RxMnemonic High-Yield Pharmacology Question Bank

Question 1

A 58-year-old woman with hypertension and type 2 diabetes develops a persistent dry cough three weeks after starting lisinopril. Her lungs are clear, spirometry is normal, and the cough resolves compl

Accepted Answer

ACE, also called kininase II, breaks down bradykinin and substance P, so inhibiting it lets these peptides accumulate in the airway and sensitize cough fibers, producing the dry cough; an ARB like losartan blocks the AT1 receptor downstream of angiotensin II and does not raise kinins, so it controls blood pressure without the cough, which is what (B) describes. (A) is the key trap: losartan does block AT1, but the cough is not driven by angiotensin II, and ACE inhibitors actually lower angiotens

Question 2

A 34-year-old pregnant woman at 18 weeks gestation is found to have worsening hypertension. Her prior antihypertensive was lisinopril. Which is the most important reason to switch medications?

Accepted Answer

Angiotensin II is essential for fetal kidney development and renal blood flow, so blocking its formation in the second and third trimesters, the period this patient is in at 18 weeks, produces ACE inhibitor fetopathy: oligohydramnios (fetal urine makes up most of the amniotic fluid), skull ossification defects, limb contractures, and pulmonary hypoplasia, which is what (B) describes. Each distractor is a real teratogenic pattern from a different drug, which is what makes this harder. (A) describ

Question 3

A 72-year-old man with metastatic prostate cancer is treated with long-term oral morphine. He develops tolerance to euphoria, sedation, and respiratory depression. Which opioid side effect does NOT de

Accepted Answer

Tolerance develops at very different rates to different opioid effects, and the pattern is high yield. Patients become tolerant fairly quickly to euphoria, sedation, respiratory depression, and nausea because those effects are mediated centrally and the receptors adapt with chronic exposure. Constipation is the exception: opioids slow the gut by acting on mu receptors in the myenteric plexus, a peripheral effect that doesn't down regulate the same way, so patients on long term opioids need ongoi

Question 4

A patient is brought to the ED unresponsive with a respiratory rate of 6/min, BP 90/60 mmHg, and pinpoint pupils. Empty fentanyl patches are found on his skin. Which is the most appropriate initial tr

Accepted Answer

The toxidrome of slow respirations, hypotension, and pinpoint pupils with fentanyl patches is opioid overdose, and naloxone is the antidote, but the tested nuance is duration. Fentanyl keeps absorbing from the skin depot for hours after the patch is removed, while naloxone wears off in roughly 30 to 90 minutes, so a single dose often is not enough and the patient can re-sedate, which is why (A), naloxone plus readiness to redose or run an infusion, is correct. (B) is the trap, since giving one d

Question 5

A 45-year-old chronic alcohol user is admitted after his last drink 48 hours ago. He develops tremors, diaphoresis, tachycardia, and a seizure. What is the mechanism of the first-line treatment for hi

Accepted Answer

Alcohol withdrawal is a hyperexcitable state from chronic GABA-A enhancement and NMDA suppression that is unmasked when alcohol is removed. Benzodiazepines are first line because they are positive allosteric modulators of the GABA-A receptor, increasing the frequency of chloride channel opening only when GABA is present, which is what (C) describes. (A) is the barbiturate mechanism, which can open the channel without GABA and is more dangerous, not how benzodiazepines work. (B) is the tempting t

Question 6

A 19-year-old presents with acute onset hyperthermia, agitation, diaphoresis, hypertension, and mydriasis after taking a pill at a party. Urine drug screen is positive for amphetamines. What is the pr

Accepted Answer

Amphetamines are substrates for the monoamine transporters (DAT, NET, and SERT) rather than simple blockers of them. Once inside the nerve terminal, they reverse the normal direction of these transporters and disrupt vesicular storage, flooding the synapse with dopamine, norepinephrine, and serotonin all at once. The resulting surge of norepinephrine is what drives the hypertension, tachycardia, and vasoconstriction seen in this patient, so (B) captures the mechanism precisely. (A) describes a m

Question 7

A 28-year-old woman with severe rheumatoid arthritis is started on methotrexate. She is counseled to also take folic acid supplementation. What is the primary mechanism by which methotrexate exerts it

Accepted Answer

Methotrexate's central antiproliferative action is inhibition of dihydrofolate reductase, the enzyme that regenerates tetrahydrofolate; without it, rapidly dividing cells cannot make the purines and thymidylate they need for DNA, which is what (B) describes, the basis for both its anticancer and disease modifying use. The distractors are deliberately close. (A) is the mechanism of 5-fluorouracil, which hits thymidylate synthase directly, a different enzyme in the same pathway. (C) describes a re

Question 8

A 24-year-old schizophrenia patient on haloperidol develops involuntary slow writhing movements of the face, tongue, and hands that persist even after the medication is tapered. What is the most likel

Accepted Answer

The combination of slow, writhing, involuntary movements of the face, tongue, and limbs that appear after months to years of antipsychotic therapy, and that persist even when the drug is stopped, is the textbook description of tardive dyskinesia. It develops because chronic D2 receptor blockade in the nigrostriatal pathway causes the postsynaptic receptors to upregulate and become supersensitive; when dopamine signaling fluctuates against that hypersensitive backdrop, it produces the characteris

Question 9

A patient taking hydrochlorothiazide for hypertension develops hypercalcemia. A nephrologist explains this is a known metabolic effect. What is the mechanism?

Accepted Answer

Thiazides block the Na-Cl cotransporter in the distal convoluted tubule, lowering intracellular sodium; the basolateral Na/Ca exchanger then works harder, pulling sodium in and pushing calcium out into the blood, so distal calcium reabsorption rises and serum calcium increases, which is what (C) describes, and the same effect makes thiazides useful for calcium stone formers. (B) is the strongest trap, because volume contraction does increase proximal calcium reabsorption and contributes modestly

Question 10

A 62-year-old man with metastatic prostate cancer is started on leuprolide. His oncologist warns him that testosterone may initially rise before falling. What is the mechanism of this "testosterone fl

Accepted Answer

Leuprolide is a GnRH agonist, and in the short term agonism at the pituitary GnRH receptor stimulates LH and FSH, driving a transient testosterone surge, the flare, before constant stimulation desensitizes and downregulates the receptor so gonadotropins fall to castration levels, which is what (B) describes. (A) is the key trap and the high yield distinction: pulsatile GnRH sustains gonadotropin release, but continuous, non-pulsatile stimulation, which is exactly what leuprolide provides, ultima

Pharmacology Question Bank

Keep going for free