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Exam l 3 : l NU641/ l NU l 641 l (Latest l 2025/ l
2026 l Update) l Advanced l Clinical l
Pharmacology l Guide| l Questions l & l
Answers| l Grade l A| l 100% l Correct l
(Verified l Solutions)- l Regis
QUESTION
rationall drugl selectionl inl skinl infections-l antivirals Answer: patho:l mostl commonl includel herpesl virall infections,l varicellal andl herpesl zoster rationall drugl selection
- drugsl ofl choicel forl recurrentl outbreaksl ofl HSV=l famciclovirl andl valacyclovirl (systemic)
- topicall antivirall medicationsl arel availablel forl hsv=l acyclovir,l penciclovir,l andl OTCl docosanoll usel topicall asl earlyl asl possiblel atl onsetl ofl prodromall symptomsl orl whenl lesionsl appearl tol increasel efficacy topicall notl indicatedl forl herpesl zosterl orl varicellla usel cautionl forl applicationl forl autol inoculation
QUESTION
Al childl presentsl withl onel golden-crustedl lesionl atl thel sitel ofl anl insectl bitel consistentl withl impetigo.l Theirl parentsl havel limitedl financesl andl requestl thel leastl expensivel treatment.l Whichl medicationl wouldl bel thel bestl choicel forl treatment? A.Mupirocinl (Bactroban)- B.Bacitracinl andl polymyxinl Bl (genericl doublel antibioticl ointment) C.Retapamulinl (Altabax) D.Orall cephalexinl (Keflex) Answer: bl becausel cheaperl andl onlyl 1 l lesionl butl al isl alsol anl optionl costl allowing
QUESTION
First-linel therapyl forl treatingl topicall fungall infectionsl suchl asl tineal corporisl (ringworm)l orl tineal pedisl (athlete'sl foot)l wouldl be: A.Over-the-counterl (OTC)l topicall azolel (clotrimazole,l miconazole) B.Orall terbinafine C.Orall griseofulvinl microsize D.Nystatinl creaml orl ointment Answer: a
QUESTION
acne Answer: 50 l milll americans,l geneticl suseceptibility,l increasedl sebuml productionl whichl occludesl thel hairl folliclel andl producesl microcomedones propionibacteriuml acnesl colonizel thel folliclesl andl convertl thel triglyceridesl inl thel sebuml intol freel fattyl acids->l inflammation twol typesl ofl medications:l retinoidsl orl antibiotics
QUESTION
acnel rationall drugl selection-l topicall retinoids Answer: topicall retinoids-l tretinoinl (retin-l a),l adapalenel (differin),l tazarotenel (tazorac)l clinicall use:l treatl inflammatoryl andl non-l inflammatoryl acne MOA:l stimulatel mitoticl activityl andl increasel thel turnoverl ofl folliculal rl epitheliall cells,l causingl extrusionl ofl thel comodones acnel mayl initiallyl worsen ADR:l mayl causel rednessl andl peelingl ofl skin,l photosensitivity
QUESTION
acnes-l RDSl topicall antibiotics Answer:
chronicl inflammatoryl disorderl ofl thel bloodl vesslesl andl pilosebaceousl glandsl ofl thel face treatment
- topicall antibacterials-l metronidazolel (metro-gel),l azelaicl acidl (finacea)l butl morel sensitivityl issues
QUESTION
acnel andl acnel rosaceal monitoringl andl education Answer: pregl prevention itl takesl 6 - 8 l weeksl tol determinel effectivness patientl education
- topicall producstsl containingl benzyoyll peroxidel mayl bleachl discolorl towels/l sheets
- adherencel importantl asl initiall worseningl ofl acnel canl occurl butl willl improvel withl time
QUESTION
Anl adolescentl femalel callsl thel clinicl withl concernsl thatl herl acnel isl worsel onel weekl afterl startingl topicall tretinoin.l Whatl wouldl bel thel appropriatel carel forl her? A.Changel herl tol al differentl topicall acnel medicationl asl shel isl havingl anl adversel reactionl tol thel tretinoin. B.Switchl herl tol anl orall antibioticl tol treatl herl acne. C.Advisel herl tol applyl anl oil-basedl lotionl tol herl facel tol soothel thel redness. D.Reassurel herl thatl thel worseningl ofl acnel isl normall andl itl shouldl improvel withl continuedl use. Answer: d
QUESTION
topicall antihistamines Answer: clinicall use:l usedl forl locall reactionsl tol insectl bites,l stingsl andl mildl skinl disordersl suchl asl poisonl ivyl andl oakl examples
- diphenhydramainel (benadryl):l minorl skinl disorders
- doxepinl (zonalon):l moderatel tol severel pruritisl (atopicl dermatitits,l eczema),l potent,l notl usuallyl firstl line,l potentl butl $$ ADR:l skinl irritationl andl drowsiness
QUESTION
topicall corticosteriods Answer: clinicall use:l eczema,l contactl dermatitis,l psoriasis MOA:l inhibitl formation,l release,l andl activityl ofl inflammatoryl mediators,l inhibitl migrationl ofl macrophagesl andl leucocytesl tol thel areal byl reversingl vascularl dilationl andl permeability examples
- lowl potency:l desonide
- midiuml potency:l triamcinolone
- highl potency:l flucionide,l **thisl orl morel potentl notl tol bel usedl onl thel face
- superl highl potent:l clobetasol canl havel substantiall topicall absorption,l canl leadl tol adrenall issuesl likel cushing
QUESTION
topicall immunomodulators Answer: clinicall use:l shortl terml ofl intermittentl longl terml treatmentl ofl atopicl dermatitis,l nextl linel whenl topicall steroidsl aren'tl effectivel orl can'tl bel usedl forl somel reason mid-mod:l pimecrolimus severe:l tacrolimus secondaryl linel therapyl forl eczemal afterl topicall corticosteroidl failure pregl c shouldl notl bel usedl inl ptsl lessl thanl 2 l yol orl whenl therel isl anl activel infectionl orl occluaivel dressing
QUESTION
dermatitisl patho Answer:
QUESTION
longl terml dermatitisl treatment Answer: eczema
- emollients=l helpl skinl retainl water=l eucerin,l applyl 4 l timesl daily nonpharm=l hydratingl baths=l avenol poder,l avoidl offendingl agents
QUESTION
contactl dermatitis Answer: topicall corticosteroids
- mild-moderatel dermatitis=lowl tol modl potency
- plantl dermatitis=l mid-highl potency orall corticosteroids=l usel ifl severel orl whenl morel thanl 10%l ofl thel skinl surfacel needsl tol bel treated,l mayl needl 2 - 3 l weeksl ofl therapy,l oftenl pred wetl dressing/baths=l aluminuml acetatel solutionl isl anl astringentl wetl dressingl appliedl forl 30 l minl fourl timesl dailyl ,l oatmeall goodl forl skin
QUESTION
diaperl dematitis Answer: barrierl medications=l whitel petrolatum,l zincl oxide,l otcl barriersl =l desitin antiinflammatoryl medications=l lowl dosel hydrocortisonel 2 - 3 l days,l avoidl longl terml orl highl dose antifungal=l nystain,l miconazole,l clotrimazole wetl soaks=l burrowsl solution nonl pharm=l exposurel tol air,l frequentl chanes,l changingl brandl ofl diaper
QUESTION
seborrheicl dermatits Answer: topicall antiseborrheicl shampoo
- OTC:l seleniuml sulfidel (selsunl blue),l pyrithionel zincl (headl andl sholder),l coall tar topicall corticosteroids:l lowl potenencyl usedl forl seborrheal thatl doesl notl respondl tol shampoo,l 2 - 3 l timesl daily
QUESTION
dermatitisl evall andl monitoring Answer: ifl initiall therapyl doesl notl work,l incresel potencyl ofl corticosteroid doublel checkl medicationl administrationl technique referl tol dermatologist=l therapyl isl notl managingl dermatitis,l highl potencyl topicall corticosteroidsl arel indiacted,l orl unusuall presentationl ADR:l discussl overusel ofl topicall corticosteorids=l adrenall supression,l increasedl riskl ofl secondaryl infection,l canl causel skinl atrophy
QUESTION
psoriasis Answer: patho=l immunel mediatedl disease,l rapidl turnoverl ofl epidernall cellsl (egl 10 l timesl fasterl turnl over) extensorl surfacesl morel commonlyl involvedl chronicl disease,l goall ofl therapyl isl tol controll symptomsl andl clearingl ofl psoriaticl lesions
QUESTION
psoriasisl RDS Answer: topicall corticosteroids=l 20%l orl lessl ofl bodyl involved
- clinicall use=l flarel ups
- 'pulse'l therapyl worksl best=l minimzel adversel effects,l limitl 2 - 4 l weeksl ofl continuedl use
- taperl tol preventl rebound
- cautionl withl sunl exposurel canl helpl generallyl withl psoriaissl butl alsol steroids coall tar
- cream,l shampoos,l ointmentsl etc
- mayl causel photsensitivity,l messyl stainl clothes tazarotenel (tazorac)
spinosad secondl line=
- l lindane:l lotionl appliedl tol dryl hairl andl leftl onl forl 4 l minutes,l notl forl pregl ***l [neurotox]
- malathion=l killl eggsl too!!,l dryl hair,l leftl onl forl 8 - 12 l hours,l flammable**** retreatl inl 1 l week,l mostl optimallyl inl 9 l days bodyl lice-l leavel treatmentl onl forl 8 l hrs
- lindane:l morel ADR,l notl forl infants,l notl firstl linel preg
- permethrin=l saferl inl preg,l kidsl downl tol 2 l mon *alll familyl membersl needl treatmentl evenl ifl asymptomaticl pubicl lice
- lindane,l pyrethrin,l andl permethrinl
- repeatl inl 7 l daysl ifl stilll evidencel ofl livel lice
QUESTION
Whenl writingl al prescriptionl ofl permethrinl 5%l creaml (Elimite)l forl scabies,l patientl educationl wouldl include: A.Alll membersl ofl thel householdl andl personall contactsl shouldl alsol bel treated. B.Infantsl shouldl havel permethrinl appliedl froml thel neckl down. C.Thel permethrinl isl washedl offl afterl 10 l tol 20 l minutes. D.Permethrinl isl flammablel andl tol avoidl openl flamel whilel thel medicationl isl applied. Answer: a
QUESTION
burnl treatment Answer:
- silverl sulfadiazinel (silvadene)=l mostl commonl agentl inl primaryl carel (bactericidal)
- pregl catl b,l butl nearl terml consideredl D ADR:***l leukopenial canl occurl inl upl tol 20%l ofl patientsl (resolutionl withl discontinuation),l discolorationl ofl skin,l pruritis,l erythema,l photosensitivity,l rash usel cautionl inl patientsl withl hepaticl orl renall diseasel andl thosel withl hematologicl disorders bacitracinl isl anl alternative stopl whenl evidencel ofl reepithelialization
QUESTION
cauterizatingl agents Answer: silverl nitrate=l antiseptic,l astringent,l andl germicide appliedl byl al healthcarel provider uses:l umbilicall granuloma,l aphthousl ulcer,l vesicularl orl bullousl lesion,l poorlyl healingl woundl orl ulcer podophyllin/l podophilox:l cytotoxicl tol wartl ceells clincaill use:l verrucal (genitall warts)l notl usedl onl mucousl membranes
QUESTION
keratolytics Answer: treatl hyperketatoticl andl scalingl lesions=l corns,l callusesl andl warts salicyclicl acid:l OTC MOA:l dissolvesl thel intrercellularl cementl substancel inl thel stratuml corneum
- l 5 - 17%l inl collodionl usedl forl commonl andl plantarl warts,l manyl productsl available ADR:l locall irritation
QUESTION
topicall anesthetics Answer: usedl forl preparingl forl painfull procedures
- biopsies,l ivl start lidocaine-prilocaine=l emla lidocainel 4%=l OTC
QUESTION
malel patternl baldness Answer: alopecial androgenetica
Answer: cholinergicl drugsl akal parasympatheticsl akal muscarinicl agonists e.g.l bethanacol,l methachloline cholinericl blockingl agentsl akal parsympl akal anticholinergicl akal antimuscarinic egl ipatropoim,l scopalamine adrenergicl drugsl akal sympathomimetics egl clonidine,l methyldopa,l mimicl NE/epi adrenergicl blockingl drugsl akal sympatholyticl egphentolamine,l terazosin,l doxazosin
QUESTION
cholinergicl agents Answer: parasympatheticsl akal muscarinicl agonists directl acting,l indirectl (cholinesterase),l ganglionicl stimulantl (nicotine)
QUESTION
cholinergicl agentsl uses Answer:
- decreasel IOPl inl glaucoma
- treatl atonyl ofl GIl tractl andl urinaryl bladder
- diagnosel andl treatl myasthenial gravis
- physostigminel usedl tol treatl anticholinergicl toxicity
- notl organl specific-l otherl organsl notl targetedl becomel ADR
QUESTION
cholinesterasel inhibitors Answer: myasthenial gravis-l neostigminel andl pyridostigmine alzheimers-l doneoezill (aricept),l galantaminel (razadyne),l rivastigminel (exelon),l memantinel (namenda-l NMDAl antagonist) ADR=l drugl notl organl specific,l HA,l nausea,l diarrhea,l insomnia
QUESTION
myasthenial gravis Answer: autoimmune-antibodiesl targetl nicotinicl receptorsl onl skeletall muscle reversiblel cholinesterasel inhibitorsl mainstayl ofl treatment-l symptomaticl managementl akal notl curative neostigminel andl pyridostigmine
- dosesl arel veryl individualized,l thesel agentsl arel alsol usedl tol reversel nonpolarizingl neuromuscularl blockade inl ORl settingl notl primaryl care
QUESTION
alzhimer'sl disease Answer: donepezill (aricept)
- uniquel fronl otherl ACheEl inhibitors
- betterl sidel effectl profile
- longerl durationl ofl action
- GIl effects;l usuallyl selfl resolving rivasigminel (exelon)
- availablel asl patchl andl liquid memantinidel (namenda)-l NMDAl antagonist
QUESTION
Anticholinesterasel inhibitorsl arel usedl tol treat: A.l Pepticl ulcerl diseasel B.l Myasthenial gravis C.l Bothl 1 l andl 2 Dl .Neitherl 1 l norl 2 Answer: b
dopaminericsl tol know Answer: ADR:l N/V,l hallucinations,l confusion PD:l restoresl dopaminel inl areasl ofl thel brain,l mayl needl upl tol 6 l motnhsl tol achievel maximuml therapeuticl effectsl PK:l manyl dru/foodl interactions,l egl additivel hypotensionl withl antihypertensives ptl education:l avoidl abruptl d/c,l drugl interactions,l TCAl decrasel effectsl andl worsenl anticholineric,l mayl increasel effectsl ofl hypertensionl drugs monitoring:l hepaticl andl renall function,l 'on-off'l phenomenon,l symptomsl worsenl thenl improve cholinergicl blockersl controll tremorl byl relxingl smoothl muscle
QUESTION
Whatl isl truel ofl Dopaminergicsl (dopaminel agonists)l likel Levodopa/Carbidopal (Sinemet)l orl Pramipexolel (Mirapex)l? a.Theyl canl bel helpfull tol usel inl psychoticl episodes b.Theyl canl bel takenl withoutl respectl tol dietaryl intake c.Theyl canl bel discontinuedl atl anyl time d.Patientsl shouldl usel cautionl whenl changingl positionsl likel sittingl tol standing Answer: d
QUESTION
anticonvulsants Answer: factorsl thatl mayl precipitatel seizures:
- sleepl deprivation,l highl caffeinel intake,l hyperventilation,l stressml hormonall changes,l sensoryl stimulo,l drug/alcoholll use,l infections,l fevef,l metabolicl disorders anticonvulsantl medicationsl arel beingl usedl forl moodl disorders,l riskl ofl recurrencel isl reducedl inl thel firstl 2 l years,l inititall treatmentl isl monotherpay drugsl workl by:
- stimulatingl anl influxl ofl chloridel ions,l usuallyl thisl isl associatedl withl thel neurotranstiterl GABA
- delayignl anl influxl ofl sodium
- delayingl anl influxl ofl calcium
QUESTION
Hydantoinsl PDl andl PK Answer: *firstl linel treatmentl forl tonic-clonicl andl partiall complexl seizures PD:l worksl byl stabilizingl neuronall membranesl andl decreasingl seizurel acitivityl byl increasingl effluxl orl decreasingl effluxl ofl sodiul ionsl acrosl celll membranesl inl thel motorl cortex PK:l metabolisnl inl liver,l levelsl withl increasel withl alc,l allpurinoll etc.l decreasel affecl withl barbituares,l antacid,l chronicl alcl intake narrowl TIl phenytoinl (dilantin):l orall orl injection fosphenytoinl (cerebryx)l NOTl forl primaryl care-l cleanerl akal lessl ADR
QUESTION
hydrantoinsl interactionsl andl ADRs Answer: interactions:l concurrentl adminl causesl thel decreasedl effectl of:l estrogens,l acetaminoophen,l steroids,l levodopal etc ADR:l MANY! liver,l renal,l nystagmus,l dizziness,l confusion,l pruritis GI:l N/V/A,l **gingivall hyperplasia GU:l urinaryl retention,l urinel discolorationl redl tol brown usedl forl grandl mall andl psychomotorl seizuresl monitoring:l baselinel labl andl plasmal levels,l TSH needsl tol accessl OTCl drugs:l ibuprofen,l antacidsl **ptsl mustl avoidl drivingl ifl notl seizurel freel forl 1 l year
QUESTION
carbamazepine Answer: PD:l depressesl neuronl transmissionl inl thel nucelsul ventralisl anteriorl ofl thel thalamusl (decreasel sodiunl influx),l canl inducel itsl ownl metabolism ****hasl BBWl forl causingl bloodl dyscrasias
tiagibrinel (gabitril) topiramatel (topamax)-l dosel adjustmentl inl renall failure,l canl causel oligohydrosisl (decreasel sweatl production)-l pregl D mostl commonl ADR-l somnolence/l otherl CNS monitoring:l moodl changes,l depression,l anxiety,l topimate-metabolicl acidosis,l oligohydrosis,l ocularl ADR ****dol notl discontinuel abruptly-l atl leastl al weekl tol taperl orl withdrawl
QUESTION
levetiracetam Answer: leviracetaml (keppra)-availablel orall andl IV precisel mechanisml ofl actionl isl unknown,l severall studiesl indicatel itl mayl bel multifactorial nowl canl bel usedl firstl linel acutel care,l canl bel usedl inl preg adjustl inl partiall onsetl seizures nol longerl REMSl forl suicidality dosel adjustl inl renall impairment,l foodl doesl delayl peak lowl numberl ofl drugl interactionsl andl proteinl bindingl butl withdrawll seizuresl withl abruptl discontinuation possiblel neuropsychiatricl ADR-l suicidalityl (mostl AEDs)l andl transientl changel inl neutrophill counts,l canl havel behaviorall issuesl inl kidsl (addl B6)
QUESTION
perampanell (fycompa) Answer: PD:l non-competivel antagonistl ofl AMPAl glutamatel receptorl (thisl isl anl excitatoryl NT) use:l 12 l yearsl andl older,l partiall onsetl orl adjunctl forl tonic-clonic adminl ofl anl emptyl stomach ***BBW-l warningl ofl psychiatric/l hostilel behavior
QUESTION
lamotrigine Answer:
usedl inl thel adjunctivel treatmentl ofl primaryl generalizedl tonic-clonicl seizuresl andl partiall seizuresl inl adultsl andl childrenl >2l yrs exactl actionl unknown ****BBW-l SJS concurrentl usel withl valpriocl acidl canl worsenl changel ofl rashl phenyoinl canl precepitiouslyl decreasel levels PK:l levelsl decreasedl byl estrogensl etc,l levelsl increasedl byl alcohol,l CNSl depressantsl etc ADR:l GIl mostlyl N/V,l constipation CV:l chestl pain,l peripherall edema CNS:l somnolence,l dizziness,l anxiety,l HA,l nystagmus BBW:l SJS education:l adhernece,l avoidl alc controversyl whetherl tol d/cl medsl afterl al fewl yearsl ofl beingl seizurel free-l needl neurologistl tol makel decision
QUESTION
Al patientl isl takingl levetiracetaml (Keppra)l tol treatl seizures.l Routinel educationl forl levetiracetaml includesl remindingl them: 1.l Tol notl abruptlyl discontinuel levetiracetaml duel tol riskl forl withdrawall seizures 2 l Tol wearl sunscreenl duel tol photosensitivityl froml levetiracetam 3.Tol getl anl annuall eyel examl whilel onl levetiracetam 4.Tol reportl weightl lossl ifl itl occurs Answer: a
QUESTION
Al patientl isl takingl lamotriginel (Lamictal)l forl theirl seizuresl andl requestsl al prescriptionl forl combinedl orall contraceptivesl (COCs),l whichl interactl withl lamotriginel andl mayl cause: 1.l Contraceptivel failure 2.l Excessivel weightl gain 3.l Reducedl lamotriginel levels,l requiringl doublingl thel dosel ofl lamotrigine 4.l Inductionl ofl estrogenl metabolism,l requiringl higherl estrogenl contentl OCsl tol bel prescribed Answer: 3
