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COMLEX LEVEL 1 PHARMACOLOGY EXAM 2025-2026 QUESTIONS AND ANSWERS GRADED A+ What is the definition of a hypertensive emergency? HTN >180/120 End organ damage i.e. elevated BUN and Cr, altered mental status Drugs used for hypertensive emergency Nitroprusside Fenoldopam labetalol clevidipine nicardipine
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What is the definition of a hypertensive emergency?
HTN >180/
End organ damage
i.e. elevated BUN and Cr, altered mental status
Drugs used for hypertensive emergency
Nitroprusside
Fenoldopam
labetalol
clevidipine
nicardipine
MOA of nitroprusside
short acting vasodilator that increases cGMP by directly releasing NO from the endothelium
AE of nitroprusside
cyanide toxicity
What's the foal of treatment of hypertensive emergencies?
Lower BP by 25% and maintain diastolic BP at no less than 100-110 mmHg
Names of bisphosphonate drugs
"-onates"
Alendronate
ibandronate
ridedronate
zoledronate
MOA of bisphosphonates
Bind calcium (hydroxyapetite) in bone AND inhibit osteoclast activity
Clinical use of bisphosphonates
Osteoporosis, hypercalcemia, Paget disease of bone, metastatic bone disease, osteogenesis imperfecta
Main AEs of typical antipsychotics
Hyperprolactinemia --> galactorhhea, oligomenorrhea, gynecomastia
QT prolongation
ADAPT:
Acute dystonia (muscle spasms or stiffness)
Akasthisia (restless, uncontrollable need to move)
Parkinsonism (bradykinesia, mask-like facies, drooling, tremor)
Tardive Dyskinesia (involuntary twisting, worm like movements, disabling, irreversible -- late effect)
Neuroleptic Malignant Syndrome
What is Neuroleptic Malignant Syndrome
fever, muscles rigid, confusion, dysrhythmias, BP fluctuation
stop drug ASAP
happens bc of typical antipsychotic haloperidol --> blocking D2 receptor induces massive glutamate release @ synapse --> catatonia, neurotoxicity, myotoxicity
Atypical antipsychotics & their MOA
-apines
-idones
Clozapine, Aripiprazole, Asenapine, Lurasidone
Potent blocker of 5-HT2A and partial blocker of D2 receptor
AEs of atypical antipsychotics
Hyperprolactinemia
Increase markers and risk of diabetes, obesity, dyslipidemia, metabolic syndrome
Clozapine - agranulocytosis (blood cell count must be monitored)
Aripiprazole - less diabetes risk
Names of Tricyclic Antidepressants
-ipramine
-triptyline
Amitriptyline, Imipramine
Indication and MOA of tricyclic antidepressants
inhibit 5-HT and NE reuptake
migraine, peripheral neuropathy, chronic neuropathic pain, OCD (clom), nocturnal enuresis (imipramine)
sleep effects from alpha 1
anxiolytic effects from alpha 2 and 3
AEs of benzodiazepines
Drowsiness
Sedation
Impaired motor function
don't use with ethanol, opiates, barbituates, antihistamines, general anesthetics or any other CNS depressant!
schedule IV drug
NO for preg or breastfeeding
use Lorazepam with liver probs
Acetazolamide MOA
carbonic anhydrase inhibitor
causes NaHCO3 diuresis and decreased body HCO3 stores --> alkalizes urine
Acetazolamide: indication
glaucoma, metabolic alkalosis, altitude sickness, idiopathic intercranial HTN
Acetazolamide AEs
proximal renal tubular acidosis (type 2 RTA), paresthesias, NH3 toxicity, sulfa allergy, hypokalemia
promotes calcium phosphate stone formation (insoluble at high pH)
Leuprolide
Indication:
fertility OR precocious puberty, endometriosis, uterine fibroids
continuous administration of GnRH agonist causes decreased FSH and LH --> decreased estrogen --> inhibits ovarian follicle growth
pulsatile administration --> increased LH and FSH --> stimulates follicle growth
Leuprolide AEs
nausea, vomiting, hot flashes
6 months can cause bone density loss
What drug inhibits bacterial folate synthesis and reduction?
TMP-SMX
What drugs inhibit the transfer RNA from binding to the bacterial ribosome?
Tetracyclines: doxycycline
Empiric treatment for infective endocarditis
Penicillin or Ampicillin + Nafcillin + Gentamicin
or if allergic to penicillins/have MRSA:
Vancomycin + Gentamicin
Aminoglycosides and their MOA
Gentamicin
Tobramycin
Amikacin
Streptomycin, Neomycin
bind to 30s ribosomal subunit and cause misreading of mRNA
AEs of Gentamicin
Aminoglycoside
Vestibular and cochlear ototoxicity --> hearing loss, vertigo, ataxia
Treatment of osteoporosis
Weight bearing exercises
Calcitonin (nasal spray)
Raloxifene
Calcium
Vit D
Bisphosphonates
PTH
MOA of calcitonin
Osteoporosis med (nasal spray)
Inhibits Calcium absorption in the intestines and decrease osteoclastic activity
Treatment for sleepwalking/somnambulism
TCAs (amitriptyline, nortriptyline, imipramine)
Benzos (diazepam, lorazepam, triazolam, etc)
InteGRASE inhibitors
inhibit HIV genome integration into host cell DNA
-navir drugs
HIV drugs
Protease inhibitors
(Pros go to the Navy)
Prevent cleavage of the polypeptide products of HIV mRNA into their functional parts --> prevents maturation of new viruses
Nonnucleoside reverse transcriptase inhibitors (HIV drugs)
Delavirdine
Efavirenz
Nevirapine
NON + DEN
bind to and inhibit reverse transcriptase at a different site than nucleoside reverse transcriptase inhibitors
-vudine
-fovir
Abacavir
Didanosine
Emtricitabine
Nucleoside reverse transcriptase inhibitors
(HIV drugs)
competitively inhibit nucleotide binding to reverse transcriptase
Serotonin Syndrome
high levels of 5-HT
fever, agitation, mental status changes, seizures, diaphoresis, hyperreflexia, hyperthermia
3 As
AEs of SSRIs
Too much serotonin --> serotonin syndrome
GI probs
prolonged QT
AEs of MAOIs
Hypertensive Crisis of tachycardia, palpitations, nausea, vomit
Avoid using with SSRIs or SNRIs bc high risk of serotonin syndrome
AEs of Bupropion
Atypical antipsychotic
reduces seizure threshold (makes it more likely to have one) especially in patients with anorexia/bulimia
headaches
can be used for smoking sessation
DONT use with MAOI
Mirtazapine AEs
sedation
increased appetite and weight gain
Trazodone AEs
prolonged erection aka priapism
sedation
postural hypotension
Firstline treatment for major depressive disorder
cog-behavioral therapy and SSRIs
SSRI drugs
A pair of oxes gave me the flu when I visited a city with Sarah
Pair of oxes = paroxetine
Flu = fluoxetine, fluvoxamine
City = citalopram, escitalopram
Sarah = serotonin reuptake inhibitors
SNRI drugs
When I was sad, I watched a movie about a man named Sven his donkey Ven who DUELed the evil character Milnacipran. It raised my mood and my blood pressure!
Phenelzine
Selegiline (can be used for parkinson's)
happy and excited = increases serotonin, NE, and dopamine
Atypical Antidepressant drugs
Bupro and Mirta had a good dating life. They were always eating out together, and they decided to try a place called Traz and it gave Bupro an erection it was so good. This caused him to faint! Luckily it wore off after he took a nap, so then they still got to go see their favorite russian band the 3 Vs - varen, vilaz, and vortio! They were definitely not your typical couple, but they were happy!
Bupropion
Mirtazapine
Trazodone (orthostatic hypotension, priapism, sedation)
Varenicline
Vilazodone
Vortioxetine
Mirtazapine MOA and AEs
Mirta is definitely the alpha between the two of them and bc of this, her boyfriend constantly antagonizes her for it. (alpha 2 antagonist)
AEs
this causes her to completely shut down, so she goes to sleep after eating her feelings in popcorn, which makes her mouth really dry
increased appetite, weight gain, sedation, dry mouth
Trazodone MOA
blocks serontonin, a1 adrenergic, and histamine receptors
The restaurant Traz is A1 everyone says. It increases everyone's serotonin levels by blocking out the real world. After eating there I always get sleepy though!
Methadone
DON'T do meth, and definitely not HEROIN! Take this if you take too much
heroin detox or longterm therapy
Buprenorphine
Bup --> think BUCCAL
sublingual form of opioid partial agonist to prevent relapse
Naloxone
