resolved), and coronary artery disease. Which
is the
most appropriate NSAID regimen to treat this patient's pain?
A. Celacoxib
B. Indomethacin and omeprazole
C. Naproxen and omeprazole
D. Naproxen -
✅C. Naproxen and omeprazole
Which statement is correct regarding the difference between acetaminophen and naproxen?
A. Acetaminophen has more anti-inflammatory effects compared with naproxen.
B. Acetaminophen has more Gl side effects but less effects on bleeding compared with naproxen.
C. Acetaminophen has less risk for CV events compared with naproxen.
D. Acetaminophen has fewer antipyretic effects than
naproxen. -
✅C. Acetaminophen has less risk for CV events compared with naproxen.
Which statement correctly describes the proposed mechanism of cardioprotection from low-dose
aspirin?
A. Aspirin preferentially inhibits COX-2 to lead to a relative reduction in thromboxane ~ levels.
B. Aspirin preferentially inhibits COX-1 to lead to a relative reduction in thromboxane ~ levels.
C. Aspirin preferentially inhibits COX-2 to lead to a relative reduction in prostacyclin levels.
D. Aspirin preferentially inhibits COX-1 to lead a relative reduction in prostacyclin levels. -
✅B. Aspirin preferentially inhibits COX-1 to lead to a relative reduction in thromboxane ~
levels.
Which statement correctly describes the pathophysiologic actions of prostaglandins at a target
tissue?
A. Promote vasoconstriction in the kidneys.
B. Promote sodium and water retention in the kidneys.
C. Decrease secretion of mucus at the lining of the
stomach.
D. Decrease secretion of gastric acid in the stomach -
✅D. Decrease secretion of gastric acid in the stomach
Which prostaglandin agent can be used to maintain the patency of the ductus arteriosus in neonates
with congenital heart problems while awaiting surgery?
A. Misoprostol
B. Epoprostenol
C. Bimatoprost
1
,D. Alprostadil -
✅D. Alprostadil
A 34-year-old woman with RA is planning for pregnancy. Which RA agents are absolutely
contraindicated
in pregnancy?
A. Abatacept and rituximab
B. Adalimumab and certolizumab
C. lnfliximab and etanercept
D. Methotrexate and leflunomide -
✅D. Methotrexate and leflunomide
Which agent for RA competes with CD28 to prevent full T-cell activation?
A. Sarilumab
B. Abatacept
C. Golimumab
D. Adalimumab -
✅B. Abatacept
Which statement correctly represents the mechanism of action of tofacitinib in the treatment of RA?
A. TNF-a inhibitor
B. Janus kinase inhibitor
C. IL-6 receptor blocker
D. Dihydrofolate reductase inhibitor -
✅B. Janus kinase inhibitor
A 54-year-old man with gout is found to have an issue with renal excretion of uric acid. Which drug
is an oral agent that would target the cause of his acute gout attacks?
A. Allopurinol
B. Febuxostat
C. Probenecid
D. Pegloticase -
✅C. Probencid
A 64-year-old man presents with signs and symptoms of an acute gouty flare. Which strategy is the
least likely to acutely improve his gout symptoms and pain?
A. Naproxen
B. Colchicine
C. Probenecid
D. Prednisone -
✅C. Probenecid
A 43-year-old heavy machine operator complains of seasonal allergies. Which medication is most
appropriate for the management of his allergy symptoms?
2
,A. Diphenhydramine
B. Doxylamine
C. Hydroxyzine
D. Fexofenadine -
✅D. Fexofenadine
Which statement concerning H, antihistamines is correct?
A. Second-generation H1 antihistamines are relatively free of adverse effects.
B. Because of the established long-term safety of first-generation H1 antihistamines, they are the
first choice for allergic rhinitis.
c. The motor coordination involved in driving an automobile is not affected by the use of first-
generation H, antihistamines.
D. H1 antihistamines can be used in the treatment of acute anaphylaxis. -
✅A. Second-generation H1 antihistamines are relatively free of adverse effects.
Which histamine receptor antagonist is known to enter the central nervous system readily and cause
sedation?
A. Hydroxyzine
B. Cetirizine
C. Desloratadine
D. Loratadine -
✅A. Hydroxyzine
Which drug is an H,-receptor antagonist that also has serotonin receptor antagonism on the appetite
center, with the ability to stimulate appetite?
A. Hydroxyzine
B. Loratadine
C. Diphenhydramine
D. Cyproheptadine -
✅D. Cyproheptadine
Which drug for headache is contraindicated in patients with peripheral vascular disease?
A. Ergotamine
B. Aspirin
C. Acetaminophen
D. Naproxen -
✅A. Ergotamine
A 29-year-old woman complains of migraine headaches associated with early onset vomiting.
Currently, she uses ibuprofen as needed for her migraines, but it is
not very effective. Which triptan would be ideal for this patient?
A. Naratriptan
B. Zolmitriptan
C. Frovatriptan
3
, D. Almotriptan -
✅B. Zolmitriptan
A 35-year-old woman is having several severe migraines per month. The migraines are usually
relieved with one or two doses of triptan drugs. Which is most appropriate for prophylaxis to reduce
the frequency of her migraines?
A. Dihydroergotamine
B. Ibuprofen
C. Propranolol
D. Sumatriptan -
✅C. Propranolol
A 27-year-old married woman is asking about treatment options for obesity. She recently stopped
taking her birth control medications, as she felt they were contributing to her weight gain. Which
medication should be avoided in this patient?
A. Phentermineltopiramate
B. Orlistat
C. Diethylpropion
D. Lorcase ri n -
✅A. Phentermineltopiramate
A fellow health care provider is concerned about prescribing orlistat to adolescent patients. Many of
his adolescent patients are stopping the medication during
the first month of treatment. Which side effect is the most likely reason the adolescents are stopping
orlistat?
A. Valvulopathy
B. Suicidal ideation
C. Drowsiness
D. Flatulence -
✅D. Flatulence
A 38-year-old obese man with depression is considering a weight loss medication following several
failed attempts with diet and exercise. Which medication could be considered in this individual?
A. Liraglutide
B. Bupropion + naltrexone
C. Orlistat
D. Lorcaserin -
✅C. Orlistat
A 12·year-old girl with asthma presents to the emergency room with complaints of cough, dyspnea,
and wheezing after visiting a riding stable. Which is the most appropriate drug to rapidly reverse
her bronchoconstriction?
A. Inhaled fluticasone
B. Inhaled beclomethasone
C. Inhaled albuterol
D. Intravenous propranolol -
4
A 64-year-old man presents with mild to moderate musculoskeletal
back pain. He states that he has tried acetaminophen without relief. His medical history includes
diabetes, hypertension, hyperlipidemia, gastric ulcer (resolved), and coronary artery disease. Which
is the
most appropriate NSAID regimen to treat this patient's pain?
A. Celacoxib
B. Indomethacin and omeprazole
C. Naproxen and omeprazole
D. Naproxen -
✅C. Naproxen and omeprazole
Which statement is correct regarding the difference between acetaminophen and naproxen?
A. Acetaminophen has more anti-inflammatory effects compared with naproxen.
B. Acetaminophen has more Gl side effects but less effects on bleeding compared with naproxen.
C. Acetaminophen has less risk for CV events compared with naproxen.
D. Acetaminophen has fewer antipyretic effects than
naproxen. -
✅C. Acetaminophen has less risk for CV events compared with naproxen.
Which statement correctly describes the proposed mechanism of cardioprotection from low-dose
aspirin?
A. Aspirin preferentially inhibits COX-2 to lead to a relative reduction in thromboxane ~ levels.
B. Aspirin preferentially inhibits COX-1 to lead to a relative reduction in thromboxane ~ levels.
C. Aspirin preferentially inhibits COX-2 to lead to a relative reduction in prostacyclin levels.
D. Aspirin preferentially inhibits COX-1 to lead a relative reduction in prostacyclin levels. -
✅B. Aspirin preferentially inhibits COX-1 to lead to a relative reduction in thromboxane ~
levels.
Which statement correctly describes the pathophysiologic actions of prostaglandins at a target
tissue?
A. Promote vasoconstriction in the kidneys.
B. Promote sodium and water retention in the kidneys.
C. Decrease secretion of mucus at the lining of the
stomach.
D. Decrease secretion of gastric acid in the stomach -
✅D. Decrease secretion of gastric acid in the stomach
Which prostaglandin agent can be used to maintain the patency of the ductus arteriosus in neonates
with congenital heart problems while awaiting surgery?
A. Misoprostol
B. Epoprostenol
C. Bimatoprost
1
,D. Alprostadil -
✅D. Alprostadil
A 34-year-old woman with RA is planning for pregnancy. Which RA agents are absolutely
contraindicated
in pregnancy?
A. Abatacept and rituximab
B. Adalimumab and certolizumab
C. lnfliximab and etanercept
D. Methotrexate and leflunomide -
✅D. Methotrexate and leflunomide
Which agent for RA competes with CD28 to prevent full T-cell activation?
A. Sarilumab
B. Abatacept
C. Golimumab
D. Adalimumab -
✅B. Abatacept
Which statement correctly represents the mechanism of action of tofacitinib in the treatment of RA?
A. TNF-a inhibitor
B. Janus kinase inhibitor
C. IL-6 receptor blocker
D. Dihydrofolate reductase inhibitor -
✅B. Janus kinase inhibitor
A 54-year-old man with gout is found to have an issue with renal excretion of uric acid. Which drug
is an oral agent that would target the cause of his acute gout attacks?
A. Allopurinol
B. Febuxostat
C. Probenecid
D. Pegloticase -
✅C. Probencid
A 64-year-old man presents with signs and symptoms of an acute gouty flare. Which strategy is the
least likely to acutely improve his gout symptoms and pain?
A. Naproxen
B. Colchicine
C. Probenecid
D. Prednisone -
✅C. Probenecid
A 43-year-old heavy machine operator complains of seasonal allergies. Which medication is most
appropriate for the management of his allergy symptoms?
2
,A. Diphenhydramine
B. Doxylamine
C. Hydroxyzine
D. Fexofenadine -
✅D. Fexofenadine
Which statement concerning H, antihistamines is correct?
A. Second-generation H1 antihistamines are relatively free of adverse effects.
B. Because of the established long-term safety of first-generation H1 antihistamines, they are the
first choice for allergic rhinitis.
c. The motor coordination involved in driving an automobile is not affected by the use of first-
generation H, antihistamines.
D. H1 antihistamines can be used in the treatment of acute anaphylaxis. -
✅A. Second-generation H1 antihistamines are relatively free of adverse effects.
Which histamine receptor antagonist is known to enter the central nervous system readily and cause
sedation?
A. Hydroxyzine
B. Cetirizine
C. Desloratadine
D. Loratadine -
✅A. Hydroxyzine
Which drug is an H,-receptor antagonist that also has serotonin receptor antagonism on the appetite
center, with the ability to stimulate appetite?
A. Hydroxyzine
B. Loratadine
C. Diphenhydramine
D. Cyproheptadine -
✅D. Cyproheptadine
Which drug for headache is contraindicated in patients with peripheral vascular disease?
A. Ergotamine
B. Aspirin
C. Acetaminophen
D. Naproxen -
✅A. Ergotamine
A 29-year-old woman complains of migraine headaches associated with early onset vomiting.
Currently, she uses ibuprofen as needed for her migraines, but it is
not very effective. Which triptan would be ideal for this patient?
A. Naratriptan
B. Zolmitriptan
C. Frovatriptan
3
, D. Almotriptan -
✅B. Zolmitriptan
A 35-year-old woman is having several severe migraines per month. The migraines are usually
relieved with one or two doses of triptan drugs. Which is most appropriate for prophylaxis to reduce
the frequency of her migraines?
A. Dihydroergotamine
B. Ibuprofen
C. Propranolol
D. Sumatriptan -
✅C. Propranolol
A 27-year-old married woman is asking about treatment options for obesity. She recently stopped
taking her birth control medications, as she felt they were contributing to her weight gain. Which
medication should be avoided in this patient?
A. Phentermineltopiramate
B. Orlistat
C. Diethylpropion
D. Lorcase ri n -
✅A. Phentermineltopiramate
A fellow health care provider is concerned about prescribing orlistat to adolescent patients. Many of
his adolescent patients are stopping the medication during
the first month of treatment. Which side effect is the most likely reason the adolescents are stopping
orlistat?
A. Valvulopathy
B. Suicidal ideation
C. Drowsiness
D. Flatulence -
✅D. Flatulence
A 38-year-old obese man with depression is considering a weight loss medication following several
failed attempts with diet and exercise. Which medication could be considered in this individual?
A. Liraglutide
B. Bupropion + naltrexone
C. Orlistat
D. Lorcaserin -
✅C. Orlistat
A 12·year-old girl with asthma presents to the emergency room with complaints of cough, dyspnea,
and wheezing after visiting a riding stable. Which is the most appropriate drug to rapidly reverse
her bronchoconstriction?
A. Inhaled fluticasone
B. Inhaled beclomethasone
C. Inhaled albuterol
D. Intravenous propranolol -
4
