NU 578: Advanced Pharmacology
Unit 3 Exam
University of South Alabama |100 Questions with Expert
Rationales
Instructions
• This examination covers advanced pharmacology concepts for the neurologic,
psychiatric, and pain management systems.
• Select the single best answer for each question.
• Rationales explain the mechanism of action, clinical application, and evidence-based
prescribing principles.
Section 1: Neurologic Pharmacology (Questions 1-30)
1. A 65-year-old male with a new diagnosis of Parkinson's disease (PD) presents
with mild tremor and bradykinesia. Which of the following is the most
appropriate first-line pharmacologic treatment?
A. Levodopa-carbidopa
B. Pramipexole
C. Selegiline
D. Benztropine
Answer: C
Expert Rationale: For early Parkinson's disease with mild symptoms, monoamine
oxidase-B (MAO-B) inhibitors (selegiline, rasagiline) or dopamine agonists are often
used first-line to delay the need for levodopa and its associated motor complications.
Levodopa is typically reserved for when symptoms impair function.
,2. A 72-year-old male with Parkinson's disease has been taking levodopa-
carbidopa for five years. He now reports that his medication "wears off" before
his next dose is due, causing a return of tremor and stiffness. This phenomenon
is known as:
A. Dyskinesia
B. Freezing
C. Wearing-off phenomenon
D. On-off phenomenon
Answer: C
Expert Rationale: The "wearing-off" phenomenon (end-of-dose akinesia) is a
common motor complication of long-term levodopa therapy, characterized by the
return of parkinsonian symptoms as the drug's effect diminishes before the next
scheduled dose. "On-off" phenomenon refers to unpredictable fluctuations between
mobility and immobility.
3. A patient on levodopa-carbidopa develops involuntary, choreiform
movements of the face and extremities. The NP recognizes this as:
A. A sign of disease progression
B. A drug interaction
C. Levodopa-induced dyskinesia
D. A psychiatric side effect
Answer: C
Expert Rationale: Levodopa-induced dyskinesias (LID) are abnormal, involuntary,
choreiform movements that occur in up to 50-80% of patients after 5-10 years of
levodopa therapy. They are a common dose-related motor complication, not a sign
of disease progression.
4. A 70-year-old female with Parkinson's disease is prescribed carbidopa-
levodopa 25/100 mg three times daily. What is the role of carbidopa in this
combination?
A. It acts as a dopamine agonist to enhance the effect of levodopa
B. It inhibits peripheral decarboxylation of levodopa, reducing peripheral side effects
and increasing central availability
C. It blocks dopamine reuptake in the central nervous system
D. It prevents the metabolism of levodopa by catechol-O-methyltransferase (COMT)
Answer: B
Expert Rationale: Carbidopa is a peripheral decarboxylase inhibitor. It prevents
the conversion of levodopa to dopamine in the periphery, which reduces peripheral
side effects (nausea, hypotension) and increases the amount of levodopa available to
cross the blood-brain barrier into the central nervous system.
,5. A 45-year-old male is started on pramipexole for Parkinson's disease. The NP
should counsel the patient about which potential adverse effect?
A. Sedation and sleep attacks
B. Peripheral neuropathy
C. Hepatotoxicity
D. Orthostatic hypertension
Answer: A
Expert Rationale: Pramipexole is a dopamine agonist. A significant adverse effect
is sedation, including sudden onset of sleep ("sleep attacks") while driving. Patients
must be warned about this risk. Other common side effects include nausea,
orthostatic hypotension, and impulse control disorders (e.g., compulsive gambling).
6. A patient with Parkinson's disease is prescribed entacapone as adjunctive
therapy to levodopa-carbidopa. The NP understands that the mechanism of
action of entacapone is:
A. Dopamine receptor agonism
B. COMT inhibition to prolong the half-life of levodopa
C. MAO-B inhibition to prevent dopamine breakdown
D. Anticholinergic effects to reduce tremor
Answer: B
Expert Rationale: Entacapone is a catechol-O-methyltransferase (COMT)
inhibitor. It prolongs the half-life of levodopa by inhibiting its metabolism in the
periphery, leading to more stable plasma levels and reduced "off" time in patients
experiencing wearing-off fluctuations.
7. A 55-year-old female is diagnosed with essential tremor. Which of the
following is the first-line medication for this condition?
A. Propranolol or primidone
B. Levodopa-carbidopa
C. Pramipexole
D. Clonazepam
Answer: A
Expert Rationale: Essential tremor is managed with propranolol (a non-selective
beta-blocker) or primidone (an anticonvulsant) as first-line agents. These medications
reduce tremor amplitude. Propranolol is often preferred due to its favorable side
effect profile.
8. A 72-year-old male with Alzheimer's disease is prescribed donepezil. The NP
should counsel the family that the expected therapeutic effect of this
medication is:
A. Halting the progression of the disease
, B. Reversing cognitive deficits
C. Providing modest, temporary improvement in cognitive function
D. Reducing behavioral symptoms only
Answer: C
Expert Rationale: Donepezil is an acetylcholinesterase inhibitor that increases
acetylcholine levels in the brain. It provides modest, temporary symptomatic
improvement in cognitive function but does not halt or reverse disease progression.
It may also delay the need for institutionalization.
9. A patient on donepezil reports new-onset bradycardia. The NP understands
that this adverse effect is due to:
A. Direct cardiac toxicity
B. Vagotonic effects of increased acetylcholine
C. Drug-drug interaction with beta-blockers
D. Allergic reaction
Answer: B
Expert Rationale: Donepezil and other cholinesterase inhibitors have vagotonic
effects due to increased acetylcholine, which can cause bradycardia, heart block, and
syncope. A baseline ECG is recommended before initiating therapy in at-risk patients.
10. A patient with moderate to severe Alzheimer's disease is prescribed
memantine. The mechanism of action of memantine is:
A. Acetylcholinesterase inhibition
B. NMDA receptor antagonism
C. Serotonin reuptake inhibition
D. Dopamine receptor agonism
Answer: B
Expert Rationale: Memantine is an NMDA (N-methyl-D-aspartate) receptor
antagonist that modulates glutamate activity. It is indicated for moderate to severe
Alzheimer's disease and may be used in combination with acetylcholinesterase
inhibitors.
11. A 35-year-old female presents with an acute, severe, unilateral headache
with nausea, photophobia, and a visual aura. She has a history of similar
episodes. Which of the following is the most appropriate acute treatment?
A. Sumatriptan
B. Propranolol
C. Topiramate
D. Acetaminophen
Unit 3 Exam
University of South Alabama |100 Questions with Expert
Rationales
Instructions
• This examination covers advanced pharmacology concepts for the neurologic,
psychiatric, and pain management systems.
• Select the single best answer for each question.
• Rationales explain the mechanism of action, clinical application, and evidence-based
prescribing principles.
Section 1: Neurologic Pharmacology (Questions 1-30)
1. A 65-year-old male with a new diagnosis of Parkinson's disease (PD) presents
with mild tremor and bradykinesia. Which of the following is the most
appropriate first-line pharmacologic treatment?
A. Levodopa-carbidopa
B. Pramipexole
C. Selegiline
D. Benztropine
Answer: C
Expert Rationale: For early Parkinson's disease with mild symptoms, monoamine
oxidase-B (MAO-B) inhibitors (selegiline, rasagiline) or dopamine agonists are often
used first-line to delay the need for levodopa and its associated motor complications.
Levodopa is typically reserved for when symptoms impair function.
,2. A 72-year-old male with Parkinson's disease has been taking levodopa-
carbidopa for five years. He now reports that his medication "wears off" before
his next dose is due, causing a return of tremor and stiffness. This phenomenon
is known as:
A. Dyskinesia
B. Freezing
C. Wearing-off phenomenon
D. On-off phenomenon
Answer: C
Expert Rationale: The "wearing-off" phenomenon (end-of-dose akinesia) is a
common motor complication of long-term levodopa therapy, characterized by the
return of parkinsonian symptoms as the drug's effect diminishes before the next
scheduled dose. "On-off" phenomenon refers to unpredictable fluctuations between
mobility and immobility.
3. A patient on levodopa-carbidopa develops involuntary, choreiform
movements of the face and extremities. The NP recognizes this as:
A. A sign of disease progression
B. A drug interaction
C. Levodopa-induced dyskinesia
D. A psychiatric side effect
Answer: C
Expert Rationale: Levodopa-induced dyskinesias (LID) are abnormal, involuntary,
choreiform movements that occur in up to 50-80% of patients after 5-10 years of
levodopa therapy. They are a common dose-related motor complication, not a sign
of disease progression.
4. A 70-year-old female with Parkinson's disease is prescribed carbidopa-
levodopa 25/100 mg three times daily. What is the role of carbidopa in this
combination?
A. It acts as a dopamine agonist to enhance the effect of levodopa
B. It inhibits peripheral decarboxylation of levodopa, reducing peripheral side effects
and increasing central availability
C. It blocks dopamine reuptake in the central nervous system
D. It prevents the metabolism of levodopa by catechol-O-methyltransferase (COMT)
Answer: B
Expert Rationale: Carbidopa is a peripheral decarboxylase inhibitor. It prevents
the conversion of levodopa to dopamine in the periphery, which reduces peripheral
side effects (nausea, hypotension) and increases the amount of levodopa available to
cross the blood-brain barrier into the central nervous system.
,5. A 45-year-old male is started on pramipexole for Parkinson's disease. The NP
should counsel the patient about which potential adverse effect?
A. Sedation and sleep attacks
B. Peripheral neuropathy
C. Hepatotoxicity
D. Orthostatic hypertension
Answer: A
Expert Rationale: Pramipexole is a dopamine agonist. A significant adverse effect
is sedation, including sudden onset of sleep ("sleep attacks") while driving. Patients
must be warned about this risk. Other common side effects include nausea,
orthostatic hypotension, and impulse control disorders (e.g., compulsive gambling).
6. A patient with Parkinson's disease is prescribed entacapone as adjunctive
therapy to levodopa-carbidopa. The NP understands that the mechanism of
action of entacapone is:
A. Dopamine receptor agonism
B. COMT inhibition to prolong the half-life of levodopa
C. MAO-B inhibition to prevent dopamine breakdown
D. Anticholinergic effects to reduce tremor
Answer: B
Expert Rationale: Entacapone is a catechol-O-methyltransferase (COMT)
inhibitor. It prolongs the half-life of levodopa by inhibiting its metabolism in the
periphery, leading to more stable plasma levels and reduced "off" time in patients
experiencing wearing-off fluctuations.
7. A 55-year-old female is diagnosed with essential tremor. Which of the
following is the first-line medication for this condition?
A. Propranolol or primidone
B. Levodopa-carbidopa
C. Pramipexole
D. Clonazepam
Answer: A
Expert Rationale: Essential tremor is managed with propranolol (a non-selective
beta-blocker) or primidone (an anticonvulsant) as first-line agents. These medications
reduce tremor amplitude. Propranolol is often preferred due to its favorable side
effect profile.
8. A 72-year-old male with Alzheimer's disease is prescribed donepezil. The NP
should counsel the family that the expected therapeutic effect of this
medication is:
A. Halting the progression of the disease
, B. Reversing cognitive deficits
C. Providing modest, temporary improvement in cognitive function
D. Reducing behavioral symptoms only
Answer: C
Expert Rationale: Donepezil is an acetylcholinesterase inhibitor that increases
acetylcholine levels in the brain. It provides modest, temporary symptomatic
improvement in cognitive function but does not halt or reverse disease progression.
It may also delay the need for institutionalization.
9. A patient on donepezil reports new-onset bradycardia. The NP understands
that this adverse effect is due to:
A. Direct cardiac toxicity
B. Vagotonic effects of increased acetylcholine
C. Drug-drug interaction with beta-blockers
D. Allergic reaction
Answer: B
Expert Rationale: Donepezil and other cholinesterase inhibitors have vagotonic
effects due to increased acetylcholine, which can cause bradycardia, heart block, and
syncope. A baseline ECG is recommended before initiating therapy in at-risk patients.
10. A patient with moderate to severe Alzheimer's disease is prescribed
memantine. The mechanism of action of memantine is:
A. Acetylcholinesterase inhibition
B. NMDA receptor antagonism
C. Serotonin reuptake inhibition
D. Dopamine receptor agonism
Answer: B
Expert Rationale: Memantine is an NMDA (N-methyl-D-aspartate) receptor
antagonist that modulates glutamate activity. It is indicated for moderate to severe
Alzheimer's disease and may be used in combination with acetylcholinesterase
inhibitors.
11. A 35-year-old female presents with an acute, severe, unilateral headache
with nausea, photophobia, and a visual aura. She has a history of similar
episodes. Which of the following is the most appropriate acute treatment?
A. Sumatriptan
B. Propranolol
C. Topiramate
D. Acetaminophen
