NU 553 Advanced Pharmacology – Unit 4 Practice Test (2026)
Instructions: Choose the best answer for each question. Rationales are provided below.
1. A 28-year-old female presents with a unilateral, pulsating headache associated
with nausea, photophobia, and phonophobia. Symptoms have been occurring 4
times per month for the last 3 months. What is the most appropriate first-line
acute treatment?
A. Naproxen 500 mg PO
B. Sumatriptan 50 mg PO
C. Propranolol 80 mg daily
D. Acetaminophen 1000 mg PO
Answer: B. Sumatriptan 50 mg PO
Rationale: This presentation is classic for migraine without aura. While NSAIDs (A) and
acetaminophen (D) can be used for mild migraines, triptans like sumatriptan are first-
line for moderate-to-severe migraines. Propranolol (C) is used
for prophylaxis (prevention), not acute treatment.
2. A patient has been using Sumatriptan for acute migraines but reports it is no
longer effective. She now has 12 headache days per month. Which medication is
FDA-approved specifically for the prevention of migraines in this scenario?
A. Topiramate
B. Ondansetron
C. Butalbital
D. Rizatriptan
Answer: A. Topiramate
Rationale: Topiramate is a first-line agent for migraine prophylaxis, particularly when
headache frequency is high (>4-5 days/month) . Ondansetron (B) treats nausea.
Butalbital (C) is an acute barbiturate combination with high risk of medication overuse
headache. Rizatriptan (D) is for acute treatment only.
3. A 45-year-old is diagnosed with migraine. Which comorbid condition would be
a contraindication to prescribing Propranolol for prophylaxis?
A. Hypertension
B. Essential tremor
C. Asthma
D. Anxiety
, Answer: C. Asthma
Rationale: Propranolol is a non-selective beta-blocker. It can cause bronchospasm by
blocking beta-2 receptors in the lungs and is therefore contraindicated in patients with
asthma or reactive airway disease . It is effective for hypertension (A), tremor (B), and
anxiety (D).
4. A patient presents with a new-onset generalized tonic-clonic seizure. According
to current guidelines for antiseizure medications, what is a key principle of therapy
initiation?
A. Begin with high-dose polytherapy immediately
B. Start monotherapy at a low dose and titrate slowly
C. Avoid medication unless a second seizure occurs
D. Use a benzodiazepine as chronic maintenance
Answer: B. Start monotherapy at a low dose and titrate slowly
Rationale: The principle of epilepsy treatment is "start low, go slow" with monotherapy
before considering polytherapy . While a single unprovoked seizure may not always
require treatment, new-onset epilepsy generally does. Benzodiazepines (D) are for acute
rescue, not maintenance.
5. Which drug used for seizures carries a strong FDA Boxed Warning regarding an
increased risk of suicidal thoughts and behaviors?
A. Levetiracetam
B. Lamotrigine
C. All antiseizure medications
D. Phenytoin
Answer: C. All antiseizure medications
Rationale: The FDA requires a Boxed Warning for all antiseizure drugs (AEDs) regarding
an increased risk of suicidal thoughts and behaviors, regardless of the specific agent .
Patients should be monitored for mood changes.
6. A 72-year-old patient is newly diagnosed with Alzheimer's disease with mild
cognitive impairment. What is the recommended first-line pharmacological
treatment?
A. Memantine
B. Donepezil
C. Quetiapine
D. Vitamin E
Instructions: Choose the best answer for each question. Rationales are provided below.
1. A 28-year-old female presents with a unilateral, pulsating headache associated
with nausea, photophobia, and phonophobia. Symptoms have been occurring 4
times per month for the last 3 months. What is the most appropriate first-line
acute treatment?
A. Naproxen 500 mg PO
B. Sumatriptan 50 mg PO
C. Propranolol 80 mg daily
D. Acetaminophen 1000 mg PO
Answer: B. Sumatriptan 50 mg PO
Rationale: This presentation is classic for migraine without aura. While NSAIDs (A) and
acetaminophen (D) can be used for mild migraines, triptans like sumatriptan are first-
line for moderate-to-severe migraines. Propranolol (C) is used
for prophylaxis (prevention), not acute treatment.
2. A patient has been using Sumatriptan for acute migraines but reports it is no
longer effective. She now has 12 headache days per month. Which medication is
FDA-approved specifically for the prevention of migraines in this scenario?
A. Topiramate
B. Ondansetron
C. Butalbital
D. Rizatriptan
Answer: A. Topiramate
Rationale: Topiramate is a first-line agent for migraine prophylaxis, particularly when
headache frequency is high (>4-5 days/month) . Ondansetron (B) treats nausea.
Butalbital (C) is an acute barbiturate combination with high risk of medication overuse
headache. Rizatriptan (D) is for acute treatment only.
3. A 45-year-old is diagnosed with migraine. Which comorbid condition would be
a contraindication to prescribing Propranolol for prophylaxis?
A. Hypertension
B. Essential tremor
C. Asthma
D. Anxiety
, Answer: C. Asthma
Rationale: Propranolol is a non-selective beta-blocker. It can cause bronchospasm by
blocking beta-2 receptors in the lungs and is therefore contraindicated in patients with
asthma or reactive airway disease . It is effective for hypertension (A), tremor (B), and
anxiety (D).
4. A patient presents with a new-onset generalized tonic-clonic seizure. According
to current guidelines for antiseizure medications, what is a key principle of therapy
initiation?
A. Begin with high-dose polytherapy immediately
B. Start monotherapy at a low dose and titrate slowly
C. Avoid medication unless a second seizure occurs
D. Use a benzodiazepine as chronic maintenance
Answer: B. Start monotherapy at a low dose and titrate slowly
Rationale: The principle of epilepsy treatment is "start low, go slow" with monotherapy
before considering polytherapy . While a single unprovoked seizure may not always
require treatment, new-onset epilepsy generally does. Benzodiazepines (D) are for acute
rescue, not maintenance.
5. Which drug used for seizures carries a strong FDA Boxed Warning regarding an
increased risk of suicidal thoughts and behaviors?
A. Levetiracetam
B. Lamotrigine
C. All antiseizure medications
D. Phenytoin
Answer: C. All antiseizure medications
Rationale: The FDA requires a Boxed Warning for all antiseizure drugs (AEDs) regarding
an increased risk of suicidal thoughts and behaviors, regardless of the specific agent .
Patients should be monitored for mood changes.
6. A 72-year-old patient is newly diagnosed with Alzheimer's disease with mild
cognitive impairment. What is the recommended first-line pharmacological
treatment?
A. Memantine
B. Donepezil
C. Quetiapine
D. Vitamin E
