NR566 Advanced Pharmacology for Care of the Family: Week
4 Midterm Complete 100-Question Study Bank with Detailed
Rationales
Chamberlain University | Latest 2026/2027 Update | A+
Graded
SECTION 1: DERMATOLOGIC PHARMACOLOGY (Qs 1-20)
Question 1
A 45-year-old male presents with a pruritic, erythematous plaque on his elbow. You diagnose plaque
psoriasis. What is the FIRST-line topical treatment?
A. Coal tar ointment
B. Calcipotriene (Dovonex) ointment
C. High-potency topical corticosteroid (e.g., clobetasol)
D. Tazarotene (Tazorac) gel
Answer: ✅ C. High-potency topical corticosteroid (e.g., clobetasol)
Rationale: Topical corticosteroids are first-line for localized plaque psoriasis due to their rapid anti-
inflammatory and antiproliferative effects. High-potency agents like clobetasol provide superior efficacy
for thick plaques on elbows and knees, though they should be used intermittently to avoid skin atrophy .
Question 2
A patient using a high-potency topical corticosteroid for 3 weeks develops skin atrophy and
telangiectasia. What is the most appropriate next step?
A. Continue use and add a moisturizer
B. Switch to a medium-potency corticosteroid
C. Discontinue use and start a topical calcineurin inhibitor
D. Increase application frequency to three times daily
Answer: ✅ B. Switch to a medium-potency corticosteroid
Rationale: Atrophy and telangiectasia are signs of steroid overuse. The patient should be stepped down
to a lower-potency agent to maintain efficacy while reducing adverse effects. Long-term use of high-
potency steroids on thin skin areas causes irreversible damage .
,Question 3
A 32-year-old woman with atopic dermatitis is concerned about steroid-induced skin thinning on her
face. Which medication is most appropriate for maintenance therapy?
A. Hydrocortisone 2.5% cream
B. Betamethasone dipropionate ointment
C. Pimecrolimus (Elidel) cream
D. Clobetasol propionate cream
Answer: ✅ C. Pimecrolimus (Elidel) cream
Rationale: Topical calcineurin inhibitors (pimecrolimus, tacrolimus) are steroid-sparing agents approved
for atopic dermatitis and are safe for use on sensitive areas like the face. Unlike corticosteroids, they do
not cause skin atrophy and are ideal for long-term maintenance in intertriginous areas .
Question 4
A patient presents with tinea corporis. What is the standard duration of treatment with a topical
antifungal like terbinafine?
A. 3-5 days
B. 1-2 weeks
C. 4-6 weeks
D. 8-12 weeks
Answer: ✅ B. 1-2 weeks
Rationale: Topical antifungals such as terbinafine and clotrimazole are typically applied for 1-2 weeks for
tinea corporis (body ringworm). Tinea pedis requires longer treatment (4 weeks), while tinea capitis
requires systemic therapy .
Question 5
A patient with scabies is prescribed permethrin 5% cream. Where should the cream be applied?
A. Only on the lesions
B. From the neck down to the soles of the feet
C. Only on the hands and wrists
D. Only on the scalp
Answer: ✅ B. From the neck down to the soles of the feet
Rationale: Scabies mites can infest the entire body (except the scalp in adults). The cream must be
applied to all skin surfaces from the neck down, paying special attention to interdigital spaces, wrists,
axillae, and genitalia. In infants and elderly, the scalp and face should also be treated .
,Question 6
Which systemic antifungal is the drug of choice for onychomycosis (nail fungus) due to its fungicidal
activity?
A. Fluconazole
B. Griseofulvin
C. Terbinafine (Lamisil)
D. Ketoconazole
Answer: ✅ C. Terbinafine (Lamisil)
Rationale: Terbinafine is fungicidal against dermatophytes and has higher cure rates for onychomycosis
compared to the fungistatic azoles. It is given orally for 6-12 weeks for fingernails or 12-16 weeks for
toenails. Baseline and periodic LFT monitoring is required due to hepatotoxicity risk .
Question 7
A patient is prescribed oral terbinafine. What baseline laboratory test is essential?
A. Complete blood count (CBC)
B. Basic metabolic panel (BMP)
C. Liver function tests (LFTs)
D. Creatine kinase (CK)
Answer: ✅ C. Liver function tests (LFTs)
Rationale: Oral terbinafine carries a risk of hepatotoxicity, including rare cases of liver failure. Baseline
LFTs are required before initiation, with periodic monitoring during treatment, especially in patients
with pre-existing liver disease. Patients should report symptoms of jaundice, dark urine, or abdominal
pain .
Question 8
What is the most common adverse effect of topical benzoyl peroxide?
A. Photosensitivity
B. Contact dermatitis and bleaching of fabric/hair
C. Systemic lupus erythematosus
D. Hyperpigmentation
Answer: ✅ B. Contact dermatitis and bleaching of fabric/hair
Rationale: Benzoyl peroxide is an oxidant that commonly causes skin irritation, dryness, and contact
dermatitis. It also bleaches clothing, towels, bed linens, and hair. Patients should be counseled to apply
to dry skin, start with lower concentrations, and use white linens .
, Question 9
For a pregnant patient with moderate acne, which topical agent is considered safest (Pregnancy
Category A/B)?
A. Tazarotene
B. Azelaic acid
C. Adapalene
D. Tretinoin
Answer: ✅ B. Azelaic acid
Rationale: Azelaic acid is Pregnancy Category B, with no evidence of risk in human studies. Retinoids
(tazarotene, adapalene, tretinoin) are Category C and generally avoided in pregnancy due to potential
teratogenic effects. Topical clindamycin and erythromycin are also acceptable options .
Question 10
A patient with chronic plaque psoriasis fails topical therapy and is started on methotrexate. What folic
acid supplementation regimen is recommended to reduce adverse effects?
A. 1 mg daily
B. 5 mg weekly
C. 10 mg daily
D. 1 mg monthly
Answer: ✅ A. 1 mg daily
Rationale: Daily folic acid (1-5 mg) is given to patients on methotrexate to reduce the risk of GI upset,
hepatotoxicity, and bone marrow suppression. Folic acid supplementation does not reduce
methotrexate's efficacy for psoriasis or rheumatoid arthritis. It is typically held on the day of
methotrexate administration .
Question 11
Which biologic agent targets IL-17A and is used for moderate-to-severe psoriasis?
A. Etanercept (Enbrel)
B. Adalimumab (Humira)
C. Secukinumab (Cosentyx)
D. Ustekinumab (Stelara)
Answer: ✅ C. Secukinumab (Cosentyx)
Rationale: Secukinumab is a monoclonal antibody that selectively binds to and neutralizes IL-17A, a pro-
inflammatory cytokine involved in psoriasis pathogenesis. It is administered by subcutaneous injection
4 Midterm Complete 100-Question Study Bank with Detailed
Rationales
Chamberlain University | Latest 2026/2027 Update | A+
Graded
SECTION 1: DERMATOLOGIC PHARMACOLOGY (Qs 1-20)
Question 1
A 45-year-old male presents with a pruritic, erythematous plaque on his elbow. You diagnose plaque
psoriasis. What is the FIRST-line topical treatment?
A. Coal tar ointment
B. Calcipotriene (Dovonex) ointment
C. High-potency topical corticosteroid (e.g., clobetasol)
D. Tazarotene (Tazorac) gel
Answer: ✅ C. High-potency topical corticosteroid (e.g., clobetasol)
Rationale: Topical corticosteroids are first-line for localized plaque psoriasis due to their rapid anti-
inflammatory and antiproliferative effects. High-potency agents like clobetasol provide superior efficacy
for thick plaques on elbows and knees, though they should be used intermittently to avoid skin atrophy .
Question 2
A patient using a high-potency topical corticosteroid for 3 weeks develops skin atrophy and
telangiectasia. What is the most appropriate next step?
A. Continue use and add a moisturizer
B. Switch to a medium-potency corticosteroid
C. Discontinue use and start a topical calcineurin inhibitor
D. Increase application frequency to three times daily
Answer: ✅ B. Switch to a medium-potency corticosteroid
Rationale: Atrophy and telangiectasia are signs of steroid overuse. The patient should be stepped down
to a lower-potency agent to maintain efficacy while reducing adverse effects. Long-term use of high-
potency steroids on thin skin areas causes irreversible damage .
,Question 3
A 32-year-old woman with atopic dermatitis is concerned about steroid-induced skin thinning on her
face. Which medication is most appropriate for maintenance therapy?
A. Hydrocortisone 2.5% cream
B. Betamethasone dipropionate ointment
C. Pimecrolimus (Elidel) cream
D. Clobetasol propionate cream
Answer: ✅ C. Pimecrolimus (Elidel) cream
Rationale: Topical calcineurin inhibitors (pimecrolimus, tacrolimus) are steroid-sparing agents approved
for atopic dermatitis and are safe for use on sensitive areas like the face. Unlike corticosteroids, they do
not cause skin atrophy and are ideal for long-term maintenance in intertriginous areas .
Question 4
A patient presents with tinea corporis. What is the standard duration of treatment with a topical
antifungal like terbinafine?
A. 3-5 days
B. 1-2 weeks
C. 4-6 weeks
D. 8-12 weeks
Answer: ✅ B. 1-2 weeks
Rationale: Topical antifungals such as terbinafine and clotrimazole are typically applied for 1-2 weeks for
tinea corporis (body ringworm). Tinea pedis requires longer treatment (4 weeks), while tinea capitis
requires systemic therapy .
Question 5
A patient with scabies is prescribed permethrin 5% cream. Where should the cream be applied?
A. Only on the lesions
B. From the neck down to the soles of the feet
C. Only on the hands and wrists
D. Only on the scalp
Answer: ✅ B. From the neck down to the soles of the feet
Rationale: Scabies mites can infest the entire body (except the scalp in adults). The cream must be
applied to all skin surfaces from the neck down, paying special attention to interdigital spaces, wrists,
axillae, and genitalia. In infants and elderly, the scalp and face should also be treated .
,Question 6
Which systemic antifungal is the drug of choice for onychomycosis (nail fungus) due to its fungicidal
activity?
A. Fluconazole
B. Griseofulvin
C. Terbinafine (Lamisil)
D. Ketoconazole
Answer: ✅ C. Terbinafine (Lamisil)
Rationale: Terbinafine is fungicidal against dermatophytes and has higher cure rates for onychomycosis
compared to the fungistatic azoles. It is given orally for 6-12 weeks for fingernails or 12-16 weeks for
toenails. Baseline and periodic LFT monitoring is required due to hepatotoxicity risk .
Question 7
A patient is prescribed oral terbinafine. What baseline laboratory test is essential?
A. Complete blood count (CBC)
B. Basic metabolic panel (BMP)
C. Liver function tests (LFTs)
D. Creatine kinase (CK)
Answer: ✅ C. Liver function tests (LFTs)
Rationale: Oral terbinafine carries a risk of hepatotoxicity, including rare cases of liver failure. Baseline
LFTs are required before initiation, with periodic monitoring during treatment, especially in patients
with pre-existing liver disease. Patients should report symptoms of jaundice, dark urine, or abdominal
pain .
Question 8
What is the most common adverse effect of topical benzoyl peroxide?
A. Photosensitivity
B. Contact dermatitis and bleaching of fabric/hair
C. Systemic lupus erythematosus
D. Hyperpigmentation
Answer: ✅ B. Contact dermatitis and bleaching of fabric/hair
Rationale: Benzoyl peroxide is an oxidant that commonly causes skin irritation, dryness, and contact
dermatitis. It also bleaches clothing, towels, bed linens, and hair. Patients should be counseled to apply
to dry skin, start with lower concentrations, and use white linens .
, Question 9
For a pregnant patient with moderate acne, which topical agent is considered safest (Pregnancy
Category A/B)?
A. Tazarotene
B. Azelaic acid
C. Adapalene
D. Tretinoin
Answer: ✅ B. Azelaic acid
Rationale: Azelaic acid is Pregnancy Category B, with no evidence of risk in human studies. Retinoids
(tazarotene, adapalene, tretinoin) are Category C and generally avoided in pregnancy due to potential
teratogenic effects. Topical clindamycin and erythromycin are also acceptable options .
Question 10
A patient with chronic plaque psoriasis fails topical therapy and is started on methotrexate. What folic
acid supplementation regimen is recommended to reduce adverse effects?
A. 1 mg daily
B. 5 mg weekly
C. 10 mg daily
D. 1 mg monthly
Answer: ✅ A. 1 mg daily
Rationale: Daily folic acid (1-5 mg) is given to patients on methotrexate to reduce the risk of GI upset,
hepatotoxicity, and bone marrow suppression. Folic acid supplementation does not reduce
methotrexate's efficacy for psoriasis or rheumatoid arthritis. It is typically held on the day of
methotrexate administration .
Question 11
Which biologic agent targets IL-17A and is used for moderate-to-severe psoriasis?
A. Etanercept (Enbrel)
B. Adalimumab (Humira)
C. Secukinumab (Cosentyx)
D. Ustekinumab (Stelara)
Answer: ✅ C. Secukinumab (Cosentyx)
Rationale: Secukinumab is a monoclonal antibody that selectively binds to and neutralizes IL-17A, a pro-
inflammatory cytokine involved in psoriasis pathogenesis. It is administered by subcutaneous injection
