NR568 Advanced Pharmacology for the Adult-Gerontology Primary Care Nurse
Practitioner: (Latest 2026/2027 Update) Weeks 5-8 FINAL EXAM Review | Q&A | Grade A
| 100% Correct (Verified Answers)
Subject: Advanced Pharmacology (NR568) - Adult-Gerontology Primary Care NP Weeks 5-8 Final Exam
Source: NR568 Weeks 5-8 Final Exam Comprehensive Review - Latest 2026/2027 Blueprint
Format: Q&A Guide with Clinical Rationale | Evidence-Based Practice | Verified Accurate Solutions
Instructions: Each question includes the verified correct answer and a detailed clinical pharmacology rationale
covering neurology, psychiatry, endocrinology, men's/women's health, infectious disease, and herbal supplements.
1: How do you manage Parkinson's disease in early stages?
Correct Answer: Either with Pramipexole (Mirapex) OR Rotigotine (Neupro).
1. Dopamine agonists are often used as initial therapy in younger patients to delay levodopa-related motor
complications.
2. These agents have lower risk of dyskinesias but higher risk of impulse control disorders and daytime
sleepiness.
3. Monotherapy may be effective for several years before levodopa is needed.
2: What is the most effective therapy for Parkinson's disease?
Correct Answer: Combination therapy with levodopa/carbidopa or levodopa/carbidopa/entacapone.
1. Levodopa is the most effective symptomatic treatment for PD, providing 50% motor improvement.
2. Carbidopa prevents peripheral conversion of levodopa, reducing side effects and increasing brain availability.
3. Entacapone (COMT inhibitor) extends levodopa half-life, reducing "off" time.
3: What medications are used to treat "off times" including wearing-off experiences in Parkinson's disease?
Correct Answer: Dopamine agonists, COMT inhibitors (Entacapone), and MAO-B inhibitors (Rasagiline).
1. COMT inhibitors (entacapone) increase levodopa bioavailability by blocking peripheral metabolism.
2. MAO-B inhibitors (rasagiline, selegiline) prevent dopamine breakdown in the brain.
3. These adjunctive agents reduce "off" time and allow levodopa dose reduction.
4: What are adverse effects of Pramipexole (Mirapex)?
Correct Answer: Nausea, dizziness, daytime somnolence, insomnia, constipation, weakness, hallucinations, impulse
control disorders.
1. Impulse control disorders (gambling, hypersexuality, compulsive shopping, binge eating) occur in up to 17%
of patients.
2. Sudden sleep attacks without warning can occur; patients must be warned about driving.
3. Hallucinations more common in elderly; reduce dose or discontinue.
5: Which medication is the safest choice for someone on oral contraceptives?
Correct Answer: Pregabalin.
1. Pregabalin (Lyrica) has no significant interaction with oral contraceptives.
2. Many anticonvulsants (carbamazepine, phenytoin, phenobarbital) induce CYP450 and reduce OC efficacy.
3. Lamotrigine may also interact; alternative contraception recommended.
,6: What is the purpose and timing of serum drug levels for phenytoin?
Correct Answer: Small changes in dosage produce large changes in plasma levels; as a result, small increases can
cause toxicity and small decreases can cause therapeutic failure. This relationship makes it difficult to establish and
maintain a safe and effective dosage. Serum drug levels and trough levels are used along with seizure control
assessments to determine dosage.
1. Phenytoin follows zero-order kinetics at therapeutic doses; small dose increases cause disproportionate level
rises.
2. Trough levels drawn just before next dose reflect steady-state concentration.
3. Therapeutic range: 10-20 mcg/mL; toxicity above 20 mcg/mL (nystagmus, ataxia, sedation).
7: What happens when you take phenytoin and oxcarbazepine together?
Correct Answer: Phenytoin toxicity and subtherapeutic levels of oxcarbazepine can occur. Levels should be
monitored and dosages adjusted accordingly.
1. Oxcarbazepine inhibits enzymes that metabolize phenytoin, raising phenytoin levels.
2. Phenytoin may decrease oxcarbazepine concentrations via enzyme induction.
3. Clinical monitoring and dose adjustment are essential when using together.
8: What is first-line therapy for migraines and headaches?
Correct Answer: OTC medications such as Tylenol and Advil (acetaminophen, ibuprofen, naproxen).
1. NSAIDs and acetaminophen are effective for mild-moderate migraines without disability.
2. Combination products with caffeine may enhance efficacy.
3. Limit use to ≤2-3 days/week to prevent medication overuse headache.
9: What medications can help prevent migraine attacks?
Correct Answer: Propranolol, metoprolol, and beta-blockers: timolol, atenolol, and nadolol.
1. Beta-blockers are first-line preventive therapy for episodic migraine.
2. Propranolol and metoprolol have strongest evidence; timolol and nadolol also effective.
3. Alternative preventives: topiramate, valproate, amitriptyline, venlafaxine.
10: What drugs can cause medication overuse headache (MOH)?
Correct Answer: Almost all medications used for abortive headache therapy: aspirin-like drugs (NSAIDs,
acetaminophen), opioids, triptans, ergotamine (but not dihydroergotamine), and caffeine.
1. MOH defined as headache on ≥15 days/month developing from overuse of acute medications.
2. Triptans and ergots cause MOH faster (≥10 days/month) than simple analgesics (≥15 days/month).
3. Treatment requires discontinuation of overused medication and transition to preventive therapy.
11: What measures can decrease medication overuse headache (MOH)?
Correct Answer: Limit use of abortive medications. Patients should not take these drugs more than 2-3 times a week
and doses should not be higher than actually needed.
1. Triptans limited to ≤9 days/month; simple analgesics ≤14 days/month.
2. Bridge therapy with NSAIDs or dihydroergotamine during withdrawal.
3. Preventive medication should be started to reduce attack frequency.
12: What are contraindications for sumatriptan and other triptans?
Correct Answer: All triptans are contraindicated for patients with ischemic heart disease, prior MI, or uncontrolled
hypertension.
1. Triptans cause coronary vasospasm; contraindicated in CAD, Prinzmetal angina, uncontrolled HTN.
2. Also contraindicated in hemiplegic or basilar migraine, stroke/TIA history, peripheral vascular disease.
3. Avoid within 24 hours of ergotamine or another triptan; avoid with MAOIs.
, 13: What are alternative medications for migraine prevention?
Correct Answer: Beta blockers, antiseizure drugs, tricyclic antidepressants, estrogens and triptans for menstrual-
associated migraines, erenumab, botulinum toxin.
1. Erenumab (CGRP antagonist) is first-in-class for migraine prevention; monthly injection.
2. Botulinum toxin type A approved for chronic migraine (≥15 days/month).
3. Topiramate and valproate effective but have cognitive and teratogenic risks.
14: What is the drug of choice for moderate Alzheimer's disease?
Correct Answer: Cholinesterase inhibitors: Aricept (donepezil), Razadyne ER (galantamine), and Exelon
(rivastigmine).
1. Cholinesterase inhibitors modestly improve cognitive function and delay decline for 6-12 months.
2. All three agents are FDA-approved for mild to moderate AD.
3. Donepezil also approved for severe AD (23 mg/day).
15: Is it recommended to combine two cholinesterase inhibitors?
Correct Answer: No.
1. No evidence supports combining two ChEIs; may increase adverse effects without benefit.
2. ChEI and memantine may be combined for moderate-severe AD.
3. Switch from one ChEI to another if inadequate response or intolerance.
16: What is memantine indicated for?
Correct Answer: Mild to moderate AD; it is NOT indicated for mild AD as studies have not shown symptom
improvement.
1. Memantine (Namenda) is FDA-approved for moderate to severe AD.
2. NMDA antagonist reduces glutamate excitotoxicity.
3. May be combined with ChEI for additional modest benefit.
17: How is Rivastigmine (Exelon) administered?
Correct Answer: Orally or transdermal patch.
1. Transdermal patch provides steady drug levels with fewer GI side effects.
2. Oral dosing twice daily; patch changed daily.
3. Patch approved for dementia associated with Parkinson's disease.
18: Where does Rivastigmine act?
Correct Answer: On both acetylcholinesterase and butyrylcholinesterase, thereby increasing its efficacy.
1. Dual inhibition distinguishes rivastigmine from donepezil and galantamine.
2. Butyrylcholinesterase increases in AD; inhibiting it may provide additional benefit.
3. No CYP450 metabolism; fewer drug interactions.
19: Who should not take rivastigmine?
Correct Answer: Patients with COPD.
1. Cholinesterase inhibitors can cause bronchoconstriction; caution in asthma/COPD.
2. Also caution in bradycardia, sick sinus syndrome, GI bleeding risk, urinary obstruction.
3. Avoid in patients with weight <50 kg (higher side effect risk).
Practitioner: (Latest 2026/2027 Update) Weeks 5-8 FINAL EXAM Review | Q&A | Grade A
| 100% Correct (Verified Answers)
Subject: Advanced Pharmacology (NR568) - Adult-Gerontology Primary Care NP Weeks 5-8 Final Exam
Source: NR568 Weeks 5-8 Final Exam Comprehensive Review - Latest 2026/2027 Blueprint
Format: Q&A Guide with Clinical Rationale | Evidence-Based Practice | Verified Accurate Solutions
Instructions: Each question includes the verified correct answer and a detailed clinical pharmacology rationale
covering neurology, psychiatry, endocrinology, men's/women's health, infectious disease, and herbal supplements.
1: How do you manage Parkinson's disease in early stages?
Correct Answer: Either with Pramipexole (Mirapex) OR Rotigotine (Neupro).
1. Dopamine agonists are often used as initial therapy in younger patients to delay levodopa-related motor
complications.
2. These agents have lower risk of dyskinesias but higher risk of impulse control disorders and daytime
sleepiness.
3. Monotherapy may be effective for several years before levodopa is needed.
2: What is the most effective therapy for Parkinson's disease?
Correct Answer: Combination therapy with levodopa/carbidopa or levodopa/carbidopa/entacapone.
1. Levodopa is the most effective symptomatic treatment for PD, providing 50% motor improvement.
2. Carbidopa prevents peripheral conversion of levodopa, reducing side effects and increasing brain availability.
3. Entacapone (COMT inhibitor) extends levodopa half-life, reducing "off" time.
3: What medications are used to treat "off times" including wearing-off experiences in Parkinson's disease?
Correct Answer: Dopamine agonists, COMT inhibitors (Entacapone), and MAO-B inhibitors (Rasagiline).
1. COMT inhibitors (entacapone) increase levodopa bioavailability by blocking peripheral metabolism.
2. MAO-B inhibitors (rasagiline, selegiline) prevent dopamine breakdown in the brain.
3. These adjunctive agents reduce "off" time and allow levodopa dose reduction.
4: What are adverse effects of Pramipexole (Mirapex)?
Correct Answer: Nausea, dizziness, daytime somnolence, insomnia, constipation, weakness, hallucinations, impulse
control disorders.
1. Impulse control disorders (gambling, hypersexuality, compulsive shopping, binge eating) occur in up to 17%
of patients.
2. Sudden sleep attacks without warning can occur; patients must be warned about driving.
3. Hallucinations more common in elderly; reduce dose or discontinue.
5: Which medication is the safest choice for someone on oral contraceptives?
Correct Answer: Pregabalin.
1. Pregabalin (Lyrica) has no significant interaction with oral contraceptives.
2. Many anticonvulsants (carbamazepine, phenytoin, phenobarbital) induce CYP450 and reduce OC efficacy.
3. Lamotrigine may also interact; alternative contraception recommended.
,6: What is the purpose and timing of serum drug levels for phenytoin?
Correct Answer: Small changes in dosage produce large changes in plasma levels; as a result, small increases can
cause toxicity and small decreases can cause therapeutic failure. This relationship makes it difficult to establish and
maintain a safe and effective dosage. Serum drug levels and trough levels are used along with seizure control
assessments to determine dosage.
1. Phenytoin follows zero-order kinetics at therapeutic doses; small dose increases cause disproportionate level
rises.
2. Trough levels drawn just before next dose reflect steady-state concentration.
3. Therapeutic range: 10-20 mcg/mL; toxicity above 20 mcg/mL (nystagmus, ataxia, sedation).
7: What happens when you take phenytoin and oxcarbazepine together?
Correct Answer: Phenytoin toxicity and subtherapeutic levels of oxcarbazepine can occur. Levels should be
monitored and dosages adjusted accordingly.
1. Oxcarbazepine inhibits enzymes that metabolize phenytoin, raising phenytoin levels.
2. Phenytoin may decrease oxcarbazepine concentrations via enzyme induction.
3. Clinical monitoring and dose adjustment are essential when using together.
8: What is first-line therapy for migraines and headaches?
Correct Answer: OTC medications such as Tylenol and Advil (acetaminophen, ibuprofen, naproxen).
1. NSAIDs and acetaminophen are effective for mild-moderate migraines without disability.
2. Combination products with caffeine may enhance efficacy.
3. Limit use to ≤2-3 days/week to prevent medication overuse headache.
9: What medications can help prevent migraine attacks?
Correct Answer: Propranolol, metoprolol, and beta-blockers: timolol, atenolol, and nadolol.
1. Beta-blockers are first-line preventive therapy for episodic migraine.
2. Propranolol and metoprolol have strongest evidence; timolol and nadolol also effective.
3. Alternative preventives: topiramate, valproate, amitriptyline, venlafaxine.
10: What drugs can cause medication overuse headache (MOH)?
Correct Answer: Almost all medications used for abortive headache therapy: aspirin-like drugs (NSAIDs,
acetaminophen), opioids, triptans, ergotamine (but not dihydroergotamine), and caffeine.
1. MOH defined as headache on ≥15 days/month developing from overuse of acute medications.
2. Triptans and ergots cause MOH faster (≥10 days/month) than simple analgesics (≥15 days/month).
3. Treatment requires discontinuation of overused medication and transition to preventive therapy.
11: What measures can decrease medication overuse headache (MOH)?
Correct Answer: Limit use of abortive medications. Patients should not take these drugs more than 2-3 times a week
and doses should not be higher than actually needed.
1. Triptans limited to ≤9 days/month; simple analgesics ≤14 days/month.
2. Bridge therapy with NSAIDs or dihydroergotamine during withdrawal.
3. Preventive medication should be started to reduce attack frequency.
12: What are contraindications for sumatriptan and other triptans?
Correct Answer: All triptans are contraindicated for patients with ischemic heart disease, prior MI, or uncontrolled
hypertension.
1. Triptans cause coronary vasospasm; contraindicated in CAD, Prinzmetal angina, uncontrolled HTN.
2. Also contraindicated in hemiplegic or basilar migraine, stroke/TIA history, peripheral vascular disease.
3. Avoid within 24 hours of ergotamine or another triptan; avoid with MAOIs.
, 13: What are alternative medications for migraine prevention?
Correct Answer: Beta blockers, antiseizure drugs, tricyclic antidepressants, estrogens and triptans for menstrual-
associated migraines, erenumab, botulinum toxin.
1. Erenumab (CGRP antagonist) is first-in-class for migraine prevention; monthly injection.
2. Botulinum toxin type A approved for chronic migraine (≥15 days/month).
3. Topiramate and valproate effective but have cognitive and teratogenic risks.
14: What is the drug of choice for moderate Alzheimer's disease?
Correct Answer: Cholinesterase inhibitors: Aricept (donepezil), Razadyne ER (galantamine), and Exelon
(rivastigmine).
1. Cholinesterase inhibitors modestly improve cognitive function and delay decline for 6-12 months.
2. All three agents are FDA-approved for mild to moderate AD.
3. Donepezil also approved for severe AD (23 mg/day).
15: Is it recommended to combine two cholinesterase inhibitors?
Correct Answer: No.
1. No evidence supports combining two ChEIs; may increase adverse effects without benefit.
2. ChEI and memantine may be combined for moderate-severe AD.
3. Switch from one ChEI to another if inadequate response or intolerance.
16: What is memantine indicated for?
Correct Answer: Mild to moderate AD; it is NOT indicated for mild AD as studies have not shown symptom
improvement.
1. Memantine (Namenda) is FDA-approved for moderate to severe AD.
2. NMDA antagonist reduces glutamate excitotoxicity.
3. May be combined with ChEI for additional modest benefit.
17: How is Rivastigmine (Exelon) administered?
Correct Answer: Orally or transdermal patch.
1. Transdermal patch provides steady drug levels with fewer GI side effects.
2. Oral dosing twice daily; patch changed daily.
3. Patch approved for dementia associated with Parkinson's disease.
18: Where does Rivastigmine act?
Correct Answer: On both acetylcholinesterase and butyrylcholinesterase, thereby increasing its efficacy.
1. Dual inhibition distinguishes rivastigmine from donepezil and galantamine.
2. Butyrylcholinesterase increases in AD; inhibiting it may provide additional benefit.
3. No CYP450 metabolism; fewer drug interactions.
19: Who should not take rivastigmine?
Correct Answer: Patients with COPD.
1. Cholinesterase inhibitors can cause bronchoconstriction; caution in asthma/COPD.
2. Also caution in bradycardia, sick sinus syndrome, GI bleeding risk, urinary obstruction.
3. Avoid in patients with weight <50 kg (higher side effect risk).
