Missed Assessment Questions

A patient is beginning Topamax therapy for new onset seizures. He brought in a prescription for Topamax 200 mg BID #60. Which of the following statements is correct?

Topiramate (Topamax) is started at 25 mg BID. It is titrated weekly. The maximum dose is 200 mg BID.

CM was recently d/c'ed from the hospital for liver failure. His PCP is aware that he has a long history of migraine HAs that occur once per week, but he does not want to exacerbate CM's current liver condition. What agent is the most reasonable option for this pt?

Topiramate. Valproic acid is associated with liver toxicity. APAP might be safe as an occasional abortive treatment but the case describes weekly migraines so a prophylactic agent is warranted. Felbamate is not used for migraine prophylaxis. It is a drug reserved for refractory epilepsy due to the risk of hepatotoxicity

Which of the following medications are glucagon-like peptide-1 agonists?

Trulicity, Tanzeum, Victoza

Which of the following statements concerning pimecrolimus is correct?

Use is associated with lymphomas and skin malignancies. Warnings for Elidel and Protopic: These drugs are associated with cases of lymphoma and skin cancer; use only as second-line agents for short-term and intermittent treatment of atopic dermatitis (eczema) in patients unresponsive to, or intolerant of other treatments. Pimecrolimus is applied twice daily.

Which of the following side effects are associated with olmesartan?

Angioedema Sprue-like enteropathy

Select the correct starting dose for ropinirole immediate-release when used daily for Parkinson's disease:

0.25 mg three times daily Ropinirole (Requip) is started at 0.25 mg TID, and can be increased slowly at weekly intervals. Alternatively, there is a once-daily XL formulation that is taken in the morning. It is important to increase the dose slowly; the dopamine-agonists can make patients suddenly sleepy.

A patient is prescribed Afrezza. After how many days does the inhaler need to be replaced?

15 days

Which of the following are acceptable treatment options for patients experiencing hypoglycemia?

15-20 grams of carbohydrates are recommended for treating hypoglycemia which includes 8 oz of milk, 3-4 glucose tabs, non-diet soda (4 oz), 2 tablespoons of raisins and other items. Be sure to retest in 15 minutes and have the patient eat a small amount of food to prevent recurrence.

A patient uses insulin glargine twice daily. She injects 40 units in the morning and 60 units in the evening. What size syringe should be provided to the patient?

1mL Syringes come in 0.3, 0.5 and 1 mL sizes. Most patients will receive the 1 mL syringes (100 per box). If a patient injects under 30 or 50 units, a smaller syringe should be used and will provide a more accurate dose. However, if they inject more at a different time, the patient would not get two different size syringes.

A 70kg pt is beginning carvedilol therapy fof HF. The starting dose is 3.125mg BID. What should the target dose be in this pt?

25mg BID

A prescriber wishes to use hydromorphone in his 55 year-old male patient, who is beginning opioid therapy. The patient had been misdiagnosed with rheumatoid arthritis, but was found to have pain due to cancer with metastases to the bone. Select a reasonable oral hydromorphone starting dose for an opioid-naive patient with a pain level of 6-7 during most of the early part of the day, and 9-10 during the later part of the day and during sleep. He is currently taking no other medications. Choose the correct initial dose:

2mg PO q4-6hrs

TP has been prescribed Nitromist. What is the dose of nitroglycerin provided with each spray?

400mcg Each spray of Nitrolmist provides 400 micrograms, which is 0.4 milligrams. Nitrostat (nitroglycerin SL tablets) come in 0.3, 0.4 and 0.6 milligrams. GoNitro (nitroglycerin SL powder) comes in 0.4 mg.

How many days is the Levemir Flexpen stable at room temperature?

42 days

TM comes into the pharmacy with a prescription for Sustiva. What is the correct dose of this medication?

600mg qHS Sustiva (efavirenz) is dosed at bedtime on an empty stomach to minimize CNS effects during waking hours

Which of the following statements are true regarding amylin?

Amylin slows gastric emptying, suppresses glucagon secretion, and increases satiety. Amylin is secreted from pancreatic beta cells. Amylin helps to control PPG

Which of the following statements are true regarding the use of ACE inhibitors in patients with UA/NSTEMI?

ACE inhibitors are recommended within the first 24 hours of an MI. ARBs are reasonable to use if a patient is intolerant to an ACE inhibitor.

ZW has just been diagnosed with hypertension. His past medical history is significant for BPH and bilateral renal artery stenosis. Which of the following medications should not be used for treatment of his hypertension?

ACE inhibitors, ARBs, and the direct renin inhibitor (aliskiren) should not be used in patients with bilateral renal artery stenosis.

The use of probenecid can block renal clearance of some of the drugs that are cleared by the kidneys. Which of the following agents may have decreased clearance if taken in a patient using probenecid?

ASA, Ampicillin, Methotrexate, Amoxicillin Probenecid can block renal clearance of penicillins, methotrexate, theophylline and aspirin.

SK is a 55 year-old female with a mechanical aortic heart valve, atrial fibrillation, and osteoporosis. What is the recommended therapeutic INR range of warfarin for this patient?

According to the 2012 CHEST guidelines, patients with a mechanical aortic valve should have an INR between 2-3.

ML is now wanting to start medication therapy. Which of the following medications should be recommended at this time?

Adalimumab ML is pregnant and should not use any medications that can harm the fetus (e.g., contraindicated in pregnancy). Rituximab must be used in combination with methotrexate. She has an allergy to sulfa so sulfasalazine is inappropriate. Of the options presented, adalimumab would be the best option to use in this patient.

VK, a 63 year-old black male, is a newly diagnosed with type 2 diabetes. He is also found to have hypertension, hypercholesterolemia, and peripheral arterial disease. Which of the following medications would be appropriate to start first-line for BP control according to JNC 8?

African American patients should be started on a thiazide-type diuretic or calcium channel blocker as long they do not have chronic kidney disease.

Which of the following parameters are assessed on the Global Risk Assessment tool?

Age, TC, HDL, Gender

What is the mechanism of action of alirocumab?

Alirocumab inhibits the process of LDL receptor degradation allowing LDL to bind to the receptor on hepatocytes, therefore, reducing blood levels of LDL.

Proton pump inhibitors are contraindicated with which of the following medications?

All PPIs are contraindicated with rilpivirine (Edurant), so PPIs are also contraindicated with the combination products containing it. NNRTIs as a class have many drug interactions.

Which of the following antihypertensives should not be taken with grapefruit or grapefruit juice?

All calcium channel blockers are substrates of CYP 3A4. Counsel patients to avoid grapefruit (the juice and the fruit), or try an alternative drug that does not interact. Separating the time a person drinks or eats grapefruit from the drug will not work.

MM is hospitalized and will require a lengthy course of therapy with gentamicin and vancomycin for endocarditis. MM also requires high doses of loop diuretics for heart failure and the prescriber is concerned about additive ototoxicity. Which of the loop diuretics has the highest risk for ototoxicity?

All of the loop diuretics can cause ototoxicity (especially with IV dosing) but ethacrynic acid has the highest risk among the loops. Additional risk is present if the patient is using other ototoxic drugs, such as vancomycin or aminoglycosides.

Generic of Exforge

Amlodipine + valsartan

A pharmacist will counsel a patient on the possible side effects of oxcarbazepine. The most likely side effects from the use of oxcarbazepine are:

Anticonvulsants commonly cause these CNS side effects: somnolence (sleepiness), dizziness, ataxia, diplopia, confusion and fatigue. A few anticonvulsants cause loss of appetite, but not oxcarbazepine. If a rash occurred with carbamazepine, there is risk with oxcarbazapine.

JW arrives at the clinic pharmacy with a prescription for apixaban 5 mg BID. He is 52 years old, 6'1" and weighs 214 lbs. His recent laboratory parameters include a Na 139 mEq/L and SCr of 1.1 mg/dL. At the clinic today, he was diagnosed with a DVT. Which of the following statements is correct regarding apixaban for this patient?

Apixaban dosing differs for each indication. It can be taken without regards to food. Discontinuation of therapy without adequate anticoagulation with an alternative agent increases the risk of stroke.

BK, a 22 year old female, is admitted for an acute PE. Her past medical history is significant for antithrombin deficiency. Her allergies include cat hair and PCN (shortness of breath for both). Which of the following agents would be best to recommend for treatment of her PE?

Argatroban; This patient is antithrombin deficient; therefore, heparin, LMWHs and fondaparinux will not work.

A patient has treatment-resistant depression. He has failed reasonable doses, with reasonable trial periods of doxepin, escitalopram, fluoxetine and venlafaxine. Which of the following statements apply to treatment-resistant depression?

Aripiprazole causes insomnia and anxiety, but does not contribute to weight gain. Symbyax is a combination of fluoxetine and olanzapine.

LE is taking warfarin 2.5 mg daily and Lovenox treatment doses. On Day 4, LE fell on her way to the grocery store. She is now in the ED with a left leg hematoma and a few lacerations but otherwise hemodynamically stable. The ED resident calls the pharmacist-managed anticoagulation services for advice on LE's anticoagulation management for her DVT treatment. Her INR today is 1.8. What should the anticoagulation pharmacist recommend regarding LE's therapy?

As long as the patient is hemodynamically stable with no sign or symptoms of uncontrollable bleeding, the patient should continue to receive LMWH and warfarin therapy as directed for recent DVT treatment. It would be appropriate to educate on local measures to stop bleeding from the leg hematoma or lacerations. Since the INR is not yet therapeutic, the Lovenox must be continued.

The pharmacist has a patient who was a chemistry major in college. The patient's physician has told him to begin daily therapy with 81 mg enteric-coated aspirin. The patient is asking the pharmacist detailed questions regarding this medication. Choose the correct statement.

Aspirin forms an irreversible (covalent) bond to cyclooxygenase I and II. Aspirin is a topical irritant (acid); the enteric coating reduces nausea. Depletion of gut-protective prostaglandins increases bleeding risk. This is a systemic problem that can occur with any aspirin formulation. Aspirin is a non-selective NSAID.

Lithium must be kept within a "narrow therapeutic range". What signs and symptoms may be present if the lithium concentration is elevated?

Ataxia ("drunk-like" uncoordinated walk), coarse hand tremor, diarrhea Ataxia (lack of coordination and unsteadiness) occurs when many drugs are toxic, including alcohol, many anticonvulsants, many CNS depressants, and lithium. Occasionally, a person suspected of being "drunk" on alcohol is actually toxic on a prescription drug. Increased serum creatinine indicates renal impairment, which can cause toxic lithium levels. Polyuria is a common side effect and cogwheel rigidity occurs with chronic use; these are not symptoms of toxicity.

A patient gave the pharmacist a prescription for Strattera. Choose the correct statements concerning Strattera:

Atomoxetine 2-week wash out period from Nardil Common SE: HA, somnolence, xerostomia, decreased appetite Selective NE reuptake inhibitor

Which statin can be taken in the morning without significantly affecting the LDL-lowering effectiveness?

Atorvastatin (and others) has a long half-life and does not need to be given in the evening to maximize inhibition of cholesterol synthesis which peaks in the early morning hours.

What other names is niacin known by?

B3, Nicotinic acid

Which of the following agents is not used for opioid-induced constipation (OIC)?

Belbuca The periperally-acting mu-opioid receptor antagonists (PAMORAs) are used for OIC, as is naloxone (off-label) and lubiprostone.

MR has been using alprazolam on a daily, scheduled basis for the past ten years. She is now 44 years old and pregnant with her first child. The use of benzodiazepines in pregnancy puts the child at risk for the following birth defect:

Benzodiazepines and barbiturates increase the risk of cleft lip and palate. Barbiturates can also cause cardiac abnormalities and neural tube defects. Benzodiazepine use shortly before birth can cause floppy infant syndrome.

EM enters the pharmacy with a prescription for alprazolam. What is the controlled category for alprazolam?

Benzodiazepines, barbiturates and the non-benzodiazepine hypnotics (sleeping pills) such as zolpidem are C-IV.

Which of the following steroids has the greatest anti-inflammatory potency?

Betamethasone

Which of the following best describes why it is important that potassium levels be maintained in the range of 4-5 mEq/L when a patient is taking digoxin?

Both digoxin and potassium compete for binding at the Na/K/ATPase pump. When serum potassium levels are low (hypokalemia), there is less competition at the site and the action (toxicity) of digoxin is potentiated. Patients with a digoxin levels within the reference range may exhibit toxic signs/symptoms in the setting of hypokalemia.

What are common migraine triggers?

Bright or flickering lights, too little sleep, stress

Possible side effects of Lovaza include:

Burping, dyspepsia, taste perversions

JS suffers from constipation. She spends a good deal of money buying over-the-counter MiraLax and occasionally needs to use a glycerin suppository. She asks the pharmacist for help. The pharmacist looks at her medications and finds that she takes ramipril, lovastatin, cholestyramine, clonidine, verapamil and sertraline. Which medication/s could be contributing to JS's chronic constipation?

Clonidine, Cholestyramine, Verapamil

QL's labs confirm a diagnosis of HIV. Over the next year, she requires several changes to her ART regimen. On this visit to her PCP, she complains that she is extremely depressed and having trouble sleeping. It is impacting her ability to care for her daughter. She states, "having HIV isn't worth living". She is currently taking Complera, Bactrim, and azithromycin. What is the most likely rationale for QL's complaints?

CNS side effects from rilpivirine include depression, mood changes, insomnia, and suicidal ideation.

Do not use the narcolepsy stimulants modafinil and armodafinil or other stimulants in patients with this pre-existing condition:

CV disease

AG is beginning warfarin therapy. She asks the pharmacist which foods are high in vitamin K. Which of the following foods are high in vitamin K?

Cauliflower, canola and soybean oils, broccoli and brussels sprouts, green and black tea

Which of the following describes the mechanism of action of Zanaflex?

Central alpha-agonist

A pharmacist will counsel a patient beginning therapy on Emsam. Which of the following statements are correct regarding Emsam?

Change daily. Medication patches are always rotated so the application site does not become irritated, with the exception of some of the topical pain patches, such as the lidocaine and diclofenac patches. The Emsam patch is applied to the upper chest, or on the back (below the neck and above the waistline).

KD presents to his primary care physician and is diagnosed with severe iron-deficiency anemia. In addition to the classic symptoms of anemia, which of the following findings would be present in a severe case?

Chest pain, fainting, glossitis, koilonychias Visual disturbances are associated with vitamin B12 deficiency.

Which of the following is a common cause of macrocytic, or megaloblastic, anemia?

Chronic alcoholism Macrocytic anemia is due to a vitamin B12 or folate deficiency, or both. Chronic alcoholism is a common cause.

Which of the following chemotherapeutic agents is associated with a > 90% frequency of emesis?

Cisplatin

Which Vaughan Williams classification represents agents that bind to sodium channels for a prolonged period of time (long-acting)?

Class I antiarrhythmics are subclassified by the duration to which they bind and block cardiac sodium channels. Ia = intermediate. Ib = short. Ic = long.

Which of the following hormone formulations used for vasomotor symptoms should be recommended as monotherapy in a female who has a uterus?

ClimaraPro Unopposed estrogen therapy in women with a uterus is dangerous and is a boxed warning. "Pro" indicates a progestin is included; this is not always the case, but is with this drug name.

AC receives counseling on all of her home medications at discharge. The pharmacist tells her "this medication can cause dry mouth, constipation and fatigue". Which medication is the pharmacist referring to?

Clonidine Clonidine is not used first-line and has many side effects that make it a difficult drug for patients to tolerate, including constipation, dry mouth, fatigue, lethargy, aggravation of depression and sexual dysfunction/impotence.

SJ has failed several trials of antipsychotics. He continues to respond to "voices" that constantly torment him. He has tried to commit suicide several times. His other medical conditions include poorly controlled seizures since childhood, phenytoin-induced gingival hyperplasia and thickening of facial features, depression, anxiety, elevated cholesterol and pre-diabetes. Fortunately, since a second-anticonvulsant was added to the phenytoin, he has not had a seizure in the past six months. His WBC is 5,500 cells/mm^3 and ANC is 1890/mm^3. Choose the correct statements:

Clozapine (Clozaril) has ~5% risk of seizures. Caution should be used in giving this drug to patients having a history of seizures or other predisposing factors. It is likely that this patient will not be able to tolerate the drug due to seizures. However, due to the history, a trial is reasonable.

AK is prescribed Copaxone for his condition. Which of the following statements is true?

Copaxone is used for multiple sclerosis and can cause injection site reactions, flushing, sweating, pain, chest pain, dyspnea and rash.

The pharmacist has received a new prescription for oral Cordarone for JC. Before the prescription for Cordarone is filled, the pharmacist should call the prescriber to recommend the following medication change/s:

Cordarone is an inhibitor of CYP 2C9, 2D6, 3A4 and p-glycoprotein. When starting Cordarone, the Digox dose must be decreased by 30-50%. Mevacor should not exceed a maximum daily dose of 40 mg in patients on Cordarone.

This test is the only way to examine the extent of atherosclerosis and coronary artery disease:

Coronary angiography

A physician wants to prescribe exenatide to his patient. He calls the pharmacy to ask if there are any precautions to the use of this medication. The pharmacist should relay that the drug may not be safe to use in the following situations:

CrCl <30 H/o pancreatitis Exenatide's warnings include the risk of pancreatitis, use is not recommended in severe renal impairment (CrCl < 30 mL/min) and use is not recommended in severe GI disease (such as gastroparesis).

Which of the following drugs could adversely affect the lipid profile?

Cyclosporine, Amiodarone, Prednisone, BB

Which of the following are causes of elevated anion gap metabolic acidosis?

DKA, Salicylate toxicity, lactic acidosis

DS is a 52 year-old HIV positive male with a CD4 count of 142 cells/mm^3 who has a history of hyperlipidemia treated with simvastatin and poorly controlled schizophrenia treated with ziprasidone. The HIV specialist has decided to initiate antiretroviral therapy with a protease inhibitor-based regimen. Which of the following statements are true regarding initiating antiretroviral therapy and other supportive care in DS?

Darunavir/ritonavir + tenofovir disoproxil fumarate/emtricitabine is a Recommended regimen and is protease inhibitor-based. Darunavir has less effect on lipids than other PIs. Simvastatin is contraindicated with protease inhibitors, so an alternate statin would need to be selected. Efavirenz should be avoided in active psychiatric disease. Reinforcement of diet/exercise should be considered at each visit for patients with active hyperlipidemia.

Many of the antidepressants increase serotonin and avoidance of excessive serotonin is required. Methylene blue, which is used in diagnostic procedures and to treat a few medical conditions has monoamine oxidase properties. Linezolid is a weak monoamine oxidase inhibitor. The use of either will generally require temporary discontinuation of the antidepressant medication. In addition, other drugs increase serotonin and can cause risk with concurrent antidepressant use. Which of the following drugs will contribute to additive serotonergic risk?

Demerol Lithobid Ultram St. John's Wort

A 73 year-old woman has a T-score of -4.3 in her right hip, -4.7 in her left hip and has had several vertebral fractures in her lumbar spine. Her only known medical conditions are osteoporosis and hypertension. She has never had any surgeries. This woman may be a candidate for the following therapy:

Denosumab (Prolia) and teriparatide (Forteo) may both be useful in this very high-risk patient.

Which of the following statements is correct regarding digoxin?

Digoxin is a positive inotrope, which means it increases the force of the heart's contractions, and is a negative chronotrope, which means it decreases heart rate.

A patient has been prescribed Lyrica. The pharmacist should counsel her on the possibility of these side effects:

Dizziness, somnolence, peripheral edema, mild euphoria. Pregabalin can cause mild euphoria; this may be helpful for the anxiety that can come with pain. Weight gain, not weight loss, is possible.

The pharmacist will counsel a patient on the correct self-administration technique for enoxaparin. Which of the following are correct counseling statements?

Do not expel the air bubble in the syringe as it can cause the patient to get a subtherapeutic dose because some of the medicine will be lost (as long as the exact dose needed is the amount in the syringe). With some medications it is recommended to rub the site after injection, but not with drugs that can cause bleeding, such as this one.

Cardiac stress testing can be done pharmacologically. Pharmacologic stress testing can utilize all of the following medications:

Dobutamine Dipyridamole Lexiscan Adenoscan

Dofetilide must be started (or restarted) in the inpatient setting in order to facilitate required monitoring of which of the following?

Dofetilide must be initiated in a hospitalized setting. The initial dose is chosen and adjusted based on the patient's renal function and QTc.

Which of the following statements is true regarding dolasetron?

Dolasetron (Anzemet) is not indicated for intravenous use for CINV due to increased risk of QT prolongation.

Which of the following options are appropriate to gain further control of KB's blood pressure?

Doses of current medications can be titrated to maximum tolerated doses or additional agents can be added. The max dose of Norvasc is 10 mg. When adding drugs, it is recommended to choose from one of the four preferred drug classes as long as an ACE inhibitor or ARB is not used together.

Which of the following chemotherapeutic medications is associated with the highest incidence of hand-foot syndrome?

Doxil and Lipodox50 are liposomal formulations of doxorubicin. These are associated with more hand-foot syndrome than the non-liposomal formulations.

Which of the following are side effects/possible adverse reactions of bupropion?

Dry mouth Insomnia Tremors/risk of seizures

A patient asks the pharmacist if Duac topical gel is a useful product for acne. Choose the correct statement concerning Duac:

Duac can be stored at room temperature for up to two months. Duac contains clindamycin and benzoyl peroxide. It can bleach clothing because it contains benzoyl peroxide. Prior to dispensing, store in the refrigerator and do not freeze. It can be stored at room temperature, for up to 60 days.

Sulfasalazine can reduce absorption of which of the following?

Folic acid Sulfasalazine can reduce the absorption of folate. Patients can take 1 mg/day of folic acid to supplement.

Which of the following statements concerning efavirenz are correct?

Efavirenz is no longer recommended in the preferred regimens for pregnant or non-pregnant patients, due to psychiatric side effects. The package insert states to avoid in the 1st trimester of pregnancy; however, if a women who is on efavirenz becomes pregnant, the guidelines recommend to continue therapy if their disease is well-controlled. The combination product contains emtricitabine + efavirenz + tenofovir and is dosed once daily. The most common side effects are CNS side effects which usually improve or resolve within a few weeks. Taking the medicine on an empty stomach at night can help lessen CNS side effects.

Which of the following medications could decrease the risk of death in UV if added to her regimen?

Empaglifozin and liraglutide should be considered in patients with long-standing diabetes (that is not well controlled) and established atherosclerotic cardiovascular disease.

HG is a 17-year-old female who is interested in tobacco cessation. She asks about starting on nicotine gum. What advice should the pharmacist offer?

Encourage her to start behavioral counseling first. FDA prohibits sale of nicotine products to individuals younger than 18 years of age (REMS).

MT was recently admitted for an acute myocardial infarction and is found to have depressed left ventricular function. The patient is currently on aspirin, benazepril, diltiazem, pravastatin, voriconazole and ranitidine. The patient is to be started on eplerenone. Which of the following drugs is contraindicated with eplerenone?

Eplerenone is contraindicated in patients receiving strong CYP3A4 inhibitors, such as voriconazole. Eplerenone dosing should not exceed 25 mg daily in patients receiving moderate 3A4 inhibitors, such as diltiazem.

Beth Huang uses Lunesta 1 mg for sleep. She tells the pharmacist that the medicine puts her to sleep, but she has difficulty staying asleep. The pharmacist should instruct the patient as follows:

Eszopiclone has unusual dosing: 1 mg if difficulty falling asleep, 2 mg if difficulty staying asleep or 3 mg if helpful for a longer duration of sleep.

ML comes to the emergency department with a severe skin rash and epidermal detachment. He is diagnosed with toxic epidermal necrolysis (TEN). He states he was recently started on some HIV medications. Which of the following medications is most likely the cause of his TEN reaction?

Etravirine can cause severe, life-threatening skin reactions.

Which of the following is the generic name of Repatha?

Evolocumab

Which of the following agents used for dementia should be taken with food regardless of whether GI side effects are present?

Exelon

Which of the following H2RAs are available in an IV formulation?

Famotidine, ranitidine

What effects can gemfibrozil have on lipids?

Fibrates, such as gemfibrozil, generally decrease TG by 20-50%, increase HDL by 15%, and decrease LDL by 5-20%. However, if TG levels are high, LDL can actually be increased.

FD is diagnosed by EMS with a STEMI. The closest hospital does not have the capability to perform percutaneous coronary intervention (PCI) and fibrinolysis may be done as an alternative. What is the mechanism of action of alteplase?

Fibrinolytics work by binding to fibrin and converting entrapped plasminogen to plasmin. Plasmin then degrades the fibrin mesh into soluble end products leading to clot dissolution.

Sarafem

Fluoxetine

Which statin is the least potent?

Fluvastatin

Select the correct dosing recommendation for dabigatran for a patient with a DVT and a creatinine clearance of 54 mL/min:

For patients with atrial fibrillation and CrCl 15-30 mL/min, the recommended dose is 75 mg twice daily. Dabigatran is dosed BID. It is important that patients remember to take both doses because the medication effect does not last long. Dabigatran is taken without regard to meals.

A patient's triglycerides were recorded at 282 mg/dL. In which of the following conditions are the fenofibrate agents contraindicated?

Gallbladder disease Severe liver impairment In addition to the above conditions, these drugs cannot be used in nursing mothers or in severe kidney disease.

Which of the following are side effects seen with dapagliflozin that should be discussed with the patient?

Genital mycotic infections, UTIs, DKA

Which of the following statements related to the use of glucagon are correct?

Glucagon is a hormone secreted by the pancreas, which triggers the liver to release glucose stores into the blood. Carbohydrates should be provided to the patient once alert and responsive after glucagon therapy. Glucagon is a drug of choice in unconscious hypoglycemic patients. Glucagon can be given SC, IM or IV and can be re-administered if needed.

RW has started to use the oral contraceptive Ortho Tri-Cyclen. Which medical conditions should the pharmacist screen for to make sure the use of this medication is safe for RW?

HTN Estrogen products can have a positive effect on bone mass, acne and heavy menses.

A patient with systolic heart failure has been given a prescription for BiDil. Which of the following side effects is most common with BiDil therapy?

Headache is a common side effect of any nitrate therapy, including BiDil. Some patients find benefit by pre-treating with acetaminophen.

Which of the following are side effects associated with cyclophosphamide therapy when treating patients with systemic lupus erythematosus?

Hemorrhagic cystitis, bone marrow suppression, infertility, infections

Visual disturbances are associated with vitamin B12 deficiency.

Her dose can be increased to 10,000 units three times weekly. In a hemodialysis patient, erythropoiesis-stimulating agents are started when the Hgb drops below 10 g/dL and treatment should be interrupted when it is at or approaching 11 g/dL. The dose can be increased by 25% no more frequently than Q4 weeks if the Hgb does not rise by 1 g/dL (as shown by the hemoglobin on 1/2 and 2/5).

Which of the following should be included when providing patient counseling for hydroxyurea?

Hydroxyurea has a boxed warning for myelosuppression which increases the risk for infection and bleeding. It has a boxed warning for malignancy, including skin cancer. Folic acid is needed to prevent macrocytosis. Patients taking hydroxyurea should avoid live vaccines and need to have CBC with differential checked every 4 weeks initially to montitor the ANC.

Which condition is most likely to contribute to a depressed state in BL?

Hypothyroidism

Which of the following are well-established side effects of amiodarone therapy?

Hypothyroidism, corneal microdeposits and photosensitivity are well-established side effects of amiodarone. Other common side effects include nausea, dizziness, hypotension and bradycardia.

A new hydrocodone formulation that is dosed once daily and contains only hydrocodone is called:

Hysingla ERHysingla is a newer hydrocodone formulation dosed once daily. Opioid-naive patients should start at 20 mg Q 24H

CJ is a 44 year-old female with hyperlipidemia and hypertension. She is referred to a pharmacist-managed anticoagulation clinic with a newly diagnosed, first unprovoked episode of lower left leg DVT. She is a teacher and drinks 1 glass of wine per day. Lab/vitals: Weight: 325 lbs, Height: 6'1", Scr 0.6 mg/dL (1 month ago), Baseline INR 1.1. What INR goal and duration of warfarin therapy should be recommended to treat CJ's DVT?

INR goal of 2-3 for at least 3 months. The 2012 CHEST guidelines recommend to treat the first unprovoked VTE for at least 3 months.

Which medications are used only IV for treating arrhythmias?

Ibutilide (Corvert) is only available in an IV formulation. Lidocaine is available in numerous formulations, but must be used IV for treating arrhythmias. It is most commonly used topically (e.g., lidocaine patch or LMX cream) or locally for numbing (e.g., viscous lidocaine).

A pharmacist will counsel a male patient beginning therapy with trazodone to help treat the patient's depressed mood. Which of the following statements concerning trazodone are correct?

If an erection lasts four hours or longer, and is painful, emergency medical attention is required. The penis will be drained and a vasoconstrictor administered. Although priapism can occur, the common side effect is sedation. A newer formulation of trazodone called Oleptro is taken at night and may have less daytime sleepiness. The use of trazodone can put a frail patient at risk for falls and injury.

Ms. Young comes back to the clinic on 2/19 for a follow-up. She was prescribed rivastigmine 3 mg PO BID, however, she cannot tolerate the nausea associated with taking the medication, even with a large meal. Her physician would like to switch her to an Exelon patch. What dosage should the pharmacist recommend when converting the patient to the patch formulation?

If oral daily dose is < 6 mg, switch to 4.6 mg/24 hrs patch. If oral daily dose is 6 - 12 mg, switch to 9.5 mg/24 hrs patch. The dose can be increased to 13.3 mg/24 hrs if 9.5 mg is tolerated x 4 weeks.

A pharmacist will counsel a patient on the proper use of the Abilify Discmelt. Choose the correct counseling points:

Immediately upon opening the foil blister, remove tablet and place in mouth; do not push the tablet through the foil because it may crumble. Do not open with wet fingers. The patient does not need water to take this medicine; use water only if desirable. Abilify Discmelt, Risperdal M-Tab, and Zyprexa Zydis are orally disintegrating tablets. If the hands are not dry the medicine will begin to dissolve when being held.

RJ is a 76 year-old male with a mechanical mitral heart valve, hypertension, type 2 diabetes, and hyperlipidemia. He underwent major, high-bleeding risk surgery and is now receiving post-operative care. The physician wants to restart his enoxaparin therapy due to his mechanical mitral heart valve. According to the CHEST guidelines, when is it safe to restart RJ on his enoxaparin treatment regimen after his surgical procedure?

In patients who are receiving bridging anticoagulation with therapeutic dose LMWH therapy and undergoing high-bleeding risk surgery, it is recommended to resume the LMWH therapy 48 to 72 hours after surgery.

A 55 year old man (weighing 222 lbs) comes in to the emergency department with crushing chest pain. His creatinine clearance is estimated at 45 mL/min. The physician makes the diagnosis of ST-segment elevation myocardial infarction (STEMI) and wants to initiate enoxaparin right away. What is the correct dose of enoxaparin in this patient?

In patients with STEMI who are less than 75 years old, give enoxaparin 30 mg IV bolus plus a 1 mg/kg SC dose followed by 1 mg/kg SC dose Q12H (max 100 mg for the first two doses) in patients with CrCl > 30 mL/min.

A patient is going to start niacin therapy. Which of the following are side effects of niacin?

Increase BS, uric acid and flushing

A patient has a history of bipolar disorder with chronic episodes of major depression. In the past she was prescribed oxaprozin, an older NSAID, and developed a GI bleed. She is having her first episode of gout and the prescriber is recommending indomethacin. Allergies include amoxicillin (rash), sulfamethoxazole and carbamazepine. Which statements represent correct advice that could be provided to the prescriber?

Indomethacin has a high risk for GI toxicity, including ulceration and bleeding. Indomethacin has a high risk for psychiatric side effects.

Which of the following could worsen hyperglycemia in PQ?

Infection, Levofloxacin Infections cause stress on the body and can lead to hyperglycemia. Drugs known to raise blood glucose include flouroquinolones. Non-selective beta-blockers can cause hyperglycemia. Metoprolol is a beta-1 selective blocker.

Which of the following should be recommended for UR at this time?

Influenza vaccine (inactivated, shot) Pneumococcal polysaccharide vaccine Hep B The patient is not a candidate for the live influenza vaccine. This is not used in patients with chronic disease. He should receive the influenza shot (inactivated), the pneumococcal polysaccharide vaccine (Pneumovax 23), and the hepatitis B vaccine.

Generic for Soliqua 100/33

Insulin glargine + lixisenatide

Which of the following are correct regarding insulin?

Insulin stimulates glucose uptake from the blood. Insulin is a hormone. Insulin stimulates formation of glycogen. Insulin promotes storage of glucose in the liver and muscle cells in order to form glycogen. Once insulin levels fall, the glycogen stores are converted to glucose and secreted into the blood. Insulin inhibits glucagon secretion.

Dihydroergotamine can be administered by the following routes:

Intramuscular, SC, nasal. Injection can be repeated hourly for a max of 2mg (IV) or 3mg (IM/SC)/day and the nasal spray can be repeated 15 minutes for a total of 4 sprays.

Choose the correct statement concerning iron supplementation:

Iron absorption is increased in an acidic environment; drinking orange juice or taking vitamin C will increase absorption minimally. Iron supplementation is recommended in all patients with anemia, not only severe cases. Oral iron therapy is preferred; the most common use of IV iron is ESRD patients on hemodialysis. Since iron absorption is decreased as gastric pH increases, proton pump inhibitors and H2-receptor antagonists should be avoided.

RT comes into the pharmacy with a prescription for Isentress tablets. What is the correct dose for this medication?

Isentress is dosed at 400 mg PO BID.

Which of the following drugs is used for tuberculosis and can cause possible vision loss due to optic neuritis?

Isoniazid

EK has systolic heart failure and is taking quinapril, carvedilol, torsemide, spironolactone and BiDil. She presents to the clinic with a mild fever and sore finger and arm joints and muscle aches. She reports she is more tired than usual and feels miserable. The patient is likely experiencing this drug adverse effect:

Isosorbide dinitrate/hydralazine (BiDil) can cause lupus-like syndrome. Instruct patients to report fever, joint/muscle aches and fatigue.

Which of the following drugs has this warning: "May impair your vision, especially at night. Be careful if you drive or do anything that requires you to see clearly"?

Isotretinoin

Which of the following statements regarding insulin glargine therapy is correct?

It comes in 300 units/mL (Toujeo SoloStar) Long-acting, basal insulin Should not be mixed with other insulins Available as a Solostar Pen

What statements are true about lomitapide?

It is contraindicated in pregnancy. It is indicated for homozygous familial hypercholesterolemia. It has a boxed warning for hepatotoxicity. Lomitapide is indicated for homozygous familial hypercholesterolemia, carries a warning for embryofetal toxicity and a boxed warning for hepatotoxicity. Enrollment in the REMS program is required for use. There is no boxed warning for renal toxicity.

HJ uses the following medications daily: Isosorbide mononitrate IR BID for stable ischemic heart disease Enalapril daily for hypertension Simvastatin QHS for dyslipidemia Finasteride daily for benign prostatic hypertrophy. Question: Based on the medication profile, the pharmacist should make the following suggestion to the perscriber:

It is not recommended to use nitrates alone for stable ischemic heart disease unless HJ has a contraindication to first-line drugs.

LR has chronic kidney disease and has been prescribed Epogen. How does Epogen work?

It stimulates red blood cell production in the bone marrow.

Which of the following are likely signs/symptoms of a heart attack?

Many myocardial infarctions involve chest discomfort that lasts more than a few minutes, or that goes away and comes back. The pain can be in one or both arms, the back, neck, jaw or stomach. Shortness of breath (dyspnea) and sweating (diaphoresis) may also occur.

KN's estimated 10-year ASCVD risk is calculated at 6.9%. According to the ACC/AHA Treatment of Blood Cholesterol Guideline, what would be the most appropriate statin regimen to initiate on the 4/14 visit?

KN has diabetes, is between 40-75 years, has an LDL between 70-189 mg/dL, and an estimated 10-year ASCVD risk < 7.5%. Therefore he will require a moderate intensity statin. Although simvastatin 40 mg is considered moderate intensity, KN is also on amlodipine and should not exceed simvastatin 20 mg due to CYP3A4 interaction. Therefore, pravastatin 40 mg is the most appropriate statin. All other choices are not moderate intensity

EJ has been using oxycodone immediate release for pain management (as-needed) for the past several months. She cannot swallow most pills and crushes her medications. The physician wishes to provide better pain control and will use a long-acting medication. Which of the following medications represent possible options?

Kadian Long-acting opioid tablets cannot be crushed; this could be fatal. Kadian and Embeda (morphine + naltrexone) are long-acting morphine capsule formulations that can be opened, but the beads cannot be chewed (or crushed in any way). Roxanol is no longer branded, but refers to the immediate release morphine solution.

A 29 year-old male patient uses the local gym daily. He was not careful to use sandals in the shower and his feet are itchy, particularly between the toes. Choose appropriate OTC medications that will eradicate the infection and are recommended for this purpose:

Lamisil AT Lotrimin AF Lotrimin AF contains clotrimazole, and Lotrimin Ultra contains butenafine; if the name has Lotrimin, it is an antifungal for somewhere on the skin, and these come in creams and sprays.

Which of the following proton pump inhibitors come in capsules that can opened and mixed in applesauce if a patient cannot swallow pills?

Lansoprazole, omeprazole, esomeprazole, deslansoprazole (NOT PANTOPRAZOLE)

RW has started to use the oral contraceptive Sprintec 28. Which of the following medications would not interact with oral contraceptives?

Levofloxacin

Which of the following insulins are available in a concentration of 200 units/mL?

Lispro Insulin lispro and degludec are available as a 200 unit/mL pen.

Which of the following represent possible advantages of using continuous birth control formulation such as Jolessa or Amethyst?

Long period of time without menstrual cycle bleeding and "period-related" effects, such as moodiness. No withdrawal effects, such as physical and emotional symptoms, that can occur with other formulations during the hormone-free interval.

What are possible complications with long-term phenytoin therapy?

Long-term complications of phenytoin therapy can include gingival hyperplasia, osteoporosis, hirsutism and peripheral neuropathy.

Which of the following medications should be avoided with simvastatin?

Lopid, VFEND, Biaxin

JR, a 52 year old Mexican male, has hypertension and he is currently taking Lotrel. His BP today is 151/91 mmHg. Which of the following medication recommendations would be in accordance with JNC 8?

Lotrel contains a CCB + an ACE inhibitor. It would be appropriate to use Exforge HCT since this contains 3 drug classes initially recommended by JNC 8. Aliskiren is not recommended first-line and adding on an ARB to an ACE inhibitor is not recommended. Azor contains a CCB + ARB so this change would not provide better control of his BP.

Which of the following statins should be taken with the evening meal?

Lovastatin immediate-release (Mevacor) needs to be taken with the evening meal.

A patient's triglycerides were recorded at 510 mg/dL. Which of the following agents will help to lower triglycerides?

Lovaza - fish oil Trilipix - fenofibrate Niacin Vascepa - fish oil

Which of the following statements regarding Lovaza are true?

Lovaza can be tried as an alternative to fenofibrates for lowering TGs. Lovaza should be used in addition to a low-fat diet. If the patient uses OTC fish oils, he/she may need to double the amount of capsules to get similar TG lowering. The usual dose of Lovaza is 4 capsules daily, which can be divided BID. OTC fish oils, which are not regulated by the FDA, may not have uniform potency of the fish oils and more capsules may be need to get the same TG-lowering effect.

Which of the following represent additional items that may be added to a pt's TPN?

MVI, trace elements, insulin, and electrolytes

A patient is picking up a new prescription for acarbose. Choose the correct statements:

Many patients have difficulty with flatulence and diarrhea from this medication. Acarbose is dosed with the first bite of each main meal. Acarbose is weight neutral. GI side effects are the most common issue (abdominal pain, diarrhea, flatulence). Glucose tablets or gel are required to treat hypoglycemia with these agents.

PD is a 3 year-old male with sickle cell disease and functional asplenia. Which of the following vaccinations are recommended for this patient?

Meningococcal, pneumococcal conjugate, pneumococcal polysaccharide, Haemophilus influenzae, type B (HiB) The spleen, which plays a unique role in clearing infections with encapsulated bacteria, is damaged by repeated vaso-occlusive crises, placing SCD patients at higher risk of infections. In addition to the normal childhood vaccine series (which includes HiB and pneumococcal conjugate [Prevnar 13 or PCV13] vaccines), PD should receive the meningococcal and pneumococcal polysaccharide [Pneumovax 23 or PPSV23] vaccines.

A patient has the following ABG: pH = 7.6, paCO2 = 60, HCO3 = 32 What is the acid-base disorder present in this patient?

Metabolic alkalosis. An acid-base disorder that leads to a pH > 7.45 is called an alkalosis. In a metabolic alkalosis, the plasma HCO3 concentration is increased. If both pCO2 and HCO3 are abnormal (meaning some degree of compensation has occurred), the primary disorder is determined by identifying which one corresponds with the pH.

Synjardy

Metformin + empaglifozin

Generic for Glucovance?

Metformin/glyburide

A patient's chronic pain has been controlled on methadone. The patient has obsessive compulsive disorder (OCD) and has been given a prescription for fluvoxamine. What effect would be caused by this drug interaction?

Methadone is pro-arrhythmic at higher doses; missing this interaction could be a fatal mistake. Fluvoxamine is an enzyme inhibitor of most isoenzymes, including the most common drug-metabolizing enzyme, CYP 450 3A4.

Which of the following medications should be taken with food?

Metoprolol and carvedilol IR and ER

A patient uses ibandronate. This medication is usually administered in the following formulation:

Monthly tablet; Ibandronate (Boniva) also comes in an injection, but most patients use the monthly oral dose of 150 mg.

TS is started on Pradaxa. He has a CrCl of 25 mL/min. Which of the following medications pose a significant interaction with Pradaxa and should be avoided?

Multaq - Dronedarone

SC is a 78 year-old female patient with Sjogren's syndrome. She has considerable difficulty with dry eyes, and dry mouth. She asks the pharmacist for advice on helping her manage the dry mouth. Which of of the following statements concerning dry mouth are correct?

Muscarinic agents are helpful for this condition. A major complication of dry mouth is tooth decay. Xylitol may be useful in chewing gum for cavity prevention. For dry mouth always use sugar-free candy or gum. A major complication of dry mouth is tooth decay (dental caries, or cavities).

JC went to see a cardiologist and was diagnosed with systolic heart failure. He had an ECG and was told his left ventricle is enlarged. He has no symptoms during ordinary physical activity except if he is doing strenuous activity. Which of the following ACC/AHA stages and NYHA functional class for heart failure best describe this patient?

NYHA Class I is defined as having cardiac disease but without resulting limitations of physical activity. Ordinary physical activity does not cause undue fatigue, palpitation, dyspnea, or anginal pain.

Which of the following cholesterol-lowering drug classes require liver enzyme monitoring at baseline due to a risk of hepatotoxicity?

Niacins, fenofibrates, Statins Niacins, statin, and the fibrates could possibly cause liver damage and liver enzymes should be monitored. In recent years it has been recognized that statins do not cause liver damage worse than placebo in most patients, but the guidelines state to check at baseline and consider if the statin could be contributory if the liver is damaged and no other cause can be identified.

Which lipid lowering therapy is contraindicated in a patient with active peptic ulcer disease?

Niaspan

CS presents to the emergency room after a motor vehicle accident. He is found to have a blood pressure of 192/112 mmHg. He has no acute organ damage and is diagnosed as having hypertensive urgency. Which of the following medications would not be an appropriate option to treat this condition:

Nifedipine SL Sublingual nifedipine can cause an uncontrollable drop in blood pressure, which can result in myocardial infarction and other ischemic complications; it should not be used.

Which of the following contraceptive options is recommended to treat menstrual-associated migraine with aura in a female pt?

Nor-QD, Nore-Be, Camila. Migraine with aura has a higher risk of stroke and estrogen should be avoided.

Select the correct primary mechanism of action for Elavil:

Norepinephrine and serotonin (5-HT) reuptake inhibitor. Elavil is the brand name for amitriptyline. In addition to the mechanism listed, the tricyclics block acetylcholine and histamine receptors, which contributes to the side effect profile.

A patient comes into the emergency department with mental confusion and states he does not feel well as his right hand is covering his heart. His blood pressure is 154/89 and his pulse is 155 BPM. His ECG indicates a tachyarrhythmia. Past medical history is unknown. What should be done next to optimize care of this patient?

Obtain laboratory parameters such as electrolytes and obtain a toxicology screen. Before deciding on starting medication for any non life-threatening arrhythmia, electrolytes and a toxicology screen should be obtained to rule out these as potential causes of the arrhythmia.

Rosie McDonald is a 52 year-old female patient with schizophrenia, depression, elevated cholesterol, pre-diabetes and hypothyroidism. The physician is considering a trial with olanzapine. Choose the correct statements:

Olanzapine can increase her blood glucose, cholesterol and weight. Olanzapine is sedating and is generally taken at bedtime.

A patient has been treated at the community hospital for osteomyelitis in the lower left extremity. The other medications that the patient uses chronically include Levitra, Oleptro, Symbyax, Novolin N, glyburide, Fortamet and Cozaar. The hospital infectious disease team has discharged the patient with a prescription for Zyvox 600 mg PO BID, to continue as an outpatient for 4 weeks. Zyvox cannot be filled in this patient due to the concurrent use of the following medications:

Oleptro (Trazodone) Symbyax The SSRIs are contraindicated with linezolid, methylene blue, pimozide (and some other strong QT prolongers), and the use of MAO inhibitors. The SNRIs and related compounds, the tricyclics, trazodone (Oleptro) and bupropion are contraindicated with linezolid and methylene blue.

A patient has been using warfarin therapy for several years. He does not like the time it takes to report for lab monitoring. He asks if he can have his INR checked every six months. The ACCP guidelines recommend the following monitoring schedule for patients who are well-controlled on a stable dose of warfarin:

Once controlled on a stable dose of warfarin for a reasonable time period, the INR can be monitored at up to a 12 week interval.

Side effects of divalproex sodium may include:

Patients should be counseled regarding the possibility of GI upset, alopecia (which is hair loss - may be preventable with selenium and zinc supplementation), sedation, tremor and weight gain. This is one of the drugs with significant weight gain, which can contribute to nonadherence.

Which diagnosis increases a patient's risk of venous thromboembolism?

Patients with antithrombin deficiency, Factor V Leiden, antiphospholipid syndrome and Protein C or S deficiency are prone to clotting. Many of these patients present with unprovoked clots at a relatively early age and require life-long anticoagulation.

A patient with hypertension has been prescribed isradipine. Which of the following are possible side effects from the use of isradipine?

Peripheral edema, flushing, HA

Which NSAID has a high risk of both severe skin reactions, including SJS/TEN, and GI toxicity, and should only be used in patients who cannot obtain adequate pain relief with other agents?

Piroxicam

The pharmacist receives a prescription for "Timoptic 0.25%, Sig: i gtt od qam." Choose the correct wording for the prescription label.

Place 1 drop in the right eye daily in the morning

Which of the following cholesterol medications are available as injectables?

Praluent - Alivocumab Kynamro - Mipomercen

A patient with a severe, rheumatoid arthritis exacerbation is prescribed a short course of oral prednisone. Choose the correct statement:

Prednisone is a prodrug of prednisolone.

A female patient with end stage renal disease secondary to hypertension has been using Fosamax, erythropoietin, cholecalciferol, cyclosporine, Coreg, prednisone and hydrocodone. Since the patient began taking this regimen she developed hypertension. Which of the medications could be contributing to increased blood pressure levels?

Prednisone, cyclosporine and erythropoietin can all cause hypertension.

Which of the following formulations contains estrogen plus a progestin?

Premphase

Which of the following should not be discussed during the counseling of Sumavel DosePro?

Press the blue button at the end of the device to administer the injection. Sumavel is ready to inject once the lever is flipped. If the device is pressed against skin at that point, the dose will be released. There is no button to press. Pts may be counseled on this and that the burst of air can scare or startle some pts.

A prescriber calls to speak to a pharmacist. A positive antinuclear antibody (ANA) was reported on his patient's labs. The pharmacist realizes that several drugs can cause this. Which antiarrhythmic drug carries a boxed warning regarding ANA?

Procainamide is notable for causing drug-induced lupus erythematosus (DILE) in up to 20-30% of patients who use it long-term. A positive antinuclear antibody (ANA), though generally nonspecific, points toward SLE or DILE.

Taclonex is a popular dermatological drug. Taclonex is used for this condition:

Psoriasis Calcipotriene and betamethasone ointment comes as Taclonex and Taclonex scalp suspension. Calcipotriene comes alone as Dovonex. Calcipotriene is a vitamin D analog.

Which groups would find benefit from statin therapy according to the ACC/AHA Blood Cholesterol Guidelines?

Pts who have a coronary stent placed 4 years ago A 45yo pt with DM and a LDL of 95

A patient with rheumatoid arthritis uses daily ibuprofen therapy and requires occasional therapy with prednisone for acute flares. She is reporting abdominal pain, with burning. Upon examination, she is found to have GI ulceration which the physician feels is due to her use of these medications. She is not a candidate for celecoxib. Which medication would provide the strongest protection from NSAID-induced GI ulceration and bleeding?

Rabeprazole

JV is a 60 year-old post-menopausal female who is overweight and sedentary. Last year, while taking a five hour cross-country flight, she developed a deep vein thrombosis (DVT). This was her second DVT in two years. She has refused warfarin, but agreed to use an aspirin daily. Aspirin is her only medication. Recently, JV's sister was diagnosed with breast cancer. During the work-up, JV's sister was found to have low bone density. Due to her sister's new diagnoses, JV is inquiring if she can use raloxifene, which she heard might protect her against breast cancer and will help her build strong bones. Choose the correct statement:

Raloxifene (Evista) has an increased risk for thromboembolism. Women with active or past history of venous thromboembolism cannot use this medication.

A patient is asking about raloxifene. Which of the following statements are correct?

Raloxifene is used primarily in women afraid of getting breast cancer.

Which triptan can be safely used with phenelzine (Nardil) - antidepressant?

Relpax. Sumatriptan, rizatriptan, and zolmitriptan are CI with MAO inhibitors. The other triptans are not, though the warning about combining them with serotonergic drugs still applies.

Which of the following medications can be given monthly or less frequently than monthly?

Rexulti is given daily and Risperdal Consta is administered every 2 weeks. Abilify Maintena and haloperidol decanoate are both given every month. Invega Trinza is given IM every 3 months. Patients must tolerate at least four months of Invega Sustenna before transitioning to Invega Trinza.

Which of the following side effects are associated with statin use?

Risk of DM, Memory loss, myopathy

Among the following second generation agents, which agents have a high risk for movement disorders and should not be chosen for this patient?

Risperidone, at higher doses, can cause movement disorders. In this case the patient is elderly and even lower doses may cause a problem. Paliperidone (Invega) is similar in side effects to risperidone and also has high risk.

A patient with Parkinson Disease is prescribed Rytary ER. Which of the following should the pharmacist include when counseling the patient?

Rytary ER (carbidopa/levodopa) is an extended-release capsule that should be swallowed whole or the contents sprinkled on a small amount of applesauce. It differs from Sinemet and Sinemet CR in that a high-fat or high-caloric meal can delay absorption by about 2 hours. Similarly with Sinemet and Sinemet CR, protein and iron can decrease the absorption.

SP's 10-year ASCVD risk is found to be 17% and the ambulatory care pharmacist assesses her current statin therapy for appropriateness. Which of the following regimens would be appropriate for this patient?

SP is between the ages of 40 and 75 with an ASCVD risk > 7.5%, LDL is between 70 and 189; she is not diabetic. She should receive moderate to high intensity statin therapy; however, with amiodarone the maximum dose of simvastatin is 20 mg. Rosuvastatin or atorvastatin 20 mg would provide the appropriate intensity while avoiding the drug interaction.

A female patient suffers from severe depression prior to the onset of menses. After the period begins, her mood appears brighter and the depression dissipates. This pattern occurs monthly and causes significant distress to her routine functioning. She has been diagnosed with pre-menstrual dysphoric disorder (PMDD). Which medication/s are indicated for this condition?

Sarafem Yaz Zoloft When an antidepressant is taken for PMDD, it is taken for the two weeks prior to menses and through the first full day of bleeding. Alternatively, the antidepressant can be taken daily. This is the only medical condition in which antidepressants are not always taken continuously.

A patient is using the selegiline patch at 12 mg/day. The patient asks the pharmacist: "I was told to avoid foods rich in tyramine, but I don't know what foods I should stop eating. Do you?" The pharmacist should counsel the patient to avoid the following foods:

Sauerkraut Soy sauce Aged cheese, air-dried meats

Which of the following signs and symptoms would be present in a patient who has received an overdose of Dilaudid?

Sedation, shallow breathing, faint breath sounds, cold and clammy skin, pinpoint pupils

Forfivo XL is a formulation of bupropion 450 mg, taken once daily. It is available only in this dose. Forfivo is not approved for smoking cessation. It has the same suicidality warning as all other antidepressants. Which of the following contraindications would rule out the use of Forfivo in a patient being treated for depression?

Seizure disorder, using other forms of bupropion, bulimia, anorexia, or MAO inhibitor use within the past 14 days

Which of the following statements regarding the use of beta blockers in patients with systolic heart failure is correct?

Select beta blockers are indicated in all severities of heart failure, including patients with symptoms at rest. The benefit of beta blockers is not considered a class effect; use only those that have shown clinical benefit and titrate to target doses as tolerated. Unless the patient has hypotension or hypoperfusion, beta blockers should be continued during a heart failure decompensation.

A 25 year-old male with recent head trauma is started on Dilantin for seizure prevention. Which of the following statements concerning Dilantin is correct?

Serious skin rashes, including SJS and TEN, can occur with the use of this drug.

A pt takes 1 dose of generic sumatriptan injection. About 90 minutes later, her migraine is partially relieved but she still has "pounding" pain in her head. Choose the correct statement.

She can use a 2nd SQ dose now; two doses are the maximum. Injectable sumatriptan can be repeated 1 hour after the first dose, if needed and only if there is some response to the first dose.

Which of the following statements concerning Detrol LA are correct?

She is likely to experience some dry mouth and should be counseled on ways to relieve this condition. It is best to combine the use of Rx drugs with pelvic floor exercises. The agents in common use do not penetrate the CNS to a great degree; if they did, they could not be used for this purpose. However, some will experience more CNS effects than others, and the risk is present with any of these agents. A centrally-acting anticholinergic such as benztropine (and even diphenhydramine, to some extent) would cause urinary retention, but would have much higher CNS penetration and CNS side effects. Patients having incontinence should not always be treated with prescription agents even though incontinence episodes are a major contributor to nursing home placement; the anticholinergics used for urge incontinence have mild benefit and contribute (primarily) to dry mouth.

SA has 2-3 migraines monthly. They reduce her ability to function for 2-3 days. Her daily medications include fosinopril for HTN and a MVI. Choose the correct statement.

She should begin prophylactic therapy to reduce her migraine incidence. If a pt uses acute txment > twice weekly or > 3 times per month, or has severe symptoms, or requests prophylaxis, an agent can be used to decrease migraine frequency. This pt has reduced QOL for >1 week per month.

CB will begin colesevelam therapy. Her other medications include citalopram, levothyroxine, metformin and phenytoin. Choose the correct statement:

She will need take phenytoin and levothyroxine 4 hours before colesevelam.

Which of the following statements regarding Kcentra are correct?

Should be administered with vitamin K Contains Factors II, VII, IX, X, protein C and protein S. Kcentra should not be used in HIT as it contains heparin in the formulation. Kcentra can cause clotting.

Which three statins undergo first pass metabolism by which CYP enzyme?

Simvastatin, atorvastatin, and lovastatin all undergo first pass metabolism by CYP3A4. Therefore these three statins have many drug interactions and doses need to be adjusted accordingly.

Curtis Hale comes back to the clinic after two years and has been taking Sinemet 25/250 mg QID, but he is now experiencing wearing-off symptoms before each dose. Which of the following is a correct combination that Mr. Hale can initially be changed to that can improve his treatment outcomes?

Sinemet 25/250 mg TID + Comtan 200 mg TID When adding on Comtan (entacapone) to Sinemet (carbidopa/levodopa), an initial decrease of 10-30% of levodopa is usually necessary. The dose or frequency of Sinemet can be increased over time if required. Comtan should only be taken with each dose of carbidopa/levodopa.

Which formulation of niacin has the highest risk for liver damage?

Slo-Niacin

A hospitalized patient was given sodium polystyrene sulfonate this morning. The pharmacist is reviewing her medications. Which of the following medications on the profile most likely needs to be discontinued?

Spironolactone The patient was given sodium polystyrene sulfonate (Kayexalate), which is used to treat hyperkalemia. Antihypertensive agents that retain potassium include ACEIs, ARBs, direct renin inhibitors, potassium-sparing diuretics and the aldosterone blockers (aldosterone and eplerenone).

A 55 year-old female patient received a kidney transplant. She required tacrolimus for chronic immunosuppression. The tacrolimus trough blood levels remained stable over several years. In the fourth year after transplant the patient expired from complications of an acute graft rejection. The hospital pharmacist reviewed the bag of medicines brought in from the home and found the following products: DHEA, women's multivitamin, B vitamin complex and St. John's Wort. What is the likely explanation for the acute graft rejection?

St. John's Wort decreased levels of cyclosporine due to enzyme induction.

Wendy is picking up a new prescription for Byetta. What important storage and handling tips should be discussed with the patient?

Store unopened pens in the refrigerator. Once opened, the pen can be kept at room temperature. Do not store the pen with the needle attached as it may leak and form air bubbles. Do not freeze the medication. Never use if the pen has been frozen. Discard after 30 days after the first use, even if some drug remains in the pen. Also, patients should be instructed to use a punture-resistant container to discard the needles. The pen should be protected from light.

A 42 year-old female received codeine with acetaminophen after a dental extraction. She developed dizziness and shortness of breath and went to the emergency room. Since this incident, she is very cautious about any medications. Which of the following medications would not cross react with codeine?

Sublimaze Fentanyl, meperidine, and methadone do not cross react with opioids of the morphine-type, however they may not always be clinically appropriate to use.

Which of the following drugs can cause the skin or urine to become orange-yellowish in color?

Sulfasalazine can cause the skin or urine to become orange-yellowish in color. It is considered harmless but can stain clothing.

A patient with ulcerative colitis is being initated on sulfasalazine therapy. Which of the following situations would represent a contraindication to the use of sulfasalazine?

Sulfasalazine is contraindicated in patients with a sulfa or salicylate allergy. Remember it is an aminosalicylate. Mesalamine can be used in patients with a sulfa allergy.

What formulation is onzetra Xsail?

Sumatriptan intranasal powder delivered via a breath-powered delivery device

A patient picks up a prescription from the pharmacy for tacrolimus capsules. Counseling should include all of the following points

Take on an empty stomach (one hour before or two hours after meals). The patient may experience headaches, nausea, diarrhea and/or tremor. The patient's weight, temperature and blood pressure (and blood sugar if the patient has diabetes) should be monitored. The patient is at risk for infection; report at once if fever develops or feelings of weakness and fatigue. This drug increases the risk of developing lymphoma. Tacrolimus has many side effects, including hypertension, hyperglycemia, hyperkalemia and hypokalemia, tremor, QT prolongation and nephrotoxicity.

A patient is purchasing Lamisil AT cream for a fungal foot infection. What is the active ingredient?

Terbinafine

Which of the following brand-generic matches are correct?

Terbinafine-Lamisil AT Butenafine-Lotrimin Ultra Tolnaftate-Tinactin Clotrimazole-Lotrimin Undecylenic acid-Desenex

If one squeezes out enough steroid cream to stretch the length from the fingertip to the first joint, what approximate area of skin would this amount of medication treat?

The "finger-tip" unit is used to estimate amount required: the amount that can be squeezed from the fingertip to the first joint covers one adult hand (which on an adult finger would weight about ½ gram).

Maria Fisher has been given a prescription for simvastatin 20 mg PO QHS. Which of the following statements are correct?

The brand name of simvastatin is Zocor. The dose of simvastatin can be titrated to a max dose of 40 mg/day. Simvastatin is taken at bedtime, with or without food. Simvastatin has a short half life and must be in the body during sleep when most cholesterol synthesis occurs. The max dose for new starts is 40 mg/day.

CF is a 60 year-old male admitted to the hospital after a motor vehicle accident. He takes digoxin 0.125 mg PO daily at home for rate control of atrial fibrillation. On admission his serum digoxin level is therapeutic. He will be NPO for numerous surgeries over the next several days. Which of the following is the best recommendation?

The dose should be reduced by 20-25% when converting digoxin from oral to IV.

A patient has been prescribed Tylenol #3. She comes to the pharmacy window and is heard with a hacking cough and congestion. Choose the correct statement.

The drug has a high risk of nausea and can worsen or cause constipation. Tylenol #3 contains codeine and acetaminophen. Codeine can cause significant GI distress. It is used as an antitussive (to decrease cough) in cough syrups. Patients who are rapid metabolizers of 2D6 will have higher levels of morphine.

Ruby Reynolds has been diagnosed with schizophrenia and has been prescribed risperidone. She is sleeping almost all day. Choose the agent on the patient's formulary that is least sedating:

The first generation ("typical") antipsychotics are sedating and the lower potency agents (such as chlorpromazine and thioridazine) have the highest degree of sedation. Of the second generation ("atypical") agents, aripiprazole is note-worthy for not being sedating-in fact, it can contribute to insomnia and is taken once daily in the morning.

The pharmacist has received a new prescription for oral Cordarone for JC. What is the half-life of Cordarone?

The half-life of amiodarone is roughly 60 days. Applying the concept of steady state, it takes a very long time for amiodarone to be completely cleared from the body when it is stopped.

GW is to be started on an insulin drip for DKA. What is the recommended initial infusion rate, in units per hour?

The insulin infusion should be dosed at 0.1 units/kg/hr.

Joanne is a 43 year-old black female with bipolar disorder who has been using lithium for 4 1/2 years. She presents to the clinic on 8/8 to complain about nausea. She says that as she has gotten older, her nausea has worsened and she noticed how bad it was during a recent trip to an amusement park. She couldn't enjoy any of the rides. The nausea is particularly bad when her brother is driving the car because he "jerks." The prescriber notes mild tremor and bilateral cogwheel rigidity. Patient reports "good" mood and states she is "fine" with lithium. Pharmacy records indicate good adherence. Ms. Sigurny says that she takes Tums for the nausea, but it doesn't help as much as it used to and asks for something stronger. Joanne Sigurny reports that she eats two primary meals per day (lunch and dinner) and rarely has breakfast except some coffee and/or juice.

The lithium is working for the patient; she should not be encouraged to switch medications. Her renal function should continue to be monitored. She can switch to a long-acting formulation and take the doses with food. Food such as toast, taken with water or ginger ale, can help. Make sure she is consuming adequate fluids, as with all patients taking lithium. In some patients lower fluid intake will worsen nausea.

A patient with chronic angina is currently taking aspirin, diltiazem, metoprolol and ranolazine. The physician wants to start the patient on simvastatin. Which of the following statements is correct regarding simvastatin in this patient?

The maximum dose of simvastatin is 10 mg daily when a patient is taking diltiazem and 20 mg daily when taking ranolazine.

JL is started on Glucophage XR 500 mg once daily. Which of the following statements is correct?

The maximum effective dose is 2-2.5 grams daily. Glucophage XR can be titrated to 2-2.5 grams daily unless the blood glucose is well-controlled on a lower dose.

HG is a 30 year-old woman who just had a baby. She has been prescribed the progestin-only mini-pill, Camila. Her physician told her that she will use this type of birth control pill until she is done breastfeeding her baby. Which of the following counseling points on the "mini pill" should be relayed to the patient?

The mini pill can be started at any time. Progestin-only pills (the mini-pill, or POPs) are used primarily by women who are lactating, since estrogen decreases milk supply. They must be taken at about the same time each day or pregnancy can occur.

A hospitalized patient is being switched from morphine to hydromorphone. The pharmacist first calculates the total daily dose, and then reduces the dose of the new drug. Why did the pharmacist make a reduction after calculating the total daily dose of hydromorphone?

The patient may have developed tolerance to the morphine, and therefore require a lower hydromorphone dose. If tolerance has developed to the current opioid, and they are switched, the new opioid should be given at at a lower dose, rather than an equivalent (mg to mg) dose.

A patient is starting diclofenac gel for pain relief due to osteoarthritis in her knees, wrists and elbows. Which of the following statements is correct?

The patient should use no more than 32 grams of diclofenac gel daily.

Select the correct chemical class for chlorpromazine:

The phenothiazines are strong dopamine (DA) blockers. When used for other conditions, such as nausea, movement disorders are possible side effects, and sedation is expected.

JG has just received a NuvaRing at the pharmacy. It is a good choice for her because she sometimes forgets to take the pill. Counseling points for the NuvaRing should include all of the following recommendations:

The ring is refrigerated at the pharmacy but can be kept at room temperature by the patient for up to 4 months. It should be inserted on the first day of menstrual bleeding. Next

Charlie Rotman presents with a new prescription for Lamictal 250 mg BID #60. Choose the correct statements:

The risk of severe, potentially life-threatening rash from Lamictal may be increased by co-administration with valproate, exceeding the recommended initial dose, or increasing the dose too rapidly. Lamictal is started at 25 mg daily for the first 2 weeks, unless the patient is on valproic acid or an inducer.

Choose the correct statement regarding carvedilol to carvedilol CR dosing:

The starting dose of carvedilol immediate release is 3.125 mg BID for heart failure (equivalent to Coreg CR 10 mg), or 6.25 BID for hypertension (equivalent to Coreg CR 20 mg). The Coreg CR doses are 10 mg, 20 mg, 40 mg or 80 mg daily.

A patient is using Wellbutrin XL for seasonal affective disorder. The prescriber instructed the patient to start early in the spring at 150 mg BID and continue indefinitely. He said that the best treatment for SAD is to take it all year since depression can be debilitating. He said that the pharmacist would instruct the patient how to use the drug. Which statement below is correct?

The total daily dose should not start this high; it should start at 150 mg once daily and then should be increased to 300 mg once daily. For SAD the drug is started in early fall and titrated off in the spring, but if the condition warrants it could be continued indefinitely.

Which of the following statement/s is/are true regarding PCSK9 inhibitors?

They decrease LDL levels by ~60%. These agents can be stored in the refrigerator or left at room temperature for up to 30 days (Repatha) or 24 hours (Praluent). They decrease LDL levels by ~60%.

Which of her medications could contribute to her lipid panel abnormalities?

Thiazides are associated with increases in LDL and triglycerides. Loop diuretics can cause increases in triglycerides and total cholesterol.

A patient is starting Byetta therapy. Which of the following counseling points are correct and should be discussed with the patient?

This SC injection should be placed in the thigh, abdomen, or upper arm. Before the first use, this medication must be stored in the refrigerator and protected from light. Do not inject the medication after a meal. Doses should be separated by at least 6 hours or more during.

A patient has received a prescription for oxycodone-acetaminophen (Percocet). Choose the correct statement/s.

This is a C-II medication. CYP 450 3A4 inhibitors will increase the concentration of this medication. Healthcare providers should be able to report abuse of this medication. Oxaydo and Oxycontin contain only oxycodone. Oxaydo is an oxycodone IR formulation that cannot be crushed into powder; it contains a nasal irritant.

What are significant adverse reactions associated with the use of Apokyn?

This is a poorly tolerated agent, yet it can be used in patients to provide some mobility in patients with advanced disease. The effect lasts about an hour. In addition to hypotension and severe nausea the drug is a QT-prolongating agent. To help with nausea and vomiting, administer trimethobenzamide (Tigan) 300 mg PO TID or a similar antiemetic, started 3 days prior to the initial dose of apomorphine and continued at least during the first two months of therapy. Other adverse effects of apomorphine include yawning, dyskinesias, somnolence and dizziness.

A patient is taking 10/100 Sinement IR when he wakes up, and 25/250 Sinemet SR TID. Choose the correct statement:

This is to have enough medicine in his system to get going in the morning, and to be able to eat his breakfast. The SR has a slower onset. This is not uncommon.

A caregiver is picking up a new prescription of Namenda for her patient. The pharmacist will counsel the caregiver on this medication. Which of the following statements are correct?

This medication comes in different forms, such as a capsule and an oral solution, which may be easier to administer. This medication can be taken with or without food. If there is any difficulty swallowing the extended-release capsule, it can be opened and the contents sprinkled on applesauce. Unfortunately, the medications used for dementia offer little (very mild) benefit. Possible side effects of Namenda include dizziness, constipation (and in some patients, diarrhea), and headache.

The pharmacist is dispensing a new prescription for pioglitazone. Choose the correct statement:

This medication has been shown to increase the risk of bladder cancer. Pioglitazone is taken once daily in the morning (15-45 mg daily), with or without food. The patient should be told to monitor for nausea, abdominal pain, passing dark-colored urine, the skin and the whites of the eyes turning yellow; these may be signs of liver damage. It can take a couple of months to have a full effect. More recently, pioglitazone has been associated with bladder cancer.

A patient is about to begin therapy with pramlintide. Which of the following statements are correct regarding pramlintide?

This medication must be titrated as it can cause significant nausea. This medication is a synthetic analog of amylin which prevents glucagon secretion following a meal. This medication is contraindicated in patients with hypoglycemia unawareness. Pramlintide is injected before meals and can cause weight loss.

The pharmacist is dispensing the contraceptive patch to SE. The patient's vitals today include a blood pressure of 106/68 mmHg, pulse 72 BPM, height 5'6" and weight 212 pounds. Select the correct statement:

This patient is not a good candidate for the contraceptive patch. The patch is not recommended for women over 198 pounds due to lower efficacy. The patch is linked to a higher risk of blood clots than low-dose oral contraceptives.

Which of the following changes should be made to AM's current regimen?

This patient is not at the target dose of Toprol XL or lisinopril. She has no contraindications to increasing the doses therefore, these medications should be up-titrated.

Which of the following patient types would benefit from moderate-intensity statin therapy according to the ACC/AHA Blood Cholesterol Guidelines?

Those unable to tolerate high-intensity statin therapy A 80yo pt who is s/p MI A 45yo pt with DM and a LDL of 140 and no other comorbidities; 10yr ASCVD risk score of 6.5%

In addition to an approval for lowering cholesterol when statins alone are not enough or when statins cannot be tolerated, Welchol has an additional indication for the following condition:

To help lower PPG in DM

Which of the following medications works by inhibiting interleukin 6 receptors?

Tocilizumab is an IL-6 receptor antagonist.

A father is picking up a prescription of Elidel for his child. Counseling statements should include the following:

Use the smallest amount needed to control symptoms. Continue as long as signs and symptoms persist; discontinue if resolution occurs. Wash hands after application. Keep the skin well hydrated by using a good moisturizer. Limit sun and ultraviolet ray exposure if using this medication. This drug may add to the child's chance of getting lymphoma or other cancers. This medication cannot be used in children who are not at least two years of age (boxed warning).

Which of the following drugs used for migraine prophylaxis is best avoided in a female of child-bearing age?

Valproic Acid as it is the most teratogenic and should be avoided.

Depakene

Valproic acid

Select the correct indication for Brisdelle:

Vasomotor symptoms of menopause The dosing for this indication is 7.5 mg, taken at bedtime. This is a version of the SSRI paroxetine.

SG is a 25yo female who presents to the pharmacy with a RX for Migranal Nasal Spray. Meds: Cimetidine

Verify when the pt is pregnant; do not fill if pregnant. Recommend changing the cimetidine to Pepcid. Ergot products are pregnancy category X and contain BBW not to use with strong/moderate CYP3A4 inhibitors (cimetidine) due to the risk of cerebral ischemia with higher drug levels.

Which of the following drugs causes abnormal vision, color vision change and/or photophobia in about 20% of patients and comes with this warning to patients: "Can cause vision problems. If used more than 28 days you need to have your vision checked"?

Voriconazole

Which of the following drugs is considered to have a lower risk of abuse since the drug requires conversion to an active stimulant and a quick "high" is averted?

Vyvanse is a pro-drug that is converted via first pass intestinal and hepatic metabolism. Snorting or injection bypasses this step and the quick "high" is not as quick as hoped for by the person injecting. Concerta is difficult to abuse as well since it is hard to chew or crush.

Choose the correct titration schedule for ropinirole or pramipexole

Wait at least 1 week before increasing the dose

Which of SN's lab results suggests that she could experience altered response to warfarin?

Warfarin is highly protein bound. Patients with low albumin will have more free drug in the system and be at increased risk of bleeding (especially if other risks are present). These patients generally require a lower dose. Monitor carefully.

Celiac disease is an immune response to gluten. Which of the following contain gluten?

Wheat, barley and rye can contain gluten.

An elderly gentleman with new-onset Parkinson's disease presents to the pharmacy with a prescription for carbidopa-levodopa 10/100 mg TID. The pharmacist contacts the physician to report the following prescribing error:

When prescribing carbidopa-levodopa (Sinemet), the carbidopa component should be within the range of 70-100 mg. This is important for two reasons: a minimum dose is required for effectiveness, and higher doses will cause nausea. The carbidopa prevents the peripheral (outside of the CNS) breakdown of levodopa by the enzyme decarboxylase. Carbidopa is a decarboxylase inhibitor.

In patients with STEMI who are less than 75 years old, give enoxaparin 30 mg IV bolus plus a 1 mg/kg SC dose followed by 1 mg/kg SC dose Q12H (max 100 mg for the first two doses) in patients with CrCl > 30 mL/min.

Xarelto, Pradaxa, Eliquis and Savaysa provide rapid systemic anticoagulation once they are taken. They are not used simultaneously with parenteral anticoagulation. When treating an acute DVT with dabigatran or edoxaban the labeling for each drug states that these are approved for use after 5-10 days of parenteral anticoagulant. Rivaroxaban and apixaban do not have this stipulation in their labeling.

What additional medication(s) would be appropriate to add for improved control of OP's rheumatoid arthritis?

Xeljanz Humira Remicade Actemra Rituxan

Which of the following formulations contain metformin?

Xigduo XR Glucophage Janumet XR Oseni contains alogliptin and pioglitazone; Avandaryl contains glimepiride and rosiglitazone

Which antiretroviral is available in intravenous formulation that is used to prevent perinatal transmission of HIV?

Zidovudine (Retrovir) is available in intravenous formulation and is used to prevent perinatal transmission of HIV during labor.

Which of the following agents have a boxed warning to avoid any amount of alcohol as it could result in fatal respiratory depression due to increased absorption?

Zohydro (Hydrocodone), Opana ER (Oxymorphone), Nucyna ER (Tapentadol)