GALEN PHARM EXAM 2 2026/2027 | 100% Correct Answers
with Complete Solutions | Autonomic, Cardiovascular, CNS,
Anti-Infective, Endocrine, Respiratory | Pass Guaranteed - A+
Graded
Unit 1: Autonomic Nervous System Pharmacology (15 Questions)
Q1: A 68-year-old male with benign prostatic hyperplasia (BPH) is prescribed tamsulosin
(Flomax) 0.4 mg daily. During medication education, he asks about potential side
effects. Which adverse effect requires immediate reporting to the healthcare provider?
A. Mild nasal congestion occurring in the morning
B. Dizziness and lightheadedness when standing up from a seated position
C. Decreased semen volume during ejaculation
D. Mild headache that resolves with acetaminophen
Correct Answer: B
Rationale: Tamsulosin is an alpha-1 adrenergic antagonist selective for prostatic
alpha-1A receptors. While this selectivity reduces orthostatic hypotension compared to
non-selective alpha blockers, dizziness and lightheadedness on standing indicate
orthostatic hypotension—a potentially dangerous adverse effect that could lead to falls,
syncope, and injury. Patients must be educated to rise slowly from sitting or lying
positions and report significant dizziness immediately.
,Why other options are incorrect:
● A: Nasal congestion is a common, expected side effect of alpha-1 blockade on
nasal vasculature; it is bothersome but not dangerous.
● C: Decreased semen volume (retrograde ejaculation) is a known, expected effect
of alpha blockers on internal sphincter tone; it is not harmful but may affect
fertility.
● D: Mild headache is a common side effect that responds to analgesics and does
not require immediate provider notification.
Q2: A 45-year-old female with myasthenia gravis is experiencing increased muscle
weakness, difficulty swallowing, and ptosis. She is taking pyridostigmine (Mestinon) 60
mg every 4 hours. Which pharmacological intervention is most appropriate?
A. Increase pyridostigmine dose to 120 mg every 4 hours
B. Administer atropine 0.4 mg IV immediately
C. Evaluate for cholinergic crisis and consider withholding pyridostigmine
D. Add neostigmine 15 mg orally to the regimen
Correct Answer: C
Rationale: The presentation could represent either myasthenic crisis (insufficient
acetylcholine) or cholinergic crisis (excessive cholinesterase inhibition). Pyridostigmine
is a reversible acetylcholinesterase inhibitor that increases acetylcholine at nicotinic
and muscarinic receptors. Excessive dosing causes cholinergic crisis with symptoms
identical to myasthenic weakness. The Tensilon (edrophonium) test or withholding a
dose helps differentiate: improvement suggests myasthenic crisis (needs more drug),
,worsening suggests cholinergic crisis (needs less drug). Atropine treats muscarinic
symptoms but not nicotinic muscle weakness.
Why other options are incorrect:
● A: Increasing the dose without differentiation could worsen cholinergic crisis,
potentially causing respiratory failure from excessive nicotinic stimulation
followed by depolarization blockade.
● B: Atropine addresses muscarinic symptoms (salivation, bradycardia, miosis) but
not nicotinic neuromuscular symptoms; it does not treat the underlying
diagnostic uncertainty.
● D: Adding another cholinesterase inhibitor (neostigmine) would worsen
cholinergic crisis if that is the underlying problem; this is dangerous without
differentiation.
Q3: A 28-year-old male presents to the emergency department with acute angle-closure
glaucoma. Intraocular pressure is 48 mmHg (normal <21). Which pharmacological
agent works by constricting the pupil to open the trabecular meshwork and increase
aqueous humor outflow?
A. Timolol ophthalmic drops
B. Acetazolamide IV
C. Pilocarpine ophthalmic drops
D. Mannitol IV
Correct Answer: C
, Rationale: Pilocarpine is a direct-acting muscarinic cholinergic agonist that causes
miosis (pupil constriction) by contracting the sphincter muscle of the iris. In acute
angle-closure glaucoma, this pulls the peripheral iris away from the trabecular
meshwork, opening the drainage angle and allowing aqueous humor outflow. This is the
definitive pharmacological mechanism for relieving pupillary block in angle-closure
glaucoma.
Why other options are incorrect:
● A: Timolol is a beta-blocker that reduces aqueous humor production but does not
address the anatomical angle closure; it is adjunctive, not definitive for angle
closure.
● B: Acetazolamide (carbonic anhydrase inhibitor) reduces aqueous production but
does not open the angle; it is used as adjunctive therapy for pressure reduction.
● D: Mannitol is an osmotic diuretic that reduces vitreous volume and intraocular
pressure temporarily but does not address the angle anatomy or provide
definitive treatment.
Q4: A 62-year-old female with chronic obstructive pulmonary disease (COPD) is
prescribed ipratropium bromide (Atrovent) via metered-dose inhaler. Which mechanism
of action and nursing consideration is most accurate?
A. Beta-2 adrenergic agonism causing bronchodilation; monitor for tachycardia
B. Muscarinic cholinergic antagonism causing bronchodilation; monitor for dry mouth
and urinary retention
C. Alpha-1 adrenergic blockade causing vasodilation; monitor for orthostatic
hypotension
with Complete Solutions | Autonomic, Cardiovascular, CNS,
Anti-Infective, Endocrine, Respiratory | Pass Guaranteed - A+
Graded
Unit 1: Autonomic Nervous System Pharmacology (15 Questions)
Q1: A 68-year-old male with benign prostatic hyperplasia (BPH) is prescribed tamsulosin
(Flomax) 0.4 mg daily. During medication education, he asks about potential side
effects. Which adverse effect requires immediate reporting to the healthcare provider?
A. Mild nasal congestion occurring in the morning
B. Dizziness and lightheadedness when standing up from a seated position
C. Decreased semen volume during ejaculation
D. Mild headache that resolves with acetaminophen
Correct Answer: B
Rationale: Tamsulosin is an alpha-1 adrenergic antagonist selective for prostatic
alpha-1A receptors. While this selectivity reduces orthostatic hypotension compared to
non-selective alpha blockers, dizziness and lightheadedness on standing indicate
orthostatic hypotension—a potentially dangerous adverse effect that could lead to falls,
syncope, and injury. Patients must be educated to rise slowly from sitting or lying
positions and report significant dizziness immediately.
,Why other options are incorrect:
● A: Nasal congestion is a common, expected side effect of alpha-1 blockade on
nasal vasculature; it is bothersome but not dangerous.
● C: Decreased semen volume (retrograde ejaculation) is a known, expected effect
of alpha blockers on internal sphincter tone; it is not harmful but may affect
fertility.
● D: Mild headache is a common side effect that responds to analgesics and does
not require immediate provider notification.
Q2: A 45-year-old female with myasthenia gravis is experiencing increased muscle
weakness, difficulty swallowing, and ptosis. She is taking pyridostigmine (Mestinon) 60
mg every 4 hours. Which pharmacological intervention is most appropriate?
A. Increase pyridostigmine dose to 120 mg every 4 hours
B. Administer atropine 0.4 mg IV immediately
C. Evaluate for cholinergic crisis and consider withholding pyridostigmine
D. Add neostigmine 15 mg orally to the regimen
Correct Answer: C
Rationale: The presentation could represent either myasthenic crisis (insufficient
acetylcholine) or cholinergic crisis (excessive cholinesterase inhibition). Pyridostigmine
is a reversible acetylcholinesterase inhibitor that increases acetylcholine at nicotinic
and muscarinic receptors. Excessive dosing causes cholinergic crisis with symptoms
identical to myasthenic weakness. The Tensilon (edrophonium) test or withholding a
dose helps differentiate: improvement suggests myasthenic crisis (needs more drug),
,worsening suggests cholinergic crisis (needs less drug). Atropine treats muscarinic
symptoms but not nicotinic muscle weakness.
Why other options are incorrect:
● A: Increasing the dose without differentiation could worsen cholinergic crisis,
potentially causing respiratory failure from excessive nicotinic stimulation
followed by depolarization blockade.
● B: Atropine addresses muscarinic symptoms (salivation, bradycardia, miosis) but
not nicotinic neuromuscular symptoms; it does not treat the underlying
diagnostic uncertainty.
● D: Adding another cholinesterase inhibitor (neostigmine) would worsen
cholinergic crisis if that is the underlying problem; this is dangerous without
differentiation.
Q3: A 28-year-old male presents to the emergency department with acute angle-closure
glaucoma. Intraocular pressure is 48 mmHg (normal <21). Which pharmacological
agent works by constricting the pupil to open the trabecular meshwork and increase
aqueous humor outflow?
A. Timolol ophthalmic drops
B. Acetazolamide IV
C. Pilocarpine ophthalmic drops
D. Mannitol IV
Correct Answer: C
, Rationale: Pilocarpine is a direct-acting muscarinic cholinergic agonist that causes
miosis (pupil constriction) by contracting the sphincter muscle of the iris. In acute
angle-closure glaucoma, this pulls the peripheral iris away from the trabecular
meshwork, opening the drainage angle and allowing aqueous humor outflow. This is the
definitive pharmacological mechanism for relieving pupillary block in angle-closure
glaucoma.
Why other options are incorrect:
● A: Timolol is a beta-blocker that reduces aqueous humor production but does not
address the anatomical angle closure; it is adjunctive, not definitive for angle
closure.
● B: Acetazolamide (carbonic anhydrase inhibitor) reduces aqueous production but
does not open the angle; it is used as adjunctive therapy for pressure reduction.
● D: Mannitol is an osmotic diuretic that reduces vitreous volume and intraocular
pressure temporarily but does not address the angle anatomy or provide
definitive treatment.
Q4: A 62-year-old female with chronic obstructive pulmonary disease (COPD) is
prescribed ipratropium bromide (Atrovent) via metered-dose inhaler. Which mechanism
of action and nursing consideration is most accurate?
A. Beta-2 adrenergic agonism causing bronchodilation; monitor for tachycardia
B. Muscarinic cholinergic antagonism causing bronchodilation; monitor for dry mouth
and urinary retention
C. Alpha-1 adrenergic blockade causing vasodilation; monitor for orthostatic
hypotension
