Final Comprehensive Exam Review 2025
Neurology & Psychiatry
1. What is the mechanism of action of Levodopa/Carbidopa in Parkinson’s disease?
→ Levodopa converts to dopamine in the brain; Carbidopa prevents peripheral
breakdown of Levodopa, enhancing CNS availability.
2. When should pharmacologic treatment be initiated in patients with Parkinson’s
disease?
→ When symptoms begin interfering with daily functioning or quality of life.
3. What patient education should be provided when prescribing Levodopa?
→ Take on an empty stomach; avoid high-protein meals; may cause nausea, dizziness,
and dyskinesias.
4. What are the goals of pharmacotherapy in Alzheimer’s disease?
→ Slow progression of cognitive decline, improve/maintain function, and manage
behavioral symptoms.
5. Which medications are first-line in managing mild to moderate Alzheimer’s disease?
→ Cholinesterase inhibitors: Donepezil, Rivastigmine, Galantamine.
6. What are key side effects of medications used to treat alcohol use disorder?
→ Naltrexone: Nausea, hepatotoxicity; Acamprosate: Diarrhea; Disulfiram: Flushing,
nausea with alcohol.
7. Which medications are commonly used in alcohol use disorder, and how are they
chosen based on comorbidities?
, → Naltrexone (avoid in liver disease), Acamprosate (avoid in renal disease), Disulfiram
(only for highly motivated patients).
8. What are common side effects associated with stimulant medications for ADHD?
→ Decreased appetite, insomnia, increased BP/HR, irritability, and potential for misuse.
9. How does insomnia treatment differ between short-term and chronic management?
→ Short-term: Z-drugs (e.g., Zolpidem); chronic: focus on CBT-I and sleep hygiene.
10. What are the first-line pharmacologic options for managing insomnia?
→ Non-benzodiazepine hypnotics (Zolpidem), Melatonin agonists (Ramelteon).
11. What is the recommended order of treatment lines for major depressive disorder?
→ 1st: SSRIs; 2nd: SNRIs, Bupropion; 3rd: TCAs, MAOIs, augmentation strategies.
12. Which antidepressants are preferred in patients who experience sexual side effects
from SSRIs?
→ Bupropion and Mirtazapine.
13. What medications are contraindicated in depression with comorbid bipolar
disorder?
→ SSRIs or SNRIs as monotherapy (may induce mania); mood stabilizers should be co-
prescribed.
Cardiology
14. What ECG changes are expected with Class I and Class III antiarrhythmic drugs?
→ Class I: Widened QRS; Class III: Prolonged QT interval.
,15. How do you choose an appropriate antiarrhythmic medication based on type of
arrhythmia and patient history?
→ Based on rhythm type and structural heart disease. Avoid Class IC in structural heart
disease; use Amiodarone in HF.
16. What are the second-line pharmacologic agents in managing HFrEF?
→ MRA (Spironolactone), Hydralazine/ISDN, Ivabradine, Digoxin.
17. Which drugs are contraindicated in HFrEF?
→ Non-dihydropyridine CCBs (Verapamil, Diltiazem), NSAIDs, TZDs.
18. What are key nonpharmacologic education points for patients with CAD?
→ Heart-healthy diet, regular exercise, smoking cessation, stress management,
medication adherence.
19. Which diuretics are used in hypertension, and what are their contraindications?
→ Thiazides: Contraindicated in gout; Loop diuretics: Reserved for CKD/HF; K-sparing:
Avoid in hyperkalemia.
20. What are the most common side effects associated with antihypertensive
pharmacotherapy?
→ Hypotension, electrolyte disturbances, bradycardia (BBs), cough (ACEIs), edema
(CCBs).
21. How should hypertension be managed in special populations like African Americans
or pregnant patients?
→ African Americans: Thiazides or CCBs; Pregnancy: Labetalol, Nifedipine,
Methyldopa.
, 22. What are the stages of hypertension according to ACC/AHA guidelines?
→ Stage 1: 130–139/80–89 mmHg; Stage 2: ≥140/90 mmHg.
23. What are important medication interactions to consider when managing
hypertension?
→ NSAIDs reduce efficacy; ACEI + ARB = increased risk of renal dysfunction; Lithium
+ diuretics = toxicity.
Women’s Health
24. What is the first-line pharmacologic treatment for bacterial vaginosis, and what is
the duration?
→ Metronidazole 500 mg PO BID for 7 days.
25. What are the diagnostic criteria for bacterial vaginosis?
→ Amsel criteria: ≥3 of 4 (discharge, clue cells, pH > 4.5, positive whiff test).
26. What organisms are responsible for vaginal yeast infections, and how are they
treated?
→ Candida albicans; treated with Fluconazole 150 mg once or topical azoles.
27. How do you determine the most appropriate contraceptive method for a patient?
→ Based on patient preference, medical history, reproductive goals, and
contraindications.
Neurology & Psychiatry
1. What is the mechanism of action of Levodopa/Carbidopa in Parkinson’s disease?
→ Levodopa converts to dopamine in the brain; Carbidopa prevents peripheral
breakdown of Levodopa, enhancing CNS availability.
2. When should pharmacologic treatment be initiated in patients with Parkinson’s
disease?
→ When symptoms begin interfering with daily functioning or quality of life.
3. What patient education should be provided when prescribing Levodopa?
→ Take on an empty stomach; avoid high-protein meals; may cause nausea, dizziness,
and dyskinesias.
4. What are the goals of pharmacotherapy in Alzheimer’s disease?
→ Slow progression of cognitive decline, improve/maintain function, and manage
behavioral symptoms.
5. Which medications are first-line in managing mild to moderate Alzheimer’s disease?
→ Cholinesterase inhibitors: Donepezil, Rivastigmine, Galantamine.
6. What are key side effects of medications used to treat alcohol use disorder?
→ Naltrexone: Nausea, hepatotoxicity; Acamprosate: Diarrhea; Disulfiram: Flushing,
nausea with alcohol.
7. Which medications are commonly used in alcohol use disorder, and how are they
chosen based on comorbidities?
, → Naltrexone (avoid in liver disease), Acamprosate (avoid in renal disease), Disulfiram
(only for highly motivated patients).
8. What are common side effects associated with stimulant medications for ADHD?
→ Decreased appetite, insomnia, increased BP/HR, irritability, and potential for misuse.
9. How does insomnia treatment differ between short-term and chronic management?
→ Short-term: Z-drugs (e.g., Zolpidem); chronic: focus on CBT-I and sleep hygiene.
10. What are the first-line pharmacologic options for managing insomnia?
→ Non-benzodiazepine hypnotics (Zolpidem), Melatonin agonists (Ramelteon).
11. What is the recommended order of treatment lines for major depressive disorder?
→ 1st: SSRIs; 2nd: SNRIs, Bupropion; 3rd: TCAs, MAOIs, augmentation strategies.
12. Which antidepressants are preferred in patients who experience sexual side effects
from SSRIs?
→ Bupropion and Mirtazapine.
13. What medications are contraindicated in depression with comorbid bipolar
disorder?
→ SSRIs or SNRIs as monotherapy (may induce mania); mood stabilizers should be co-
prescribed.
Cardiology
14. What ECG changes are expected with Class I and Class III antiarrhythmic drugs?
→ Class I: Widened QRS; Class III: Prolonged QT interval.
,15. How do you choose an appropriate antiarrhythmic medication based on type of
arrhythmia and patient history?
→ Based on rhythm type and structural heart disease. Avoid Class IC in structural heart
disease; use Amiodarone in HF.
16. What are the second-line pharmacologic agents in managing HFrEF?
→ MRA (Spironolactone), Hydralazine/ISDN, Ivabradine, Digoxin.
17. Which drugs are contraindicated in HFrEF?
→ Non-dihydropyridine CCBs (Verapamil, Diltiazem), NSAIDs, TZDs.
18. What are key nonpharmacologic education points for patients with CAD?
→ Heart-healthy diet, regular exercise, smoking cessation, stress management,
medication adherence.
19. Which diuretics are used in hypertension, and what are their contraindications?
→ Thiazides: Contraindicated in gout; Loop diuretics: Reserved for CKD/HF; K-sparing:
Avoid in hyperkalemia.
20. What are the most common side effects associated with antihypertensive
pharmacotherapy?
→ Hypotension, electrolyte disturbances, bradycardia (BBs), cough (ACEIs), edema
(CCBs).
21. How should hypertension be managed in special populations like African Americans
or pregnant patients?
→ African Americans: Thiazides or CCBs; Pregnancy: Labetalol, Nifedipine,
Methyldopa.
, 22. What are the stages of hypertension according to ACC/AHA guidelines?
→ Stage 1: 130–139/80–89 mmHg; Stage 2: ≥140/90 mmHg.
23. What are important medication interactions to consider when managing
hypertension?
→ NSAIDs reduce efficacy; ACEI + ARB = increased risk of renal dysfunction; Lithium
+ diuretics = toxicity.
Women’s Health
24. What is the first-line pharmacologic treatment for bacterial vaginosis, and what is
the duration?
→ Metronidazole 500 mg PO BID for 7 days.
25. What are the diagnostic criteria for bacterial vaginosis?
→ Amsel criteria: ≥3 of 4 (discharge, clue cells, pH > 4.5, positive whiff test).
26. What organisms are responsible for vaginal yeast infections, and how are they
treated?
→ Candida albicans; treated with Fluconazole 150 mg once or topical azoles.
27. How do you determine the most appropriate contraceptive method for a patient?
→ Based on patient preference, medical history, reproductive goals, and
contraindications.
