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NR 565 Advanced Pharmacology Exam 2026-2027 BANK
QUESTIONS WITH DETAILED VERIFIED ANSWERS EXAM
QUESTIONS WILL COME FROM HERE (100% CORRECT
ANSWERS A+ GRADED
1. A nurse practitioner prescribes a drug that is a CYP450 3A4 substrate.
Concurrent prescription of which medication would most likely lead to
toxicity of the first drug?
A. Rifampin
B. Ketoconazole
C. Phenobarbital
D. Carbamazepine
Answer: B. Ketoconazole is a potent inhibitor of CYP450 3A4. When a
3A4 substrate is co-administered with an inhibitor like ketoconazole,
metabolism of the substrate is decreased, leading to higher serum
levels and potential toxicity. The other options are CYP450 inducers.
2. What is the primary mechanism of action of propranolol?
A. Selective beta-1 adrenergic receptor blockade
B. Nonselective beta-adrenergic receptor blockade
C. Alpha-1 adrenergic receptor blockade
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D. Central alpha-2 adrenergic receptor agonism
Answer: B. Propranolol is a nonselective beta-blocker, meaning it
antagonizes both beta-1 and beta-2 adrenergic receptors. This
contrasts with drugs like metoprolol, which are cardioselective beta-1
blockers.
3. A patient on warfarin is prescribed trimethoprim-sulfamethoxazole
for a urinary tract infection. What alteration in warfarin therapy is most
likely needed?
A. Increase the warfarin dose due to increased metabolism
B. Decrease the warfarin dose due to inhibition of metabolism
C. No change, as there is no drug interaction
D. Discontinue warfarin for the duration of antibiotic therapy
Answer: B. Trimethoprim-sulfamethoxazole inhibits CYP2C9, the
primary enzyme responsible for metabolizing the more active S-isomer
of warfarin. This leads to potentiation of warfarin's anticoagulant
effect, requiring a dose reduction and close monitoring of INR.
4. Which adverse effect is specifically associated with amiodarone due
to its high iodine content and structural similarity to thyroxine?
A. Pulmonary fibrosis
B. Corneal microdeposits
C. Both hyperthyroidism and hypothyroidism
D. Blue-gray skin discoloration
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Answer: C. Amiodarone's chemical structure resembles thyroid
hormones, and it contains a high proportion of iodine. This can lead to
both thyrotoxicosis (hyperthyroidism) and hypothyroidism due to the
Wolff-Chaikoff effect or iodine-induced thyrotoxicosis.
5. A patient with hypertension and benign prostatic hyperplasia would
benefit most from which alpha-1 antagonist?
A. Phenoxybenzamine
B. Phentolamine
C. Doxazosin
D. Propranolol
Answer: C. Doxazosin is a selective alpha-1 receptor antagonist that
relaxes smooth muscle in the prostate and bladder neck, improving
urine flow, while also lowering blood pressure. Phenoxybenzamine is a
nonselective irreversible alpha-blocker used for pheochromocytoma.
6. What is the underlying pharmacodynamic principle for using
flumazenil in a benzodiazepine overdose?
A. It acts as a non-competitive antagonist at GABA receptors
B. It is a competitive antagonist at the benzodiazepine binding site on
the GABA-A receptor
C. It enhances GABA’s affinity for the receptor independently
D. It directly opens chloride ion channels
Answer: B. Flumazenil acts as a competitive antagonist at the
benzodiazepine recognition site on the GABA-A receptor complex,
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reversing the central nervous system depressant effects of
benzodiazepines.
7. Which laboratory value requires the most urgent assessment before
initiating metformin therapy?
A. Hemoglobin A1c
B. Serum creatinine
C. Fasting lipid panel
D. Alanine aminotransferase
Answer: B. Metformin is renally cleared, and its use is contraindicated if
the estimated glomerular filtration rate (eGFR) is below 30
mL/min/1.73 m². Assessing renal function via serum creatinine and
eGFR is critical to prevent the rare but serious adverse effect of lactic
acidosis.
8. A patient with asthma develops angina. Which antianginal agent is
relatively contraindicated?
A. Nifedipine
B. Verapamil
C. Isosorbide mononitrate
D. Propranolol
Answer: D. Propranolol is a nonselective beta-blocker that can block
beta-2 receptors in the bronchial smooth muscle, leading to
bronchoconstriction and potential exacerbation of asthma.
Cardioselective beta-1 blockers are preferred but still require caution.
NR 565 Advanced Pharmacology Exam 2026-2027 BANK
QUESTIONS WITH DETAILED VERIFIED ANSWERS EXAM
QUESTIONS WILL COME FROM HERE (100% CORRECT
ANSWERS A+ GRADED
1. A nurse practitioner prescribes a drug that is a CYP450 3A4 substrate.
Concurrent prescription of which medication would most likely lead to
toxicity of the first drug?
A. Rifampin
B. Ketoconazole
C. Phenobarbital
D. Carbamazepine
Answer: B. Ketoconazole is a potent inhibitor of CYP450 3A4. When a
3A4 substrate is co-administered with an inhibitor like ketoconazole,
metabolism of the substrate is decreased, leading to higher serum
levels and potential toxicity. The other options are CYP450 inducers.
2. What is the primary mechanism of action of propranolol?
A. Selective beta-1 adrenergic receptor blockade
B. Nonselective beta-adrenergic receptor blockade
C. Alpha-1 adrenergic receptor blockade
,2|Page
D. Central alpha-2 adrenergic receptor agonism
Answer: B. Propranolol is a nonselective beta-blocker, meaning it
antagonizes both beta-1 and beta-2 adrenergic receptors. This
contrasts with drugs like metoprolol, which are cardioselective beta-1
blockers.
3. A patient on warfarin is prescribed trimethoprim-sulfamethoxazole
for a urinary tract infection. What alteration in warfarin therapy is most
likely needed?
A. Increase the warfarin dose due to increased metabolism
B. Decrease the warfarin dose due to inhibition of metabolism
C. No change, as there is no drug interaction
D. Discontinue warfarin for the duration of antibiotic therapy
Answer: B. Trimethoprim-sulfamethoxazole inhibits CYP2C9, the
primary enzyme responsible for metabolizing the more active S-isomer
of warfarin. This leads to potentiation of warfarin's anticoagulant
effect, requiring a dose reduction and close monitoring of INR.
4. Which adverse effect is specifically associated with amiodarone due
to its high iodine content and structural similarity to thyroxine?
A. Pulmonary fibrosis
B. Corneal microdeposits
C. Both hyperthyroidism and hypothyroidism
D. Blue-gray skin discoloration
,3|Page
Answer: C. Amiodarone's chemical structure resembles thyroid
hormones, and it contains a high proportion of iodine. This can lead to
both thyrotoxicosis (hyperthyroidism) and hypothyroidism due to the
Wolff-Chaikoff effect or iodine-induced thyrotoxicosis.
5. A patient with hypertension and benign prostatic hyperplasia would
benefit most from which alpha-1 antagonist?
A. Phenoxybenzamine
B. Phentolamine
C. Doxazosin
D. Propranolol
Answer: C. Doxazosin is a selective alpha-1 receptor antagonist that
relaxes smooth muscle in the prostate and bladder neck, improving
urine flow, while also lowering blood pressure. Phenoxybenzamine is a
nonselective irreversible alpha-blocker used for pheochromocytoma.
6. What is the underlying pharmacodynamic principle for using
flumazenil in a benzodiazepine overdose?
A. It acts as a non-competitive antagonist at GABA receptors
B. It is a competitive antagonist at the benzodiazepine binding site on
the GABA-A receptor
C. It enhances GABA’s affinity for the receptor independently
D. It directly opens chloride ion channels
Answer: B. Flumazenil acts as a competitive antagonist at the
benzodiazepine recognition site on the GABA-A receptor complex,
, 4|Page
reversing the central nervous system depressant effects of
benzodiazepines.
7. Which laboratory value requires the most urgent assessment before
initiating metformin therapy?
A. Hemoglobin A1c
B. Serum creatinine
C. Fasting lipid panel
D. Alanine aminotransferase
Answer: B. Metformin is renally cleared, and its use is contraindicated if
the estimated glomerular filtration rate (eGFR) is below 30
mL/min/1.73 m². Assessing renal function via serum creatinine and
eGFR is critical to prevent the rare but serious adverse effect of lactic
acidosis.
8. A patient with asthma develops angina. Which antianginal agent is
relatively contraindicated?
A. Nifedipine
B. Verapamil
C. Isosorbide mononitrate
D. Propranolol
Answer: D. Propranolol is a nonselective beta-blocker that can block
beta-2 receptors in the bronchial smooth muscle, leading to
bronchoconstriction and potential exacerbation of asthma.
Cardioselective beta-1 blockers are preferred but still require caution.
