RxPrep Practice #3

5 control risk: 73 / 159 = 0.459 treatment risk: 31 / 140 = 0.221 1 / (0.459 - 0.221) = 4.2 --> round up --> 5

A randomized, double-blind, placebo-controlled trial was created to establish efficacy of rifaximin in preventing acute hepatic encephalopathy (HE). Patients were randomized to receive either rifaximin or placebo for 6 months. Breakthrough episodes of HE were reported in 31 of 140 patients in the rifaximin group and 73 of 159 patients in the placebo group. Hospitalization involving HE was reported for 19 of 140 patients in the rifaximin group (13.6%) and 36 of 159 patients in the placebo group (22.6%). What's the number needed to treat to prevent one episode of overt HE?

40 (0.226 - 0.136) / 0.226 = 0.398 x 100 = 40

A randomized, double-blind, placebo-controlled trial was created to establish efficacy of rifaximin in preventing acute hepatic encephalopathy (HE). Patients were randomized to receive either rifaximin or placebo for 6 months. Breakthrough episodes of HE were reported in 31 of 140 patients in the rifaximin group and 73 of 159 patients in the placebo group. Hospitalization involving HE was reported for 19 of 140 patients in the rifaximin group (13.6%) and 36 of 159 patients in the placebo group (22.6%). What's the relative risk reduction for hospitalization involving HE? (express answer as percentage, round to nearest whole number)

a, b, c

BG is a 71 YOM who presents to the hospital. He currently takes Sinemet, donepezil, finasteride, Cogentin, midodrine, warfarin, cyanocobalamin, dofetilide, fludrocortisone, Soma, and St. John's wort. He'll be started on Cipro and Flagyl while inpatient. The pharmacist reviews the antibiotic orders for BG. Which of the following safety concerns should the pharmacist discuss with the physician? (select all that apply) a) bleeding risk b) risk for arrhythmia c) CNS side effects d) risk for constipation e) risk for ototoxicity

d

BG is a 71 YOM who presents to the hospital. He currently takes Sinemet, donepezil, finasteride, Cogentin, midodrine, warfarin, cyanocobalamin, dofetilide, fludrocortisone, Soma, and St. John's wort. His ECG results show a prolonged QT at 522 milliseconds. Which medication on BG's home medication list is most likely responsible for the ECG results? a) Cogentin b) finasteride c) Sinemet d) dofetilide e) fludrocortisone

b

BG is a 71 YOM who presents to the hospital. He currently takes Sinemet, donepezil, finasteride, Cogentin, midodrine, warfarin, cyanocobalamin, dofetilide, fludrocortisone, Soma, and St. John's wort. His PMH includes Parkinson disease, atrial fibrillation, mitral valve repair (bioprosthetic valve), cerebrovascular accident, moderate-severe Alzheimer's disease, ankylosing spondylitis, cholecystectomy, and right knee arthroscopy. What condition is missing from BG's past medical history based on his home medication list? a) hypertension b) Addison's disease c) stroke d) schizophrenia e) deep vein thrombosis

a

BG is a 71 YOM who presents to the hospital. He currently takes Sinemet, donepezil, finasteride, Cogentin, midodrine, warfarin, cyanocobalamin, dofetilide, fludrocortisone, Soma, and St. John's wort. His PMH includes Parkinson disease, atrial fibrillation, mitral valve repair (bioprosthetic valve), cerebrovascular accident, moderate-severe Alzheimer's disease, ankylosing spondylitis, cholecystectomy, and right knee arthroscopy. Which medication could be used as an alternative to donepezil in this patient? a) memantine b) Aloprim c) Requip d) Mirapex e) carmustine

b

BG is a 71 YOM who presents to the hospital. He currently takes Sinemet, donepezil, finasteride, Cogentin, midodrine, warfarin, cyanocobalamin, dofetilide, fludrocortisone, Soma, and St. John's wort. The investigational drug service identifies BG as a potential candidate for a pharmacogenomic study to assess bleeding risk associated with anticoagulant medications. Which pharmacogenomic test relates to BG's anticoagulant medication? a) KRAS mutation b) CYP450 2C9*3 c) HLA-B*5801 d) HER2 gene expression e) CYP450 2C19

c

BG is a 71 YOM who presents to the hospital. He currently takes Sinemet, donepezil, finasteride, Cogentin, midodrine, warfarin, cyanocobalamin, dofetilide, fludrocortisone, Soma, and St. John's wort. Which medication can be used to reverse the effect of BG's anticoagulant? a) idarucizumab b) protamine c) phytonadione d) andexanet alfa e) methylene blue

c, e

BG is a 71 YOM who presents to the hospital. He currently takes Sinemet, donepezil, finasteride, Cogentin, midodrine, warfarin, cyanocobalamin, dofetilide, fludrocortisone, Soma, and St. John's wort. Which medications on BG's profile can worsen his dementia? (select all that apply) a) finasteride b) donepezil c) Soma d) warfarin e) Cogentin

e

BG is a 71 YOM who presents to the hospital. He currently takes Sinemet, donepezil, finasteride, Cogentin, midodrine, warfarin, cyanocobalamin, dofetilide, fludrocortisone, Soma, and St. John's wort. Which of the following could be used to monitor this patient's response to finasteride treatment? a) Mini-Mental State Exam b) electrocardiogram c) Coombs test d) potassium levels e) lower urinary tract symptoms

a, c, d, e

BG is a 71 YOM who presents to the hospital. He currently takes Sinemet, donepezil, finasteride, Cogentin, midodrine, warfarin, cyanocobalamin, dofetilide, fludrocortisone, Soma, and St. John's wort. Which side effects are associated with the dopamine replacement medication that BG takes for Parkinson disease? (select all that apply) a) dyskinesias b) increased amylase and lipase c) dark urine d) orthostatic hypotension e) hemolytic anemia

b

BG is a 71 YOM who presents to the hospital. He currently takes Sinemet, donepezil, finasteride, Cogentin, midodrine, warfarin, cyanocobalamin, dofetilide, fludrocortisone, Soma, and St. John's wort. While completing the admission medication reconciliation, the pharmacy technician institutes the "No Natural Products" policy that allows automatic discontinuation of natural products upon hospital admission. Which of the following is expected to occur when BG's natural product is discontinued? a) the ECG findings should normalize b) the effects of warfarin will increase c) the risk of photosensitivity will increase d) the risk of serotonin syndrome will increase e) the risk of nephrotoxicity will decrease

a

BG, a 71 YOM, presents to the hospital with a 6-day history of non-bloody diarrhea that he believes may be a side effect of donepezil. He's had no sick contacts or changes to his usual diet. He denies fever, sweating, chills, chest pain, SOB, and N/V. His CT abdomen shows diffuse inflammation with some skip areas of small-bowel enteritis and partial small bowel obstruction. What's the likely diagnosis given BG's presentation and the results of the CT abdomen? a) Crohn's disease b) spontaneous bacterial peritonitis c) gastroparesis d) peptic ulcer disease e) abdominal ascites

c

BG, a 71 YOM, presents to the hospital with a 6-day history of non-bloody diarrhea that he believes may be a side effect of donepezil. He's had no sick contacts or changes to his usual diet. He denies fever, sweating, chills, chest pain, SOB, and N/V. His PMH includes Parkinson disease, atrial fibrillation, mitral valve repair (bioprosthetic valve), cerebrovascular accident, moderate-severe Alzheimer's disease, ankylosing spondylitis, cholecystectomy, and right knee arthroscopy. BG's medical history and clinical presentation indicate which of the following? a) he has hyperhidrosis b) he has pyrexia c) his gallbladder has been removed d) he has a history of bone infections

a

BG, a 71 YOM, presents to the hospital with a 6-day history of non-bloody diarrhea that he believes may be a side effect of donepezil. He's had no sick contacts or changes to his usual diet. He denies fever, sweating, chills, chest pain, SOB, and N/V. They plan to test TPMT activity. Based on the documented plan for pharmacogenomic testing, which medication is the physician potentially going to prescribe for BG? a) azathioprine b) allopurinol c) cetuximab d) cyclosporine e) adalimumab

c

BG, a 71 YOM, presents to the hospital. The nurse caring for BG is worried because his urine is dark in color. Which of BG's medications is most likely responsible? a) fludrocortisone b) dofetilide c) carbidopa/levodopa d) finasteride e) donepezil

b

TN is a 67 YO Vietnamese female. She presents with the following labs: Na (mEq/L) = 132 (135-145) K (mEq/L) = 4.8 (3.5-5) Cl (mEq/L) = 102 (95-103) HCO3 (mEq/L) = 28 (24-30) BUN (mg/dL) = 28 (7-20) SCr (mg/dL) = 2.8 (0.6-1.3) Glucose (mg/dL) = 287 (100-125) Ca (mg/dL) = 7.7 (8.5-10.5) Mg (mEq/L) = 2.1 (1.3-2.1) A1C (%) = 9.2 PO4 (mg/dL) = 5.2 (2.3-4.7) Albumin (g/dL) = 2.6 (3.5-5) WBC (cells/mm^3) = 12.3 (4-11 x 10^3) Hgb (g/dL) = 9.8 (12-16) Hct (%) = 26.8 (36-46) Plt (cells/mm^3) = 215 (150-450 x 10^3) AST (IU/L) = 15 (10-40) ALT (IU/L) = 18 (10-40) TSH (mIU/L) = 3.2 (0.3-3) Amylase (units/L) = 182 (60-180) Lipase (units/L) = 165 (5-160) PTH (ng/L) = 126 (10-65) A new prescription is written for Sensipar. Which of TN's lab results is consistent with an indication for this medication? a) lipase b) PTH c) TSH d) A1C e) hemoglobin

c

TN is a 67 YO Vietnamese female. She states that she's very weak, but cannot really elaborate on how her symptoms are different than normal. Her daily activities have declined over the past two months and she's sleeping most of the day. She describes a tingling sensation over the "rash on her back" for the last 48 hours. Physical exam shows a localized rash with small round blisters in a horizontal line from the spine outward onto her right shoulder blade. Based on the subjective and objective information presented, which diagnosis is most likely? a) measles b) poison ivy c) herpes zoster d) sunburn e) lice

d

TN, a 67 YO Vietnamese female, presents feeling weak and exhausted. An ultrasound of her kidneys shows evidence of CKD. After evaluating these findings, which reference should the pharmacist consult to determine best practices in managing TN's condition? a) the GOLD guidelines b) the GINA guidelines c) the IDSA guidelines d) the KDIGO guidelines e) the CHEST guidelines

a

What lab values are characteristic of a metabolic acidosis? a) low pH, low serum bicarbonate b) low pH, high serum bicarbonate c) high pH, low serum bicarbonate d) high pH, high serum bicarbonate e) low pH, low alkaline phosphatase

d

What's the mechanism of action of Zyloprim? a) increases renal excretion of uric acid b) depletes CD20 B cells c) inhibits tumor necrosis factor alpha d) decreases uric acid production e) increases production of allantoin

a

When FW is picking up his medication refills at the pharmacy, he tells the pharmacist that he can't find his OTC allergy medication (Nasacort Allergy 24-HR) on the usual shelf. The pharmacist confirms that his particular brand is out of stock, but tells FW that he can purchase another brand, or a generic, with the same active ingredient. What ingredient should FW be looking for in the products available? a) triamcinolone b) mometasone c) fluticasone d) budesonide e) ciclesonide

a

Which antiepileptic drug is a strong CYP enzyme inducer? a) fosphenytoin b) valproic acid c) Keppra d) Zarontin e) lamotrigine

a

Which compounding area is matched correctly with the minimum requirement for ISO air quality rating when compounding a nonhazardous sterile drug? a) buffer area - ISO 7 b) ante area - ISO 5 c) primary engineering control - ISO 6 d) ante area - ISO 9 e) buffer area - ISO 8

d

Which drug is paired correctly with the pharmacogenomic test result that's required prior to use? a) erlotinib - B-cell antigen CD20 positive b) cetuximab - BRAF V600K positive c) Rituxan - KRAS mutation negative (wild-type) d) Gleevec - Philadelphia chromosome (BCR-ABL) positive e) trastuzumab - EGFR mutation positive

e

Which medication can induce or exacerbate psychotic symptoms associated with schizophrenia? a) Descovy b) Zithromax c) Isentress d) Risperdal e) Adderall

d

Which medication is preferred for the treatment of Prinzmetal's (variant) angina? a) isosorbide dinitrate b) Plavix c) Lopressor d) Procardia XL e) ranolazine

a, d

Which medications are available in nebulized form? (select all that apply) a) albuterol b) theophylline c) salmeterol d) levalbuterol e) fluticasone

b, e

Which medications can cause the urine to be discolored red? (select all that apply) a) mitoxantrone b) rifampin c) levodopa d) nitrofurantoin e) doxorubicin

b

Which of TN's lab abnormalities are most consistent with the diagnosis of CKD? a) leukocytosis and hypocalcemia b) decreased hemoglobin and increased parathyroid hormone c) hyponatremia and increased TSH d) hypoalbuminemia and increased lipase e) hyperglycemia and increased amylase

b

Which of the following best describes the mechanism of action of Vesicare? a) muscarinic receptor agonist b) muscarinic receptor antagonist c) alpha receptor agonist d) alpha receptor antagonist e) beta-3 receptor agonist

b

Which of the following best describes the mechanism of action of goserelin (Zoladex)? a) selective estrogen receptor modulator b) gonadotropin-releasing hormone agonist c) aromatase inhibitor d) antiandrogen e) tyrosine kinase inhibitor

e

Which of the following best represents guideline criteria for discontinuation of Mycobacterium avium complex primary prophylaxis? a) CD4 count >50 cells/mm^3 for at least 3 months b) CD4 count >100 cells/mm^3 for at least 3 months c) CD4 count >200 cells/mm^3 for at least 3 months d) CD4 count >50 cells/mm^3 and no signs of active infection e) taking fully suppressive antiretroviral therapy

b

Which of the following brand/generic pairs is correct? a) etanercept - Simponi b) adalimumab - Humira c) infliximab - Enbrel d) certolizumab - Rituxan e) golimumab - Cimzia

a, b, c, e

Which of the following can be found on the list of high-alert medications? (select all that apply) a) Lantus b) Eliquis c) Dilaudid d) Ditropan e) 3% saline

e

While verifying medication orders, the pharmacist receives an alert about a medication that's a CYP1A2 inhibitor. Which medication meets this criteria? a) donepezil b) dofetilide c) warfarin d) Flagyl e) Cipro

b 17 lb / 2.2 = 7.7 kg 7.7 x 10 mg = 77 mg 7.7 x 15 mg = 115.5 mg 77-115.5 mg Q4-6H

YG is a 15-month-old male with a fever of 39.4ºC. He weighs 17 lbs. The pediatrician suspects a viral infection and has recommended acetaminophen. Which dosing regimen is correct for this child? a) 40 mg Q4-6H PRN b) 90 mg Q4-6H PRN c) 100 mg Q3-4H PRN d) 150 mg Q8H PRN e) 160 mg Q4-6H PRN

e

ZB is a 66 YOWF with a PMH of hypertension, type 2 diabetes, dyslipidemia, osteoporosis, anxiety, and chronic pain. Which treatment would be best for the long-term management of ZB's anxiety? a) Lunesta b) amitriptyline c) phenelzine d) Abilify e) Effexor XR

d

ZB, a 66 YOWF, is here for her flu vaccine. Select the correct administration instructions for the vaccine that ZB is scheduled to receive today. a) fatty tissue over the triceps, 90º angle b) fatty tissue over the triceps, 45º angle c) intranasal, 1/2 dose in each nostril d) deltoid, 90º angle e) intradermal, 90º angle

b

ZB, a 66 YOWF, presents to her PCP with a 2-week history of gastric pain that's worse at night and in between meals. She describes a burning pain that goes from a "9 out of 10" to a "5 out of 10" when she eats. Her urea breath test is positive. Which treatment regimen is recommended based on ZB's urea breath test result? a) psyllium + senna b) Protonix + Pylera c) Pepcid + Reglan d) Entereg e) oral budesonide + azathioprine

a

ZB, a 66 YOWF, presents to her PCP with the following labs: Na (mEq/L) = 142 (135-145) K (mEq/L) = 3.4 (3.5-5) Cl (mEq/L) = 102 (95-103) HCO3 (mEq/L) = 27 (24-30) BUN (mg/dL) = 10 (7-20) SCr (mg/dL) = 0.9 (0.6-1.3) Which of ZB's medications is most likely responsible for the potassium abnormality reported? a) HCTZ b) Norvasc c) Crestor d) Fexmid e) ibandronate

c

ZB, a 66 YOWF, takes the following medications: HCTZ 12.5 mg PO QD, Norvasc 10 mg PO QD, Crestor 10 mg PO QD, Caltrate 600 + D3 1 tablet PO BID, ibandronate PO as instructed, Glucophage 1 g PO BID, Qsymia (takes QD, can't recall dose), hydrocodone/acetaminophen 7.5/300 mg PO Q6H PRN, Klonopin 0.5 mg PO BID PRN, and Fexmid 10 mg TID PRN. The nurse calls the clinic pharmacy to verify the frequency of administration for medications with missing information. How often should ZB take her osteoporosis medication? a) daily b) weekly c) monthly d) every 3 months e) yearly

a, c

ZB, a 66 YOWF, takes the following medications: HCTZ, Norvasc, Crestor, Caltrate + D3, ibandronate, Glucophage, Qsymia, hydrocodone/acetaminophen, Klonopin, and Fexmid. Which of the following are antidotes to drugs on ZB's medication profile? a) naloxone b) protamine c) flumazenil d) sodium bicarbonate e) leucovorin

b

ZB, a 66 YOWF, takes the following medications: HCTZ, Norvasc, Crestor, Caltrate, ibandronate, Glucophage, Qsymia, hydrocodone/acetaminophen, Klonopin, and Fexmid. What are the components of the medication ZB is taking for weight loss? a) phentermine and fenfluramine b) phentermine and topiramate c) orlistat and semaglutide d) naltrexone and bupropion e) orlistat and liraglutide

e

ZB, a 66 YOWF, takes the following medications: HCTZ, Norvasc, Crestor, Caltrate, ibandronate, Glucophage, Qsymia, hydrocodone/acetaminophen, Klonopin, and Fexmid. Which of the following is ZB most at risk for based on her medication profile? a) drug-induced lupus erythematosus b) intracranial bleeding c) seizure d) diabetic ketoacidosis e) central nervous system depression

b

ZB, a 66 YOWF, will be receiving 2 pneumococcal vaccines. Which of the following regimens represents the correct vaccines, sequence, and interval? a) PCV13 today, PPSV23 in 8 weeks b) PCV15 today, PPSV23 in 1 year c) PPSV23 today, PCV15 in 8 weeks d) PPSV23 today, PCV13 in 1 year e) PCV15 today, PPSV23 in 5 years

b TBW: 142 lb / 2.2 = 64.545 kg IBW: 50 + 2.3(7) = 66.1 kg [(140 - 47) x 64.545] / (72 x 1.5) = 55.6 mL/min

FW is a 47 YOM (5'7", 142 lbs) who presents to the HIV clinic for follow-up. His SCr is 1.5 mg/dL. His CD4 count has decreased and he's diagnosed with cytomegalovirus colitis. Based on the information below, which dose of valganciclovir is appropriate for FW? CrCl ≥60 mL/min --> 900 mg BID CrCl 40-59 mL/min --> 450 mg BID CrCl 25-39 mL/min --> 450 mg QD CrCl 10-24 mL/min --> 450 mg every 2 days CrCl <10 mL/min --> not recommended a) 900 mg BID b) 450 mg BID c) 450 mg QD d) 450 mg every 2 days e) valganciclovir isn't recommended for FW

a

FW is a 47 YOM who presents to the HIV clinic for follow-up. His medications include Complera, warfarin, Toprol XL, Bactrim, and Nasacort Allergy 24-HR. Which of the following ingredients are contained in FW's antiretroviral treatment? a) emtricitabine + tenofovir disoproxil fumarate + rilpivirine b) efavirenz + tenofovir alafenamide + rilpivirine c) emtricitabine + tenofovir alafenamide d) abacavir + lamivudine + dolutegravir e) emtricitabine + tenofovir disoproxil fumarate + elvitegravir + cobicistat

c

FW is a 47 YOM who presents to the HIV clinic for follow-up. His physician plans to discontinue primary prophylaxis of PCP today due to a sustained increase in CD4+ count observed over many months. His medications include Complera, warfarin, Toprol XL, Bactrim, and Nasacort Allergy 24-HR. What's likely to occur when FW's PCP prophylaxis is discontinued? a) his INR will increase b) his CD4 count will increase c) his INR will decrease d) his HIV viral load will increase e) his HIV viral load will decrease

a, d, e

How should a patient be counseled to take lanthanum carbonate? (select all that apply) a) take with meals b) swallow tablets whole c) take on an empty stomach, 1 hour before meals d) chew tablet thoroughly e) separate from levothyroxine

c

If a diagnostic test has 75% specificity, this means that the test will be: a) positive 75% of the time in patients who have the disease b) positive 65% of the time in patients who don't have the disease c) negative 75% of the time In patients who don't have the disease d) negative 25% of the time In patients who don't have the disease e) positive 25% of the time In patients who have the disease

d D not E b/c of liver impairment

JK, a 51 YOF, is admitted to the hospital for abdominal pain with the following labs: albumin (g/dL) = 2.8 (3.5-5) Ca (mg/dL) = 8.5 (8.5-10.5) AST (IU/L) = 102 (10-40) ALT (IU/L) = 89 (10-40) T Bili (mg/dL) = 0.7 (0.1-1.2) amylase (units/L) = 72 (60-180) ESR (mm/hr) = 35 (≤30) HCV Ab = positive HIV p24 antigen = positive After receiving the news about her lab results, JK becomes very emotional. Psychiatry is consulted for support and an oral agent for short-term anxiety is recommended. Which medication is best for JK based on this recommendation? a) lithium b) duloxetine c) quetiapine d) oxazepam e) diazepam

d

JK, an 18 YOM, is being treated in the hospital for altered mental status. This morning he threatened another patient and a nurse. He was restrained and medicated with Haldol and Ativan. When the nurse entered his room later, she found JK with his neck twisted in an odd position. She described a muscle spasm in his neck, head, and arms. Select the correct diagnosis and treatment. a) akathisia, treat with diphenhydramine b) tardive dyskinesia, switch Haldol to Risperdal c) parkinsonism, treat with propranolol d) dystonia, treat with benztropine e) dyskinesia, doesn't require treatment

d

JL, a 52 YOM, comes to the neurology clinic for follow-up. He was recently diagnosed with epilepsy and is now open to starting treatment. His PMH includes allergic rhinitis, epilepsy, erectile dysfunction, and nephrolithiasis. Which medication is most likely to worsen one of the patient's preexisting conditions and should likely be avoided? a) Depakote b) Dilantin c) Tegretol d) Topamax e) Trileptal

b

JM has cut back on his smoking but wants to quit for good. He reports having smoked 1 pack per day for 25 years and recently cut back to 8 cigarettes per day for the last year. Which treatment recommendation is preferred to help JM quit? a) nicotine patch 21 mg/24 hr b) nicotine patch 14 mg/24 hr c) Chantix d) electronic cigarettes e) nicotine patch 7 mg/24 hr

d

JM is prescribed warfarin 3 mg on Monday/Wednesday and warfarin 4 mg on Tuesday/Thursday/Friday/Saturday/Sunday. He does not remember the doses of his tablets, but he knows the colors. If he's fully adherent, what should he tell the pharmacist about his warfarin? a) I take a white tablet on Monday and Wednesday and a peach tablet on the other days. b) I take a pink tablet on Monday and Wednesday and a teal tablet on the other days. c) I take a lavender tablet on Monday and Wednesday and a yellow tablet on the other days. d) I take a brown tablet on Monday and Wednesday and a blue tablet on the other days. e) I take a green tablet on Monday and Wednesday and a pink tablet on the other days.

c

JM takes the following medications: metoprolol tartrate, isosorbide mononitrate, warfarin, dronedarone, Tricor, AndroGel, Kadian, saw palmetto, and diphenhydramine. JM is most likely taking the natural product to help with which of the following? a) insomnia b) smoking cessation c) urinary urgency/frequency d) productive cough e) chronic pain

c

JM takes the following medications: metoprolol tartrate, isosorbide mononitrate, warfarin, dronedarone, Tricor, AndroGel, Kadian, saw palmetto, and diphenhydramine. The medication JM takes for his heart rhythm primarily works by blocking which of the following? a) sodium channels b) calcium channels c) potassium channels d) sodium-potassium ATPase pumps e) adenosine receptors

a, b, d

JM takes the following medications: metoprolol tartrate, isosorbide mononitrate, warfarin, dronedarone, Tricor, AndroGel, Kadian, saw palmetto, and diphenhydramine. What are possible indications for the use of metoprolol in this patient? (select all that apply) a) hypertension b) stable angina c) heart failure, systolic d) atrial fibrillation e) COPD

c

JM's home medications include metoprolol tartrate, isosorbide mononitrate, warfarin, dronedarone, Tricor, AndroGel, Kadian, saw palmetto, and diphenhydramine. What type of medication is JM taking for dyslipidemia? a) statin b) bile acid sequestrant c) fibrate d) fish oil e) PCSK9 inhibitor

d

JM's lab results are as follows. Which of his lab values should the pharmacist address as being outside the desired target range? Na (mEq/L) = 137 (135-145) K (mEq/L) = 3.8 (3.5-5) HCO3 (mEq/L) = 28 (24-30) BUN (mg/dL) = 16 (7-20) SCr (mg/dL) = 1.1 (0.6-1.3) Hgb (g/dL) = 12.9 (13.5-18) Hct (%) = 37 (38-50) Plt (cells/mm^3) = 201 (150-450 x 10^3) MCV (fL) = 110 (80-100) Fe (mcg/dL) = 75 (65-150) B12 (pg/mL) = 145 (>200) Folic acid (mcg/L) = 8 (5-25) TSH (mIU/L) = 3.5 (0.3-3) A1C (%) = 5.4INR = 1.8 (0.9-1.1) PSA (ng/mL) = 3.8 (<4) a) A1C b) serum creatinine c) potassium d) INR e) PSA

a

JM's lab results are as follows: WBC = 6.8 (4-11 x 10^3) Hgb = 12.9 (13.5-18) Hct = 37 (38-50) Plt = 201 (150-450 x 10^3) Albumin = 3.1 (3.5-5) MCV = 110 (80-100) Fe = 75 (65-150) B12 = 145 (>200) Folic acid = 8 (5-25) Which of the following is consistent with JM's lab results? a) macrocytic anemia caused by B12 deficiency b) leukopenia caused by dronedarone c) microcytic anemia caused by folic acid deficiency d) thrombocytopenia caused by tobacco use e) normocytic anemia caused by warfarin

a

JM's physician would like to convert him to a fentanyl patch. He's been taking Kadian 40 mg PO Q12H for 2 months. Recommended dose conversions (based on mg/day) for the Duragesic patch are as follows. -25 mcg/hr: oral morphine 60-134 mg, IM/IV morphine 10-22 mg, oral oxycodone 30-67 mg, oral codeine 150-447 mg, oral hydromorphone 8-17 mg, IV hydromorphone 1.5-3.4, IM meperidine 75-165, oral methadone 20-44 mg -50 mcg/hr: oral morphine 135-224 mg, IM/IV morphine 23-37 mg, oral oxycodone 67.5-112 mg, oral hydromorphone 17.1-28 mg, IV hydromorphone 3.5-5.6 mg, IM meperidine 166-278 mg, oral methadone 45-74 mg -75 mcg/hr: oral morphine 225-314 mg, IM/IV morphine 38-52 mg, oral oxycodone 112.5-157 mg, oral hydromorphone 28.1-39 mg, IV hydromorphone 5.7-7.9 mg, IM meperidine 279-390 mg, oral methadone 75-104 mg -100 mcg/hr: oral morphine 315-404 mg, IM/IV morphine 53-67 mg, oral oxycodone 157.5-202 mg, oral hydromorphone 39.1-51 mg, IV hydromorphone 8-10 mg, IM meperidine 391-503 mg, oral methadone 105-134 mg Which patch dose is most appropriate? a) 25 mcg/hr b) 50 mcg/hr c) 75 mcg/hr d) 100 mcg/hr e) JM isn't a candidate for a fentanyl patch

e

JM, a 62 YOWM, is being seen in the Family Medicine Clinic for management of his chronic medical conditions. He complains of urinary urgency and frequency and feeling like his bladder is always full. His digital rectal exam shows a slightly enlarged prostate gland with no nodules. Urinalysis is within normal limits. Which medication is recommended for JM's urinary symptoms? a) solifenacin b) bicalutamide c) Cialis d) desmopressin e) Flomax

b

JM, a 62 YOWM, is being seen in the Family Medicine Clinic for management of his chronic medical conditions. He currently takes metoprolol tartrate 50 mg BID, isosorbide mononitrate 10 mg BID, warfarin 3 mg on M/W, warfarin 4 mg on T/TH/F/SA/SU, dronedarone 400 mg BID, Tricor 145 mg QD, AndroGel 1% QD as directed, Kadian 40 mg PO Q12H, saw palmetto 450 mg TID, and diphenhydramine 25 mg PO QHS. The clinic pharmacist performs a medication reconciliation and reviews each of JM's medications with him to ensure he's taking them appropriately. Which medication should JM take twice daily, with doses separated by ~7 hours (e.g., 8 am and 3 pm)? a) metoprolol tartrate b) isosorbide mononitrate c) dronedarone d) Tricor e) warfarin

d

JM, a 62 YOWM, is being seen in the Family Medicine Clinic for management of his chronic medical conditions. He reports frequent productive cough with copious phlegm. He has no chest pain and no recent hospitalizations. Spirometry shows FEV1/FVC = 0.57 and FEV1 65% predicted. COPD assessment test score is 14. His lab results are as follows: HCO3 = 28 (24-30) BUN = 16 (7-20) SCr = 1.1 (0.6-1.3) WBC = 6.8 (4-11 x 10^3) Hgb = 12.9 (13.5-18) Hct = 37 (38-50) Plt = 201 (150-450 x 10^3) Albumin = 3.1 (3.5-5) MCV = 110 (80-100) Fe = 75 (65-150) B12 = 145 (>200) Folic acid = 8 (5-25) TSH = 3.5 (0.3-3) Which new diagnosis should be added to JM's problem list? a) dehydration b) asthma c) hyperthyroidism d) COPD e) iron deficiency anemia

d

JM, a 62 YOWM, is being seen in the Family Medicine Clinic for management of his chronic medical conditions. He reports frequent productive cough with copious phlegm. He has no chest pain and no recent hospitalizations. Spirometry shows FEV1/FVC = 0.57 and FEV1 65% predicted. COPD assessment test score is 14. Which of the following is appropriate to recommend for JM's new pulmonary condition? a) budesonide b) montelukast c) theophylline d) salmeterol e) omalizumab

c, d

JM, a 62 YOWM, is being seen in the Family Medicine Clinic for management of his chronic medical conditions. Today he complains of urinary urgency and frequency, and feeling like his bladder is always full. Which medications on JM's profile can worsen his urinary symptoms? (select all that apply) a) metoprolol b) Tricor c) AndroGel d) diphenhydramine e) dronedarone

e

JM, a 62 YOWM, takes the following medications: metoprolol tartrate, isosorbide mononitrate, warfarin, dronedarone, Tricor, AndroGel, Kadian, saw palmetto, and diphenhydramine. His PMH includes hypertension, angina, atrial fibrillation, dyslipidemia, chronic pain, and tobacco use. After assessing JM's past medical history and the medication list, the pharmacist identifies that the following medication is indicated: a) aspirin b) HCTZ c) Calan SR d) ranolazine e) Nitrostat

b

KM's PCP prescribed ProAir HFA for PRN use 5 months ago. Today, KM returns to his PCP and describes his symptoms and activity over the past 3 months. He feels "ok," but cannot always play outside with his son as much as he's like, even when he uses his inhaler. Initially, he didn't use the inhaler much, but now he uses it about 3x/week. He rarely wakes up at night with symptoms. The addition of which treatment to ProAir HFA PRN is consistent with asthma guidelines? a) Spiriva Respimat b) Flovent HFA c) Atrovent HFA d) Singulair e) Xolair

b

KN is a 42 YOM being prepped for an appendectomy. He's being started on D5NS + 40 mEq KCl per liter (run at 125 mL/hr), cefotetan, and morphine 2 mg IV Q4H PRN. KN receives 2 doses of pain medication and begins to complain of itching. The nurse notes that he's been scratching his arms. Which medication can be administered to prevent this type of reaction to KN's pain medication? a) bisacodyl b) diphenhydramine c) naloxone d) N-acetylcysteine e) aspirin

35 mEq 125 mL / 1 hr = x / 7 hr x = 875 mL 875 mL / x = 1000 mL / 40 mEq x = 35

KN is a 42 YOM being prepped for an appendectomy. He's being started on D5NS + 40 mEq KCl per liter (run at 125 mL/hr), cefotetan, and morphine 2 mg IV Q4H PRN. KN's intravenous fluids were started at 1300 per the medication administration record. If the time is now 2000, how many mEq of KCl has KN received? (round to nearest whole number)

a, c, d

KN is a 42 YOM being prepped for an appendectomy. His home medications include HCTZ, Claritin, Tylenol, ProAir RespiClick, red yeast rice, garlic, and fish oils. KN's antihypertensive medication can cause which laboratory abnormalities? (select all that apply) a) hypokalemia b) elevated AST and ALT c) hyperglycemia d) hypomagnesemia e) hypocalcemia

b

KN is a 42 YOM being prepped for an appendectomy. His home medications include HCTZ, Claritin, Tylenol, ProAir RespiClick, red yeast rice, garlic, and fish oils. Which condition is KN likely self-treating with the natural products listed on his home medication list? a) diabetes b) dyslipidemia c) migraines d) liver disease e) dementia

a, b, d

KN is a 42 YOM being prepped for an appendectomy. His home medications include HCTZ, Claritin, Tylenol, ProAir RespiClick, red yeast rice, garlic, and fish oils. Which of the following counseling points are correct for the beta-2 agonist on KN's home medication list? (select all that apply) a) When you open the cap, you will hear a "click"; the dose is now ready for inhalation. b) Breathe out through your mouth, away from the inhaler, to push as much air out of the lungs as you can. c) After putting the mouthpiece in your mouth, breathe in slowly and deeply while pressing the top of the canister all the way down. d) After putting the mouthpiece in your mouth, breathe in deeply and forcefully until your lungs are completely full of air. e) After each inhalation, rinse your mouth with water and spit to prevent thrush.

e

LT is a 21 YOF with severe depression. Her physician prescribes Effexor XR. Which of the following is an important counseling point for LT before starting this treatment? a) This medication should improve depressed mood within 1-2 weeks. b) Clotting risk is increased if this medication is used with garlic or ginger. c) This medication increases the risk of low blood pressure. d) This medication may increase libido and sexual tendencies. e) Family members should monitor you closely for suicidal thoughts/behaviors.

c

TB, a 34 YO pregnant female diagnosed with gestational diabetes is seeing her prenatal care provider for a follow-up appointment after trialing medical nutrition therapy with increased exercise for the past 2 weeks. They're starting her on Levemir FlexTouch 15 units SQ HS and will have a clinical pharmacist counsel on insulin injection technique. Which statement should be included in the pharmacist's counseling? a) inject into the abdomen only b) insert needle into the skin at a 45º angle c) prime the pen before each use d) return the pen to the refrigerator after each use e) store the pen with the needle attached

a

TN is a 67 YO Vietnamese female. She presents with a BP of 162/96 mmHg and HR 88 bpm. She currently takes Avapro, levothyroxine, Toujeo SoloStar, lanthanum carbonate, and aspirin. Which medication should be added to TN's profile for improved blood pressure management? a) amlodipine b) metoprolol c) hydralazine d) benazepril e) diltiazem

c

TN is a 67 YO Vietnamese female. She presents with the following labs: Na (mEq/L) = 132 (135-145) K (mEq/L) = 4.8 (3.5-5) Cl (mEq/L) = 102 (95-103) HCO3 (mEq/L) = 28 (24-30) BUN (mg/dL) = 28 (7-20) SCr (mg/dL) = 2.8 (0.6-1.3) Glucose (mg/dL) = 287 (100-125) Ca (mg/dL) = 7.7 (8.5-10.5) Mg (mEq/L) = 2.1 (1.3-2.1) A1C (%) = 9.2 PO4 (mg/dL) = 5.2 (2.3-4.7) Albumin (g/dL) = 2.6 (3.5-5) An ultrasound of her kidneys shows evidence of CKD. Which medication is currently indicated for TN? a) calcium gluconate b) SPS c) Renvela d) naproxen e) ribavirin

8.8 mg/dL 0.8(4 - 2.6) + 7.7 = 8.8

TN is a 67 YO Vietnamese female. She presents with the following labs: Na (mEq/L) = 132 (135-145) K (mEq/L) = 4.8 (3.5-5) Cl (mEq/L) = 102 (95-103) HCO3 (mEq/L) = 28 (24-30) BUN (mg/dL) = 28 (7-20) SCr (mg/dL) = 2.8 (0.6-1.3) Glucose (mg/dL) = 287 (100-125) Ca (mg/dL) = 7.7 (8.5-10.5) Mg (mEq/L) = 2.1 (1.3-2.1) A1C (%) = 9.2 PO4 (mg/dL) = 5.2 (2.3-4.7) Albumin (g/dL) = 2.6 (3.5-5) Calculate TN's corrected calcium. (round to nearest tenth)

a

A pharmacy student wants to learn more about the treatment for inflammatory bowel disease. The student learns that adalimumab is an FDA-approved product for this condition. Where might the student find information about biosimilar products and whether they're interchangeable with adalimumab? a) The Purple Book b) The Natural Medicines Database c) ASHP's Handbook on Injectable Drugs d) The Orange Book e) The NIOSH List

c

A positive serum hCG confirms which condition? a) neuropathy b) epilepsy c) pregnancy d) pancreatitis e) osteoarthritis

48 ng/kg/min (0.045 mL/hr) / 60 min = 0.00075 mL/min 0.00075 x (100 mg/20 mL) = 0.00375 mg/min 0.00375 x 1000 mcg = 3.75 mcg/min 3.75 x 1000 ng = 3750 ng/min 3750 / (172 lb / 2.2) = 48

A 172 lb male receives 0.045 mL/hr of Remodulin SQ to manage his pulmonary arterial hypertension. He uses an undiluted vial of Remodulin 100 mg/20 mL. What's his dose in ng/kg/min? (round to nearest whole number)

d

A 29 YO pregnant female has an upcoming business trip to New Delhi. Which treatment is recommended to prevent malaria in this patient? a) doxycycline b) primaquine c) atovaquone/proguanil d) mefloquine e) acetazolamide

c 0.75 / 1 = 66 mcg / x x = 88 mcg

A 60 YO patient was hospitalized due to multiple medical problems. During the hospitalization, the patient was NPO and received most medications parenterally, including levothyroxine 66 mcg IV QD. Choose the correct oral dose for the patient in preparation for discharge. a) 66 mcg b) 75 mcg c) 88 mcg d) 100 mcg e) 125 mcg

e

A 68 YOM arrives at his first follow-up appointment in the cardiology clinic. He was discharged on November 17 with new prescriptions for metoprolol tartrate PO and nitroglycerin SL. The newly prescribed oral medication reduces chest pain through which of the following mechanisms? a) coronary artery vasodilation b) decreased cardiac afterload c) decreased cardiac preload d) decreased intracellular calcium e) decreased myocardial contractility

e

A healthy college student is traveling to Peru on vacation. He expects to visit rural areas and is worried about contracting a disease through contaminated food or water. Which disease is transmitted in this manner? a) malaria b) dengue c) yellow fever d) hepatitis B e) typhoid fever

a

A mean corpuscular volume should be monitored for which of the following medications? a) cyanocobalamin b) dofetilide c) Cogentin d) Soma e) finasteride

b

A patient approaches the pharmacist for advice on OTC cough and cold products. Her physician recommended that she purchase a decongestant for her symptoms. Which product contains a decongestant? a) Flonase Allergy Relief b) Mucinex D c) Claritin Reditabs d) G Tussin AC e) Robitussin DM

d

A patient is being counseled on a new medication. Counseling points include impaired vision and hearing, a drop in blood pressure, and a risk of priapism. Which of the following medications is the pharmacist dispensing? a) rifampin b) medroxyprogesterone c) procainamide d) avanafil e) posaconazole

b

A patient presents with fatigue, joint pain/stiffness, and a malar rash on the face. Which medication is most likely responsible for this presentation? a) Januvia b) isoniazid c) Mobic d) Remeron e) metformin

e

A pharmacist is counseling a patient with a new Oxytrol patch prescription. How often should the patch be changed? a) once daily b) once weekly c) once monthly d) twice daily e) twice weekly

10 g alligation: 1% - 0.75% = 0.25 parts Aquaphor 0.75% - 0% = 0.75 parts 1% ointment 30 g / 0.75 parts = x / 0.25 parts x = 10

A pharmacist is preparing a 0.75% hydrocortisone ointment from commercially available 1% ointment and Aquaphor ointment (as a diluent). How many g of Aquaphor ointment should be added to 30 g of the 1% ointment to prepare the 0.75% strength? (round to nearest whole number)

c

A pharmacist working in an Oncology Infusion Center is responsible for the sterile preparation of chemotherapy drugs. All of the following resources would be useful to educate the pharmacist regarding standard work practices EXCEPT: a) USP Chapter 800 b) USP Chapter 797 c) USP Chapter 795 d) NIOSH List e) ASHP Guidelines

d

A randomized, double-blind, placebo-controlled trial was created to establish efficacy of rifaximin in preventing acute hepatic encephalopathy (HE). Patients were randomized to receive either rifaximin or placebo for 6 months. The primary efficacy endpoint was the time to the first breakthrough episode of HE. The key secondary endpoint was the time to the first hospitalization involving HE. Breakthrough episodes of HE were reported in 31 of 140 patients in the rifaximin group and 73 of 159 patients in the placebo group. Hospitalization involving HE was reported for 19 of 140 patients in the rifaximin group (13.6%) and 36 of 159 patients in the placebo group (22.6%). Which of the following statements is correct regarding hospitalization involving HE? a) rifaximin resulted in a statistically significant reduction in hospitalizations involving HE vs. placebo b) hospitalization involving HE was the primary endpoint of the trial c) patients receiving rifaximin experienced more hospitalizations involving HE than patients receiving placebo d) patients receiving rifaximin experienced fewer hospitalizations involving HE than patients receiving placebo e) 36 patients in the rifaximin group experienced hospitalization involving HE in this trial

e

All of the following are risks of correcting hyponatremia too rapidly (>12 mEq/L increase in 24 hours) EXCEPT: a) paralysis b) death c) seizures d) osmotic demyelination syndrome e) thrombosis

c

An investigational medication for hyponatremia has the following pharmacokinetic parameters: Vd = 22 L F = 0.7 Ke = 0.124 hr^-1 recommended dose = 600 mg IV Q6H recommended monitoring = trough level (immediately before dose) at steady state A test subject started receiving the investigational medication on Monday at 0600 (dose #1). Assuming all doses are given on schedule, what's the earliest time point that a trough level can be obtained? a) immediately before dose on Monday at 1800 b) immediately before dose on Monday at 1200 c) immediately before dose on Tuesday at 1200 d) immediately before dose on Monday at 2400 e) immediately before dose on Tuesday at 1800

2.7 22 x 0.124 = 2.7

An investigational medication for hyponatremia has the following pharmacokinetic parameters: Vd = 22 L F = 0.7 Ke = 0.124 hr^-1 recommended dose = 600 mg IV Q6H recommended monitoring = trough level (immediately before dose) at steady state Calculate the clearance of this drug in L/hr. (round to nearest tenth)

d

An oncologist is considering treatment with cetuximab for a patient. Which pharmacogenomic test should be performed prior to prescribing this medication? a) HER2 gene expression b) thiopurine methyltransferase activity c) dihydropyrimidine dehydrogenase deficiency d) KRAS mutation e) HLA-B*1502

d

BG is a 71 YOM who presents to the hospital with a BP of 124/59 mmHg, HR of 59 bpm, and RR of 18 bpm. He currently takes Sinemet, donepezil, finasteride, Cogentin, midodrine, warfarin, cyanocobalamin, dofetilide, fludrocortisone, Soma, and St. John's wort. Which medication on BG's profile could be contributing to the documented heart rate? a) Cogentin b) Sinemet c) finasteride d) donepezil e) cyanocobalamin