Week 10 PHARM

5. A 15-month-old male has a screening hemoglobin of 10.4 g/dL. Treatment for anemia in toddlers is: 1. 18 mg/day of iron supplementation 2. 6 mg/kg per day of elemental iron 3. 325 mg ferrous sulfate per day 4. 325 mg ferrous sulfate tid

6 mg/kg per day of elemental iron

8. A patient has just had her pregnancy confirmed and is asking about how to ensure a healthy baby. What is the folic acid requirement during pregnancy? 1. 40 mcg/day 2. 200 mcg/day 3. 600 mcg/day 4. 2 g/day

600 mcg/day

3. Providers should use an antibiogram when prescribing. An antibiogram is: 1. The other name for the Centers for Disease Control guidelines for prescribing antibiotics 2. An algorithm used for prescribing antibiotics for certain infections 3. The reference also known as the Pink Book, published by the Centers for Disease Control 4. A chart of the local resistance patterns to antibiotics developed by laboratories

A chart of the local resistance patterns to antibiotics developed by laboratories

17. Monitoring for a patient prescribed iron for iron deficiency anemia includes: 1. Reticulocyte count one week after therapy is started 2. Complete blood count every two weeks throughout therapy 3. Hemoglobin level at one week of therapy 4. INR weekly throughout therapy

Reticulocyte count one week after therapy is started

12. Effective treatment for pinworms in children is: 1. Over-the-counter (OTC) pyrantel pamoate 2. Ivermectin 3. Itraconazole 4. Metronidazole

Over-the-counter (OTC) pyrantel pamoate

4. The average starting dose of warfarin is 5 mg daily. Higher doses of 7.5 mg daily should be considered in which patients? 1. Pregnant women 2. Elderly men 3. Overweight or obese patients 4. Patients with multiple comorbidities

Overweight or obese patients

20. Meningococcal B vaccine is administered to: 1. Infants and children traveling to Saudi Arabia or other hyperendemic areas 2. Pregnant adolescents who are attending school 3. Patients 10 to 25 years of age during an outbreak 4. Infants with functional asplenia

Patients 10 to 25 years of age during an outbreak

15. Rho(D) immune globulin (RhoGAM) is given to: 1. Infants born to women who are Rh positive 2. Sexual partners of Rh-positive women 3. Rh-negative women after a birth, miscarriage, or abortion 4. Rh-negative women at 36 weeks gestation

Rh-negative women after a birth, miscarriage, or abortion

22. A patient taking carbamazepine needs to be started on a direct factor Xa inhibitor for antithrombotic therapy. Which of the direct factor Xa inhibitors should be avoided due to drug interactions? 1. Betrixaban 2. Apixaban 3. Rivaroxaban 4. Edoxaban

Rivaroxaban

14. ________ should be monitored when vitamin B12 therapy is started. 1. Serum calcium 2. Serum potassium 3. Ferritin 4. C-reactive protein

Serum potassium

3. Breastfed infants should receive iron supplementation of: 1. 3 mg/kg per day 2. 6 mg/kg per day 3. 1 mg/kg per day 4. Breastfed babies do not need iron supplementation.

1 mg/kg per day

11. The treatment of vitamin B12 deficiency is: 1. 1,000 mcg daily of oral cobalamin 2. 2 g per day of oral cobalamin 3. Vitamin B12 100 mcg/day IM 4. 500 mcg/dose nasal cyanocobalamin two sprays once a week

1,000 mcg daily of oral cobalamin

2. Premature infants require iron supplementation with: 1. 10 mg/day of iron 2. 2 mg/kg per day until age 12 months 3. 7 mg/day in their diet 4. 1 mg/kg per day until they are receiving adequate intake of iron from foods

2 mg/kg per day until age 12 months

4. An adult female presents to the clinic with menorrhagia. Her hemoglobin is 10.2 and her ferritin is 15 ng/mL. Initial treatment for her anemia is: 1. 18 mg/day of iron supplementation 2. 6 mg/kg per day of iron supplementation 3. 325 mg ferrous sulfate per day 4. 325 mg ferrous sulfate tid

325 mg ferrous sulfate tid

10. Hepatitis B vaccine is contraindicated in patients who: 1. Were born at less than 32 weeks gestation 2. Are pregnant 3. Are on hemodialysis 4. Are allergic to yeast

Are allergic to yeast

15. Anemia due to chronic renal failure is treated with: 1. Epoetin alfa (Epogen) 2. Ferrous sulfate 3. Vitamin B12 4. Hydroxyurea

Epoetin alfa (Epogen)

16. Tetracyclines should not be prescribed to children younger than 8 years due to: 1. Risk of developing cartilage problems 2. Development of significant diarrhea 3. Risk of kernicterus 4. Adverse effects on bone growth

Adverse effects on bone growth

1. A patient is taking warfarin and is asking about what they can take for minor aches and pains. The best recommendation is: 1. Ibuprofen 400 mg three times a day 2. Acetaminophen, not to exceed 4 grams per day 3. Prescription acetaminophen with codeine 4. Aspirin 640 mg three times a day

Acetaminophen, not to exceed 4 grams per day

15. Tetracyclines such as minocycline are safe to use in: 1. Pregnant women 2. Adolescents 3. Patients with renal dysfunction 4. Patients with hepatic dysfunction

Adolescents

6. A 12-month-old child is being treated with amoxicillin for acute otitis media. His parents call the clinic and say he has developed diarrhea. The appropriate action would be to: 1. Advise the parents that some diarrhea is normal with amoxicillin and recommend probiotics daily. 2. Change the antibiotic to one that is less of a gastrointestinal irritant. 3. Order stool cultures for suspected viral pathogens not treated by the amoxicillin. 4. Recommend increased fluids and fiber in his diet.

Advise the parents that some diarrhea is normal with amoxicillin and recommend probiotics daily.

1. The goals of treatment when prescribing antiretroviral therapy (ART) medication to patients with human immunodeficiency virus (HIV) include: 1. Prevention of vertical HIV transmission 2. Improvement in quality of life 3. Prolonging of survival 4. All of the above

All of the above

13. Before beginning IM vitamin B12 therapy, which laboratory values should be obtained? 1. Reticulocyte count, hemoglobin, and hematocrit 2. Iron 3. Vitamin B12 4. All of the above

All of the above

14. If a patient is allergic to sulfonamide antibiotics, he or she will most likely have cross-sensitivity to: 1. Loop diuretics 2. Sulfonylureas 3. Thiazide diuretics 4. All of the above

All of the above

6. ART is recommended for HIV-positive patients who: 1. Have a history of acquired immunodeficiency syndrome (AIDS)-defining illness 2. Are pregnant 3. Have a hepatitis B co-infection 4. All of the above

All of the above

6. The rotavirus vaccine (RotaTeq, Rotarix): 1. Is a live vaccine that replicates in the small intestine, providing active immunity against rotavirus 2. Should not be administered to infants who are or may be immunocompromised 3. Is not given to an infant who has a febrile illness (temperature greater than 100.5oF) 4. All of the above

All of the above

2. Live attenuated influenza vaccine (FluMist) may be administered to: 1. All patients over six months of age 2. Patients between ages 2 and 49 with no risk factors 3. Patients with an upper respiratory infection (URI) or asthma 4. Pregnant women

All patients over six months of age

4. A child has been diagnosed with strep throat and needs a prescription for an antibiotic. The parent says the last time they had penicillin they developed a pink, blotchy rash five or six days after starting the antibiotic. An appropriate antibiotic to prescribe would be: 1. Clindamycin 2. Amoxicillin 3. Cefadroxil (Duricef) 4. Azithromycin

Amoxicillin

5. A 25-year-old female is eight weeks pregnant and has a urinary tract infection. What would be the appropriate antibiotic to prescribe for her? 1. Ciprofloxacin (Cipro) 2. Amoxicillin (Trimox) 3. Doxycycline 4. Trimethoprim-sulfamethoxazole (Septra)

Amoxicillin (Trimox)

9. True contraindications to diphtheria, tetanus, and acellular pertussis (DTaP or Tdap) vaccine include: 1. Fever up to 104oF (40.5oC) after previous DTaP vaccine 2. Family history of seizures after DTaP vaccine 3. Adolescent pregnancy 4. Anaphylactic reaction with a previous dose

Anaphylactic reaction with a previous dose

13. Immune globulin serums: 1. Provide active immunity against infectious diseases 2. Are contraindicated during pregnancy 3. Are heated to above body temperature to kill most hepatitis, human immunodeficiency virus (HIV), and other viruses such as parvovirus 4. Are derived from pooled plasma of adults and contain specific antibodies in proportion to the donor population

Are derived from pooled plasma of adults and contain specific antibodies in proportion to the donor population

5. Pregnant women who are HIV positive: 1. Are treated with azidothymidine (AZT) alone to prevent birth defects 2. Are treated with a combination ART regimen 3. Should not be treated with ART due to teratogenicity of the drugs 4. Are at high risk of developing resistance to ART drugs

Are treated with a combination ART regimen

4. Monitoring for patients who are on long-term antifungal therapy with ketoconazole includes: 1. Platelet count 2. Blood urea nitrogen (BUN) and creatinine (Cr) 3. White blood cell count 4. Aspartate aminotransferase (AST), alanine aminotransferase (ALT), alkaline phosphatase, and bilirubin

Aspartate aminotransferase (AST), alanine aminotransferase (ALT), alkaline phosphatase, and bilirubin

6. A 51-year-old male has been told by his PCP to take an aspirin a day. Why would this be recommended? 1. He has arthritis and this will help with the inflammation and pain. 2. Aspirin has antiplatelet activity and prevents clots that cause strokes. 3. Aspirin acidifies the urine and he needs this for prostrate health. 4. He has a history of gastrointestinal (GI) bleed, and one aspirin a day is a safe dosage.

Aspirin has antiplatelet activity and prevents clots that cause strokes.

11. A patient who was recently treated with clindamycin for an infection calls the advice nurse because she is having frequent diarrhea that she thinks may have blood in it. What would be the appropriate care for her? 1. Encourage increased fluids and fiber. 2. Assess her for pseudomembranous colitis. 3. Advise her to eat yogurt daily to help restore her gut bacteria. 4. Start her on an antidiarrheal medication.

Assess her for pseudomembranous colitis.

13. Education of patients who are taking warfarin includes discussing their diet. Instructions include: 1. Avoid any food containing vitamin K. 2. Avoid foods high in vitamin K . 3. Increase intake of iron-containing foods. 4. Eat 35 grams of fiber daily.

Avoid foods high in vitamin K .

11. A 2-year-old child with asthma has been diagnosed with influenza A. Appropriate treatment would be: 1. Amantadine (Symmetrel) 2. Zanamivir (Relenza) 3. Oseltamivir phosphate (Tamiflu) 4. Symptomatic care

Oseltamivir phosphate (Tamiflu)

12. A patient with chronic hepatitis that has led to mildly impaired liver function has an infection that would be best treated by a macrolide. Which would be the best choice for a patient with liver dysfunction? 1. Azithromycin (Zithromax) 2. Clarithromycin (Biaxin) 3. Erythromycin (E-mycin) 4. None of the above

Clarithromycin (Biaxin)

9. To prevent further development of antibacterial resistance it is recommended that fluoroquinolones be reserved for treatment of: 1. Urinary tract infections in young women 2. Upper respiratory infections in adults 3. Skin and soft tissue infections in adults 4. Community-acquired pneumonia in patients with comorbidities

Community-acquired pneumonia in patients with comorbidities

5. When prescribing metronidazole (Flagyl) to treat bacterial vaginosis, patient education would include: 1. Metronidazole is safe in the first trimester of pregnancy. 2. Consuming alcohol in any form may cause a severe reaction. 3. Sexual partners need concurrent therapy. 4. Headaches are a sign of a serious adverse reaction and need immediate evaluation.

Consuming alcohol in any form may cause a severe reaction

23. The recommended long-term antithrombotic therapy for a patient with a DVT in their leg is: 1. Low-molecular-weight heparin 2. Warfarin, tapered monthly 3. Aspirin, 325 mg daily 4. Direct factor Xa inhibitor

Direct factor Xa inhibitor

8. Patient education when prescribing clopidogrel includes: 1. Do not take any herbal products without first discussing this with the provider. 2. Monitor urine output closely and contact the provider if it decreases. 3. Clopidogrel can be constipating; use a stool softener if needed. 4. The patient will need regular anticoagulant studies while on clopidogrel.

Do not take any herbal products without first discussing this with the provider.

8. A female patient is pregnant and has tested HIV positive. Which ART drug should be avoided in women who are pregnant? 1. Dolutegravir 2. Zidovudine 3. Ritonavir 4. Lopinavir/ritonavir

Dolutegravir

2. A challenge faced with ART is: 1. Patients abusing ART 2. Drug-resistant mutations of HIV 3. Reduction of transmissibility of HIV 4. Lack of efficacy data

Drug-resistant mutations of HIV

8. Zoster vaccine (Zostavax) is: 1. A live varicella zoster vaccine from the same strain used to develop the varicella vaccine 2. Effective in preventing varicella zoster in patients of all ages 3. Recommended for patients age 40 to 80 who have had chickenpox 4. Administered at the same time as other live vaccines, as long as they are given the same day

Effective in preventing varicella zoster in patients of all ages

17. A 16-year-old female who is taking minocycline for acne comes to the clinic complaining of a headache. What would be the appropriate care? 1. Advise acetaminophen or ibuprofen as needed for headaches. 2. Prescribe sumatriptan (Imitrex) to be taken at the onset of headache. 3. Evaluate her for pseudotumor cerebri. 4. Assess her caffeine intake and sleep patterns.

Evaluate her for pseudotumor cerebri.

5. A patient is traveling to Southeast Asia on vacation and has come into the clinic to review their medications. They are healthy with only mild hypertension that is well controlled. They ask about getting "a shot" to prevent blood clots like their friend did before international travel. The correct response would be to: 1. Administer one dose of low-molecular-weight heparin 24 hours before travel. 2. Prescribe one dose of warfarin to be taken the day of travel. 3. Consult with a hematologist regarding a treatment plan for the patient. 4. Explain that they are not at high risk of a blood clot and provide education about how to prevent blood clots while traveling.

Explain that they are not at high risk of a blood clot and provide education about how to prevent blood clots while traveling.

2. A patient had a deep vein thrombosis (DVT) and was on heparin and warfarin in the hospital and discharged home on warfarin. She asks her primary care nurse practitioner (NP) why she was getting both medications while in the hospital. The best response is to: 1. Contact the hospitalist as this is not the normal guideline for prescribing these two medications and she may have had a more complicated case. 2. Explain that warfarin is often started while a patient is still on heparin because warfarin takes a few days to reach effectiveness. 3. Encourage the patient to contact the customer service department at the hospital, as this was most likely a medication error during her admission. 4. Draw anticoagulation studies to make sure she does not have dangerously high bleeding times.

Explain that warfarin is often started while a patient is still on heparin because warfarin takes a few days to reach effectiveness.

11. The routine monitoring recommended for low-molecular-weight heparin is: 1. INR every two days until stable, then weekly 2. Activated partial thromboplastin time (aPTT) every week while on therapy 3. Factor Xa levels if the patient is pregnant 4. White blood cell count every 2 weeks

Factor Xa levels if the patient is pregnant

8. Selection of drug therapy for hepatitis C (HCV) infection is based on: 1. Patient cardiac function 2. Genotype and stage of disease 3. Age of the patient 4. Availability of generic preparation

Genotype and stage of disease

18. Azathioprine has significant adverse drug effects, including: 1. Hypertension 2. Hirsutism 3. Risk of cancer 4. Gingival hyperplasia

Gingival hyperplasia

11. Human papillomavirus (HPV) vaccine (Gardasil): 1. Is a live virus vaccine that provides immunity to six strains of HPV virus 2. Has a common adverse effect of syncope within 15 minutes of giving the vaccine 3. Should not be given to males younger than age 12 years 4. May be given to pregnant women

Has a common adverse effect of syncope within 15 minutes of giving the vaccine

10. Patients who are being treated for folate deficiency require monitoring of: 1. Complete blood count every four weeks 2. Hematocrit and hemoglobin at one week and then at eight weeks 3. Reticulocyte count at one week 4. Folate levels every four weeks until hemoglobin stabilizes

Hematocrit and hemoglobin at one week and then at eight weeks

20. The first laboratory value indication that vitamin B12 therapy is adequately treating pernicious anemia is: 1. Hematocrit levels start to rise. 2. Hemoglobin levels return to normal. 3. Reticulocyte count begins to rise. 4. Vitamin B12 levels return to normal.

Hemoglobin levels return to normal.

6. Monitoring for a patient taking iron to treat iron deficiency anemia includes: 1. Hemoglobin, hematocrit, and ferritin four weeks after treatment is started 2. Complete blood count every four weeks throughout treatment 3. Annual complete blood count 4. Reticulocyte count four weeks after treatment is started

Hemoglobin, hematocrit, and ferritin four weeks after treatment is started

10. Prior to starting HCV antivirals the following laboratory tests should be conducted: 1. Complete blood count 2. Serum lipids 3. Hepatitis B surface antigen (HBsAg) 4. Thyroid function (TSH and free T4)

Hepatitis B surface antigen (HBsAg)

9. For patients taking warfarin, international normalized ratios (INRs) are best drawn: 1. Monthly throughout therapy 2. Three times a week throughout therapy 3. Two hours after the last dose of warfarin to get an accurate peak level 4. In the morning if the patient takes their warfarin at night

In the morning if the patient takes their warfarin at night

19. Pregnant women should receive the Tdap vaccine: 1. In the first trimester 2. Once every 10 years 3. In the third trimester of every pregnancy 4. Tdap is contraindicated in pregnancy

In the third trimester of every pregnancy

1. Factors that place a patient at risk of developing an antimicrobial-resistant organism include: 1. Age over 50 years 2. School attendance 3. Travel within the United States 4. Inappropriate use of antimicrobials

Inappropriate use of antimicrobials

7. An adult female has been prescribed iron to treat her anemia. Education of patients prescribed iron would include: 1. Take the iron with milk if it upsets her stomach. 2. Antacids may help with the nausea and gastrointestinal (GI) upset caused by iron. 3. Increase fluids and fiber to treat constipation. 4. Iron is best tolerated if it is taken at the same time as her other medications.

Increase fluids and fiber to treat constipation

14. Hepatitis B immune globulin is administered to provide passive immunity to: 1. Infants born to HBsAg-positive mothers 2. Sexual contacts of those infected with hepatitis B virus 3. Persons exposed to blood containing hepatitis B virus 4. All of the above

Infants born to HBsAg-positive mothers

21. The following pediatric patients should receive meningococcal ACWY conjugate vaccine: 1. Infants who are HIV infected 2. All school-age children 3. Children who attend daycare 4. Infants with congenital hearing defects

Infants who are HIV infected

18. Patient education regarding taking iron replacements includes: 1. Double the dose if they miss a dose to maintain therapeutic levels. 2. Take the iron with milk or crackers if it upsets their stomach. 3. Iron is best taken on an empty stomach with juice. 4. Antacids such as Tums may help an upset stomach caused by iron therapy.

Iron is best taken on an empty stomach with juice.

16. A patient is having hip replacement surgery and would like to self-donate blood for the surgery. In addition to being prescribed epogen alfa he should also be prescribed: 1. Folic acid to prevent megaloblastic anemia 2. Iron, to start when the epogen starts 3. An antihypertensive to counter the adverse effects of epogen 4. Vitamin B12 to prevent pernicious anemia

Iron, to start when the epogen starts

21. Patients who are beginning therapy with vitamin B12 need to be monitored for: 1. Hypertensive crisis that may occur in the first 36 hours 2. Hypokalemia that occurs in the first 48 hours 3. Leukopenia that occurs at one to three weeks of therapy 4. Thrombocytopenia that may occur at any time in therapy

Leukopenia that occurs at one to three weeks of therapy

1. Attenuated vaccines are also known as: 1. Killed vaccines 2. Booster vaccines 3. Inactivated vaccines 4. Live vaccines

Live vaccines

The safest drug to use to treat pregnant women who require anticoagulant therapy is: 1. Low-molecular-weight heparin 2. Warfarin 3. Aspirin 4. Heparin

Low-molecular-weight heparin

4. The goal of ART in HIV-positive patients is: 1. Maximum suppression of HIV replication 2. Eradication of HIV virus from the body 3. Determining a treatment regimen that is free of adverse effects 4. Suppression of CD4 T-cell count

Maximum suppression of HIV replication

16. Tuberculin purified protein derivative: 1. Is administered to patients who are known tuberculin-positive reactors 2. May be administered to patients who are on immunosuppressives 3. Should be administered two to three weeks after an MMR or varicella vaccine 4. May be administered the same day as the MMR and/or varicella vaccine

May be administered the same day as the MMR and/or varicella vaccine

22. Hepatitis A virus (HAV) vaccination is recommended for: 1. All infants traveling internationally, but the dose is not counted 2. All health-care providers 3. Members of a household with children adopted from Africa 4. Immunocompromised patients

Members of a household with children adopted from Africa

2. When prescribing acyclovir, patients should be educated regarding the: 1. High risk of developing diarrhea 2. Need to drink lots of fluids during treatment 3. Risk for life-threatening rash such as Stevens-Johnson syndrome 4. Eccentric dosing schedule

Need to drink lots of fluids during treatment

7. Pharmacological treatment for uncomplicated chicken pox in an immunocompetent child is: 1. Acyclovir within 48 hours of onset of varicella rash 2. Varicella-zoster immune globulin within 72 hours of onset of varicella rash 3. Famciclovir within 24 hours of onset of varicella rash 4. No pharmacologic treatment is indicated.

No pharmacologic treatment is indicated.

8. A patient had a small ventricle septal defect (VSD) repaired when they were three years old and has no residual cardiac problems. They are now 28 and are requesting prophylactic antibiotics for an upcoming dental visit. The appropriate antibiotic to prescribe according to current American College of Cardiology and American Heart Association guidelines is: 1. None, no antibiotic is required for dental procedures 2. Amoxicillin 2 grams 1 hour before the procedure 3. Ampicillin 2 grams given intramuscularly (IM) or intravenously (IV) 30 minutes before the procedure 4. Azithromycin 1 gram 1 hour before the procedure

None, no antibiotic is required for dental procedures

3. The reason that two measles, mumps, and rubella (MMR) vaccines at least a month apart are recommended is: 1. The second dose of MMR "boosts" the immunity built from the first dose. 2. Two vaccines one month apart is the standard dosing for all live virus vaccines. 3. If the two MMR vaccine doses are given too closely together there is a greater likelihood of severe localized reaction to the vaccine. 4. Only 95% of patients are fully immunized for measles after the first vaccine, with 99% having immunity after two doses of MMR.

Only 95% of patients are fully immunized for measles after the first vaccine, with 99% having immunity after two doses of MMR.

9. A patient with Crohn's disease has a documented folate deficiency. Drug therapy for folate deficiency anemia is: 1. Oral folic acid 1 to 2 mg per day 2. Oral folic acid 1 g per day 3. Intramuscular (IM) folate weekly for at least six months 4. Oral folic acid 400 mcg daily

Oral folic acid 1 to 2 mg per day

5. If the measles, mumps, rubella, and varicella (MMRV) combined vaccine is ordered to be given as the first MMR and varicella dose to a child the Centers for Disease Control and Prevention (CDC) recommends: 1. Parents be informed of the increased risk of fever and febrile seizures over the MMR plus varicella two-shot regimen. 2. Patients must also receive MMRV as the second dose of MMR and varicella in order to build adequate immunity. 3. Patients be premedicated with acetaminophen 15 minutes before the vaccine is given. 4. Patients should not be around pregnant women for the first 48 hours after the vaccine is given.

Patients should not be around pregnant women for the first 48 hours after the vaccine is given.

12. Recombinant influenza vaccine (Flucelvax, Flublok) may be administered annually to: 1. Patients with an egg allergy 2. Pregnant adolescent patients 3. Patients age six weeks or older 4. Patients with acute febrile illness

Patients with an egg allergy

24. Who should receive a third dose of MMR vaccine: 1. Children traveling internationally who have had two doses of MMR 2. Pregnant women who are exposed to measles 3. People who have had two doses of MMR and are at risk during a mumps outbreak 4. No one; a third dose is never recommended

People who have had two doses of MMR and are at risk during a mumps outbreak

10. Patients receiving heparin therapy require monitoring of: 1. Platelets every two to three days for thrombocytopenia that may occur on day four of therapy 2. Electrolytes for elevated potassium levels in the first 24 hours of therapy 3. INR throughout therapy to stay within the range of 2.0 4. Blood pressure for hypertension that may occur in the first two days of treatment

Platelets every two to three days for thrombocytopenia that may occur on day four of therapy

19. To prevent the development of peripheral neuropathy in patients taking isoniazid for tuberculosis the patient is also prescribed: 1. Niacin (vitamin B3) 2. Pyridoxine (vitamin B6) 3. Riboflavin (vitamin B2) 4. Thiamine (vitamin B1)

Pyridoxine (vitamin B6)

1. An 82-year-old patient has herpes zoster (shingles) and would benefit from an antiviral such as valacyclovir. Prior to prescribing valacyclovir they will need an assessment of: 1. Complete blood count to rule out anemia 2. Liver function 3. Renal function 4. Immunocompetence

Renal function

15. If a patient is taking darbepoetin alfa (Aranesp), their blood counts should be monitored to determine if a dosage adjustment is needed. How soon should this be done after starting the drug? 1. Six weeks if they are a cancer patient 2. One week if they have chronic renal failure 3. Two weeks if they are taking it for allogenic transfusion 4. Each week throughout therapy

Six weeks if they are a cancer patient

3. A patient has been diagnosed with type A influenza. Appropriate prescribing of oseltamivir (Tamiflu) would include: 1. Starting oseltamivir within the first 48 hours of influenza symptoms 2. Advising the patient he can stop the oseltamivir when his symptoms resolve 3. Educating the patient that oseltamivir will cure influenza 4. Prophylactic treatment of all family members

Starting oseltamivir within the first 48 hours of influenza symptoms

13. A patient with glucose-6-phosphate dehydrogenase deficiency (G6PD) requires an antibiotic. Which class of antibiotics should be avoided in this patient? 1. Penicillins 2. Macrolides 3. Cephalosporins 4. Sulfonamides

Sulfonamides

7. A 13-year-old child comes to the clinic with a four-day history of cough, low-grade fever, and rhinorrhea. When she blows her nose or coughs the mucous is greenish-yellow. The appropriate treatment would be: 1. Amoxicillin 2. Amoxicillin/clavulanate 3. TMP/SMZ (Septra) 4. Symptomatic care

Symptomatic care

7. Varicella vaccine may be given to patients who are: 1. HIV positive with a CD4+ T-lymphocyte percentage less than 15% 2. Taking corticosteroids (up to 2 mg/kg/day or less than 20 mg/day) 3. Pregnant 4. Immunocompromised

Taking corticosteroids (up to 2 mg/kg/day or less than 20 mg/day)

10. Fluoroquinolones have a black box warning regarding ________ even months after treatment. 1. Renal dysfunction 2. Hepatic toxicity 3. Tendon rupture 4. Development of glaucoma

Tendon rupture

12. When writing a prescription for warfarin it is common to write _________ on the prescription. 1. "OK to substitute for generic" 2. The brand name of warfarin and "do not substitute" 3. "PRN refills" 4. "Refills for 1 year"

The brand name of warfarin and "do not substitute"

17. A patient may benefit from cyclosporine (Sandimmune). Cyclosporine may be prescribed to: 1. Treat rheumatoid arthritis 2. Treat patients with a corn allergy 3. Pregnant patients 4. Treat patients with liver dysfunction

Treat patients with a corn allergy

6. Education for elderly persons prescribed famciclovir includes: 1. The drug may cause confusion or dizziness. 2. Gloves should be worn when handling tablets. 3. Take the antiviral with milk to decrease gastrointestinal upset. 4. Famciclovir may cause tendon problems.

The drug may cause confusion or dizziness.

2. Infants and young children are at higher risk of developing antibiotic-resistant infections due to: 1. Developmental differences in pharmacokinetics of the antibiotics in children 2. The fact that children this age are more likely to be in daycare and exposed to pathogens from other children 3. Parents of young children insisting on preventive antibiotics so they don't miss work when their child is sick 4. Immunosuppression from the multiple vaccines they receive in the first two years of life

The fact that children this age are more likely to be in daycare and exposed to pathogens from other children

3. Predictors for successful treatment with ART in HIV-positive patients include: 1. They respond to a low-potency treatment regimen. 2. They have demonstrated resistance in the past and should respond to newer ART drugs. 3. The patient is strictly adherent to the ART treatment regimen. 4. Lower baseline CD4 T-cell count

The patient is strictly adherent to the ART treatment regimen.

4. The MMR vaccine is not recommended for pregnant women because: 1. Pregnant women do not build adequate immunity to the vaccine. 2. There is a risk of pregnant women developing measles encephalopathy. 3. There is a risk of the fetus developing congenital rubella syndrome. 4. Pregnant women can receive the MMR vaccine.

There is a risk of the fetus developing congenital rubella syndrome.

23. A two-year-old child recently immigrated and has presented for immunization review. Their immunization record indicates they have received three doses of bivalent oral polio (bOPV). What polio vaccine(s) does the child need? 1. None, they are fully vaccinated for polio as recommended 2. Three doses of inactivated poliovirus (IPV) 3. One dose of IPV after four years of age 4. One dose of trivalent oral polio virus (tOPV)

Three doses of inactivated poliovirus (IPV)

14. Patients who are being treated with epoetin alfa need to be monitored for the development of: 1. Thrombocytopenia 2. Neutropenia 3. Hypertension 4. Gout

Thrombocytopenia

7. A patient has been prescribed aspirin 320 mg per day for their atrial fibrillation. They also take aspirin four or more times a day for arthritis pain. What are the symptoms of aspirin toxicity for which they would need to be evaluated? 1. Tinnitus 2. Diarrhea 3. Hearing loss 4. Photosensitivity

Tinnitus

9. A pregnant patient is diagnosed with HCV. Recommendations for treatment include: 1. Initiating sofosbuvir-velpatasvir (Epclusa) as soon as possible. 2. Treatment with famciclovir until delivery to prevent transmission to fetus. 3. Administer immunoglobulin (IG) immediately after delivery to prevent transmission to the newborn. 4. Treatment of pregnant women with HCV is delayed until after delivery.

Treatment of pregnant women with HCV is delayed until after delivery.

20. Every antibiotic drug class has resistant organisms that influence prescribing decisions. 1. True 2. False

True

18. An adult female has been prescribed doxycycline for a chlamydia infection. She is healthy and her only medication is an oral combined contraceptive. Education would include: 1. Use a back-up method of birth control (condom) until her next menses. 2. Doxycycline may cause tendonitis and she should report any joint pain. 3. Her partner will need treatment if her infection doesn't clear with the doxycycline. 4. Doxycycline is used for one-dose treatment of sexually transmitted infections (STIs); take the whole prescription at once.

Use a back-up method of birth control (condom) until her next menses.

1. Pernicious anemia is treated with: 1. Folic acid supplements 2. Thiamine supplements 3. Vitamin B12 4. Iron

Vitamin B12

19. Patients with pernicious anemia require treatment with: 1. Iron 2. Folic acid 3. Epogen alfa 4. Vitamin B12

Vitamin B12

12. The dosage of Vitamin B12 to initially treat pernicious anemia is: 1. Nasal cyanocobalamin 1 g spray in each nostril daily for one week then weekly for one month 2. Vitamin B12 IM monthly 3. Vitamin B12 1,000 mcg IM daily for one week then 1,000 mg IM weekly for a month 4. Oral cobalamin 1,000 mcg daily

Vitamin B12 1,000 mcg IM daily for one week then 1,000 mg IM weekly for a month