RxPrep Practice #2

e

A 17 YOF with a seizure disorder started taking phenytoin 6 months ago. On January 11th, she took 100 mg phenytoin TID, and her phenytoin (total, mcg/mL) level was 13.8. On April 15th, she took 200 mg phenytoin TID and 100 mg nitrofurantoin BID (prescribed for 5 days), and her phenytoin level was 12.6. On April 21st, the patient is seen in Urgent Care. She's confused, dizzy, and her speech is slurred. Her phenytoin (total, mcg/mL) level was 39.7. Which assessment is most accurate? a) phenytoin clearance increased as the dose increased b) nitrofurantoin inhibited the metabolism of phenytoin c) the patient was likely nonadherent to phenytoin d) absorption of phenytoin decreased as the dose increased e) metabolism of phenytoin became saturated

a, c, d, e

A 26 YOF is prescribed Absorica for severe refractory nodular acne. Which of the following measures are required to decrease the risk of pregnancy and subsequent fetal abnormalities? (select all that apply) a) evidence of 2 negative pregnancy tests before starting treatment b) routine use of a progestin-only pill during treatment c) preventing pregnancy for 1 month before, during, and 1 month after treatment d) routine use of 2 forms of birth control during treatment e) dispensing pharmacy registration with the iPLEDGE program

1:77 0.65 mL / 50 mL = x / 100 mL x = 1.3 mL 1.3 mL / 100 mL = 1 / x x = 77

A 50 mL bottle is labeled as containing 0.65 mL of active drug. What's the ratio strength (v/v) of this solution? (round to nearest whole number)

5 hrs 170 lb / 2.2 = 77.273 kg x 19 units = 1468.187 units/hr 25,000 units / 500 mL = 1468.187 units / x x = 29.363 mL/hr 29.363 mL / 1 hr = 150 mL / x x = 5

A 51 YOF (height: 5'11", weight: 170 lb) in the medical ICU is receiving a heparin drip for a pulmonary embolism. The current order is for heparin 25,000 units in 500 mL D5W to infuse at 19 units/kg/hr. There are currently 150 mL left in the bag. Assuming there are no rate changes, how many hours remain before the bag will be empty? (round to nearest whole number)

a, b, c, d

A 57 YOF is going on a 14-day cruise and is concerned about having motion sickness, as she often gets very carsick. The patient is given a prescription for Transderm-Scop. Which counseling points for this medication are correct? (select all that apply) a) apply to the skin behind the ear b) this medication can cause pupil dilation c) the patch will work for up to 72 hours d) this medication can cause drowsiness e) diarrhea Is a common side effect

c

A 58 YOF comes to the pharmacy with a prescription for icosapent ethyl and liraglutide. She also asks for a refill of all her other prescriptions that are available for refill. Which of the past prescriptions should the pharmacist confirm has been discontinued prior to dispensing the new medications? a) benazepril b) glyburide c) linagliptin d) metformin e) rosuvastatin

a

A group of investigators designed a study to examine a possible link between quinolone antibiotics and C. difficile colitis. Patients who were admitted to the hospital between March 1, 2005 and August 31, 2005 who tested positive for C. difficile were matched in a 1:2 ratio with patients who were admitted during the same time period, to the same medical unit, but who didn't develop C. difficile. Data was collected retrospectively and included patient age, quinolone use within the 6 weeks prior to diagnosis, length of quinolone therapy, history of GI surgery within 120 days, presence of current underlying malignancy, time to diagnosis of C. difficile colitis, and number of stools per day. Which of the following data could be analyzed using a Chi-square test? a) occurrence of C. difficile colitis b) length of quinolone therapy c) patient age d) time to diagnosis of C. difficile colitis e) number of stools per day

b

A group of investigators designed a study to examine a possible link between quinolone antibiotics and C. difficile colitis. Patients who were admitted to the hospital between March 1, 2005 and August 31, 2005 who tested positive for C. difficile were matched in a 1:2 ratio with patients who were admitted during the same time period, to the same medical unit, but who didn't develop C. difficile. Data was collected retrospectively and included patient age, quinolone use within the 6 weeks prior to diagnosis, length of quinolone therapy, history of GI surgery within 120 days, presence of current underlying malignancy, time to diagnosis of C. difficile colitis, and number of stools per day. Which study design describes this analysis of C. difficile colitis and quinolone antibiotics? a) cross-sectional study b) case-control study c) case series d) case report e) cohort study

e (22 x 45) / (15 x 8) = 8.3

A group of investigators designed a study to examine a possible link between quinolone antibiotics and C. difficile colitis. These were the results: C. difficile YES C. difficile NO quinolone YES 22 15 quinolone NO 8 45 The odds ratio of quinolone-induced C. difficile colitis in this study is: a) 0.04 b) 0.1 c) 0.8 d) 1 e) 8.3

3 mL/hr 50 mg x 1000 = 50,000 mcg 50,000 mcg / 250 mL = 10 mcg / x x = 0.05 mL/min x 60 min = 3 mL/hr

A nitroglycerin drip is ordered to start at 5 mcg/min, with titration as needed for the relief of chest pain. The drip is increased to 10 mcg/min after the patient reports continued pain at the initial rate. The standard concentration stocked in the ED is nitroglycerin 50 mg/250 mL. What's the current rate in mL/hr? (round to nearest whole number)

d

A patient comes to the pharmacy with questions regarding his Flolan. What's the primary indication for this drug? a) chronic MRSA infection b) Cushing's syndrome c) ulcerative colitis d) pulmonary arterial hypertension e) severe, psoriatic arthritis

a, c

A patient experiencing an acute gout attack is given a prescription for colchicine 0.6 mg. The pharmacist should counsel the patient regarding the risk of which side effects? (select all that apply) a) diarrhea b) orthostasis c) nausea d) hyperglycemia e) insomnia

d

A patient has a pH of 7.6 (7.35-7.45), pCO2 of 25 (35-45), and HCO3 of 24 (22-26). Which acid-base disorder is present in this patient? a) metabolic acidosis b) respiratory acidosis c) metabolic alkalosis d) respiratory alkalosis e) this is a normal ABG

17% 3.4 kcal / 1 g = 1340 kcal / x x = 394.118 g 394.118 g / (96 mL x 24 hr) = x / 100 mL x = 17

A patient is receiving 1,340 kcal from dextrose in his PN solution that's running at 96 mL/hr over 24 hours. What's the concentration (% w/v) of dextrose in this PN solution? (round to nearest whole number)

a

A patient is starting a new medication for glaucoma. The pharmacist includes the following statement when counseling the patient: "this medication can cause a darkening of eyelid skin and eyelashes." Which medication has been prescribed? a) Lumigan b) Timoptic c) Cosopt PF d) Pataday e) Alaway

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

c

A patient taking levofloxacin for community-acquired pneumonia experiences a seizure-like event. A report is best submitted to: a) IDSA b) REMS c) FAERS d) VAERS e) NIOSH

c

A patient using subcutaneous methotrexate for rheumatoid arthritis should be instructed to inject the medication: a) once daily b) once daily and as needed for acute flares c) once weekly d) once monthly e) as needed for acute flares

197 L 26 lb / 2.2 = 11.818 kg x 25 mcg = 295.45 mcg / 1.5 mcg/L = 197

A pediatric patient (weight 26 lbs) is given 25 mcg/kg of IV digoxin. If a measured serum concentration is 1.5 mcg/L, what's the volume of distribution (in L) of digoxin in this patient? (round to nearest whole number)

b

A pharmacist is mixing a large quantity of a topical compounded product. Which equipment can be used to assist in making a homogenous mixture in a timely manner? a) hot plate b) ointment mill c) closed system transfer device d) Wedgwood mortar and pestle e) Mohr pipette

10 g alligation: 1% - 0.75% = 0.25 parts Aquaphor 0.75% - 0% = 0.75 parts 1% hydrocortisone 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)

61.8 mL alligation 23.4% - 5% = 18.4 parts of 1/2NS 5% - 0.45% = 4.55 parts of 23.4% NaCl 4.55 parts / 18.4 parts = x / 250 mL x = 61.8

A pharmacist receives an order for 5% sodium chloride inhalation Q6H for a patient with cystic fibrosis. The pharmacy doesn't stock this strength but has 250 mL bags of 1/2NS and 20 mL vials of 23.4% sodium chloride. How many mL of the 23.4% sodium chloride must be mixed with the contents of 1 bag of 1/2NS to prepare the 5% sodium chloride that was ordered? (round to nearest tenth)

a

A pharmacist receives an order for Integrilin. What's an indication for the use of this medication? a) percutaneous coronary intervention b) acute ischemic stroke c) neuroleptic malignant syndrome d) thyroid storm e) Addisonian crisis

e

A pharmacy manager is taking an inventory of the sterile compounding area garbing supplies and finds some garb that shouldn't be worn in the sterile compounding area. According to USP 797, all of the following items can be worn in the cleanroom EXCEPT: a) chemotherapy-rated gloves b) face masks c) shoe covers d) disposable gowns e) powdered gloves

c 80 - 13 = 67

A randomized, controlled trial compared the Aptocaine mucosal patch versus a placebo patch. 8 out of 62 (13%) patients in the Aptocaine group and 49 out of 61 (80%) patients in the placebo group were unable to return to baseline oral intake within 24 hours. For this endpoint, what's the absolute risk reduction between groups? a) 41 b) 13 c) 67 d) 80 e) 49

b

A randomized, controlled trial compared the Aptocaine mucosal patch versus a placebo patch. A student t-test could be used to evaluate between-group differences for which criteria? a) gender b) age c) pain scale score d) return to baseline oral intake within 24 hours e) weight loss >2 lb within 72 hours

d

A randomized, controlled trial compared the Aptocaine mucosal patch versus a placebo patch. Alpha was set at 0.03 for all endpoints. These were the following endpoint results for p-value: pain relief (pain scale score <3) - 0.0012, median pain scale score before patch application - 0.085, median pain scale score 24 hours after patch application - 0.002, unable to return to baseline oral intake within 24 hours - 0.003, weight loss >2 lb within 72 hours - 0.043. The use of Aptocaine didn't result in a statistically significant difference compared to placebo when evaluating which endpoint? a) pain scale score <3 b) pain scale score 24 hours after patch application c) return to baseline oral intake within 24 hours d) weight loss >2 lb within 72 hours e) resolution of aphthous ulcers within 72 hours

10% treatment: (62 - 57) / 62 = 0.08065 control: (61 - 11) / 61 = 0.8197 0.08065 / 0.8197 = 0.09839 x 100 = 10

A randomized, controlled trial compared the Aptocaine mucosal patch versus a placebo patch. The primary outcome of the study was pain relief (defined as a pain scale score <3). 57 out of 62 patients in the Aptocaine group experienced pain relief. 11 out of 61 patients in the placebo group experienced pain relief. Calculate the relative risk for the primary outcome in this study. (express answer as percentage, round to nearest whole number)

b

A technician has completed the steps to garb for sterile compounding in this order: 1. wash hands with soap and water for 30 seconds 2. dry hands with lint-free cloth or dryer 3. don shoe and hair covers 4. don gown 5. use alcohol-based scrub on hands 6. don sterile gloves Which correction should the supervising pharmacist make to the order of the steps taken? a) the gown should be donned before hands are washed b) shoe and hair covers should be donned before hands are washed c) hands should be dried with a lint-free towel or dryer after applying alcohol-based scrub d) sterile gloves should be donned before donning the gown e) the gown should be donned before shoe and hair covers

a

All of the following chemotherapy agents are correctly matched with their major toxicity EXCEPT: a) bleomycin - hemorrhagic cystitis b) cisplatin - kidney damage c) vincristine - peripheral neuropathy d) doxorubicin - decreased left ventricular ejection fraction e) methotrexate - mucositis

c

An HIV-positive patient currently taking Complera comes to the pharmacy counter with a box of Prilosec OTC. How should the pharmacist counsel the patient? a) separate Prilosec OTC from Complera by 12 hours b) take Prilosec OTC at the same time as Complera c) do not take Prilosec OTC with Complera d) take Complera on an empty stomach to reduce heartburn e) use Tums, instead of Prilosec OTC, and take Complera simultaneously

b

An outpatient pharmacy is preparing Mile's Solution (a type of magic mouthwash). The ingredients include viscous lidocaine 2%, diphenhydramine 12.5 mg/5 mL, hydrocortisone, tetracycline, nystatin suspension, and distilled water. This compounded preparation has a water activity (Aw) of 0.992 and doesn't contain a preservative. It should be assigned a BUD of: a) 7 days b) 14 days c) 35 days d) 45 days e) 90 days

b

BH is a 52 YOM admitted to the hospital with a STEMI 5 days ago. He had a cardiac catheterization with stent placement and is now awaiting discharge with the following medication orders: Brilinta 90 mg PO BID, Coreg CR 20 mg PO QD, Accupril 40 mg PO QD, furosemide 20 mg PO BID, Lantus 17 units SC QHS, metformin 1000 mg PO BID, Cymbalta 60 mg PO QD, Spiriva HandiHaler 1 capsule (2 puffs) QD, aspirin 325 mg PO QD, and hydrocodone/acetaminophen 5/325 mg PO Q6H PRN pain. Which change should be implemented to BH's antiplatelet regimen? a) clopidogrel should be added to the discharge medication list b) the aspirin dose should be reduced to 81 mg daily c) Integrilin should be added to the discharge medication list d) the Brilinta dose should be reduced to once daily e) aspirin should be discontinued while the patient is on Brilinta

a, b, d, e

BH is a 52 YOM admitted to the hospital with a STEMI 5 days ago. He had a cardiac catheterization with stent placement and is now awaiting discharge with the following medication orders: Brilinta, Coreg, Accupril, furosemide, Lantus, metformin, Cymbalta, Spiriva HandiHaler, aspirin, and hydrocodone/acetaminophen. The serotonin and norepinephrine reuptake inhibitor on BH's medication list is indicated for the treatment of: (select all that apply) a) fibromyalgia b) depression c) seizures d) generalized anxiety disorder e) neuropathic pain

a, b, c, d

BH is a 52 YOM admitted to the hospital with a STEMI 5 days ago. He had a cardiac catheterization with stent placement and is now awaiting discharge with the following medication orders: Brilinta, Coreg, Accupril, furosemide, Lantus, metformin, Cymbalta, Spiriva HandiHaler, aspirin, and hydrocodone/acetaminophen. Which of the following are correct counseling points for BH's COPD medication? (select all that apply) a) load the capsule into the device chamber b) take 2 puffs from each capsule daily c) press the green button only once to pierce the capsule d) when you inhale the medication, you should hear or feel the capsule "rattle" e) rinse mouth with water after using to prevent thrush

d

BL is a 19 YOM admitted to the hospital with increased productive cough, dyspnea, and fever. He's had a decreased appetite over the last 3 days. His PMH includes cystic fibrosis, diabetes, pancreatic insufficiency, and GERD. On physical exam, his lungs have decreased breath sounds in the right lung base. Chest x-ray shows increased infiltrate in the right lung based compared to 5 months ago. Sputum culture shows numerous WBCs, rare squamous epithelial cells, and many gram-negative bacilli. The plan is to admit him for an acute pulmonary exacerbation. Which antibiotic regimen is most appropriate to treat BL's acute lung infection? a) azithromycin b) ceftriaxone + doxycycline c) vancomycin + azithromycin d) tobramycin + cefepime e) moxifloxacin

b; e; a; c; d

BL is a 19 YOM admitted to the hospital with increased productive cough, dyspnea, and fever. He's had a decreased appetite over the last 3 days. His PMH includes cystic fibrosis, diabetes, pancreatic insufficiency, and GERD. Rank BL's inhaled treatments and chest physiotherapy in the recommended order of administration, from first to last. a) dornase alfa b) albuterol c) chest physiotherapy d) TOBI Podhaler e) hypertonic saline

9 days 300 units / 1 mL = x / 1.5 mL x = 450 units / 50 units = 9

BL is a 19 YOM with prescriptions for Humalog KwikPen 8 units SC TID with meals and Toujeo Solostar (1.5 mL) 50 units SC QD. How many days will BL's long-acting insulin pen last based on this current dose? (round to nearest whole number)

1197 mOsmol/L 3.5 g / 100 mL = x / 1000 mL x = 35 g (35 / 58.5) x 1000 x 2 = 1197

BL is a 19 YOM with the following home medications: TOBI Podhaler 112 mg via inhalation BID, Advair HFA 230 mcg/21 mcg 2 inhalations BID, dornase alfa 2.5 mg via jet nebulizer QD, hypertonic saline 3.5% 4 mL via nebulizer BID, Creon as directed, Humalog KwikPen 8 units SC TID with meals, Toujeo SoloStar (1.5 mL) 50 units SC QD, albuterol 2.5 mg via nebulizer Q4-6H PRN, and omeprazole 40 mg PO QD. What's the osmolarity (mOsmol/L) of BL's sodium chloride solution for inhalation (MW 58.5)? (round to nearest whole number)

640 mg 265 lb / 2.2 = 120.455 kg 50 + 2.3(10) = 73 kg 0.4(120.455 - 73) + 73 = 91.982 kg x 7 mg = 640

DR, a 58 YOM (height: 5'10", weight: 265 lb), presents to the hospital with septic shock and a severe left foot infection. According to the hospital-based Hartford Nomogram, DR would require 7 mg/kg of tobramycin using adjusted body weight. What initial dose of tobramycin should be ordered for DR? (round to nearest ten mg)

44.5 mEq 100 mL x 4 = 400 mL 400 mL / x = 100 mL / 0.256 g x = 1.024 g x 1000 = 1024 mg / 23 = 44.5

DR, a 58 YOM, presents to the hospital with septic shock and a severe left foot infection. He's prescribed Zosyn 4.5 g/100 mL NS IV Q6H. DR's physician is concerned with the sodium load he's receiving. If Zosyn contains 0.256 g of sodium in each 100 mL bag, how many mEq of sodium is DR receiving each day from the antibiotic (MW of sodium is 23)? (round to nearest one decimal place)

a

DR, a 58 YOM, presents to the hospital with septic shock and a severe left foot infection. He's prescribed Zosyn, vancomycin, and tobramycin. His antibiotic regimen provides coverage for all of the following pathogens EXCEPT: a) Mycoplasma pneumoniae b) methicillin-resistant Staphylococcus aureus c) Pseudomonas aeruginosa d) Proteus mirabilis e) Bacteroides fragilis

20 g 150 mL / 1 hr = x / 15 hr x = 2250 mL 2250 mL / x = 100 mL / 0.9 g x = 20

DR, a 58 YOM, presents to the hospital with septic shock and a severe left foot infection. He's prescribed a normal saline continuous infusion to be run at 150 mL/hr. It was started at 2 am on August 6th. When his labs were checked at 5 pm on August 6th, he was hypernatremic. How many g of sodium chloride had he received from the continuous infusion of normal saline during that time period? (round to nearest whole number)

b

DR, a 58 YOM, presents to the hospital with septic shock and a severe left foot infection. His inpatient stat medication orders include normal saline continuous infusion at 150 mL/hr, norepinephrine (8 mg/250 mL) at 18 mL/hr, Zosyn 4.5 g/100 mL NS IV Q6H, vancomycin (pharmacy to dose), and tobramycin (pharmacy to dose). During his hospitalization, DR receives phentolamine. What's the most likely reason this medication was administered to DR? a) hypotension b) extravasation c) hyperglycemia d) acidosis e) leukopenia

c

DR, a 58 YOM, presents to the hospital with septic shock and a severe left foot infection. His inpatient stat medication orders include normal saline continuous infusion at 150 mL/hr, norepinephrine (8 mg/250 mL) at 18 mL/hr, Zosyn 4.5 g/100 mL NS IV Q6H, vancomycin (pharmacy to dose), and tobramycin (pharmacy to dose). What's the primary mechanism of action of the vasopressor being used to maintain DR's blood pressure? a) vasopressin agonist b) venous vasodilator c) alpha-1 agonist d) beta-1 antagonist e) phosphodiesterase-3 inhibitor

d 30 mg / 20 mg = x / 40 mg x = 60 mg

DR, a 58 YOM, presents to the hospital with septic shock and a severe left foot infection. Once his blood pressure is stabilized, the medical team initiates furosemide to help maintain DR's fluid status. Which furosemide dose will provide an equivalent diuretic effect to DR's home diuretic regimen? His home medications include: Glucophage XR 1,000 mg QD, lisinopril 20 mg QD, Toprol XL 100 mg QD, torsemide 30 mg QD, and aspirin 81 mg QD. a) 60 mg IV BID b) 80 mg IV BID c) 30 mg PO daily d) 60 mg PO daily e) 15 mg PO daily

d

During planned maintenance of the electronic medical record system, computerized provider order entry is unavailable in the hospital for a short period of time. A prescriber handwrites an order for "insulin glargine 10 IU SC daily" for a patient in the ICU and faxes it to the pharmacy. Which modification will improve the safety of the order? a) add a decimal point and a zero after "10" b) add a weight-based dose c) change "daily" to "Q.D." d) change "IU" to "units" e) change the generic drug name to the brand name

c

FS, a 37 YOF, is admitted to the hospital with complaints of a headache and blurry vision. Her urine hCG is positive. Which medication is preferred for the chronic management of hypertension in FS? a) Lotensin b) Exforge c) Adalat CC d) Cozaar e) Zestoretic

8 hrs 1 L x 1000 = 1000 mL x 20 gtt/mL = 20,000 gtt / 42 gtt/min = 476.1905 min / 60 min = 8

FS, a 37 YOF, is admitted to the hospital with complaints of a headache and blurry vision. She's started on a 1 L Lactated Ringers infusion. If the hospital has IV tubing sets that deliver 20 gtt/mL and FS's IV fluid is to infuse at a rate of 42 gtt/min, how many hours will it take to complete the infusion? (round to nearest whole number)

b, d, e

FS, a 37 YOF, is admitted to the hospital with complaints of a headache and blurry vision. She's started on labetalol 20 mg IV PRN and a 1 L Lactated Ringers infusion. The IV antihypertensive medication ordered on admission for FS works as an antagonist at which receptors? (select all that apply) a) angiotensin II b) alpha-1 c) alpha-2 d) beta-1 e) beta-2 f) dopamine

c

GS is a 72 YOM with heart failure. He's admitted to the hospital, and tolvaptan 15 mg PO daily is ordered. What's tolvaptan used for? a) anesthesia b) life-threatening hypokalemia c) hypervolemic hyponatremia d) neuromuscular blockade e) hemostasis

12 capsules 50 mg / 100 caps = x / 1 cap x = 0.5 mg/cap 50 mcg / 1000 = 0.05 mg x 120 mL = 6 mg 6 mg / x = 0.5 mg / 1 cap x = 12

If a bottle containing 100 capsules contains 50 mg total of an active ingredient, how many capsules would be needed to compound 120 mL of a 50 mcg/mL suspension? (round to nearest whole number)

a, b, c

Imitrex is available in which of the following formulations? (select all that apply) a) nasal spray b) subcutaneous injection c) oral tablet d) sublingual spray e) intramuscular injection

a

JB is a 64 YOM who calls his community pharmacy because he's concerned his medications aren't being absorbed properly. He reports seeing a tablet in his stool for the last week. The pharmacist reviews the prescription profile and finds he takes Cardura XL, cholecalciferol, rosuvastatin, Janumet, doxazosin, aspirin, and lisinopril. What's the patient seeing in his stool? a) empty shell of Cardura XL b) enteric coating of aspirin c) partially absorbed cholecalciferol tablet d) remnant of Janumet e) unabsorbed rosuvastatin tablet

a

JJ, a 45 YOF, comes to the office for follow-up of chronic conditions diagnosed 6 months ago. She reports difficulty losing weight through diet and exercise as advised at the last visit and would like to discuss options. Her PMH includes GERD, hypertension, and type 2 diabetes. Her home meds include lisinopril, metformin, omeprazole, and rosuvastatin. Her hemoglobin A1C is 7.6%. Which of the following medications would be best to add given the patient's current concern? a) canagliflozin b) glipizide c) insulin glargine d) repaglinide e) rosiglitazone

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

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 (%) = 5.4 INR = 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 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

a

JM, a 50 YOM, comes to the ED with a 2-day history of new-onset diarrhea. He describes 5-6 loose bowel movements per day, nausea, and abdominal cramping. He has no history of similar symptoms. JM recently completed a course of levofloxacin for community-acquired pneumonia. His lab results show WBC 15,500 cells/mm^3 and SCr 1.2 g/dL. His stool PCR is positive for Clostridioides difficile. What is the first-line treatment for JM? a) fidaxomicin 200 mg PO Q12H b) metronidazole 500 mg PO Q8H c) metronidazole 500 mg IV Q8H and vancomycin 500 mg PO Q6H d) vancomycin 125 mg PO QID followed by a prolonged taper e) vancomycin 1,250 mg IV Q12H

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. He also reports frequent productive cough with copious phlegm. He has no chest pain and no recent hospitalizations. Digital rectal exam showed a slightly enlarged prostate gland with no nodules. Urinalysis was within normal limits. Spirometry showed an FEV1/FVC of 0.57 with predicted FEV1 65%. COPD assessment test was 14. His labs are as follows: 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) Which new diagnosis should be added to JM's problem list? a) dehydration b) asthma c) hyperthyroidism d) COPD e) iron deficiency anemia

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

JW is a 49 YOF with a history of chronic back and knee pain attributed to morbid obesity. Her chronic medications include Kadian, Percocet, Senna S, and Cymbalta. She asks her primary care provider for a weight loss medication. Which weight loss drug is contraindicated in JW? a) Qsymia b) Saxenda c) Alli d) Adipex-P e) Contrave

a

JZ, an 87 YOF, is in the ED with septic shock. Norepinephrine (4 mg/250 mL) is being administered at 0.4 mcg/kg/min IV using the smart infusion drug library. She's later transferred to the ICU, and the norepinephrine infusion is transferred to a new IV pump. The smart infusion drug library isn't used, and the administration rate is incorrectly set to 0.4 mL/hr. The patient experiences a significant drop in blood pressure and worsened renal function. A root cause analysis is performed. The primary purpose of this analysis is to identify which of the following? a) all underlying reasons why this error occurred b) inefficiencies in workflow when transitioning patients between medical units c) prescribing practices of norepinephrine within the healthcare system d) system vulnerabilities that could potentially cause future infusion pump errors e) which personnel will potentially make the same error in the future

a, c, d

KS is a 72 YOF brought by her daughter to the primary care clinic to follow up on laboratory and imaging results obtained 1 week ago to evaluate symptoms of forgetfulness and word-finding difficulties. She's started on donepezil. Which of the following are potential adverse effects of the new medication initiated at today's visit? (select all that apply) a) bradycardia b) constipation c) insomnia d) nausea e) photosensitivity f) renal impairment

e

LB is a 24 YOF admitted to the hospital 6 weeks ago for cryptococcal meningitis and newly diagnosed HIV. She was transferred to the medical ward from the ICU 4 weeks ago. Allergies: penicillin (hives). PMH: none. Medications: fluconazole, Bactrim, acetaminophen. Lab results: HIV viral load - 200,000 copies/mL, HIV-1 antibody reactive, CD4 count - 80 cells/mm^3, HLA-5*5701 negative. Which of the following is most appropriate for the first-line treatment of this patient's HIV? a) Genvoya b) Isentress + Truvada c) Odefsey d) Prezista + Truvada e) Triumeq

e

MN is a 6 YOF being seen in the pediatrician's office. She has a temperature of 102.4ºF and a rash covering her entire body. Three days ago, MN's mother noticed spots in her daughter's mouth. She said they were small, white, and located on the inside of her daughter's cheeks. The pediatrician believes these to be Koplik spots. Based on this presentation, what childhood disease does MN likely have? a) mumps b) rubella c) varicella d) pertussis e) measles

d

Naloxone is available in which of the following dosage forms? a) buccal tablet b) orally dissolving film c) patch d) nasal spray e) sublingual tablet

31 mEq 21 mmol / x = 3 mmol / 1 mL x = 7 mL 7 mL / x = 1 mL / 4.4 mEq x = 31

Potassium phosphate (4.4 mEq/mL of potassium, 3 mmol/mL of phosphate) will be used to supply the phosphate in the parenteral nutrition formula. How many mEq of potassium will be added to the formula when the required phosphate amount (21 mmol) is added? (round to nearest whole number)

d

TD is a 60 YOM to be treated for community-acquired pneumonia. He has no recent history of antibiotic use and is allergic to penicillin (anaphylaxis). Which antibiotic regimen is most appropriate for this patient? a) Augmentin monotherapy b) Cubicin + clarithromycin c) dicloxacillin + clindamycin d) levofloxacin monotherapy e) Zithromax monotherapy

20 days 55 lb / 2.2 = 25 kg x 2 mg = 50 mg 50 mg / 1 day = (1 g x 1000) / x x = 20

The pharmacist is compounding cyclophosphamide oral suspension using the following ingredients: cyclophosphamide injection 1 g, 0.9% sodium chloride for injection 50 mL, Ora-Plus (or simple syrup) QS 100 mL. If the compound is prepared for a 7 YO child (height: 48 in, weight: 55 lb) who requires 2 mg/kg cyclophosphamide daily for 8 weeks, how many days will the bottle last? (round to nearest whole number)

b

The pharmacist is compounding cyclophosphamide oral suspension using the following ingredients: cyclophosphamide injection 1 g, 0.9% sodium chloride for injection 50 mL, Ora-Plus (or simple syrup) QS 100 mL. Which resource sets the standards for safe preparation of this compound? a) The FDA's Purple Book b) The United States Pharmacopeia Chapter 800 c) Goodman and Gilman's d) The King Guide to Parenteral Admixtures e) Index Nominum

b; d; e; a; c

The pharmacist is compounding cyclophosphamide oral suspension with the following steps of preparation: 1. calculate the quantity of each ingredient for the amount to be prepared 2. reconstitute cyclosphosphamide powder for injection with 0.9% normal saline, according to manufacturer's instructuions, to make a 20 mg/mL solution 3. withdraw the entire contents of the vial into a syringe and add to a graduated cylinder 4. QS to the final volume with Ora-Plus or simple syrup 5. stir well Put the required steps to complete preparation item #2 and #3 in the correct order. a) withdraw 50 mL of reconstituted cyclophosphamide solution from the vial b) inject 50 mL of air into the vial of 0.9% sodium chloride c) add 50 mL of reconstituted cyclophosphamide solution to the graduated cylinder d) withdraw 50 mL of liquid from the vial of 0.9% sodium chloride e) inject 50 mL of 0.9% sodium chloride into the vial of cyclophosphamide

c

The pharmacist is compounding cyclophosphamide oral suspension. If the space used to prepare this compound is also used to prepare sterile compounded products, what is the required air quality for the buffer room? a) ISO 6 b) ISO 5 c) ISO 7 d) ISO 8 e) unclassified air

9.6 mL 0.465 mEq / 1 mL = 4.45 mEq / x x = 9.6

The pharmacy has calcium gluconate 10% (0.465 mEq/mL) in stock. How many mL of calcium gluconate 10% should be added to the PN if 4.45 mEq of calcium are needed? (round to nearest one decimal place)

d

The preparation of some compounds may require melting of ingredients in order for them to mix well. How should ingredients be melted? a) melt all ingredients at the same time, using the highest melting point from among the ingredients b) melt each ingredient separately and then mix them all together using geometric dilution c) melt the ingredient with the lowest melting point first, then add the other ingredients according to the increasing melting points d) melt the ingredient with the highest melting point first, then add the other ingredients according to their decreasing melting points e) melt each ingredient separately and then mix them together with an electronic mortar and pestle

d

The surfaces of the laminar airflow workbench should be disinfected with: a) peroxide b) germicidal detergent c) 2% sodium hypochlorite d) 70% isopropyl alcohol e) chlorhexidine spray

c

WP, a 56 YOF, is being evaluated after she was recently exposed to a patient with active pulmonary tuberculosis. She will be starting isoniazid 300 mg PO daily and pyridoxine 50 mg daily. Which of the following laboratory tests should be ordered before the patient starts the prescribed latent tuberculosis treatment? a) creatinine phosphokinase b) hemoglobin A1C c) liver function tests d) serum creatinine e) serum uric acid level

a

WT, a 48 YOM, comes to the ED with acute onset headache, fever, and nausea. During the initial patient interview, he's also noted to be confused. He has no known drug allergies. Acute bacterial meningitis is suspected. The pharmacist receives empiric antibiotic orders for cefepime and vancomycin for this patient. Which additional antibiotic should be added to this regimen? a) ampicillin b) azithromycin c) clindamycin d) gentamicin e) no additional antibiotic is needed

a, d, e

Which antipsychotics are available in a long-acting intramuscular formulation? (select all that apply) a) aripiprazole b) lurasidone c) clozapine d) paliperidone e) risperidone

d

Which drug can be used to control ventricular rate in a patient with atrial fibrillation? a) irbesartan b) procainamide c) ticagrelor d) diltiazem e) mexiletine

b, c, d

Which inhalers require priming prior to the first use? (select all that apply) a) Proair RespiClick b) Spiriva Respimat c) Symbicort d) Atrovent HFA e) Advair Diskus

c

Which medication can be purchased over-the-counter for the treatment of cold sores (herpes simplex labialis)? a) Propecia b) Differin c) Abreva d) Lamisil e) Nizoral

e

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

c

Which medication has a warning for serious symptomatic bradycardia if used in combination with amiodarone? a) Mavyret b) ribavirin c) Epclusa d) interferon alfa-2b e) Vemlidy

e

Which medication lowers serum potassium by enhancing elimination from the body? a) sodium bicarbonate b) albuterol c) insulin d) calcium gluconate e) furosemide

b, d, f, g

Which medications are considered unsafe and should generally be avoided in children <2 years of age? (select all that apply) a) vancomycin b) doxycycline c) iron d) codeine e) simethicone f) promethazine g) moxifloxacin

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

a, c, d, e

Which of the following are acceptable reasons to compound a drug product for a patient? (select all that apply) a) the patient needs a drug in a formulation that's not commercially available b) the compounded drug product would be less expensive than the commercially available product c) there's currently a shortage of the commercially available product d) the patient is allergic to preservatives, dyes, or other inactive ingredients in the commercially available product e) the patient needs a drug strength that's not commercially available

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

a, c, d

Which of the following medications are teratogenic and should be discontinued, if possible, prior to pregnancy? (select all that apply) a) Zocor b) levothyroxine c) lithium d) Depakote ER e) insulin

b, c, d

Which of the following medications can cause a patient to have symptoms that resemble Parkinson disease (tremors, abnormal gait)? (select all that apply) a) tramadol b) metoclopramide c) prochlorperazine d) haloperidol e) pramipexole

a, e

Which of the following oral nonsteroidal anti-inflammatory drugs are available over-the-counter? (select all that apply) a) naproxen b) Celebrex c) diclofenac d) ketorolac e) Ecotrin

a, c, d, e, g

Which of the following patients is a candidate for Menveo? (select all that apply) a) a healthy 12-year-old female b) a 9-year-old male victim of sexual abuse c) a 6-year-old female with sickle cell disease d) a 42-year-old male with a CD4 count of 124 e) an 18-year-old first-year college student living in resident housing f) a 24-year-old pregnant female g) a 30-year-old male traveling to Sub-Saharan Africa regions with a high prevalence of meningitis

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

c

ZB, a 66 YOWF, cannot recall how often she takes her ibandronate (PO) for osteoporosis. How often should she take it? a) daily b) weekly c) monthly d) every 3 months e) yearly

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

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