Wilkes NSG 533 Exam 3 Advanced Pharmacology Practice
Test Questions with Answers & Rationales | latest update
this year .pdf
1. A patient with atrial fibrillation is started on warfarin. Which laboratory parameter should be
monitored to assess therapeutic effect?
A) aPTT
✓ B) INR
C) Platelet count
D) Bleeding time
Warfarin exerts its anticoagulant effect by inhibiting vitamin K-dependent clotting factors (II,
VII, IX, X). The International Normalized Ratio (INR) standardizes prothrombin time
measurement and is used to monitor warfarin therapy. aPTT is used for unfractionated
heparin.
2. A 68-year-old man with heart failure is prescribed carvedilol. What is the primary
mechanism of action that benefits heart failure patients?
A) Selective beta-1 blockade
✓ B) Alpha-1 and nonselective beta blockade
C) Calcium channel blockade
D) ACE inhibition
Carvedilol is a nonselective beta-blocker with additional alpha-1 blocking properties. The
, alpha blockade causes vasodilation, reducing afterload, while beta blockade reduces heart
rate and myocardial oxygen demand. This combined effect is particularly beneficial in
chronic heart failure.
3. Which antiarrhythmic drug class is associated with a high risk of pulmonary fibrosis?
A) Class Ia (quinidine)
B) Class Ic (flecainide)
✓ C) Class III (amiodarone)
D) Class IV (verapamil)
Amiodarone (Class III) can cause serious pulmonary toxicity, including interstitial
pneumonitis and pulmonary fibrosis. The mechanism is thought to involve direct cytotoxicity
and immune-mediated reactions. Baseline pulmonary function tests and periodic monitoring
are recommended.
4. A patient on lisinopril develops a dry, hacking cough. What is the most appropriate
management?
A) Add dextromethorphan
✓ B) Discontinue lisinopril and switch to an angiotensin receptor blocker (ARB)
C) Reduce the dose of lisinopril
D) Add an inhaled corticosteroid
ACE inhibitors prevent the breakdown of bradykinin, leading to accumulation and a
, characteristic dry cough. ARBs do not affect bradykinin levels and are an appropriate
alternative.
5. Which of the following diuretics is a potassium-sparing aldosterone antagonist?
A) Furosemide
B) Hydrochlorothiazide
C) Triamterene
✓ D) Spironolactone
Spironolactone competitively inhibits aldosterone in the distal tubule, promoting sodium and
water excretion while retaining potassium. Triamterene and amiloride are also potassium-
sparing but act directly on sodium channels, not via aldosterone antagonism.
6. A patient on metformin is scheduled for coronary angiography with iodinated contrast. What
is the most important action?
✓ A) Hold metformin at the time of or prior to the procedure and restart 48 hours later
if renal function is normal
B) Continue metformin without interruption
C) Replace metformin with insulin permanently
D) Administer N-acetylcysteine to protect kidneys
Metformin should be discontinued before contrast administration and withheld for 48 hours
afterward to reduce the risk of lactic acidosis if contrast-induced nephropathy occurs. It can
be resumed once renal function is confirmed stable.
, 7. Which antibiotic class exerts its effect by inhibiting bacterial cell wall synthesis?
A) Aminoglycosides
B) Fluoroquinolones
✓ C) Cephalosporins
D) Macrolides
Cephalosporins, like penicillins, bind to penicillin-binding proteins and inhibit
transpeptidation in peptidoglycan synthesis, weakening the bacterial cell wall and causing
lysis. Aminoglycosides and macrolides inhibit protein synthesis; fluoroquinolones inhibit
DNA gyrase.
8. A patient on a statin reports muscle aches and weakness. Which laboratory test is most
important to obtain?
A) Liver function tests
✓ B) Creatine kinase (CK) levels
C) C-reactive protein
D) Electrolyte panel
Muscle symptoms may indicate statin-induced myopathy or rhabdomyolysis. Measuring CK
helps assess severity; markedly elevated CK (>10 times upper normal limit) suggests
rhabdomyolysis and necessitates discontinuation.
9. What is the mechanism of action of clopidogrel?
A) Cyclooxygenase-1 inhibition
Test Questions with Answers & Rationales | latest update
this year .pdf
1. A patient with atrial fibrillation is started on warfarin. Which laboratory parameter should be
monitored to assess therapeutic effect?
A) aPTT
✓ B) INR
C) Platelet count
D) Bleeding time
Warfarin exerts its anticoagulant effect by inhibiting vitamin K-dependent clotting factors (II,
VII, IX, X). The International Normalized Ratio (INR) standardizes prothrombin time
measurement and is used to monitor warfarin therapy. aPTT is used for unfractionated
heparin.
2. A 68-year-old man with heart failure is prescribed carvedilol. What is the primary
mechanism of action that benefits heart failure patients?
A) Selective beta-1 blockade
✓ B) Alpha-1 and nonselective beta blockade
C) Calcium channel blockade
D) ACE inhibition
Carvedilol is a nonselective beta-blocker with additional alpha-1 blocking properties. The
, alpha blockade causes vasodilation, reducing afterload, while beta blockade reduces heart
rate and myocardial oxygen demand. This combined effect is particularly beneficial in
chronic heart failure.
3. Which antiarrhythmic drug class is associated with a high risk of pulmonary fibrosis?
A) Class Ia (quinidine)
B) Class Ic (flecainide)
✓ C) Class III (amiodarone)
D) Class IV (verapamil)
Amiodarone (Class III) can cause serious pulmonary toxicity, including interstitial
pneumonitis and pulmonary fibrosis. The mechanism is thought to involve direct cytotoxicity
and immune-mediated reactions. Baseline pulmonary function tests and periodic monitoring
are recommended.
4. A patient on lisinopril develops a dry, hacking cough. What is the most appropriate
management?
A) Add dextromethorphan
✓ B) Discontinue lisinopril and switch to an angiotensin receptor blocker (ARB)
C) Reduce the dose of lisinopril
D) Add an inhaled corticosteroid
ACE inhibitors prevent the breakdown of bradykinin, leading to accumulation and a
, characteristic dry cough. ARBs do not affect bradykinin levels and are an appropriate
alternative.
5. Which of the following diuretics is a potassium-sparing aldosterone antagonist?
A) Furosemide
B) Hydrochlorothiazide
C) Triamterene
✓ D) Spironolactone
Spironolactone competitively inhibits aldosterone in the distal tubule, promoting sodium and
water excretion while retaining potassium. Triamterene and amiloride are also potassium-
sparing but act directly on sodium channels, not via aldosterone antagonism.
6. A patient on metformin is scheduled for coronary angiography with iodinated contrast. What
is the most important action?
✓ A) Hold metformin at the time of or prior to the procedure and restart 48 hours later
if renal function is normal
B) Continue metformin without interruption
C) Replace metformin with insulin permanently
D) Administer N-acetylcysteine to protect kidneys
Metformin should be discontinued before contrast administration and withheld for 48 hours
afterward to reduce the risk of lactic acidosis if contrast-induced nephropathy occurs. It can
be resumed once renal function is confirmed stable.
, 7. Which antibiotic class exerts its effect by inhibiting bacterial cell wall synthesis?
A) Aminoglycosides
B) Fluoroquinolones
✓ C) Cephalosporins
D) Macrolides
Cephalosporins, like penicillins, bind to penicillin-binding proteins and inhibit
transpeptidation in peptidoglycan synthesis, weakening the bacterial cell wall and causing
lysis. Aminoglycosides and macrolides inhibit protein synthesis; fluoroquinolones inhibit
DNA gyrase.
8. A patient on a statin reports muscle aches and weakness. Which laboratory test is most
important to obtain?
A) Liver function tests
✓ B) Creatine kinase (CK) levels
C) C-reactive protein
D) Electrolyte panel
Muscle symptoms may indicate statin-induced myopathy or rhabdomyolysis. Measuring CK
helps assess severity; markedly elevated CK (>10 times upper normal limit) suggests
rhabdomyolysis and necessitates discontinuation.
9. What is the mechanism of action of clopidogrel?
A) Cyclooxygenase-1 inhibition
