COMSAE Exam 49-Style Practice Questions:
High-Yield Q&A with Rationales
PHARMACOLOGY
Question 1
,A 45-year-old woman with ulcerative colitis is started on a medication that is a combination of
sulfapyridine and 5-aminosalicylic acid. What is the most likely drug prescribed?
- A) Mesalamine
- B) Sulfasalazine
- C) Balsalazide
- D) Olsalazine
Answer: B) Sulfasalazine
Rationale: Sulfasalazine is a first-line agent for ulcerative colitis and Crohn's disease. It consists of
sulfapyridine (an antibiotic) linked to 5-aminosalicylic acid (5-ASA), which is the active anti-
inflammatory component. The drug is cleaved by colonic bacteria to release 5-ASA .
Question 2
,A 68-year-old man with depression is started on imipramine. He develops confusion, dry mouth,
urinary retention, and orthostatic hypotension. Which receptor blockade is responsible for the
orthostatic hypotension?
- A) Beta-1 receptor blockade
- B) Muscarinic receptor blockade
- C) Alpha-1 receptor blockade
- D) Histamine-1 receptor blockade
Answer: C) Alpha-1 receptor blockade
Rationale: Imipramine is a tricyclic antidepressant (TCA) that blocks alpha-1 adrenergic receptors,
leading to orthostatic hypotension. The anticholinergic effects (dry mouth, urinary retention,
confusion in elderly) are due to muscarinic receptor blockade. TCAs also block histamine and
sodium channels .
, Question 3
A 32-year-old woman with allergic rhinitis is prescribed loratadine. Which statement best describes
this medication's mechanism and side effect profile?
- A) H2 receptor antagonist with significant sedation
- B) H1 receptor antagonist that crosses the BBB causing sedation
- C) H1 receptor antagonist that does not cross the BBB causing minimal sedation
- D) H2 receptor antagonist with no sedative effects
Answer: C) H1 receptor antagonist that does not cross the BBB causing minimal sedation
Rationale: Loratadine is a second-generation H1 receptor antagonist. Unlike first-generation
antihistamines (e.g., diphenhydramine), it does not readily cross the blood-brain barrier, resulting
in significantly less sedation .
Question 4
High-Yield Q&A with Rationales
PHARMACOLOGY
Question 1
,A 45-year-old woman with ulcerative colitis is started on a medication that is a combination of
sulfapyridine and 5-aminosalicylic acid. What is the most likely drug prescribed?
- A) Mesalamine
- B) Sulfasalazine
- C) Balsalazide
- D) Olsalazine
Answer: B) Sulfasalazine
Rationale: Sulfasalazine is a first-line agent for ulcerative colitis and Crohn's disease. It consists of
sulfapyridine (an antibiotic) linked to 5-aminosalicylic acid (5-ASA), which is the active anti-
inflammatory component. The drug is cleaved by colonic bacteria to release 5-ASA .
Question 2
,A 68-year-old man with depression is started on imipramine. He develops confusion, dry mouth,
urinary retention, and orthostatic hypotension. Which receptor blockade is responsible for the
orthostatic hypotension?
- A) Beta-1 receptor blockade
- B) Muscarinic receptor blockade
- C) Alpha-1 receptor blockade
- D) Histamine-1 receptor blockade
Answer: C) Alpha-1 receptor blockade
Rationale: Imipramine is a tricyclic antidepressant (TCA) that blocks alpha-1 adrenergic receptors,
leading to orthostatic hypotension. The anticholinergic effects (dry mouth, urinary retention,
confusion in elderly) are due to muscarinic receptor blockade. TCAs also block histamine and
sodium channels .
, Question 3
A 32-year-old woman with allergic rhinitis is prescribed loratadine. Which statement best describes
this medication's mechanism and side effect profile?
- A) H2 receptor antagonist with significant sedation
- B) H1 receptor antagonist that crosses the BBB causing sedation
- C) H1 receptor antagonist that does not cross the BBB causing minimal sedation
- D) H2 receptor antagonist with no sedative effects
Answer: C) H1 receptor antagonist that does not cross the BBB causing minimal sedation
Rationale: Loratadine is a second-generation H1 receptor antagonist. Unlike first-generation
antihistamines (e.g., diphenhydramine), it does not readily cross the blood-brain barrier, resulting
in significantly less sedation .
Question 4
