McGraw-Hill Education NAPLEX Review Guide

McGrawHillEducationNAPLEXReviewGuide
Quiz2
1)FSisa56yearoldmanwithdiabetesmellitusandnewlydiagnosedhypertension.Hismeanblood
pressureinclinictodayafterthreepropermeasurementsis158/101mmHg.Heisnotcurrentlyon
treatment.WhichofthefollowingdrugregimenswouldbethemostappropriatetotreatFS?
A.Chlorthalidone
B.Quinapril
C.Benazepril+amlodipine
D.Benazepril+losartan
E.Atenolol+HCTZ
2)Whatdiagnosticcategoryisabloodpressureof158/104mmHgonJune1andabloodpressureof
150/110mmHgonJune4(bothofthesebloodpressuresweretakenontwoseparateclinicdatesasthe
patientrefusedtogototheemergencydepartment)?
A.Normal
B.Prehypertension
C.Stage1hypertension
D.Stage2hypertension
3)Whatmedicationorcombinationissafesttouseforapatientwithadvancedhepaticdisease?
A.Colesevelam
B.Ezetimibe/simvastatin
C.Niacin
D.Gemfibrozil
4)JMisa64yearoldwomanwithaPMHofpancreatitis(whenTG2200mg/dL),uncontrolledgout,
severepsoriasis,recurrentinfectionsrequiringhospitalization,andlovastatinassociatedmyopathy.Her
currentmedicationsincluderosuvastatin,prednisone,andallopurinol.Colchicinewasalsoaddedafew
daysagoforagoutexacerbation.Shereportsananaphylacticreactionaftereatingseafoodincollege.Her
LDLCis96mg/dL,HDLC42mg/dL,andTG640mg/dL.Whichofthefollowingisthesafestaddition
tohertherapy?
A.Niacin
B.Colesevelam
C.Fishoil
D.Fenofibrate
5)Selectthebrandnameforlovastatin.
A.Lescol
B.Crestor
C.Mevacor
D.Zocor
6)Whichofthefollowingstatindosesmaybedispensedtoapatientalsotakinggemfibrozil?
A.Rosuvastatin20mg
B.Simvastatin20mg
C.Lovastatin40mg
D.Fluvastatin40mg
.
7)WhichdrugcanbeusedsafelyinaHeparininducedthrombocytopenia(HIT)patientwithacreatinine
clearanceof25mL/min?
A.Enoxaparin
B.Dalteparin
C.Fondaparinux
D.Argatroban
8)Whichagenthasadelayedonsetofanticoagulanteffect?
A.Lovenox
B.Arixtra
C.Warfarin
D.Innohep
9)A57yearoldwoman(65kg,BMI28)wasjustadmittedtothehospitalfortreatmentofapulmonary
embolism.AnorderwaswrittenforheparinIVbolus80U/kgfollowedbyacontinuousinfusionof18
U/kg/h.Whatarerespectiveheparinbolusdoseandcontinuousinfusionrateforthispatient?
A.5000UIVbolus;1200U/hinfusion
B.4000UIVbolus;800U/hinfusion
C.6000UIVbolus;1150U/hinfusion
D.4000UIVbolus;1150U/hinfusion
10)A61yearoldmanwithperipheralarterialdisease,hypertension,hyperlipidemia,andNewYorkHeart
AssociationclassIIIheartfailureisnotedtohavesignificantfunctionalimpairmentduetointermittent
claudication.Whichofthefollowingpharmacologicinterventionshasamedication/diseasestateinteraction
withthepatient?A.Aspirin
B.Clopidogrel
C.Simvastatin
D.Cilostazol
11)Whichofthefollowingantiplateletagentsshouldbemonitoredwithperiodiccompletebloodcount
testingrelatedtopotentialhematologiccomplicationsthatincludeagranulocytosisandaplasticanemia?
A.Aspirin
B.Simvastatin
C.Ticlopidine
D.Dipyridamoleplusaspirin
12)WhichofthefollowingisappropriaterationaleforswitchinganACEinhibitortoanARB?
A.Hypotension
B.Renaldysfunction
C.Hyperkalemia
D.Cough
13)WhichofthefollowingblockerregimenswouldbeagoalformostHFpatients?
A.MetoprololsuccinateXL150mgoncedailyB.Carvedilol25mgtwicedailyC.Atenolol100mgonce
dailyD.Bisoprolol2.5mgoncedaily
Feedback:
AnswerBiscorrect.
ThreeblockershavebeenshowntoreducemortalityinHFpatients.Inthesestudies,targetdosesofthese
therapiesincludedmetoprololXL200mgoncedaily,carvedilol25mgtwicedaily,andbisoprolol10mg
oncedaily.
AnswerAisincorrect.
MetoprololXL150mgoncedailyisthemeandoseachievedintheHFstudydemonstratingamortality
benefit;however,thetargetdoseinthisstudywas200mgoncedaily.Themortalitybenefitofblockeris
doserelated,andthus,reachingtargetdoseastoleratedisimportant.
AnswerCisincorrect.
AtenololhasnotbeenstudiedinarandomizedcontrolledtrialofHFpatients,andthus,shouldnotbe
considered.
AnswerDisincorrect.
Bisoprolol2.5mgoncedailyisanappropriatestartingdosetoconsiderinHFpatients.Thetargetdoseis
bisoprolol10mgoncedaily.
14)Whichofthefollowingareimportanttomonitorforwheninitiatingblockertherapy?
A.TachycardiaB.DehydrationC.FatigueD.Hypokalemia
Feedback:
AnswerCiscorrect.
Wheninitiatingblockertherapy,itisimportanttomonitorforworseningHFincludingfatigueandfluid
retention.WorseningHFmayoccurasaresultoftheacutenegativeinotropiceffectsoftherapy.
AnswerAisincorrect.
Bradycardiaratherthantachycardiaisacommonsideeffectofblocker.
AnswerBisincorrect.
Anincreaseinvolumeisassociatedwithblockertherapy(fluidretention).Dehydrationisnotassociated
withblockers.
AnswerDisincorrect.
HyperkalemiaoccurswithmanyHFtherapiesincludingACEinhibitors,ARBs,andARAsbutnotwith
blockers.
15)Whichofthefollowingisreferredtoasaninodilator,havingbothinotropicandvasodilatory
properties?
A.MilrinoneB.DobutamineC.NesiritideD.Nitroprusside
Feedback:
AnswerAiscorrect.
Milrinonedecreasesthebreakdownofcyclicadenosinemonophosphate(cAMP)incardiactissue,resulting
inanincreaseincardiaccontractilityandoutput.ByincreasingcAMPinvascularsmoothmuscle,systemic
andpulmonaryvascularresistancearereduced,thusmilrinoneisoftenreferredtoasaninodilator
(inotropeandvasodilator).
AnswerBisincorrect.
Dobutamineisaninotrope.Whiledobutaminestimulates2receptorsintheperipherycausingmild
vasodilation,italsostimulatesreceptors,whichcounteractswithmildvasoconstriction.Therefore,the
decreaseinSVRthatoccurswithdobutamineisareflexiveresponsetotheincreaseincardiacoutput.
AnswersCandDareincorrect.
Nesiritide(Answerc)andnitroprusside(Answerd)arepotentarterialandvenousvasodilators.These
agentsdilatethearterialvessels(decreaseinSVR)andcauseareflexincreaseincardiacoutput.
16)MJisa45yearoldman(70kg)admittedforADHFrefractorytooutpatienttitrationoforaldiuretics,
includingtorsemideandmetolazone.Heisnowreceivingintravenousfurosemide30mg/hand
chlorothiazide500mgintravenouslytwicedaily.WhileMJsvitalsignsandrenalfunctionappearstable
(BP110/65mmHg,HR85beats/min,SCr1.3mg/dL),hisurineoutputisunchangeddespiteover24hours
oftheaboveregimen.Additionally,reviewofcontinuoustelemetrydemonstratesmultiple10beatrunsof
ventriculartachycardia.Whichofthefollowingisanappropriatenextstepintherapy?
A.Initiatemilrinone0.1g/kg/min.B.Initiatedobutamine2.5g/kg/min.C.Initiatenesiritide0.01
g/kg/min.D.Increasefurosemideto60mg/h.
Feedback:
AnswerCiscorrect.
NesiritideisarecombinantBNPmoleculethatpromotesnatriuresis,venodilation,andarterialvasodilation.
Whenadministeredasacontinuousinfusion,nesiritidedecreasesPCWP,decreasesSVR(indirectly
increasingCO),andassistsindiuresiswhencoadministeredwithloopdiuretics.Pharmacotherapyoptions
fordiureticresistanceincludeadrugwithanalternativemechanismofactionsuchasathiazidediureticor
nesiritide.MJhasalreadyreceivedtherapywithathiazide.MJssystolicbloodpressureisgreaterthan100
mmHg,makingnesiritideasafeoption.
AnswersAandBareincorrect.
MJisdemonstratingrefractoryfluidoverload.Whiletheinotropicagents,milrinone(Answera)and
dobutamine(Answerb),canbeconsideredinthissetting,ventriculartachycardiaprecludesuseofthese
proarrhythmicagents.
AnswerDisincorrect.
Thecontinuousinfusionoffurosemidecanbeuptitratedtothemaximaltargetdoseof0.4mg/kg/h,and
thus,theinfusionrateoffurosemidecanbeincreasedfrom30to60mg/h.However,thisisnotexpectedto
enhancediuresis.
17)WhichofthefollowingisassociatedwiththeuseofIVnitroglycerininADHF?
A.NatriuresisB.IncreasedriskofventriculararrhythmiasC.Accumulationoftoxicmetabolitesin
hepaticorrenalimpairmentD.Primarilyvenousdilationatlowerdoses(ie,
Feedback:
AnswerDiscorrect.
Atlowerdoses,nitroglycerinproducesprimarilyvenodilation;dosesinexcessof100g/minaretypically
requiredtoproducebothvenousandarterialdilation.Athigherdoses(>100g/min),nitroglycerinalso
dilatesthearterialvasculature,decreasingafterloadandSVRandincreasingCO.
AnswerAisincorrect.
AlthoughIVnitroglycerincanenhancediuresiswhenaddedtoaloopdiuretic,thisoccursindirectlyvia
vasodilationandmobilizationoffluidfromtheextravascularspace.
AnswerBisincorrect.
WhileventriculararrhythmiasarecommonwithIVinotropes,thisisnottrueofIVnitroglycerin.
AnswerCisincorrect.
Nitroprussideformstoxicbyproductsthatmayaccumulateinpatientshepaticorrenalimpairment,butthis
isnottrueofnitroglycerin.
18)A63yearoldAfricanAmericanmanwithaPMHsignificantfordyslipidemiapresentedtothe
emergencydepartmentseveraldaysagowithsymptomsofanacutestroke.Thephysicianyouareworking
withwantsyourrecommendationsonwhattosendthispatienthomeonforbloodpressurecontrol.Current
vitalsareasfollows:BP138/88mmHg,HR86beats/min.Whatdoyourecommend?
A.Blocker.B.Nondihydropyridinecalciumchannelblocker.C.Angiotensinconvertingenzyme
inhibitorplusadiuretic.D.Nobloodpressuremedication.Thepatientsbloodpressureisatgoal.
Feedback:
AnswerCiscorrect.
CurrentlytheAmericanHeartAssociationStrokeCouncilrecommendstheuseofdiureticsorthe
combinationofdiureticsplusanangiotensinconvertingenzymeinhibitor.
AnswerAisincorrect.
Thereisnodatatosupporttheuseofablockerpostischemicstroke,andthispatientdoesnothaveany
compellingindicationsthatwarrantblockeruse.CurrentlytheAmericanHeartAssociationStroke
Councilrecommendstheuseofdiureticsorthecombinationofdiureticsplusanangiotensinconverting
enzymeinhibitor.
AnswerBisincorrect.
Thereisnodatatosupporttheuseofacalciumchannelblocker,bothnondihydropyridineand
dihydropyridine,postischemicstroke.CurrentlytheAmericanHeartAssociationStrokeCouncil
recommendstheuseofdiureticsorthecombinationofdiureticsplusanangiotensinconvertingenzyme
inhibitor.
AnswerDisincorrect.
PertheAmericanHeartAssociationStrokeCouncil,antihypertensivetreatmentisrecommendedforall
patientswithahistoryofischemicstrokeregardlessofwhetherornotthepatienthasahistoryof
hypertension.
19)Whatisthebrandnameofextendedreleasedipyridamole200mgplusaspirin25mg?
A.AngiomaxB.AggrastatC.AggrenoxD.Abraxane
Feedback:
AnswerCiscorrect.
ThegenericnameforAggrenoxisextendedreleasedipyridamole200mgplusaspirin25mg.Thedose
usedinthesecondarypreventionofstrokeisonecapsulepobid.
AnswerAisincorrect.
ThegenericnameforAngiomaxisbivalirudin.Bivalirudinisadirectthrombininhibitor.
AnswerBisincorrect.
ThegenericnameforAggrastatistirofiban.TirofibanisaglycoproteinIIb/IIIainhibitor.
AnswerDisincorrect.
ThegenericnameforAbraxaneispaclitaxel.Paclitaxelisanantineoplasticagent.
20)A49yearoldwhitemanwithaPMHsignificantonlyforosteoarthritiswasdiagnosedwithan
ischemicstrokeduetoanatheroscleroticprocessseveraldaysago.Thepatientdrinksonetotwobeersper
dayanddeniessmoking.Familyhistoryisunremarkable.Hiscurrentlipidpanelisasfollows:TC168
mg/dL,TG88mg/dL,HDL44mg/dL,andLDL116mg/dL.Vitals:BP136/84mmHgandHR78
beats/min.Thephysicianyouareworkingwithwantstoknowifthispatientneedstobeplacedonstatin
therapy.Whatdoyourecommend?
A.Thispatientsonlymajorriskfactorforcoronary
heartdiseaseishisage.Hedoesnotneedtobeplacedonstatintherapy.B.Thispatientsonlymajorrisk
factorsforcoronaryheartdiseasearehisageandhistoryofpreviousischemicstroke.Hedoesnotneedto
beplacedonstatintherapy.C.Thispatientsonlymajorriskfactorsforcoronaryheartdiseasearehisage
andhistoryofpreviousischemicstroke.Hedoesnotneedtobeplacedonstatintherapy,buttherapeutic
lifestylerecommendationshouldbeinitiated.D.Statintherapyisrecommendedforallpatientswithan
atheroscleroticischemicstroke.Heshouldbeputonstatintherapy.
Feedback:
AnswerDiscorrect.
Allpatientswithatherosclerotic,ischemicstrokeshouldreceivestatintherapytoreducetheriskof
recurrentevents.
AnswersA,b,andCareincorrect.
Ifthispatienthadnothadanatheroscleroticischemicstroke,thenhewouldneedtohavehis10yearrisk
assessedbecauseheisbetweentheagesof40and75withanLDLbetween70and189mg/dL.Ifhis10
yearriskwas7.5%ormore,hewouldneedstatintherapy.
21)Whatlaboratoryvalueistraditionallyusedtomonitorthelevelofanticoagulationachievedwith
unfractionatedheparin?
A.Internationalnormalizedratio(INR)B.PT(Prothrombin
time)C.AntiXalevelD.Activatedpartialthromboplastintime(aPTT)
Feedback:
AnswerDiscorrect.
aPTTsareusedtomonitorunfractionatedheparinanticoagulation.WhentreatingACSthegoalaPTTis1.5
to2timesapatientsbaseline(approximately50to70seconds).
AnswerAisincorrect.
INRisusedtomonitorvitaminKantagonismtherapy(warfarin).
AnswerBisincorrect.
PTistheunstandardizedlaboratoryvalueassociatedwithINR.Thereforeitisalsousedtomonitorwarfarin
therapy.
AnswerCisincorrect.
AntiXalevelscanbemonitoredwhenpatientsareonlowmolecularweightheparin.Therearealsoan
increasingnumberofinstitutionsusingantiXalevelstomonitorunfractionatedheparin.However,thishas
notbeenusedhistorically.
22)Whichofthefollowingantiplatelet/anticoagulantregimenswouldberecommendedfortreatmentofa
NSTEMIpatientwithaheparinallergy?ThepatientisgoingtoreceivePCIlaterintheday.
A.BivalirudinB.EptifibatideandlowmolecularweightheparinC.Abciximabandunfractionated
heparinD.Fondaparinux
Feedback:
AnswerAiscorrect.
InpatientswithUAandNSTEMIbivalirudinmaybestartedpriortoPCI(ifPCIisplanned).Itisadirect
thrombininhibitoranddoesnotrequireconcomitantusewithheparinorglycoproteinIIb/IIIainhibitors.
AnswerBisincorrect.
Eptifibatidetherapyisappropriate,butadministrationwithLMWHisnotappropriateinthispatientdueto
heparinallergy.
AnswerCisincorrect.
AbciximabmaybeusedinthispatientsinceitisindicatedwhenPCIisplanned.Howeveritisnot
necessarytostartitearly.Also,thispatienthasaheparinallergyandshouldnotreceiveheparin.
AnswerDisincorrect.
Fondaparinuxwouldbesafetouseinpatientswithheparinallergies,howeveritisnotrecommendedwhen
PCIisplanned.
23)Oncetheacutephaseofmyocardialinfarctionhaspassed,whichofthefollowingtherapiesismost
likelytoslowthedevelopmentofheartfailure(HF)?
A.ClopidogrelB.Atenolol
C.RamiprilD.AmiodaroneE.Isosorbidemononitrate
Feedback:
AnswerCiscorrect.
Angiotensinconvertingenzymeinhibitor(ACEI),likeramipril,havebeenshowntopreventventricular
remodeling.Thisisthemainpathophysiologicchangethatresultsinheartfailurefollowingmyocardial
infarction.
AnswerAisincorrect.
ClopidogrelpreventsrecurrentischemiceventsandprovidesanimportantreductioninmorbiditypostMI,
howeverdoesnotalterprogressionofleftventriculardysfunction.
AnswerBisincorrect.
AtenololpreventsrecurrentischemiceventsandprovidesmortalitypostMI,howeverdoesnotalter
progressionofleftventriculardysfunction.
AnswerDisincorrect.
Amiodaronetreatsatrialandventriculararrhythmias,whichoccurwithincreasedfrequencyfollowing
ACS.However,itdoesnotaffectheartfailureprogression.
AnswerEisincorrect.
Isosorbidemononitrateandothernitrateproductsshouldbeconsideredforpatientstotreatongoing
symptomsofischemicheartdiseasenotrelievedwithblockers.However,theydonotalter
cardiovascularmortalityorpreventheartfailure.
24)TLisan82yearoldwomanwhoisstatuspostdrugelutingstentplacementfollowingpresentations
withaSTEMI.Shehasapastmedicalhistorysignificantforhypertension,dyslipidemia,and
hypothyroidism.Shehasnoknowndrugallergies.Whichofthefollowingisthebestchoiceoflongterm
antiplatelettherapy?
A.Aspirin325mgorallydailyB.Aspirin325mgplus
Ticagrelor90mgorallytwicedailyC.Ticagrelor180mgorallytwicedailyD.Aspirin81mgplus
clopidogrel75mgorallydailyE.Clopidogrel75mgorallydaily
Feedback:
AnswerDiscorrect.
Thisregimenoflowdoseaspirinandathienopyridinerepresentsthebestoptioninthispatient.Aspirin
plusclopidogrelshouldbecontinuedforatleastayearfollowingdrugelutingstentplacement.
AnswerAisincorrect.
Followingtreatmentwithdrugeluginbcoronaryarterystentsdualantiplatelettherapyisindicated(aspirin
plusthienopyridine).
AnswerBisincorrect.
Althoughuseoflowdoseaspirinisappropriate,Ticagrelorisonlyapprovedtobegivenwith75100
mg/dayofaspirin.
AnswerCisincorrect.
Followingtreatmentwithcoronaryarterystentsdualantiplatelettherapyisindicated(aspirinplus
thienopyridine).Thedoseforticagreloris90mgorallytwicedaily.
AnswerEisincorrect.
Followingtreatmentwithcoronaryarterystentsdualantiplatelettherapyisindicated(aspirinplus
thienopyridine).Thiswouldbeanoptionforpatientswithaspirinallergies.
25)Amiodaronerequiressubstantialsafetymonitoringduringlongtermtherapyduetoitsnumerousside
effects.Whichofthefollowingisrequiredtoberoutinelyperformedinapatientonlongtermamiodarone
therapy?
A.HepaticfunctionpanelB.RenalfunctionpanelC.Erythrocyte
SedimentationRateD.Btypenatriureticpeptidelevels
Feedback:
AnswerAiscorrect.
Amiodaronecancauseelevationsinliverfunctiontest(LFT)andmayrequiredoseadjustmentinpatients
withliverimpairment.Hepaticfunctionpanelsshouldbemonitoredroutinely.
AnswerBisincorrect.
Amiodaroneisnotappreciablyeliminatedbythekidneys.
AnswerCisincorrect.
Amiodaroneisnotknowntoaffectsedimentationrates.
AnswerDisincorrect.
AmiodaronedoesnotaffectBtypenatriureticpeptide(BNP)levels,whichisconsideredameasurementof
heartfailurestatusandresponsetoventricularstretch.
26)Dofetilideisindicatedinwhichofthefollowing?
A.Apatientinitiatedinan
outpatientsettingB.ApatientwithCrClC.AbaselineQTc510millisecondD.Apatientwithleft
ventricularhypertrophy
Feedback:
AnswerDiscorrect.
Dofetilideisrelativelysafeinpatientswithstructuralheartdiseaseandventricularhypertrophy.
AnswerAisincorrect.
Dofetilidemustbeinitiatedinaninpatientsettingundertelemetry.
AnswerBisincorrect.
DofetilideiscontraindicatedinpatientswithaCrCl
AnswerCisincorrect.
DofetilideiscontraindicatedinpatientswithaQTc>440millisecond(or500millisecondwithaventricular
conductionabnormality).
27)Whichantiarrhythmicdrugissafetouseformaintenanceofsinusrhythminapatientwithatrial
fibrillation,heartfailure,andanejectionfractionof15%?
A.SotalolB.Flecainide
C.AmiodaroneD.Procainamide
Feedback:
AnswerCiscorrect.
Amiodaroneissafeforuseinpatientswithheartfailureandimpairedventricularoutput.
AnswerAisincorrect.
Sotalol,aClassIIIantiarrhythmic,whileusedoftenforatrialfibrillationandventriculararrhythmias,isnot
safeforuseinpatientswithleftventriculardysfunctionandheartfailure.
AnswerBisincorrect.
Flecainide,aClassIcantiarrhythmic,whileusedoftenforatrialfibrillation,isnotsafeforpatientswith
impairedleftventricularfunction.
AnswerDisincorrect.
Procainamide,aClassIaantiarrhythmicisnotsafeforthispatient.ClassIaagentsarenottypically
recommendedforatrialarrhythmiasanylonger.
28)Whatantiarrhythmicdrughasthepotentialforcausingtastedisturbances?
A.NorpaceB.MexitilC.BetapaceD.Rythmol
Feedback:
AnswerDiscorrect.
Rythmol(propafenone)canillicittastedisturbances.
AnswerAisincorrect.
Norpace(disopyramide)hasnotbeenshowntoproducetastedisturbances.
AnswerBisincorrect.
Mexitil(mexiletine)hasnotbeenshowntoproducetastedisturbances.
AnswerCisincorrect.
Betapace(sotalol)hasnotbeenshowntoproducetastedisturbances.
29)KGisa55yearoldmanwhopresentswithrecurrentcomplaintsofshortnessofbreathanddescribes
feelinglikehisheartisracing.AnECGisperformedanditisdeterminedthatheisinatrialfibrillationwith
aventricularrateof160bpm.Anevaluationofhisleftventricularfunctionconcludedthathisejection
fractionis35%.Whilethepatientwasstillintheexaminationroom,hereportsthathissymptomshave
subsidedandarepeatECGwascompletedanditwasfoundthatthepatientwasinnormalsinusrhythm.
WhatmedicationshouldbeprescribedtoKGtocontrolhisrate?
A.Flecainide
B.AmiodaroneC.DiltiazemD.Verapamil
Feedback:
AnswerBiscorrect.
IfapatientpresentingwithAFisstable,theinitialfocusoftherapyisratecontrol.Inpatientswith
decreasedLVfunction(EF40%),digoxinoramiodaronearetherecommendedtreatmentsforrate
control
AnswerAisincorrect.
FlecainideiscontraindicatedinpatientswithstructuralheartdiseaseandlowEF.
AnswerCisincorrect.
DiltiazemorothercalciumchannelblockersareusedinAFratecontrolifthepatienthasnocomorbid
conditions.Inaddition,diltiazemiscontraindicatedinpatientswithLVdysfunction.
AnswerDisincorrect.
VerapamilorothercalciumchannelblockersareusedinAFratecontrolifthepatienthasnocomorbid
conditions.Inaddition,verapamiliscontraindicatedinpatientswithLVdysfunction.
30)CRisa57yearoldmalepatientwhowaspreviouslydiagnosedwithirondeficiencyanemia.Hehas
beentakingoralironsupplementationasdirectedfor16weekswithoutachievinghisgoalhemoglobinof
12g/dL.Hismostrecenthemoglobinlevelwas9.8g/dL.Thedecisionhasbeenmadetoadminister
intravenousirondextran.Heis5ft11intallandweighs186lb.Whatisthecorrectdoseofirondextranfor
CR?
A.25mLB.27mLC.30mLD.37mL
Feedback:
AnswerBiscorrect.
Usingtheequation:Doseofirondextrancanbecalculatedby:Dose(mL)=0.0442(DesiredHb
ObservedHb)LBW+(0.26LBW).Herdosecalculatesat27mL.Thevariableusedaredesired
hemoglobin12g/dL,observedhemoglobin9.8g/dL,LBW(leanbodyweight)75.3kg.LBWiscalculated
foramaleas50+2.3(ht60)wherehtismeasuredininches.
AnswerAisincorrect.
ThisisthevaluethatiscalculatedifyouusetheLBWformulaforafemalepatient.
AnswerCisincorrect.
ThisisthevalueifyoucalculatedthedoseusingactualbodyweightinsteadofLBW.
AnswerDisincorrect.
Thisisthevalueifyoucalculatedthedoseusing16g/dLasyourtargethemoglobin.
31)RHisa47yearoldwomanwhoisadmittedtothehospitalforpneumonia.Duringhisclinicaland
laboratoryevaluation,hewasfoundtohaveamicrocyticanemia.Whichofthefollowingadditional
diagnostictestswouldbemostusefulindeterminingifRHhasanemiaduetoirondeficiency?
A.FerritinB.RedcelldistributionwidthC.TransferrinsaturationD.Reticulocytecount
Feedback:
AnswerCiscorrect.
Therearemultipleindicesthatcanbeusefulinassessingironstores,includingferritinandtransferrin
saturation.Ferritinisanacutephasereactantandiselevatedinpatientswithanacuteillness,suchas
pneumonia.Transferrinsaturationisnotaffectedbyacuteillnessandisamorereliableindicatorofiron
storesinthissituation.
AnswerAisincorrect.
Ferritinisanacutephasereactantandisfalselyelevatedinacuteillnesses.Thiscanleadtoclinicians
falselyconcludingthepatientisnotdeficientiniron.
AnswerBisincorrect.
Theredcelldistributionwidthmeasuresthevariabilityinsizesofredbloodcells.Itisatoolthatis
especiallyusefulwhenmultiplecausesofanemiaaresuspected.
AnswerDisincorrect.
Intheassessmentofanemiathereticulocytecountisagoodmeasureofbonemarrowresponse.Inthe
settingofanemiathereticulocytecountshouldbeelevatedasthemarrowworkstoproducemoreredblood
cells.Ifthereticulocytecountisnotelevated,itcouldindicatethereisdifficultywithproductionofnewred
bloodcells.Itwillnothelpdetermineironstatus.
32)Whichofthefollowingironpreparationsrequiresaprescription?
A.Ferrous
fumarateB.PolysaccharideironcomplexC.FerroussulfateD.Ferrousgluconate
Feedback:
AnswerBiscorrect.
Polysaccharideironcomplexisaprescriptiononlymedication.Theoriginalbrandnameproductis
Niferex.
AnswerAisincorrect.
FerrousfumarateisavailablewithoutaprescriptionunderthebrandnameFeostat(amongothers).
AnswerCisincorrect.
FerroussulfateisavailablewithoutaprescriptionunderthebrandnameFeosol(amongothers).
AnswerDisincorrect.
FerrousgluconateisavailablewithoutaprescriptionunderthebrandnameFergon(amongothers).
33)Selectthecellthatispartofcellmediatedimmunity.
A.Blymphocyte
B.NeutrophilC.MacrophageD.TlymphocyteE.Complement
Feedback:
AnswerDiscorrect.
Tlymphocytescomposethecellmediatedpartoftheadaptivefunctionaldivisionandaretailoredto
defendagainstinfectionsthatareintracellular(viralinfections).
AnswerAisincorrect.
Blymphocytescomposethehumoralpartoftheadaptiveimmunesystemandsecreteantibodiesthat
neutralizepathogenspriortotheirentryintohostcells.Bcells,onceactivatedbyTcellsorantigen
presentingcells,becomeaplasmacellthatwillproduceoneoffiveimmunoglobulintypes:IgA,IgD,IgE,
IgG,orIgM.
AnswerBisincorrect.
Neutrophilsarekeycellsoftheinnatechemicalimmunitythatfightoffbacterialinfections.
AnswerCisincorrect.
Macrophagesarethemainscavengercellsoftheimmunesystem.Inadditiontoattackingforeigncells,
theyareinvolvedinthedestructionofolderythrocytes,denaturedplasmaproteins,andplasmalipids.
AnswerEisincorrect.
Thecomplementsystemisamediatorofinnateimmunity.Thecomplementsystemconsistsofmultiple
proteinsthatplayakeyroleinimmunedefense.Thecomplementsystemservesasanadjunctor
complementtohumoralimmunity.
34)BandTlymphocytesmaybedistinguishedfromeachotherbythepresenceoflineagespecific
membranemarkerstermed:
A.Clustersofdifferentiation(CD)B.Complement
C.Creactiveprotein(CRP)D.ChemokinesE.CCR5coreceptor
Feedback:
AnswerAiscorrect.
Morphologicdifferentiationoflymphocytesisdifficult,andvisualinspectionofabloodsmearcannot
distinguishbetweenTandBcells.Fortunately,lymphocytescanbedistinguishedbythepresenceof
lineagespecificmembranemarkers,termedclustersofdifferentiation(CD).MatureTcellsareCD4or
CD8andBcellsareCD20.Identificationofthesubtypeoflymphocyteisnotaroutineclinicalhematology
test;lymphocytesarereportedasatotallymphocytecountonthecompletebloodcount(CBC).An
exceptionisthereporting/monitoringofCD4cellsforpatientswithhumanimmunodeficiencyvirus(HIV).
AnswerBisincorrect.
Thecomplementsystemisamediatorofinnateimmunity.Thecomplementsystemconsistsofmultiple
proteinsthatplayakeyroleinimmunedefense.Thecomplementsystemservesasanadjunctor
complementtohumoralimmunity.
AnswerCisincorrect.
Creactiveproteinisanacutephasereactantproducedbytheliverduringearlystagesofinfectionor
inflammation.Acutephasereactantsorproteinsincreaseinresponsetoinflammatorystimulisuchastissue
injuryorinfection.RecentclinicalevidencefoundthatCRPisalsoreleasedinresponsetoinflammatory
markerspresentwithinatheroscleroticplaquesandleadstocardiovasculardisease.Cholesterolmedications
(HMGCoAreductaseinhibitors/statins)decreaseCRPlevelsandrosuvastatinwasfoundtodecrease
cardiovasculardiseaseinpatientswithelevatedCRPlevels.
AnswerDisincorrect.
Chemokinesplayanessentialroleinlinkingtheinnateandadaptiveimmuneresponsesbyorchestrating
traffic.Thechemokinesystemconsistsofagroupofsmallpolypeptidesandtheirreceptors.Chemokines
possessfourcysteines.Baseduponthepositionsofthecysteines,almostallchemokinesfallintooneof
twocategories:(1)CCgroupor(2)CXCgroup.
AnswerEisincorrect.
CCR5isachemokinereceptorlocatedonCD4cells.MaravirocblocksCCR5andtheCCR5antagonism
preventsinteractionbetweenthehumanCCR5coreceptorandthegp120subunitoftheviralenvelope
glycoprotein,therebyinhibitinggp120conformationalchangerequiredforthefusionofCCR5HIVwith
theCD4cellandsubsequententry.
35)Duetoanincreasedriskofpulmonaryhemorrhage,bevacizumabshouldbeavoidedinpatientswith
NSCLCofwhichhistology?
A.AdenocarcinomaB.LargecellC.Bronchoalveolar
D.Squamous
Feedback:
AnswerDiscorrect.
Bevacizumabshouldnotbeusedinsquamouscellcarcinomaofthelungbecauseofitsassociationwith
causingpulmonaryhemorrhageinthissubtypeoflungcancer.
AnswerAisincorrect.
Bevacizumabcanbesafelyusedinpatientswithadenocarcinomaofthelungbutnotsquamouscell.
AnswerBisincorrect.
Bevacizumabcanbesafelyusedinpatientswithlargecellcarcinomaofthelungbutnotsquamouscell.
AnswerCisincorrect.
Bevacizumabcanbesafelyusedinpatientswithbronchoalveolarsubtypeofadenocarcinomaofthelung
butnotsquamouscell.
36)Whichofthefollowingisthetradenameofbevacizumab?
A.GemzarB.Avastin
C.TaxotereD.VePesid
Feedback:
AnswerBiscorrect.
Avastinisthetradenameforbevacizumab.
AnswerAisincorrect.
Gemzaristhetradenameforgemcitabine.
AnswerCisincorrect.
Taxotereisthetradenamefordocetaxel.
AnswerDisincorrect.
VePesidisoneofthetradenamesforetoposide.
37)Patientsreceivingpemetrexedshouldalsoreceivewhichofthefollowing?
A.Folate
andvitaminB12supplementationB.AggressivehydrationwithnormalsalineC.Oralpotassiumand
magnesiumsupplementationD.Caroteneandtocopherolsupplementation
Feedback:
AnswerAiscorrect.
FolateandvitaminB12supplementationisrequiredtominimizethemyelosuppressionassociatedwith
pemetrexed.Therecommendeddosesarefolate1mgpodailyandvitaminB121mgSC/IMevery3
months.
AnswerBisincorrect.
Aggressivehydrationwithnormalsalineisneededtopreventthenephrotoxicityofcisplatin.
AnswerCisincorrect.
Oralpotassiumandmagnesiumsupplementationmaybeneededforpatientsreceivingcisplatinnot
pemetrexed.
AnswerDisincorrect.
Caroteneandtocopherolhavebeenusedunsuccessfullytopreventlungcancer,andtheydonot
mitigateanyofthetoxicitiesofpemetrexed.
38)Whichofthefollowingisthetradenameofpemetrexed?
A.ParaplatinB.Taxol
C.AlimtaD.Taxotere
Feedback:
AnswerCiscorrect.
Alimtaisthetradenameforpemetrexed.
AnswerAisincorrect.
Paraplatinisthetradenameforcarboplatin.
AnswerBisincorrect.
Taxolisthetradenameforpaclitaxel.
AnswerDisincorrect.
Taxotereisthetradenamefordocetaxel.
39)Whichofthefollowingpatientswithsmallcelllungcancershouldreceiveprophylacticcranial
irradiation?
A.AllpatientswithlimitedstageSCLC.B.Allpatientswithextensive
stageSCLC.C.PatientswithlimitedstageSCLCwhoachieveacompleteresponsetotheirinitialtherapy.
D.PatientswithextensivestageSCLCwhodonotrespondtotheirinitialtherapy.
Feedback:
AnswerCiscorrect.
Whetherlimitedorextensivestage,patientswithSCLCwhoachieveacompleteresponsetotheir
chemotherapyregimenshouldreceiveprophylacticcranialirradiation(PCI).Inthissituation,PCI
decreasestheincidenceofbrainmetastasesandimprovesoverallsurvival.
AnswerAisincorrect.
ProphylacticcranialirradiationisonlyrecommendedinSCLC,whetherlimitedorextensivestage,ifthe
patientachievesacompleteresponsetotheirchemotherapyregimen.
AnswerBisincorrect.
AnswerDisincorrect.
40)SOisa67yearoldmanwhowasrecentlydiagnosedwithprostatecancerandisinitiatedonleuprolide
forandrogendeprivation.Whichofthefollowingagentsshouldbeaddedtohistherapytopreventtumor
flare?
A.BicalutamideB.FinasterideC.MitoxantroneD.Goserelin
Feedback:
AnswerAiscorrect.
ThemostcommonadverseeffectsreportedwithLHRHagonisttherapyincludeadiseaseflareupduring
thefirstweekoftherapy,hotflashes,erectileimpotence,decreasedlibido,andinjectionsitereactions.The
diseaseflareupiscausedbyaninitialinductionofLHandFSHbytheLHRHagonist,leadingtoaninitial
phaseofincreasedtestosteroneproductionandmanifestsclinicallyaseitherincreasedbonepainor
increasedurinarysymptoms.InitiatinganantiandrogenpriortotheadministrationoftheLHRHagonist
andcontinuingfor1weekisafrequentlyemployedstrategytominimizethisinitialtumorflare.
AnswerBisincorrect.
Finasterideisa5reductaseinhibitorhasbeenevaluatedforthepreventionofprostatecancer,notthe
treatmentofprostatecancer.
AnswerCisincorrect.
Mitoxantroneisusedinmetastaticcastrateresistantprostatecancerinpatientswhohavefailedother
therapies,althoughtheeffectivenessofthisagentinprostatecancerhasnotbeendetermined.
AnswerDisincorrect.
GoserelinisanLHRHagonist.ItwouldnotbeappropriatetoplacethepatientontwoLHRHagonists.
41)Whichofthefollowingsideeffectsareassociatedwithflutamide?
A.Constipation
B.IncreasedlibidoC.RashD.Diarrhea
Feedback:
AnswerDiscorrect.
Flutamidecausesdiarrhea.
AnswerAisincorrect.
Flutamidedoesnotcauseconstipationbutactuallycausesdiarrhea.
AnswerBisincorrect.
Flutamideisnotassociatedwithincreasedlibido.
AnswerCisincorrect.
Rashisnotasideeffectofflutamidetherapy.
42)WhichofthefollowingLHRHagonistsisgivensubcutaneouslyevery12months?
A.Leuprolideimplant(Viadur)B.Goserelinimplant(Zoladex)C.Leuprolidedepot(Lupron)
D.Triptorelindepot(TrelstarDepot)
Feedback:
AnswerAiscorrect.
Theleuprolideimplantisadministeredsubcutaneouslyandisaminiosmoticpumpthatdelivers120gof
leuprolidedailyfor12months.After12monthstheimplantisremoved,andadifferentimplantcanbe
placed.
AnswerBisincorrect.
Goserelinacetateimplantcontainsgoserelinacetatedispersedinaplasticmatrixof D,Llacticandglycolic
acidcopolymerandisadministeredsubcutaneouslyeverymonthorevery3months.Hydrolysisofthe
copolymermaterialprovidescontinuousreleaseofgoserelinoverthedosingperiod.
AnswerCisincorrect.
Theleuprolidedepotformulationisnotaminiosmoticpumpandisdosedmonthly,every3months,or
every4months.
AnswerDisincorrect.
Triptorelindepotisadministeredintramuscularlyevery28days.
43)WhichofthefollowingLHRHagonistscontainscoatedpelletsandisadministeredintramuscularlyto
allowforsustainedlevelsthroughoutthedosinginterval?
A.Leuprolideimplant
(Viadur)B.Goserelinimplant(Zoladex)C.Leuprolidedepot(Lupron)D.Triptorelindepot(Trelstar
Depot)
Feedback:
AnswerCiscorrect.
Theleuprolidedepotformulationcontainsleuprolideacetateincoatedpelletsthatisadministered
intramuscularlymonthly,every3months,orevery4months.
AnswerAisincorrect.
Theleuprolideimplantisadministeredsubcutaneouslyandisaminiosmoticpumpthatdelivers120gof
leuprolidedailyfor12months.After12monthstheimplantisremoved,andadifferentimplantcanbe
placed.
AnswerBisincorrect.
Goserelinacetateimplantcontainsgoserelinacetatedispersedinaplasticmatrixof D,Llacticandglycolic
acidcopolymerandisadministeredsubcutaneouslyeverymonthorevery3months.Hydrolysisofthe
copolymermaterialprovidescontinuousreleaseofgoserelinoverthedosingperiod.
AnswerDisincorrect.
Triptorelindepotisadministeredintramuscularlyevery28days.
44)PremenopausalwomenwithERnegative,nodepositivebreastcancerisstartingdoxorubicinand
cyclophosphamideadjuvanttreatment.Whatwouldyourecommendtodeterminetheseverityofthemost
commontoxicityassociatedwiththistreatmentregimen?
A.AnelectrocardiogramB.A
completebloodcountincludingplateletsoneweekafteradministrationofthechemotherapy.C.Serum
bilirubinandaspartatetransaminaseD.Urinalysis
Feedback:
AnswerBiscorrect.
Myelosuppression(neutropenia,thrombocytopenia)isthemostcommontreatmentrelatedadverseeffect
associatedwiththisadjuvanttreatmentregimen.Nearly100%ofpatientsreceivingthistreatmentregimen
willexperiencemyelosuppression.
AnswerAisincorrect.
Althoughdoxorubicinhasbeenassociatedwithcardiomyopathythatincreasesinincidencewith
cumulativedosesexceeding400mg/m2.Theincidenceofcardiomyopathyinpatientsadministered
cumulativedosesexceeding400mg/m2isintherangeof5%.Itisnotthemostcommontoxicityassociated
withthistreatmentregimen.
AnswerCisincorrect.
Althoughthesedrugsmaycauseelevationsofserumbilirubinandaspartatetransaminase,itoccursless
frequentlythanmyelosuppression.
AnswerDisincorrect.
Althoughurinalysiscouldbeusefulindetectinghematuriacausedbycyclophosphamide,thisadverse
effect(hemorrhagiccystitis)occursinfrequentlywiththisadjuvantchemotherapyregimen.
45)Selectthetoxicitythathasbeenassociatedwiththeadministrationofbothtrastuzumaband
bevacizumab.
A.MyelosuppressionB.GIperforationC.AlopeciaD.Infusion
reactions
Feedback:
AnswerDiscorrect.
Trastuzumabandbevacizumabaremonoclonalantibodiesadministeredbyintravenousinfusion.Infusion
reactions(theonsetofchills,fever,changesinbloodpressurewithin1hourofadministration)havebeen
reportedtooccurwithbothagents.
AnswerAisincorrect.
Trastuzumabandbevacizumabaremonoclonalantibodiesthatarerarelyassociatedwithmyelosuppression.
AnswerBisincorrect.
AlthoughGIperforationisaknownbevacizumabtoxicity,itisnotassociatedwiththeadministrationof
trastuzumab.
AnswerCisincorrect.
Monoclonalantibodiesarenotassociatedwithhairloss.
46)WhichofthefollowingregimensisrecommendedfirstlineforadjuvanttreatmentofstageIIIcolon
cancer?
A.FluorouracilplusleucovorinB.FOLFOXC.FOLFIRID.IFL
E.Fluorouracilplusradiation
Feedback:
AnswerBiscorrect.
TheMOSAICtrialdemonstratedaddingoxaliplatintoinfusionalfluorouracilinstageIIIpatients.Both
increasedthediseasefreesurvivalandoverallsurvival.
AnswerAisincorrect.
Ifpatientscantolerateasecondchemotherapyagent,multipleclinicaltrialshaveshownabenefitofadding
oxaliplatintofluoropyrimidinebasedchemotherapy.
AnswerCisincorrect.
Addingirinotecantoinfusionalfluorouraciltherapyhasnotdemonstratedclinicallysignificantoutcomesin
theadjuvantsetting,butitcanbeconsideredasafirstlinetherapyformetastaticdisease.
AnswerDisincorrect.
HighratesofGItoxicityhavemadebolusfluorouracilplusirinotecannolongerrecommendedstandard
therapyforcoloncancers.
AnswerEisincorrect.
Chemoradiationisafirstlineadjuvanttherapyforrectalcancers.
47)WKisa36yearoldmalewithnewlydiagnosedunresectableBRAFV600E(+)melanoma.Heisin
excellenthealthwithnocomorbidconditions.WKisbeingadmittedtotheoncologyunittostarttreatment
withinterleulin2.WhichofthefollowingisthecorrectFDAapproveddosingofinterleukin2whenused
assingleagentfortreatmentofunresectablemelanoma?
A.375mg/m2IVPBon
days1and15withcyclerepeatevery28daysB.20millionIU/m2IVPBfivetimesweeklyfor4weeks,
then10millionIU/m2subcutaneouslythreetimesweeklyfor48weeksC.250mg/m2IVPBondays1to5
withcyclerepeatevery21daysD.600,000IU/kgIVPBevery8hoursforamaximumof14doses;repeat
after9daysforatotalof28dosespercourseE.150mg/m2podailyfor5dayswithcyclerepeatevery28
days
Feedback:
AnswerDiscorrect.
TheFDAapproveddosingofinterleukin2whenusedasasingleagentforthetreatmentofmelanomais
600,000IU/kgIVPBevery8hoursforamaximumof14doses;repeatafter9daysforatotalof28doses
percourse.Retreatifneededin7weeksafterpreviouscourse.
AnswerAisincorrect.
Incorrectdosingofinterleukin2whenusedasasingleagentforthetreatmentofmelanoma.
AnswerBisincorrect.
AnswerCisincorrect.
AnswerEisincorrect.
48)RCisa47yearoldmalewithstageIVunresectablemelanomawhoisinthehospitalforhistreatment
withhighdoseinterleukin2(IL2).SelectthesideeffectassociatedwithIL2thatcanleadtohypotension
andreducedorganperfusion.
A.CapillaryleaksyndromeB.Myelosuppression
C.AnemiaD.HepatotoxicityE.Delirium
Feedback:
AnswerAiscorrect.
VascularorcapillaryleaksyndromeisadoselimitingtoxicitycommonlyreportedwithIL2.Itcanbe
observedimmediatelyafterinitiationoftherapy;clinicalpresentationsmayincludeweightgain,ascites,
peripheraledema,arrhythmiasand/ortachycardia,hypotension,oliguriaandrenalinsufficiency,pleural
effusions,andpulmonarycongestion.
AnswerBisincorrect.
Myelosuppression,withneutropenia,anemia,andthrombocytopenia,hasbeenreportedwithIL2,butdoes
notusuallyleadtohypotensionandreducedorganperfusion.Monitorpatientscloselyforanyinfectious
process.
AnswerCisincorrect.
AnemiahasbeenreportedwithIL2,butdoesnotusuallyleadtohypotensionandreducedorganperfusion.
AnswerDisincorrect.
HepatotoxicityhasbeenreportedwithIL2,butdoesnotusuallyleadtohypotensionandreducedorgan
perfusion.
AnswerEisincorrect.
DeliriumshavebeenobservedwithIL2andgenerallyresolvewhentherapyisdiscontinued,butdoesnot
usuallyleadtohypotensionandreducedorganperfusion.
49)Anewlydiagnosedpatientwithacutepromyelocyticleukemia(APL)beginstreatmentwithtretinoin
40mgorallytwicedaily.Within48hoursoftheinitiation,thepatientdevelopsfever,dyspnea,and
respiratorydistress.Whichofthefollowingshouldbeimmediatelyinitiatedtotreatapparentdifferentiation
syndrome(DS)?
A.DexamethasoneB.AcetaminophenC.Diphenhydramine
D.Epinephrine
Feedback:
AnswerAiscorrect.
Dexamethasone10mgIVevery12hoursisrecommendedfor3daysoruntilresolutionofsymptoms,
immediatelystartingatonsetofsymptomsofDS.Steroidshaveshownamortalitybenefit.
AnswerBisincorrect.
AcetaminophenisnotrecommendedinthemanagementofDS.
AnswerCisincorrect.
DiphenhydramineisnotrecommendedinthemanagementofDS.
AnswerDisincorrect.
Epinephrineisusedforanaphylacticreactions,notapplicableinthisclinicalsetting.
50)GHpresentstoyourpharmacywithaprescriptionforclarithromycin.Hesaysthathisprimarycare
physicianprescribedthismedicationtotreatcommunityacquiredpneumonia.YoureviewGHs
medicationprofileandyouseethathereceivedarenaltransplanttwoyearsagoandhis
immunosuppressiveregimenincludestacrolimus,mycophenolatemofetil,andprednisone.Whichofthe
followingwouldbemostappropriateasyournextcourseofaction?
A.Dispense
clarithromycinandcounselonavoidinggrapefruitjuice.B.Contacttheprescriberabouttheinteractions
betweenclarithromycinandtacrolimusasclarithromycinwillinhibitthemetabolismoftacrolimus
resultinginsupratherapeuticlevelsandtoxicity.C.Contacttheprescriberabouttheinteractionsbetween
clarithromycinandmycophenolatemofetilasclarithromycinwillinhibitthemetabolismofmycophenolate
mofetilresultinginsupratherapeuticlevelsandtoxicity.D.Recommendanalternativeasclarithromycinis
notanappropriatetherapyforcommunityacquiredpneumoniainanimmunosuppressedhost.
Feedback:
AnswerBiscorrect.
ClarithromycinisaninhibitorofCYP3A,andthereforewillinhibitthemetabolismoftacrolimusresulting
insupratherapeuticconcentrationsandpotentialtoxicity.
AnswerAisincorrect.
ClarithromycinisaninhibitorofCYP3A,andthereforewillinhibitthemetabolismoftacrolimusresulting
insupratherapeuticconcentrationsandpotentialtoxicity.
AnswerCisincorrect.
Mycophenolatemofetilismetabolizedtoitsactivemetabolite,mycophenolicacidwhichthenundergoes
enterohepaticrecirculationuntilitiseventuallyclearedviahepaticglucuronidation.Clarithromycinwill
notsignificantlyaffectmycophenolateclearance.
AnswerDisincorrect.
Generalimmunosuppressedstateisnotacontraindicationfortheuseofclarithromycin,aslongasthe
organismsisolatedorsuspectedaresusceptibletothisagent.
51)AJisalungtransplantrecipientwhoisfoundtohaveAspergillusonroutinebronchoscopy.AJs
transplantphysicianwantstobegintreatmentwiththeantifungalvoriconazoleandisinquiringwhichofthe
medicationshispatientistakingwillinteractwithvoriconazole.Thepatientiscurrentlytakingprednisone,
cyclosporine,azathioprine,clotrimazole,rabeprazole,cotrimoxazole,valganciclovirandinhaled
amphotericin.
A.PrednisoneB.AzathioprineC.CyclosporineD.Valganciclovir
Feedback:
AnswerCiscorrect.
VoriconazoleisapotentinhibitorofCYP3AandPglycoprotein.Cyclosporineisextensivelymetabolized
viaCYP3AandalsoasubstrateofPglycoprotein.Voriconazolewillsignificantlyincreasecyclosporine
levels,anditisrecommendedtodecreasecyclosporinedosingempiricallybymorethan50%toavoidtoxic
serumconcentrations.
AnswerAisincorrect.
VoriconazoleisapotentinhibitorofCYP3AandPglycoprotein.Prednisoneisnotsuspectedtointeract,as
itisnotinvolvedwitheitherofthesemechanisms.
AnswerBisincorrect.
VoriconazoleisapotentinhibitorofCYP3AandPglycoprotein.Azathioprineisnotsuspectedtointeract,
asitismetabolizedtoitsinactivemetaboliteviaxanthineoxidase.
AnswerDisincorrect.
VoriconazoleisapotentinhibitorofCYP3AandPglycoprotein.Followingoraladministration,
valganciclovirishydrolyzedtoganciclovir,whichisthenexcretedrenally.Therefore,nointeractionis
suspectedbetweentheseagents.
52)Apatientwithahealthcareassociatedpneumoniainfectionisfoundtohaveamultidrugresistant
organism(thiswasfoundbythecultureandsusceptibilityandthepathogenP.aeruginosaexhibitsahigh
MICtoallantibiotics).Sincethepathogenexhibitsahighlevelresistance,modificationstothedoseor
intervalwillberequiredtoachievesuccessfuloutcomes.Currentlythepatientisreceivingthe lactam
piperacillin/tazobactam4.5gintravenouslyevery6hoursinfusedover30minutes.Selectthefactorthat
maybedonetopiperacillin/tazobactamthatcouldoptimizethepharmacodynamicproperty.
A.IncreasetheinfusiontimeB.IncreasethedoseC.Addcombinationtherapywithanotherlactam
D.Decreasethedoseto3.375mg
Feedback:
AnswerAiscorrect.
Lactamantimicrobialsareoftenadministeredintravenouslyas30minuteinfusions.Anexampleis
piperacillin/tazobactam(Zosyn)4.5gintravenouslyevery6hoursinfusedover30minutes.Ineffortsto
optimizethetimedependentactivityoflactams,extendingtheinfusionintervalisbeingclinically
utilized(piperacillin/tazobactam3.375gintravenouslyevery8hoursinfusedover4hours).Extendingthe
infusionintervalallowsfortheconcentrationtoremainabovetheminimalinhibitoryconcentrationfor
longerperiodsoftime(timedependentactivity).
AnswerBisincorrect.
Increasingthedosewouldoptimizethepharmacodynamicpropertyforconcentrationdependentagents,not
timedependentagents.
AnswerCisincorrect.
Acommonsubjectofdebateinvolvestheutilizationofcombinationofantiinfectivetherapy.Proponents
statethatdoublecoveragemaybesynergistic,preventtheemergenceofresistance,andimproveoutcomes.
However,therearefewclinicalexamplesintheliteraturetosupporttheseassertions.Doubleantimicrobial
coveragemaybebeneficialforselectedinfectionsassociatedwithhighbacterialloadsorforinitial
empiricalcoverageofcriticallyillpatientsinwhomantimicrobialresistantorganismsaresuspected.
Monotherapyusuallyissatisfactoryonceantimicrobialsusceptibilitiesareknown.Inthecaseapplication
questionabove,thecombinationofthetwoantiinfectiveswouldnotbeidealbecausetheyareofthesame
mechanismofaction(lactams).Whentheclinicalsituationcallsforcombinationtherapy,utilizationof
drugswithdifferentmechanismsofactionispreferred.
AnswerDisincorrect.
DecreasingthedosewouldnotassistinoptimizingthePK/PDpropertyofpiperacillin/tazobactam.
Note:Someprovidersmaydecreasethedosewhentheyincreasetheinfusiontime.
53)Centralnervoussystem(CNS)sideeffects(seizuresandmentalstatuschanges)areassociatedwith
betalactamandquinoloneantiinfectives.Ariskfactorfordevelopmentofthecentralnervoussystem
reactionsis:
A.DurationoftherapyB.InfusionintervalC.BioavailabilityD.Renal
dysfunction
Feedback:
AnswerDiscorrect.
Antibioticassociatedcentralnervoussystemtoxicitiesmaybecommoneffectsforpenicillin,
cephalosporin,carbapenem,andquinoloneantiinfectives,especiallyifthedoseorintervalisnotadjusted
forrenaldysfunction.
AnswerAisincorrect.
DurationoftherapywouldnotbeafactorinCNSsideeffectsoflactamsorquinolones,unlessthepatient
wasaccumulating(noteliminating)theantiinfective.
AnswerBisincorrect.
Theinfusionintervalwouldnotimpactthecentralnervoussystemsideeffect.
AnswerCisincorrect.
Bioavailabilitywouldnotimpactthecentralnervoussystemsideeffect.
54)Selecttheantiinfectivethatisassociatedwiththeadverseeffectsofnephrotoxicityandototoxicity.
A.Amoxicillin/ClavulanateB.CefpodoximeC.MoxifloxacinD.Gentamicin
Feedback:
AnswerDiscorrect.
Theaminoglycosidegentamicin(Garamycin)isassociatedwithnephrotoxicityandototoxicity.
AnswerAisincorrect.
Thepenicillinlactamamoxicillin/clavulanate(Augmentin)isnotassociatedwithnephrotoxicityand
ototoxicity.
AnswerBisincorrect.
Thecephalosporinlactamcefpodoxime(Vantin)isnotassociatedwithnephrotoxicityandototoxicity.
AnswerCisincorrect.
Thefluoroquinolonemoxifloxacin(Avelox)isnotassociatedwithnephrotoxicityandototoxicity.
55)Selecttheparenteralcephalosporinthatisoftenadministeredintramuscularlyforacuteotitismedia.
A.ClarithromycinB.AmoxicillinclavulanateC.Trimethoprimsulfamethoxazole
D.ClindamycinE.Ceftriaxone
Feedback:
AnswerEiscorrect.
Ceftriaxoneisathirdgenerationcephalosporinthatisavailableonlyasaparenteralformulation.
Ceftriaxoneisusedintramuscularly.
AnswerAisincorrect.
Clarithromycinisusedfortreatmentofotitismedia;however,itisamacrolideandonlyavailableorally.
AnswerBisincorrect.
Amoxicillinclavulanateisusedforthetreatmentofotitismedia;however,itisapenicillinandonly
availableorally.
AnswerCisincorrect.
Trimethoprimsulfamethoxazoleisnotrecommendedfortheempirictreatmentofotitismedia;furthermore,
itisasulfonamideantibiotic.Trimethoprimsulfamethoxazoleisavailableinoralandparenteral
formulations.
AnswerDisincorrect.
Clindamycinisusedforthetreatmentofotitismedia(usedforPRSPitdoesnothavecoverageagainst
gramnegativebacteria);however,itisalincosamideantibiotic.Clindamycinisavailableinoraland
parenteralformulations;however,onlytheoralformulationisutilizedforotitismedia.
56)AQisa44yearoldfemalepatientwithapastmedicalhistoryofhypertensionanddyslipidemia.
Medicationsincludelisinoprilandsimvastatin.AQhasdevelopedpneumoniaandwouldliketotakean
oralagentthatwillnotinteractwithhermedications.Whichofthefollowingantibioticsusedinthe
treatmentofcommunityacquiredpneumoniaisastronginhibitoroftheCYP4503A4hepaticenzymeand
wouldhaveadruginteractionwithhermedications.
A.Azithromycin
B.ClarithromycinC.AmoxicillinD.Cefpodoxime
Feedback:
AnswerBiscorrect.
ClarithromycinisutilizedfortreatmentofCAP,inhibitsproteinsynthesis,andisastronginhibitorofthe
CYP4503A4hepaticenzyme.Thereforedruginteractionswiththemacrolideantimicrobialmaybe
common.MedicationsthataresubstratesoftheCYP4503A4hepaticenzymewillhavetheir
metabolism/clearancedecreased.CommonexamplesofsubstratesoftheCYP4503A4hepaticenzymeare
theazoleantifungals,calciumchannelblockers(verapamilanddiltiazem),andHMGCoAreductase
inhibitors,andmanyothers.
AnswerAisincorrect.
Theazalideazithromycinisutilizedforcommunityacquiredpneumonia(CAP)andinhibitsprotein
synthesis;however,itisaweakinhibitoroftheCYP4503A4hepaticenzyme.Druginteractionsarea
majordifferencebetweenthemacrolides(erythromycinandclarithromycin)andtheazalideazithromycin.
AnswerCisincorrect.
AmoxicillinmaybeusedaspartofatreatmentregimenforCAP;however,amoxicillindoesnotinhibitthe
CYP450system.
AnswerDisincorrect.
CefpodoximemaybeusedaspartofatreatmentregimenforCAP;however,cefpodoximedoesnotinhibit
theCYP450system.
57)Whatisthebrandnameoflinezolid?
A.TeflaroB.TygacilC.ZosynD.Zyvox
Feedback:
AnswerDiscorrect.
Zyvoxisthebrandnameoflinezolid.
AnswerAisincorrect.
Teflaroisthebrandnameofceftaroline.
AnswerBisincorrect.
Tygacilisthebrandnameoftigacycline.
AnswerCisincorrect.
Zosynisthebrandnameofpiperacillintazobactam.
58)Selecttheantibioticthatmaycauseanadversereactionduringorsoonafterinfusioncharacterizedby
itching,warmth,flushing,andrash(amongothersymptoms),especiallyifinfusedataratefasterthan
recommended.
A.AmpicillinB.CefazolinC.DaptomycinD.Vancomycin
Feedback:
AnswerDiscorrect.
Vancomycin,ifinfusedtooquicklymaycauseredmansyndrome.Redmansyndromeiscausedbyanon
immunereleaseofhistamineandischaracterizedbyitching,warmth,flushing,andrash(typicallyonface
anduppertorso).Insomecases,angioedema,tachycardia,andhypotensionmayalsooccur.Ittypically
occursduring,orsoonafteradministrationofvancomycinandresolveswithinafewhoursafterthe
infusion.Formostpatients,extendingtheinfusionofvancomycinand/orpretreatingwithanantihistamine
resolvesfutureepisodesofredmansyndrome.
AnswerAisincorrect.
Ampicillinmaycauseahypersensitivityreactionsimilartowhatisdescribedinthequestion,butitisnot
infusionrelated.
AnswerBisincorrect.
Daptomycinisnotassociatedwithaninfusionrelatedreactionasdescribed.
AnswerCisincorrect.
Cefazolinisnotassociatedwithaninfusionrelatedreactionasdescribed.
59)WhatistheappropriatedurationoftherapyforGB?
A.1dayB.3daysC.7days
D.14days
Feedback:
AnswerBiscorrect.
TheInfectiousDiseaseSocietyofAmerica(IDSA)recommends3daytherapyfortreatmentof
uncomplicatedlowertractinfectionsinwomen.
AnswerAisincorrect.
Multiplereviewshaveconcludedthat3daysoftherapyisbetterthan1dayoftherapy.TheInfectious
DiseaseSocietyofAmerica(IDSA)recommends3daytherapyfortreatmentofuncomplicatedlowertract
infectionsinwomen.
AnswerCisincorrect.
SevendaysisrecommendedinpregnantwomenorwomenwithahistoryofUTIscausedbyantibiotic
resistantbacteriaormorethan7daysofsymptoms.
AnswerDisincorrect.
Fourteendaysistherecommendeddurationoftherapyformenandpyelonephritis.
60)Whoshouldbescreenedforasymptomaticbacteriuria?
A.CollegestudentsB.Men
C.PatientswithindwellingcathetersD.Pregnantwomen
Feedback:
AnswerDiscorrect.
TheIDSArecommendspregnantwomenshouldbescreenedforbacteriuriabyurinecultureatleastonce
duringearlypregnancy(1216weeksgestation)orattheirfirstprenatalvisit.Allpositiveurinecultures,
includingasymptomaticbacteriuria,shouldbetreatedinpregnantwomen.
AnswerAisincorrect.
Collegestudentsdonotneedtobescreenedforasymptomaticbacteriuria.
AnswerBisincorrect.
Mendonotneedtobescreenedforasymptomaticbacteriuria.
AnswerCisincorrect.
Patientswithindwellingcathetersdonotneedtobescreenedforasymptomaticbacteriuria.Patientswith
chroniccathetersuniversallyhaveasymptomaticbacteriuria.
61)A22yearoldmale(94kg)withnosignificantpastmedicalhistorypresentstoyourhospitalwith
fever,severeheadache,photophobia,andneckpain.Thephysiciandoesalumbarpunctureandsendsthe
CSFcollectionstothelaboratory.Baseduponclinicaldiagnosisthepatientissuspectedtohavebacterial
meningitis.Whichofthefollowingarelikelypathogensassociatedwithbacterialmeningitisinthispatient?
A.StreptococcuspneumoniaeandHaemophilusinfluenzaeB.Neisseriameningitidis
andListeriamonocytogenesC.ListeriamonocytogenesandStreptococcusagalactiae(groupB)
D.StreptococcuspneumoniaeandNeisseriameningitidis
Feedback:
AnswerDiscorrect.
N.meningitidisandS.pneumoniaearethemostlikelycausativepathogensofbacterialmeningitisinadult
patientsyoungerthan50yearsofage.
AnswerAisincorrect.
WhileS.pneumoniaeiscorrect,H.influenzaeisnotalikelypathogeninadultpatientsyoungerthan50
yearsofage.H.influenzaeisalikelypathogenforyounginfantsaged1to23months.
AnswerBisincorrect.
WhileN.meningitidisiscorrect,L.monocytogenesisnotalikelypathogeninadultpatientsyoungerthan
50yearsofage.L.monocytogenesisalikelypathogeninneonatesandadultsolderthan50yearsold.
AnswerCisincorrect.
NeitherL.monocytogenesnorS.agalactiae(groupB)arelikelypathogensinadultpatientsyoungerthan
50yearsofage.S.agalactiae(groupB)isalikelypathogeninneonatesandyounginfantsaged1to23
months.
62)Whatisanappropriateempiricantibiotictherapyforthis22yearoldpatientwithsuspectedbacterial
meningitis?
A.CeftriaxoneB.CeftriaxoneandampicillinC.Cefotaximeand
vancomycinD.Ampicillinandgentamicin
Feedback:
AnswerCiscorrect.
CefotaximeprovidesappropriateempiriccoverageforN.meningitidisandmostS.pneumoniae.
VancomycinprovidesadditionalempiriccoverageagainstmultidrugresistantS.pneumoniae(resistantto
thirdgenerationcephalosporinslikecefotaxime).
AnswerAisincorrect.
CeftriaxoneprovidesappropriateempiriccoverageforN.meningitidisandmostS.pneumoniae;yet,this
therapyismissingempiriccoverageagainstmultidrugresistantS.pneumoniae(ie,vancomycin).
AnswerBisincorrect.
CeftriaxoneprovidesappropriateempiriccoverageforN.meningitidisandmostS.pneumoniae.Ampicillin
providesadditionalempiriccoverageforL.monocytogenes,whichisunnecessaryforayoungadultpatient.
ThistherapyisalsomissingempiriccoverageagainstmultidrugresistantS.pneumoniae(ievancomycin).
AnswerDisincorrect.
AmpicillinandgentamicinareinadequateempiriccoverageforS.pneumoniaeandN.meningitidis.This
regimenwouldinsteadbepreferredinneonatesgivenappropriateempiriccoverageforS.agalactiae,
aerobicgramnegativebacilli,andL.monocytogenes.
63)AAisapatientwithhypotensionsecondarytosepsis.Pastmedicalhistoryissignificantforheart
failurewithactivefluidoverload,hypertension,diabetes,previousmyocardialinfarction,anddyslipidemia.
Medicationsincludelisinopril,spironolactone,glipizide,metoprololsuccinate,simvastatin,andababy
aspirin.LabswerewithinnormallimitsexceptforaSCrof1.9mg/dL,glucose180mg/dL,andpotassium
of5.6mEq/L.Selecttheappropriateearlygoalresuscitationcolloidtherapyforthispatient.
A.5%albumin500mLB.5%dextrose500mLC.0.45%sodiumchloridewith5%dextrose500
mLD.0.45%sodiumchloride500mL
Feedback:
AnswerAiscorrect.
Fivepercentalbuminisacolloidresuscitationfluidusedforpatientsatriskforfluidoverload.Colloidsare
largemoleculesthatdonotpassacrossdiffusionalbarriersasreadilyascrystalloids.Colloidfluidsinfused
intothevascularspacehaveagreatertendencytostayputandenhancetheplasmavolumethando
crystalloidfluids.Theplasmaexpansionwithalbuminisnearlytwicethatproducedbyanequivalent
volumeofisotonicsaline(500mLversus275mL,respectively).Thisistheprincipalbenefitofcolloid
fluidresuscitation:moreeffectiveresuscitationofplasmavolumethanthatproducedbycrystalloidfluids.
AnswerBisincorrect.
Fivepercentdextroseisacrystalloidfluidandhasnoplaceintherestorationofcirculatingvolumebecause
itisrapidlydistributedthroughouttheentirebodywatercomponentofabout40L.
AnswerCisincorrect.
Sodiumchloride0.45%isacrystalloidfluidandisinappropriateforfluidresuscitation.Fivepercent
dextroseisacrystalloidfluidandhasnoplaceintherestorationofcirculatingvolumebecauseitisrapidly
distributedthroughouttheentirebodywatercomponentofabout40L.
AnswerDisincorrect.
Sodiumchloride0.45%isacrystalloidfluidandisinappropriateforfluidresuscitation.
64)KTisa65yearoldmanwithahistoryofendstagerenaldiseaseonhemodialysisadmittedwithsevere
sepsislikelysecondarytoaninfecteddialysiscatheter.KTwasdiagnosed30minutesagoandhasnotyet
receivedintervention.WhichofthefollowingrepresentsthebestorderofeventstomanageKT?
A.Vasopressors,fluids,microbiologiccultures,antimicrobialtherapyB.Vasopressors,
antimicrobialtherapy,microbiologiccultures,fluidsC.Fluids,microbiologiccultures,antimicrobial
therapy,insulinforglucose>180mg/dLD.Fluids,antimicrobialtherapy,microbiologiccultures,insulin
forglucose>180mg/dL
Feedback:
AnswerCiscorrect.
Inpatientswithsepsissyndromes,earlygoaldirectedfluidresuscitationshouldbeadministeredfirst.
Microbiologicculturesshouldbecollectedpriortoantimicrobialtherapy,unlesswaitingforculturesmight
causeasignificantdelayinantibioticadministration(>45minutes).Aprotocolizedapproachtoinsulin
therapyisrecommendedforpatientswithseveresepsiswhentwoconsecutivebloodglucoselevelsare
morethan180mg/dl.
AnswerAisincorrect.
Inpatientswithsepsissyndromes,priorityisplacedonfluidresuscitationandantimicrobialtherapy.
Vasopressorsareutilizedforhypotensionthatdoesnotrespondtoinitialfluidresuscitation.
AnswerBisincorrect.
Priorityshouldbeplacedonfluidresuscitationandantimicrobialtherapy.Vasopressorsareutilizedfor
hypotensionthatdoesnotrespondtoinitialfluidresuscitation.
AnswerDisincorrect.
Microbiologicculturesshouldbeobtainedpriortoadministrationofantimicrobialtherapytohelpensure
theiraccuracy.
65)TPisa63yearoldmalepatientwithapastmedicalhistoryofhypertension,diabetes,chronic
obstructivepulmonarydisease,anddyslipidemia.Medicationsincludeamlodipine,metformin,tiotropium,
albuterolasneeded,andpravastatin.TPisdiagnosedwithseveresepsis.PertinentlabsincludeapHof
7.25,whitebloodcellcountof13,500cells/mm3,glucoseof170mg/dL,serumcreatinineof2.3mg/dL,
andbloodpressureof85/43mmHg.Whattherapyshouldbeadministeredwithin1houroftherecognition
ofseveresepsis?
A.BroadspectrumantimicrobialtherapyB.Corticosteroids
C.SodiumbicarbonateD.Vasopressortherapy
Feedback:
AnswerAiscorrect.
Administrationofbroadspectrumantimicrobial(s)therapywithinthefirsthourofrecognitionimproves
mortalityinsepticshockandseveresepsis.Obtainingvascularaccessandstartingaggressivefluid
resuscitationarethefirstprioritieswhenmanagingpatientswithseveresepsisorsepticshock.Prompt
administrationofantiinfectiveagent(s)isalsoapriority.Eachhourdelayinachievingadministrationof
effectiveantibioticsisassociatedwithanincreaseinmortality.
AnswerBisincorrect.
Optimaltimingofcorticosteroidsinsepsisisnotwelldefined,butitmostlikelywouldnotbewithinfirst
hour.Additionally,adrenalinsufficiencyisnolongerroutinelyassessedbecausehydrocortisoneshould
NOTbeusedtotreatsepsisIFfluidresuscitationorvasopressortherapyisabletorestorehemodynamic
stability.Fluidresuscitationandvasopressors(ifneeded)wouldbeinitiatedpriortohydrocortisone
therapy.Therefore,incaseswherefluidresuscitationandvasopressortherapydonotachievehemodynamic
goals,intravenoushydrocortisoneatadoseof200mg/deitherindivideddailydosesorasacontinuous
infusionmaybeused.
AnswerCisincorrect.
Thesepsisguidelinesrecommendagainstusingsodiumbicarbonateforimprovinghemodynamicsor
reducingvasopressorrequirementsinpatientswithhypoperfusioninducedlacticacidosiswithapHgreater
than7.15.EffectsofbicarbonateonpatientswithapHlessthan7.15arenotcurrentlyknown.
AnswerDisincorrect.
Thereisnospecifictimingofvasopressortherapyinsepsis.Itshouldbeadministeredinpatientswith
persistenthypotensionfollowingaggressivefluidresuscitation.
66)WhichofthefollowingistrueregardingStribildtherapy?
A.Thismedication
shouldbetakenonanemptystomachatbedtime.B.Thismedicationwillcommonlyincreaseserum
creatininevalue.C.ThismedicationshouldonlybeusedinpatientswithaneGFRD.Thismedication
willcommonlyincreaseindirectbilirubin.
Feedback:
AnswerBiscorrect.
Thecobicistatboostingagentcommonlyincreasesserumcreatininewithoutimpactingrenalfunction.The
increaseinSCrwillaffectthecalculatedestimatedglomerularfiltration(eGFR),butwillnotaffectthe
actualglomerularfiltration.
AnswerAisincorrect.
Stribildshouldbetakenwithamealtomaximizebioavailability.
AnswerCisincorrect.
StribildshouldnotbeusedinpatientswithCrCllessthan70ml/minbecausetheindividualagents
requiringvarieddoseadjustmentsinrenaldysfunction.
AnswerDisincorrect.
Stribildhasnotbeencommonlyassociatedwithincreasesinindirectbilirubin.ThePIatazanaviris
commonlyassociatedwiththislababnormality.
67)Whatisthebrandnameformoxifloxacin?
A.AveloxB.SeptraC.Mepron
D.Aczone
Feedback:
AnswerAiscorrect.
Aveloxisthebrandnameofmoxifloxacin.
AnswerBisincorrect.
Septraisthebrandnameofsulfamethoxazoleandtrimethoprim.
AnswerCisincorrect.
Mepronisthebrandnameofatovaquone.
AnswerDisincorrect.
Aczoneisthebrandnameofdapsone.
68)JKisapatientatalocalclinicwitharecentdiagnosisofAIDS.Hispastmedicalhistoryincludes
hypertension,dyslipidemia,anddepression.Medicationsincludelosartan,atorvastatin,andescitalopram.
Labsinclude:CD4countof120cells/mm3,serumandpotassium4.8mEq/L(Increasedfrom3.5mEq/
L).WhichagentisrecommendedasapreferredtherapyforPCPprophylaxis?
A.ClindamycinB.TMPSMXC.AmikacinD.Levofloxacin
Feedback:
AnswerBiscorrect.
TMPSMXisthepreferredtherapyforPCPprophylaxisdespiteitspotassiumretainingcapabilities.
AnswerAisincorrect.
Clindamycin,alincosamide,isanalternativetherapyforPCPprophylaxis.
AnswerCisincorrect.
Amikacin,anaminoglycoside,isnotpreferredtherapyforPCPprophylaxis.
AnswerDisincorrect.
Levofloxacin,afluoroquinolone,isnotconsideredpreferredtherapyforPCPprophylaxis.
69)Theadditionofwhichofthefollowingdrugsnecessitatesfollowupliverfunctiontestsinapatient
beingtreatedforlatentTBinfectiontreatedwithisoniazid?
A.Naproxen
B.MultivitaminC.SertralineD.AcetaminophenE.Lisinopril
Feedback:
AnswerDiscorrect.
Acetaminophencanincreasetheriskofisoniazidinducedhepatotoxicity.Ifpatientsareplacedon
scheduledacetaminophenyouneedtocloselymonitorforhepatotoxicityincludingliverenzymes.Youmay
wanttorecommendanalternativepainregimenwhileonisoniazid.
AnswerAisincorrect.
Naproxendoesnotcommonlycausechangesinisoniazidmetabolismandisnotknowntocommonlycause
hepatotoxicityorelevateliverenzymes.
AnswerBisincorrect.
Multivitaminsdonotcommonlycausechangesinisoniazidmetabolismandarenotknowntocommonly
causehepatotoxicityorelevateliverenzymes.
AnswerCisincorrect.
Sertralinedoesnotcommonlycausechangesinisoniazidmetabolismandisnotknowntocommonlycause
AnswerEisincorrect.
Lisinoprildoesnotcommonlycausechangesinisoniazidmetabolismandisnotknowntocommonlycause
70)Whatisthepreferredregimenfortreatinglatenttuberculosisinfectioninadults?
A.Isoniazid300mgdaily6monthsB.Isoniazid300mgdaily9monthsC.Rifampin600mgdaily
6monthsD.Rifampin600mgdaily9months
Feedback:
AnswerBiscorrect.
Isoniazidisthepreferreddrugand9monthsisthepreferredtimeperiod.Itisbeenfoundtobesuperiorto6
months.
AnswerAisincorrect.
Isoniazidisthepreferreddrugandcanbeusedfor6monthsincertaincases;however,thisisnotthe
preferredtimeperiodoftreatment.
AnswerCisincorrect.
RifampinissecondlineregimeninlatentTBtreatmentifthepatientisintoleranttoisoniazidorifisoniazid
resistanceishighinthearea.Rifampinisalsotypicallygivenfor4months.
AnswerDisincorrect.
RifampinissecondlineregimeninlatentTBtreatmentifthepatientisintoleranttoisoniazidorifisoniazid
resistanceishighinthearea.Rifampinisalsotypicallygivenfor4months.
71)RSisa45yearfemalewhowasplacedonisoniazidforlatenttuberculosis.Medicationsinclude:
metformin1000mgtwicedaily,glipizide10mgtwicedaily,lisinopril20mgdaily,andatorvastatin40mg
daily.ShepresentstoyourpharmacytopurchasesomevitaminB6(pyridoxine)asrecommendedbyher
doctor.Whichadverseeffectofisoniaziddoespyridoxinereduce?
A.Hepatotoxicity
B.PeripheralneuropathyC.GastrointestinalupsetD.Rash
Feedback:
AnswerBiscorrect.
Isoniazidpromotesexcretionofpyridoxine.Thispyridoxinedeficiencycancauseneuropathysoonecan
supplementwithpyridoxinetopreventperipheralneuropathiesfromisoniazid.
AnswerAisincorrect.
Therearenoprotectivedrugstogiveagainstisoniazidhepatotoxicity.
AnswerCisincorrect.
Gastrointestinalupsetcanbealleviatedpotentiallybytakingtheisoniazidwithfood.
AnswerDisincorrect.
Therearenoprotectivedrugstogivetopreventrash.
72)LipidbasedorliposomalamphotericinBformulationshavewhatadvantageoverconventional
amphotericinB(desoxycholate)?
A.LessexpensivethanconventionalamphotericinB
B.DecreasedmortalityC.DecreasedratesofnephrotoxicityD.Moreefficaciousthanconventional
amphotericinB
Feedback:
AnswerCiscorrect.
Changesinserumcreatininearelesspronouncedwithlipidbasedformulations.
AnswerAisincorrect.
Liposomalformulationsareconsiderablymoreexpensive.
AnswerBisincorrect.
Thishasnotbeenshowninwelldesignedtrials.
AnswerDisincorrect.
Thishasnotbeenshowninwelldesignedtrials.
73)A58yearoldfebrilewomaninthesurgicalintensivecareunithasoneoutoftwobloodculturebottles
growingyeast.Aurinesamplecollected2daysagoisgrowingC.glabrata.Whatisthebestempiric
decisionforthispatient?
A.Startfluconazole400mgdailyB.Waitforasusceptibility
reportandthenstartwithasensitiveantifungalagentC.Theoneoutoftwobloodbottlesandtheurine
culturedonotrequiretherapyD.Initiatecaspofungin70mg1dose,then50mgdaily
Feedback:
AnswerAiscorrect.
Thisoptioncouldbeused,butmanyC.glabratastrainsmayrequirehigherdosesoffluconazolebasedon
invitrosusceptibilities(SDD).Therapyordosecouldbechangedaftersusceptibilitiesbecomeknown.
AnswerBisincorrect.
Generallyantifungaltherapyisinitiatedandchangedifneededbasedonthesusceptibilityresultsorclinical
situation.
AnswerCisincorrect.
Allpositivebloodculturesgrowingyeastshouldreceivetreatment
AnswerDisincorrect.
WhilecaspofunginwouldbeactiveagainstC.glabrata,caspofunginundergoesextensivehepatic
metabolismandwouldnotbethebestagentforaurinarysource.
74)GeneticvariabilityinCytochromeP450CYP2C19hasbeenlinkedtosignificantinterpatient
pharmacokineticdifferencesforwhichantifungalagent?
A.Fluconazole
B.VoriconazoleC.MicafunginD.Flucytosine
Feedback:
AnswerBiscorrect.
StudiesindicatedthatCYP2C19issignificantlyinvolvedinthemetabolismofvoriconazole.Thisenzyme
exhibitsgeneticpolymorphism.About3%to5%ofCaucasiansand12%to23%ofAsiansareexpectedto
bepoormetabolizers.
AnswerAisincorrect.
FluconazoleisnotasignificantsubstrateforCYP2C19.
AnswerCisincorrect.
MicafunginisnotaCYP450substrate.
AnswerDisincorrect.
FlucytosineisnotaCYP450substrate.
75)Whichofthefollowingrepresentsanadverseeffectassociatedwithfluoroquinoloneuse?
A.PermanenttoothdarkeningB.NeurologictoxicityC.DysglycemiaD.JarischHerxheimer
reaction
Feedback:
AnswerCiscorrect.
Fluoroquinoloneshavethepotentialtocausedysglycemia(hypoorhyperglycemia),andthisadverse
effecthasbeenmostcommonlyreportedinpatientswithunderlyingdiabetesmellitus.
AnswerAisincorrect.
Permanenttoothdarkeningisassociatedwithtetracyclineuseinchildrenyoungerthan8years.
AnswerBisincorrect.
Neurologictoxicityhasbeenreportedwiththeuseofacyclovirandvalacyclovirduetodrugaccumulation
inrenalfailure.
AnswerDisincorrect.
TheJarischHerxheimerreactionisanacutefebrilereactionthatcanoccurwithinhoursofinitiationof
therapyforsyphilis.
76)Whichofthefollowingistrueregardinggonococcalurethritisand/orcervicitis?
A.Gonorrheainfectionsaretreatedwithoralvancomycin.B.Menaretypicallyasymptomaticorhave
minorsymptoms.C.IncreasedtransmissionofHIVinfectionisassociatedwithgonococcalinfection.
D.Antibioticsusceptibilitydatacanbeobtainedusingnonculturediagnostictestsforgonorrhea.
Feedback:
AnswerCiscorrect.
Inbothmenandwomen,gonorrheacancauseincreasedsusceptibilitytoandtransmissionofhuman
immunodeficiencyvirus(HIV)infection.
AnswerAisincorrect.
OralvancomycinisutilizedtotreatClostridiumdifficileantibioticcolitis.
AnswerBisincorrect.
Womenwithgonorrheaareusuallyasymptomaticorhaveonlyminorsymptoms.Inmen,symptomsof
gonorrheaincludedysuriaandpurulenturethraldischarge.Becauseoftheearlypresentationand
discomfortassociatedwithsymptomsinmen,treatmentisoftensoughtearlyenoughtoprevent
complications.
AnswerDisincorrect.
Nonculturediagnostictestscannotprovideantibioticsusceptibilityresults,whichmaybenecessaryin
casesofinfectionthatpersistsaftertreatment.
77)ITisapatientthatreportstoherprimarycareproviderforevaluationofavaginaldischarge,dysuria,
andvaginalbleeding.Theproviderordersseverallabsandcultures.Agramstainrevealsgramnegative
diplococcic.ThepresenceofgramnegativediplococcionGramstainissuggestiveofwhichorganism?
A.TreponemapallidumB.ChlamydiatrachomatisC.Herpessimplexvirus2
D.Neisseriagonorrhoeae
Feedback:
AnswerDiscorrect.
NeisseriagonorrhoeaeisagramnegativeDiplococcus.
AnswerAisincorrect.
Treponemapallidumisaspiralshapedorganismthatisinvisibleonlightmicroscopy.
AnswerBisincorrect.
Chlamydiatrachomatisisanobligateintracellularpathogen.
AnswerCisincorrect.
Herpesisaviralorganism.
78)Adamantaneshaveactivityagainstwhichinfluenzatypes?
A.InfluenzaA
B.InfluenzaBC.InfluenzaCD.Haemophilusinfluenzae
Feedback:
AnswerAiscorrect.
Adamantanes(rimantadineandamantadine)haveactivityagainstinfluenzaA,however,overthepastfew
influenzaseasons,resistancetotheadamantaneshassignificantlyincreased.
AnswerBisincorrect.
AdamantanesdonothaveactivityagainstinfluenzaB.
AnswerCisincorrect.
InfluenzaCisnotacommoncauseininfluenzainfections.
AnswerDisincorrect.
Haemophilusinfluenzaeisagramnegativebacterialorganismthatcausesupperrespiratorytract
infections.
79)Selectthebrandnameforzanamivir.
A.RelenzaB.TamifluC.Symmetrel
D.Fluzone
Feedback:
AnswerAiscorrect.
Relenzaisthebrandnameforzanamivir.
AnswerBisincorrect.
Tamifluisthebrandnameforoseltamivir.
AnswerCisincorrect.
Symmetrelisthebrandnameforamantadine.
AnswerDisincorrect.
FluzoneisthebrandnameforIIV.IIVhasseveraldifferentbrandnamesbecausetherearedifferent
manufacturers.OfnoteFluBlokisthebrandnameforRIV.
80)SelecttheantiinfluenzaagentthatisformulatedasaRotadiskinhaler.
A.RimantadineB.AmantadineC.OseltamivirD.Zanamivir
Feedback:
AnswerDiscorrect.
ZanamivirisformulatedasaRotadiskinhaler(5mg/blister).
AnswerAisincorrect.
Rimantadineisformulatedassyrup(50mg/5mL)andatablet(100mg).
AnswerBisincorrect.
Amantadineisformulatedassyrup(50mg/mL),tablet(100mg),andcapsule(100mg).
AnswerCisincorrect.
Oseltamivirisformulatedasacapsule(75mg)andpowderfororalsuspension(12mg/mL).
81)Apatientpresentstotheemergencydepartmentunconscious,afteringestingabottleoflorazepam.
Whatacidbasedisturbancewouldyouexpecttosee?
A.Increasedaniongapmetabolic
acidosisB.RespiratoryalkalosisC.MetabolicalkalosisD.Respiratoryacidosis
Feedback:
AnswerDiscorrect.
Benzodiazepineoverdosageresultsinsuppressionoftherespiratorycenterofthebrain.This,therefore,
leadstodecreasedexhalationofCO2andincreasedlevelsofPaCO2.Thus,thepatientwhooverdoseson
benzodiazepineswillhavearespiratoryacidosis.
AnswerAisincorrect.
Thiscouldoccurifthepatientwasgiventoohighadoseofintravenouslorazepamduetotheexcipientin
theformulation,propyleneglycol.
AnswerBisincorrect.
Thisisaprimarymetabolicprocess.
AnswerCisincorrect.
Thisisaprimarymetabolicprocess.
82)Whichofthefollowingstatementsiscorrect?
A.Modularformulascontaina
balancedmixtureofcarbohydratesandlipids.B.Caloricallydenseformulasprovidenutritiontargetedtoa
specificdiseasestate.C.Elementalformulascontainintactproteinsandpolysaccharides.D.Standard
formulascontainintactproteins.
Feedback:
AnswerDiscorrect.
Standardformulascontainintactproteinsandaremeantforpatientswhocanfullydigestproteinsanddo
notrequirehydrolyzedproteins.
AnswerAisincorrect.
Modularformulascontainasinglenutriententitythatisusedtosupplementtraditionalformulas,therefore
targetingspecificpatientneeds.
AnswerBisincorrect.
Caloricallydenseformulasarecompletenutritionsourcesandcontainabalancedmixofnutrients.
AnswerCisincorrect.
Elementalformulascontainhydrolyzedproteins(peptidesandaminoacids)whichareeasiertodigestthan
intactproteins.
83)Aspirationrisksduringenteralnutritionfeedingsareincreasedbywhichofthefollowing?
A.FeedinginanelevatedoruprightpositionB.Highgastricresidualpriortofeeding
C.ContinuousfeedingregimensD.Highproteinmodularfeeding
Feedback:
AnswerBiscorrect.
Initiatingenteralfeedswhenthegastricresidualishighincreasestherisk
AnswerAisincorrect.
Anelevatedoruprightpositionispreferabletoasupinepositionifariskofaspirationexists.
AnswerCisincorrect.
Continuousfeedingregimensareprotectiveagainstaspiration.
AnswerDisincorrect.
Highproteinmodularfeedingdoesnothaveaneffectonaspirationrisk.
84)Y.N.isa43yearoldmanwithshortbowelsyndromewhoreceiveshomePN.Whatisthemost
commonPNrelatedreasonthatpatientsonhomePNrequirehospitalization?
A.MetabolicbonediseaseB.CatheterrelatedsepsisC.TraceelementdeficiencyD.Hyperglycemia
Feedback:
AnswerBiscorrect.
CatheterrelatedsepsisisacommonadverseeventinpatientsonhomePNthatoften,althoughnotalways,
resultsinhospitalization.Becauseplacementofacentralvenouscatheterisaninvasiveprocedure,and
suitablevenoussitesforplacementofsuchcathetersarelimited,effortsaremadeifpossibletosalvage
infectedcathetersratherthanremovingandreplacingthem.Treatmentsincludeinfusionofsystemic
antibioticsandplacementofantibioticlocksolutionswithinthecatheter.Catheterrelatedsepsisismost
commonlycausedbygrampositivebacteriabutcanalsobecausedbygramnegativebacteriaandfungi.
Fungalinfectionsalmostuniversallyrequirecatheterremovalandreplacement.
AnswerAisincorrect.
AlthoughmetabolicbonediseaseisacommonprobleminlongtermhomePNpatients,itisnotthemost
commoncauseofhospitalizationinthispopulation.Theetiologyofmetabolicbonediseaseinlongterm
PNisnotwellelucidated.
AnswerCisincorrect.
TraceelementdeficienciesdooccurduringlongtermhomePN,althoughtheycanbedifficultto
definitivelydiagnose.Whenatraceelementdeficiencyissuspected,higheramountsofthattraceelement
aregenerallyprovidedbythePN;thisdoesnotusuallyrequirehospitalization.
AnswerDisincorrect.
HyperglycemiaisapotentialadverseeventduringPN,eithershorttermorlongterm.Itisprudentto
stabilizebloodglucosepriortoinitialdischargefromthehospitalonhomePN.Onesettinginwhich
hyperglycemiamaydevelopinapatientonhomePNisinthesettingofinfectionsuchascatheterrelated
sepsis.Inthissituation,itistypicallythesignsandsymptomsofinfectionsuchasfever,chills,andrigors,
ratherthanhyperglycemiathatbringthepatienttothehospital.
85)An82yearoldmanwasbroughttotheemergencydepartmentbyhisdaughterforworseningconfusion
anddiarrhea.Thedaughterreportshehashadpoororalintakeoverthelastweek.Medicalhistoryis
significantforhypertension,ischemicstroke,reflux,andchronicconstipation.Medicationsincludeaspirin,
lactulose,lisinopril,omeprazole,andsimvastatin.Hisphysicalexaminationissignificantfororthostatic
hypotension,tachycardia,anddrymucousmembranes.Significantlaboratoryvaluesincludeserumsodium
of162,BUNof66,andserumcreatinineof2.5.Appropriateinitialtreatmentforthispatientwould
include:
A.0.45%SalineinfusionB.5%DextroseinfusionC.Desmopressin
D.Normalsalineinfusion
Feedback:
AnswerDiscorrect.
Thispatientisshowingsignsofhemodynamicinstability(orthostatichypotension,tachycardia)andshould
firstreceiveisotonicsalineuntilvolumestatusisrestored.Aftervolumerepletion,hypotonicfluidswould
beappropriatetocorrectserumsodium.
AnswerAisincorrect.
Whilehypotonicfluidswillhelpcorrectthispatientsserumsodium,patientswithhemodynamicinstability
(orthostatichypotension,tachycardia)shouldfirstreceivenormalsalineuntilvolumestatusisrestored.
Freewater,from0.45%salineor5%dextrose,distributesthroughouttheICFandECF.Normalsalineis
theappropriateinitialchoice.BecauseitisconfinedtotheECF,itwillrestoreintravascularvolumemore
efficientlythanhypotonicfluids.
AnswerBisincorrect.
SeeexplanationforAnswera.
AnswerCisincorrect.
Desmopressinisindicatedinpatientswithcentraldiabetesinsipidus.
86)A39yearoldmanpresentstotheemergencydepartmentwithabnormallaboratoryvaluesfromalocal
psychiatrichospital.Heis4dayspostneurosurgicalrepairofintraventricularhemorrhagesecondaryto
bilateralselfenucleation.Heiscurrentlyconstrainedtothehospitalbedandhallucinating.Medicalhistory
includeshypertensionandschizophrenia.Medicationsincludehaloperidol,fluphenazine,andbenztropine.
Physicalexaminationisnormal.Pertinentlaboratoryvaluesincludesodiumof158mEq/Landaurine
osmolarityof76mOsm/kg.Urineoutputwas6500mLoverthelast24hours.Thepatientisadmittedfor
thetreatmentofcentraldiabetesinsipidus.Themostappropriatetreatmenttocorrectthispatientssodium
abnormalityincludes:
A.DesmopressinB.Freeaccesstowater
C.HydrochlorothiazideD.Normalsalineinfusion
Feedback:
AnswerAiscorrect.
PatientswithcentraldiabetesinsipidusrequireexogenousADH.
AnswerBisincorrect.
Oralreplacementofwaterwouldbedifficultinarestrained,hallucinatingpatient.Freewatershouldbe
givenintheformofintravenoushypotonicfluidswhenoralreplacementisnotpossible.
AnswerCisincorrect.
Hydrochlorothiazidecanbeusefulinnephrogenicdiabetesinsipidus.ThispatientrequiresexogenousADH
replacement.
AnswerDisincorrect.
Normalsalineisnotappropriateinhypernatremicpatientswithoutsignsofvolumedepletion.
87)WhichofthefollowingisconsideredthegoldstandardformeasurementofGFR?
A.CockcroftGaultequationB.MDRDequationC.24hoururinecreatinineD.Inulinclearance
Feedback:
AnswerDiscorrect.
InulinclearancemethodisconsideredthegoldstandardformeasurementofGFR.Itisrarelydonein
clinicalpracticeduetocostandcomplexityissues.
AnswerAisincorrect.
TheCockcroftGaultequationisthemostcommonlyusedmethodtoestimatecreatinineclearancebutdoes
notmeasureGFR.
AnswerBisincorrect.
TheMDRDequationestimatesbutdoesnotmeasureGFR.
AnswerCisincorrect.
TwentyfourhoururinecreatinineanalysishasshowntobenomoreaccuratethantheCockcroftGaultand
MDRDequationsanddoesnotmeasureGFR.
88)RTisa50yearoldmanwhoisadmittedwithserumcreatinineof1.1mg/dL.Twentyfourhourslater,
hisserumcreatinineis2.0mg/dL.RTisonseveralmedicationsthatneedtobedoseadjustedforrenal
function.Whatisthemostappropriatecourseofaction?
A.CalculateRTsGFRusing
theMDRDequationanddoseadjustbasedontheresult.B.CalculateRTsCrClusingtheCockcroftGault
equationanddoseadjustbasedontheresult.C.DiscontinueallofRTsmedicationsuntilhisrenal
functionimproves.D.AssesseachofRTsmedicationsanduseclinicaljudgmenttodeterminethebest
courseofaction,balancingtheriskoftreatmentfailurewithdrugtoxicity.
Feedback:
AnswerDiscorrect.
Eachmedicationshouldbeassessedtodeterminethemostappropriatecourseofactionbasedonthe
patientsconditionandthecombinedrisksofdrugtoxicityandtreatmentfailure.
AnswerAisincorrect.
TheMDRDequationmayoverestimateGFRinthispatientwhoisinacuterenalfailure.Thiscouldleadto
overdosingandpotentialtoxicities.
AnswerBisincorrect.
TheCockcroftGaultequationmayalsooverestimaterenalfunctioninapatientwithacuterenalfailure.
AnswerCisincorrect.
Itwouldbeinappropriatetosimplydiscontinuenecessarymedications.
89)WhichofthefollowingstatementsistrueregardingtheuseofdiureticsinpatientswitholiguricAKI?
A.Diureticsmayincreaseurineoutputandreversekidneydamage.B.Diuretics
shouldneverbeusedinAKIastheymaycausedehydrationandexacerbateAKI.C.DIureticscanbeused
inveryhighdosesastherearenotoxicitiestobeconcernedwith.D.Thiazidesandpotassiumsparing
diureticsarethepreferredagentsinAKI.E.Diureticsmayimproveurineoutputandhelpmanagefluid
andelectrolyteabnormalities.
Feedback:
AnswerEiscorrect.
Whilestudieshaveshownthatnonoliguricpatientshavebetteroutcomesthanoliguric/anuricpatients,there
isnoevidencethatdemonstratesthatenhancingurineproductionthroughdiureticuseconfersthesebetter
outcomes.Diureticsmaybehelpfulincontrollingfluidoverloadandelectrolyteabnormalities(particularly
hyperkalemia).
AnswerAisincorrect.
Diureticsremovefluid,predominantlyfromtheintravascularspace.Forthisreason,theymayactually
worsenAKIandmustbeusedwithextremecaution.
AnswerBisincorrect.
Ifusedunwisely,diureticsmaycauseacutedehydrationandworsenAKI.Iftheseagentsareusedproperly,
theymayaidinthemanagementoffluidandelectrolytedisordersandenhanceeliminationoftoxins.
AnswerCisincorrect.
Highdosesofdiureticscanhaveseriousconsequencessuchasototoxicity.Whilehigherdosesmaybe
necessarytoovercomediureticresistanceinAKI,carefulmonitoringshouldbeemployed.
AnswerDisincorrect.
Whilethiazidetypediureticsmaybeusedincombinationwithloopdiureticstoenhanceurineproduction,
theyarenotgenerallyeffectiveincasesofdecreasedkidneyfunction.Potassiumsparingdiureticsare
generallycontraindicated,especiallyifthepatientisanuric/oliguricashyperkalemiamayoccurrapidlyand
ispotentiallylifethreatening.
90)Apatientcallsthepharmacytocomplainabouthertongueturningblackafterstartinganewregimen
forpepticulcerdisease.Whichmedicationiscausingthesideeffect?
A.Amoxicillin
B.MetronidazoleC.BismuthsubsalicylateD.Clarithromycin
Feedback:
AnswerCiscorrect.
Bismuthmaycausenauseaandadarktongueand/orstool.
AnswerAisincorrect.
Amoxicillinmaycauseheadache,diarrhea,orGIupset.
AnswerBisincorrect.
Metronidazolecancausemetallictaste,dyspepsia,peripheralneuropathy,andadisulfiramlikereaction
withalcohol.
AnswerDisincorrect.
ClarithromycinmaycauseGIupset,diarrhea,QTcprolongation,oralteredtaste(bitterormetallic).
91)IfapatientwastreatedinitiallywithPPI,amoxicillin,andclarithromycin,whichregimenis
recommendedforsalvagetherapy?
A.PPI+amoxicillinB.PPI+tetracycline+
metronidazole+bismuthC.PPI+metronidazole+clarithromycinD.PPI+amoxicillin+levofloxacin
Feedback:
AnswerBiscorrect.
Bismuthquadrupletherapyiscommonlyusedasthesecondcourseorsalvagetherapy.Salvagetherapy
shouldavoidantibioticsthatwerepreviouslyutilizedforthetreatmentofH.pylori.
AnswerAisincorrect.
AllregimensforthetreatmentofH.pylorishouldcontaintwoantibiotics.
AnswerCisincorrect.
Clarithromycinwasusedintheinitialtreatmentregimen;therefore,itshouldbeavoidedinthesalvage
regimen.
AnswerDisincorrect.
LevofloxacinbasedtripletherapyhasbeenusedoutsidetheUnitedStates.Additionally,levofloxacinisa
broadspectrumantibioticcomparedtoclarithromycin.Ifpossible,anarrowspectrumantibioticshouldbe
utilizedoverabroadspectrumantibiotic.Therefore,Answerc(primary)orAnswerb(salvage)shouldbe
utilizedbeforelevofloxacintherapyunlessapatientcannottolerateorobtainpreferredregimens.
92)TRisa54yearoldmanwithHCVgenotype2infection.Whichofthefollowingwouldbethebest
treatmentoptionforTR?
A.peginterferonandribavirinfor24weeksB.peginterferon
andribavirinfor48weeksC.sofosbuvirandribavirinfor12weeksD.sofosbuvirandribavirinfor24
weeks
Feedback:
AnswerCiscorrect.
Genotype2onlyrequires12weeksofsofosbuvirandribavirin.Patientswithgenotype2havea95%
chanceofrespondingto12weeksoftherapy.
AnswerAisincorrect.
Onlygenotypes1and4require48weeksoftherapyduetothelowefficacyrate(50%60%)of
peginterferonandribavirininthispatientpopulation.
AnswerBisincorrect.
A1to5yeardurationofNRTItherapyforHBViscommon.
AnswerDisincorrect.
A1to5yeardurationofNRTItherapyforHBViscommon.
93)RMisamanwhohasjustlearnedheiscoinfectedwithHIV/HCV.WhenshouldRMschronicHCV
betreated?
A.ImmediatelyB.AssoonashisHIViswellcontrolledwithmedication.
C.Never.HisHCVisnottreatable.D.Afterhedevelopsdecompensatedcirrhosis.
Feedback:
AnswerBiscorrect.
RMshouldwaituntilhisHIViswellcontrolledwithmedicationstoincreasehislikelihoodofresponse.
AnswerAisincorrect.
RMshouldwaituntilhisHIViswellcontrolledwithmedications.TreatmentforbothHIVandchronic
HCVisdifficultduetosideeffects,complicatedregimens,andpoorresponsetomedications.
AnswerCisincorrect.
ItispossibletotreathischronicHCVeventhoughthelikelihoodthathewillhaveanSVRislowerthanif
hehadchronicHCVmonoinfection.
AnswerDisincorrect.
Pegylatedinterferonandribavirincanonlybeusedincompensatedcirrhoticpatients.Itiscontraindicated
inpatientswithdecompensatedcirrhosisbecauseoftheriskthatitmayworsenthecirrhosis.
94)DAhasbeendiagnosedwithchronicHCVgenotype1.Hispastmedicalandsocialhistoriesincludea
historyofIVdrugabuse,alcoholism,awife(married30years)withchronicHCV,andabloodtransfusion
in2002.Duringyourpatientcounselingsession,DAasksyouhowhemostlikelyacquiredHCV.You
correctlytellhim
A.Bloodtransfusionin2002B.Sexuallytransmittedfromhiswife
C.IntravenousdrugabuseD.Alcoholism
Feedback:
AnswerCiscorrect.
ContactwithbloodcontaminatedwiththeHCVvirusisthemostcommonrouteoftransmissionwith
intravenousdrugusebeingthenumberonemethodoftransmission.
AnswerAisincorrect.
After1992,bloodbanksbeganscreeningbloodforHCV;hisriskforacquiringHCVfromhisblood
transfusionin2002isextremelylow.
AnswerBisincorrect.
TransmissionofHCVfromonemonogamousheterosexualpartnertoanotherisextremelylow.Infact,itis
notnecessaryforHCVpatientstowearacondomtoprotectthepartnerunlesstheyareonpeginterferon
andribavirintreatment,becausetheriskofspreadingviasexualcontactisverylow.
AnswerDisincorrect.
ChronicalcoholuseanduntreatedchronicHCVcanbothleadtocirrhosis,butalcoholismdoesincreasethe
susceptibilityofacquiringHCV.
95)SNisa67yearoldmale,admittedtoreceivehighdosecytarabineasconsolidationtherapyforacute
myelogenousleukemia.Whichserotonin(5HT3)receptorantagonistispreferredaspartofhisantiemetic
prophylaxisregimen?
A.AloxiB.AnzemetC.KytrilD.Zofran
Feedback:
AnswerAiscorrect.
Palonosetron(Aloxi)hasaprolonged(40hour)serumhalflife.AloxiisFDAapprovedfortheprevention
ofacuteCINVinmoderatelytohighlyemetogenicchemotherapyandinthepreventionofdelayedCINVin
moderatelyemetogenicchemotherapy.
AnswerBisincorrect.
Dolasetron(Anzemet)canbeused(onlyorally),butpalonosetronisthepreferred5HT3antagonistfor
moderatelyemetogenicchemotherapy.
AnswerCisincorrect.
Granisetron(Kytril)canbeused,butpalonosetronisthepreferred5HT3antagonistformoderately
emetogenicchemotherapy.
AnswerDisincorrect.
Ondansetron(Zofran)canbeused,butpalonosetronisthepreferred5HT3antagonistformoderately
96)Whichstatementconcerning5HT3antagonisttherapyforCINViscorrect?
A.Dolasetronhassimilarefficacytoondansetronwhenusedatequipotentdoses.B.Granisetronisthe
only5HT3antagonistapprovedforpreventionofdelayedCINVwithhighlyemetogenicchemotherapy.
C.Palonosetronissuperiortoprochlorperazineforthetreatmentofbreakthroughnauseaandvomiting.
D.TheIVrouteofadministrationofondansetronissuperiortooraladministration.
Feedback:
AnswerAiscorrect.
Studiesshowthatwhen5HT3antagonistsaregivenatequipotentdoses,theyhavesimilarefficacyinthe
preventionofacutenauseaandvomiting.
AnswerBisincorrect.
Currently,no5HT3antagonistisapprovedforthepreventionofdelayedCINVwithhighlyemetogenic
chemotherapy.Palonosetronistheonly5HT3antagonistapprovedfordelayedCINVinmoderately
AnswerCisincorrect.
Dopamineantagonistssuchasprochlorperazineshouldbeusedinthetreatmentofbreakthroughnauseaand
vomiting.Superiorityofthe5HT3hasnotbeenshown.
AnswerDisincorrect.
TheIVrouteofadministrationof5HT3antagonistsisequaltotheoralrouteregardingefficacy.
97)DSisa36yearoldmalewhopresentswithalteredmentalstatus,anorexia,significantweightlossover
thepastthreemonths,recentabdominalswelling,andgeneralmalaise.Currentmedicationsinclude
simvastatin,nicotinicacid,acetaminophen,andalprazolam.Uponexaminationhewasfoundtohave
palmererythemaandsplenomegalyandhislabsweresignificantformildlyelevatedAST,ALT,bilirubin,
andbloodglucose.Heisdiagnosedwithhepaticcirrhosis.
WhichofthefollowingistrueabouttheoralbioavailabilityofhighhepaticratiodrugsinBTifportal
systemicshuntinghasoccurred?
A.Oralbioavailabilitywillbeincreasedandinitial
dosageshouldbedecreased.B.Oralbioavailabilitywillbedecreasedandinitialdosageshouldbe
increased.C.Oralbioavailabilitywillbeincreasedbutnodosageadjustmentneedbeconsidered.D.Oral
bioavailabilitywillbeunchangedandnoinitialdosageadjustmentneedbeconsidered.
Feedback:
AnswerAiscorrect.
Oralbioavailabilityofahighhepaticratiodrugwouldbeexpectedtobeincreasedifportalsystemic
shuntingispresent.Hepaticeliminationofhighhepaticextractionratiodrugsisdependentuponblood
flow.Bloodflowinportalsystemicshuntingisalteredsothatbloodflowsdirectlyfromtheportalveininto
systemiccirculationbypassingtheliver.Ifthedrugisnormallyclearedtoalargeextentbyfirstpasseffect,
thiscouldchangedrasticallytheserumconcentrationthatwouldbeachievedaftertheinitialdose.
AnswerBisincorrect.
Oralbioavailabilitywouldbeexpectedtobeincreased,notdecreased.
AnswerCisincorrect.
Duetothepossibilityforsignificantlyhigherserumconcentrationsfollowinginitialdosing,consideration
shouldbegiventoloweringtheinitialdosegiventothepatient.
AnswerDisincorrect.
Inthissituation,oralbioavailabilitywouldbeexpectedtobeincreased.
Pharmacokineticevaluationoflowhepaticextractionandhighplasmaproteinbounddrugsshouldbebased
onwhichofthefollowing?
A.UnboundconcentrationB.Boundconcentration
C.TotaldrugconcentrationD.Hepaticbloodflow
Feedback:
AnswerAiscorrect.
Hepaticeliminationofalowhepaticextractionratiodrugisaffectedbyproteinbindingandhepatic
intrinsicclearance.Sincethisdrugissaidtobehighlyplasmaproteinbound,dosingshouldbeadjustedin
ordertomaintainanormalunboundconcentration.Asignificantincreaseinunboundconcentrationwould
havethepotentialtosignificantlyincreasetheamountofdrugfreetoactinthebody.
AnswerBisincorrect.
Dosinginthissituationshouldbechangedinordertomaintainunbound,notboundconcentration.
AnswerCisincorrect.
Dosinginthissituationshouldbechangedinordertomaintainunbound,nottotalconcentration.
AnswerDisincorrect.
Hepaticeliminationofalowhepaticextractionratiodrugwouldnotbeexpectedtobesignificantly
affectedbychangesinhepaticbloodflow.
Dosageadjustmentoflowhepaticextractionratio/lowplasmaproteinbounddrugsshouldbeaimedat
maintainingwhichofthefollowing?
A.Normalunboundplasmaconcentrations
B.NormalboundplasmaconcentrationsC.Normaltotal(boundplusunbound)plasmaconcentrations
D.Nodosageadjustmentsneedbeconsidered
Feedback:
AnswerCiscorrect.
Dosageadjustmentforalowhepaticextractionratio/lowplasmaproteinbounddrugshouldbeaimedat
maintainingnormaltotalplasmaconcentrations.Lowhepaticextractionratiodrugsareaffectedmostby
changesinproteinbindingandhepaticintrinsicclearance.Sincethisdrugisnothighlyproteinbound,a
changeintheamountofdrugthatisproteinboundisunlikelytosignificantlychangetheamountofdrug
freetoactinthebodyinthissituation.Therefore,boundversusunboundconcentrationislessimportant.
Totalplasmaconcentrationshouldbethetargetofdosageadjustmentsinthiscase.
AnswerAisincorrect.
maintainingnormaltotalplasmaconcentrations.
AnswerBisincorrect.
AnswerDisincorrect.
100)DSisa36yearoldmalewhopresentswithalteredmentalstatus,anorexia,significantweightloss
overthepastthreemonths,recentabdominalswelling,andgeneralmalaise.Currentmedicationsinclude
Whichofthefollowingstatementsistrue?
A.Inliverdisease,phaseIIconjugation
metabolismisaffectedtoagreaterextentthanphaseIoxidativereactions.B.Inliverdisease,phaseI
oxidativemetabolismisaffectedtoagreaterextentthanphaseIIconjugationreactions.C.Chronicliver
diseaseisassociatedwithuniformreductionsinmetabolismviathedifferentcytochromeP450pathways.
D.Serumcreatinineisanaccuratereflectionofrenalfunctioninchronicliverdisease.
Feedback:
AnswerBiscorrect.
PhaseIoxidativereactions(whichtypicallyinvolvethecytochromeP450enzymaticpathways)areaffected
toagreaterextentincirrhosisthanphaseIIreactionssuchasglucuronidation.Thisisbecausethe
cytochromeP450enzymesaredependentuponoxygentoact.Incirrhosis,thereisarelativelackofoxygen
duetoshunting,sinusoidalcapillarization,andreducedliverperfusion.Inseverecirrhosis,glucuronidation
maybeaffected.
AnswerAisincorrect.
PhaseIoxidativereactionsareaffectedtoagreaterextentincirrhosisthanphaseIIconjugationreactions.
AnswerCisincorrect.
ChronicliverdiseaseisassociatedwithnonuniformreductionsinmetabolismviathecytochromeP450
system.Forexample,inearlystageliverdisease,drugmetabolismthroughthecytochromeP4502C19
enzymecanbeexpectedtobereducedwhilethecytochromeP4501A2,2D6,and2E1enzymepathways
retainnormalornearnormalactivity.Asliverdiseaseprogresses,theactivitylevelsofthedifferent
cytochromeP450enzymepathwayschange.
AnswerDisincorrect.
Serumcreatinineisnotconsideredareliablepredictorofrenalfunctioninchronicliverdisease.Thisis
becauseofthereducedmusclemassandimpairedmetabolismofcreatinetocreatininethataccompanies
severeliverdisease.
101)A37yearoldwomanhasbeenreceivingmaximaldosesofAsacolfortreatmentofUC,butcontinues
tohavedailymoderatesymptomsincludingurgency,abdominalpain,andrectalbleeding.Whichtherapy
wouldbebestfortreatmentofhersymptomsatthistime?
A.EnterocortB.Trexall
C.RemicadeD.Apriso
Feedback:
AnswerCiscorrect.
Infliximabisindicatedinpatientswithmoderatetoseveresymptomswhoareunresponsivetoother
therapies,suchasaminosalicylatesorcorticosteroids.Infliximabworksfasterthanazathioprineandwould
beabetterchoiceforthispatientbasedonthefactthatsheisexperiencingmoderatesymptomsonadaily
basis.
AnswerAisincorrect.
BudesonideisacorticosteroidthatisonlyindicatedforpatientswithCD,whohaveinvolvementofthe
terminalileumorascendingcolon.
AnswerBisincorrect.
MethotrexateisusedmoreinthesettingofCDand,likeazathioprine,hasadelayedonsetofaction,taking
atleast3to4monthstowork.Thispatientneedsmorerapidcontrolofhersymptoms.
AnswerDisincorrect.
Aprisoisaoncedailyformulationofmesalamine.Sincethispatientisalreadyfailingmaximaldosesof
mesalamine,switchingtoanothermesalamineproductwouldprovideminimalbenefit.
102)A48yearoldmalepatientwithCDisprescribedHumirafortreatmentofseveresymptoms.Which
counselingpointshouldyouprovidetothispatientpriortostartingthistherapy?
A.CorrectnumberoftabletstotakeonadailybasisB.ProperinjectiontechniqueC.Monitorfor
developmentofdiarrheaD.Thenextdoseshouldbegivenin8weeks
Feedback:
AnswerBiscorrect.
SinceHumiraisadministeredbysubcutaneousinjectionandisavailableasasingledosesyringeorapen
device,thatpatientshouldbeinstructedonhowtousetheformulationandadministertheinjection
properly.Themanufacturermedicationguidehasdetailedinstructionswhichcanbeusedtoeducate
patientsonthisprocess.
AnswerAisincorrect.
Humiraisaninjectableproduct,andisnotavailableinanoraltabletformulation.
AnswerCisincorrect.
Humiraisnotcommonlyassociatedwithdevelopmentofdiarrhea.
AnswerDisincorrect.
Followingtheinitialdose,thenexttwodosesoccurat2weekintervals,followedthenbyaneveryother
weekdoseschedule.
103)A38yearoldfemalepresentswithan8weekhistoryofnewonsetcrampingabdominalpaintogether
with23bloodystoolsperday.SheisdiagnosedwithleftsidedUC.Whichoneofthefollowingisthemost
appropriateinitialtherapy?
A.Sulfasalazineorally1g4timesperday.B.Mesalamine
enemarectally4geverynight.C.6mercaptopurine(6MP)orally75mg/day.D.Hydrocortisoneenema
rectally100mgeverynight.
Feedback:
AnswerBiscorrect.
AnaminosalycilatewouldbeappropriateinitialtherapyforapatientswithmildtomoderateUC.Topical
therapywithanenemawouldtreatfromtherectumuptothesplenicflexure,whichistheportionofthe
colonaffectedinleftsidedUC.Therefore,amesalamineenemaformulationwouldbethemostappropriate
initialtherapyforthispatient.
AnswerAisincorrect.
Whileoralaminosalycilatetherapyisanoption,useoftopicaltherapyfirstprovidesgoodefficacywhile
minimizingsystemicdrugexposureandadverseeffects.
AnswerCisincorrect.
6mercaptopurineiseffectiveforthemaintenanceofremissionofUC.Becauseitmaytakeseveralmonths
toexperiencethefulleffectofthisagent,itisnotappropriateforuseintheinductionofremission.
AnswerDisincorrect.
TopicalcorticosteroidtherapyiseffectivefortheinductionofremissioninmildtomoderateleftsidedUC;
however,theyarereservedforpatientswhoarenotsuccessfullytreatedwithaminosalycilatetherapy.
104)A46yearoldfemalepatientisnewlydiagnosedwithmildtomoderateCDconfinedtotheileumand
ascendingcolon.Whatisthebestrecommendation?
A.Mesalamineenema1gramPR
atbedtimeB.Certolizumabpegol400mgsubcutaneouslyC.Budesonide9mgdailyorallyD.Prednisone
40mgdailyorally
Feedback:
AnswerCiscorrect.
Oralbudesonideiseffectivefortheinductionofremissionofmildtomoderatediseaseaffectingtheileum
orascendingcolon.Budesonideundergoesfirstpassmetabolismwhichlimitssystemicexposureand
adverseeffects.
AnswerAisincorrect.
Topicalmesalamineenemawouldonlybeeffectiveforleftsideddiseasethatisdistaltothesplenic
flexure.Itwouldnotbeeffectivefordiseasetheaffectstheileumandascendingcolon.
AnswerBisincorrect.
TNFantagonistsarereservedfortheinductionofremissionforpatientswithmoderatetosevereCDwho
areunresponsivetocorticosteroidtherapy.ItwouldnotbeappropriatetoinitiateaTNF antagonistfora
patientwithmildtomoderatediseasewhoistreatmentnave.
AnswerDisincorrect.
SystemiccorticosteroidtherapyisreservedfortheinductionofremissioninmoderatetosevereCD.
105)BDisa59yearoldmalewithCOPD,hypertensionanddyslipidemia.Hereportstoyourpharmacy
complainingofdevelopingatremorsincestartingoneofhismedications.Whichmedicationisthemost
likelycause?
A.IpratropiumB.TiotropiumC.FluticasoneD.Prednisone
E.Albuterol
Feedback:
AnswerEiscorrect.
Tremorisacommonsideeffectofagonists.Othercommoneffectsincludetachycardiaandcentral
nervoussystemstimulation/excitation.
AnswerAisincorrect.
Tremorisnotasideeffectofinhaledanticholinergics.
AnswerBisincorrect.
Tremorisnotasideeffectofinhaledanticholinergics.
AnswerCisincorrect.
Tremorisnotasideeffectofinhaledcorticosteroids.
AnswerDisincorrect.
Tremorisnotasideeffectoforalcorticosteroids.
106)ZHisa59yearoldwithCOPDwhowasrecentlyprescribedafluticasoneinhalerforCOPD.Heis
concernedaboutthesideeffectsofinhaledcorticosteroidsandyouconductinhalercounselingforhim.
Whichofthefollowingisthemostlikelysideeffecttobecausedbyinhaledcorticosteroids?
A.OralcandidiasisB.GlucoseintoleranceC.TachycardiaD.ImmunosuppressionE.Weight
gain
Feedback:
AnswerAiscorrect.
Inhaledcorticosteroidscancausecandidiasisofthemouthand/orthroat.
AnswerBisincorrect.
Longtermsystemic(notinhaled)corticosteroidscancauseglucoseintolerance.
AnswerCisincorrect.
Inhaled2agonistscancausetachycardia.
AnswerDisincorrect.
Longtermsystemic(notinhaled)corticosteroidscancauseimmunosuppression.
AnswerEisincorrect.
Longtermsystemic(notinhaled)corticosteroidscancauseweightgain.
107)Whatisthefollowuptreatmentrecommendationfora16yearoldgirlcurrentlyonQVAR80g2
puffsbidwhoisexperiencingnolimitationonactivityandhasnotusedherSABAinover3months?
SABA
A.StepuptherapyB.StepdowntherapyC.ContinuecurrenttreatmentD.Discontinue
Feedback:
AnswerBiscorrect.
Whenapatientiswellcontrolledforatleast3months,therapyissteppeddown.
AnswerAisincorrect.
Whenapatientiswellcontrolledforatleast3months,therapyissteppeddown.
AnswerCisincorrect.
Apatientwhoiswellcontrolledwouldbenefitfromdecreaseinsteroiddosing.
AnswerDisincorrect.
AllpersonswithasthmaregardlessofseverityrequireaccesstoSABA.
108)Youarecounselinga25yearoldwomanwithasthmawhoiswellcontrolledwithAdvair250/50g1
puffbidandalbuterol2puffsevery4to6hoursprn.Shepresentsaprescriptionforprenatalvitaminfrom
herinitialobstetricappointment.Whatisthesafestmedicationtorecommendforcontrolofherasthma?
A.Albuterol2puffsqidB.Advair250/501puffsbidC.Alvesco160g1puffdaily
D.Pulmicort90mg1puffbid
Feedback:
AnswerBiscorrect.
Inpregnancywhenapatientiswellcontrolledonacurrentregimen,continuetreatment.Ifinitiating
controllertherapy,budesonideistheonlycategoryBinhaledcorticosteroid.
AnswerAisincorrect.
Itisusedforquickreliefofsymptomsnotforcontrol.
AnswerCisincorrect.
AnswerDisincorrect.
109)PRisachildwithcysticfibrosis.Thedoctorswouldliketoadministeramedicineshowntodecrease
thetimebetweenpulmonaryinfections.Whatwouldyourecommend?
A.Inhaled
tobramycinB.InhaledalbuterolC.InhaledDNAseD.Inhaledhypertonicsaline
Feedback:
AnswerCiscorrect.
InhaledDNAsehasbeenshowntoincreasethetimebetweenCFexacerbationsandhospitalizations.
AnswerAisincorrect.
InhaledtobramycinhasbeenshowntoimprovePFTsinCFpatients.
AnswerBisincorrect.
InhaledalbuterolwillimprovegasexchangeinapatientwithanasthmaticcomponenttotheirCF.
AnswerDisincorrect.
InhaledhypertonicsalinehasbeenshowntoslowtheprogressionofdamageinthelungsofCFpatients.
110)Aresidentphysicianapproachesyouaboutapatientadmittedforanacutegoutflare.Hewantstostart
thepatientoncorticosteroidtherapy.Whichofthefollowingwouldbeimportanttocommunicatetothe
residentregardingmonitoringparameters?
A.Recommendtomonitorserumcreatinine
forrenaldysfunction.B.Recommendtomonitorbloodglucoselevels.C.Recommendtomonitorfor
diarrhea.D.Recommendtomonitorforpresenceofskinrash.
Feedback:
AnswerBiscorrect.
Itisimportanttomonitorbloodglucoselevelsinpatientswhoarestartedoncorticosteroidtherapy
regardlessifpatientsarediabeticornot,duetocorticosteroidsabilitytoincreasebloodglucoselevels.
AnswerAisincorrect.
Corticosteroidsareagouttreatmentoptionforpatientswhohaverenalinsufficiency;corticosteroidsdonot
causerenalimpairment.
AnswerCisincorrect.
Thiswouldbeanimportantmonitoringparameterifthepatientwasstartedoncolchicine.
AnswerDisincorrect.
Itwouldbeimportanttomonitorforthispossiblesideeffectifthepatientwasstartedonallopurinolonce
theinitialepisodewasundercontrol.
111)Apatientispickingupanewprescriptionforcolchicine.Whichofthefollowingaretheappropriate
counselingpointstodiscusswiththepatient?
A.Thepatientshouldbecounseledon
gastrointestinalsideeffectsofnausea,vomiting,diarrhea,andabdominalpain.B.Thepatientshouldbe
counseledonpossibilityofarash.C.Thepatientshouldbecounseledonsignsandsymptomsofbleeding.
D.Thepatientshouldbecounseledonclosemonitoringofbloodglucoselevels.
Feedback:
AnswerAiscorrect.
Themajorsideeffectswhichcanlimittheuseofcolchicinearegastrointestinal.
AnswerBisincorrect.
Thiswouldbeacounselingpointforallopurinol.
AnswerCisincorrect.
ThiswouldbeacounselingpointforNSAIDs.
AnswerDisincorrect.
Thiswouldbeacounselingpointforcorticosteroids.
112)Selecttheagentthatcanbeadministeredmonthlyforosteoporosistreatment.
A.RisedronateB.RaloxifeneC.ZoledronicacidD.Alendronate
Feedback:
AnswerAiscorrect.
Risedronateistakenorallyeitherdaily,weekly,every2consecutivedays,ormonthly.Ibandronateisalso
availableasanoralmonthlyformulation.
AnswerBisincorrect.
Raloxifeneistakenorallyqdfortreatment.
AnswerCisincorrect.
ZoledronicacidisgivenIVannuallyfortreatment.
AnswerDisincorrect.
Alendronateistakenorallyqdoreveryweekfortreatment.
113)Selecttheosteoporosismedicationthatisavailableasanasalspray.
A.Ibandronate
B.TeriparatideC.CalcitoninD.Zoledronicacid
Feedback:
AnswerCiscorrect.
Calcitoninisavailableasanasalspray,aswellasinjectable(SQorIM).
AnswerAisincorrect.
IbandronateisavailableinoralandIVforms.
AnswerBisincorrect.
TeriparatideisavailableinSQform.
AnswerDisincorrect.
ZoledronicacidisavailableinIVform.
114)WhichofthefollowingmedicationsisanantiTNFbiologicDMARD?
A.TofacitinibB.TocilizumabC.RituximabD.Golimumab
Feedback:
AnswerDiscorrect.
GolimumabisanantiTNFagent.ItisahumanIgG1monoconalantibodyspecificforhumanTNF.
AnswerAisincorrect.
TofacitinibisanonbiologicDMARDwhichactsthroughtheinhibitionofjanuskinase.
AnswerBisincorrect.
Tocilizumabisahumanizedmonoclonalantibodythatselectivelyantagonizesinterleukin6receptors.
AnswerCisincorrect.
RituximabdoesnotworkbyinterferingwiththeactionsofTNF.Thisdrugisamonoclonalantibodythat
targetstheCD20antigenonBlymphocytes.
115)Whyisfolicacid1mgPOdailyoftenrecommendedalongwithmethotrexatetherapy?
A.FolicacidcanpreventrenaltoxicitycausedbymethotrexateB.Folicacidcanprevent
gastrointestinaltoxicitycausedbymethotrexateC.Mostpeoplewithrheumatoidarthritishavefolicacid
deficienciesD.Folicacidwillenhancetheefficacyofmethotrexate
Feedback:
AnswerBiscorrect.
Folate(thenaturallyoccurringformoffolicacid,whichisalsoknownasvitaminB9)isnecessaryforthe
synthesisandmaintenanceofnewcells.Methotrexateisafolicacidantagonistandwilldepletethebodys
folatestoresbyinhibitingtheenzymedihydrofolatereductase.Becausemanyfastdividingcells(suchas
thosethatlinethegastricmucosa)utilizefolateduringtheirreplication,adeficiencyoffolicacidwill
inhibittheirgrowthandproliferation.Forthisreasonitisrecommendedthatpatientsonmethotrexatetake
1mgdailyoffolicacid.
AnswerAisincorrect.
Althoughmethotrexatemaycauserenaltoxicity,folicacidisnotindicatedtoreducethenephrotoxic
effectsofthedrug.
AnswerCisincorrect.
Patientswhohaverheumatoidarthritisarenotalsolikelytohaveafolatedeficiency.
AnswerDisincorrect.
Whilefolicacidhasnotbeenshowntodecreasetheefficacyofmethotrexate,itwillnotenhancethe
efficacyofmethotrexate.
116)AphysicianwouldliketoaddanantiTNFagentwhichcanbeadministeredsubcutaneouslyfora
patientwhohasfailedtorespondadequatelytomethotrexatemonotherapyafter3months.Whichofthe
followingmedicationsmeetsbothofthesecriteria?
A.AbataceptB.Cytoxan
C.CimziaD.RemicadeE.Rituxan
Feedback:
AnswerCiscorrect.
CimziaisanantiTNFagentandisgivenasanSQinjection.
AnswerAisincorrect.
AbataceptisnotanantiTNFagent.ItisanimmunoglobulinproteinagentthatinhibitsTlymphocyte
activationthroughtheblockageofitsstimulationbyantigenpresentingcells.ItisgivenasanIVinfusion
atweeks0,2,and4andthenevery4weeksthereafter.
AnswerBisincorrect.
CytoxanisanonbiolgicDMARD,notanantiTNFagent.ItisavailableorallyandbyIVinjection.
AnswerDisincorrect.
RemicadeisanantiTNFagent,butitisnotavailableasasubcutaneousinjection.Remicadeisavailableas
anIVinfusiongivenatweeks0,2,and6andthenevery8weeksthereafter.
AnswerEisincorrect.
RituxanisnotanantiTNFagent.ItisamonoclonalantibodythattargetstheCD20antigenonB
lymphocytes.Itisadministeredintravenouslyastwoinfusions2weeksapart.
117)Selectthebrandnameforhydroxychloroquine.
A.AravaB.Cytoxan
C.HumiraD.PlaquenilE.Rituxan
Feedback:
AnswerDiscorrect.
Plaquenilisthebrandnameforhydroxychloroquine.
AnswerAisincorrect.
Aravaisthebrandnameforleflunomide.
AnswerBisincorrect.
Cytoxanisthebrandnameforcyclophosphamide.
AnswerCisincorrect.
Humiraisthebrandnameforadalimumab.
AnswerEisincorrect.
Rituxanisthebrandnameforrituximab.
118)WhichofthefollowingistrueaboutDMARDtherapy?
A.DMARDsreduceor
preventjointdamageinRA.B.Onsetofactionisusually1to2weeks.C.Reservedforuseinsevere
longtermRA.D.IfapatientfailsoneDMARD,theywilllikelyfailallDMARDs.
Feedback:
AnswerAiscorrect.
Diseasemodifyingantirheumaticdrugs(DMARDs)havebeenshowntosloworpreventdisease
progression.
AnswerBisincorrect.
DMARDshaveatypicalonsetof1to6months.
AnswerCisincorrect.
ItisrecommendedtoinitiateDMARDswithin3monthsoftheonsetofsymptoms.AllRApatientsare
candidatesforDMARDtherapy.
AnswerDisincorrect.
IfoneDMARDdoesnotprovidesufficientcontrolofRA,thedoseshouldbeincreasedoradditional
DMARDsshouldbeaddedorsubstituted.
119)Selectthefirstlinepharmacologicagentfortreatingosteoarthritis?
A.AcetaminophenB.IntraarticularcorticosteroidsC.TramadolD.Ibuprofen
Feedback:
AnswerAiscorrect.
Acetaminophenhasbeenshowntobethemostappropriatefirstlineagenttorelievepainand
inflammation.
AnswerBisincorrect.
Intraarticularcorticosteroidsareappropriateforexacerbationsofosteoarthritisofforpatientswhoarenot
candidatesforNSAIDs.
AnswerCisincorrect.
TramadolisusedforthosewithcontraindicationstononselectiveNSAIDsandCOX2inhibitorswith
failureonpreviousdrugtrials.
AnswerDisincorrect.
NonselectiveNSAIDsisthesecondlinetherapyafteracetaminophen.
120)BYisa65yearoldmanwithconfirmedosteoarthritis.Hehasbeenpainfreeonhiscurrentregimen
ofacetaminophen650mgevery6hoursfor2years.Pastmedicalhistoryissignificantforgastrointestinal
bleed4yearsagoandhypertension.Henowpresentstoyourclinicwithpaininhislefthip.BYs
medicationregimenalsoconsistsoflisinopril40mgdailyandhydrochlorothiazide25mgdaily.What
recommendationwillyoupresenttothephysician?
A.Increaseacetaminophento
1000mgevery4hours,reinforcefitnessprogram.B.Addpantoprazole40mgdailytohisregimen,
reinforcefitnessprogram.C.Stopacetaminophen,beginibuprofen400mgtid,reinforcefitnessprogram.
D.Stopacetaminophen,beginAnaprox250mgbid,Protonix40mgdaily,reinforcefitnessprogram.
E.Addcelecoxib200mgdaily,reinforcefitnessprogram.
Feedback:
AnswerDiscorrect.
NaproxenisamemberofthenonselectiveNSAIDclass.Increasedcardiovasculardiseasemaybehigherin
NSAIDsasaclass.Atthistime,naproxenistheonlynonselectivedrugstudiedthathasalowerriskthan
ibuprofenordiclofenac.BYhasaPMHofGIbleed,soaGIprotectiveagentsuchaspantoprazoleshould
beaddedtohisNSAIDregimen.Reinforcingmusclestrengtheningandrangeofmotionexercisesshould
bepartofeveryosteoarthritistreatment.
AnswerAisincorrect.
Themaximumdoseforacetaminophenis4000mgdaily.Thisanswergivesadailydoseof6000mgdaily
andincreasesthepatientsriskfordevelopinghepatotoxicity.
AnswerBisincorrect.
TheadditionofpantoprazolewouldprovidesomeGIprotection,butwouldnotprovideanymorepain
relief.
AnswerCisincorrect.
BYhashypertensionandisathighriskforcardiovasculardisease.Thoughstudiesarenotconclusiveand
alldrugsinthenonselectiveNSAIDclasshavenotbeenstudied,ibuprofenhasshownsomeincreasedrisk
ofMI,stroke,heartfailure,andhypertension.
AnswerEisincorrect.
StudieshaveshownthatCOX2inhibitorshaveanincreasedriskofMI,stroke,heartfailure,andHTN.
CelecoxibwouldnotbeanappropriatechoiceasBYhashypertensionandisathighCVrisk.
121)Aphysiciantellsyoushewouldliketobeginlamotrigineinapatientinordertoavoidsomedrug
interactionswithotherAEDs,butshewouldliketoknowifthereareanyotheradverseeffectssheshould
educatethepatientabout.Whichofthefollowingshouldbeaddressedwiththepatient?
A.RashB.EdemaC.PancreatitisD.Alopecia
Feedback:
AnswerAiscorrect.
Rashisanidiosyncraticreactionassociatedwithlamotrigine.Patientsshouldbeawareofthepossibilityof
hypersensitivityreactions.Ifapatientexperiencesrash,thedrugshouldbediscontinuedunlessitwas
clearlycausedbysomethingelse.
AnswerBisincorrect.
Gabapentinandpregabalinareassociatedwiththedevelopmentofpedaledema.
AnswerCisincorrect.
Lamotrigineisnotassociatedwiththedevelopmentofpancreatitisoralopecia.Valproicacidhasbeen
linkedtoboththeseeffects.
AnswerDisincorrect.
Lamotrigineisnotassociatedwiththedevelopmentofpancreatitisoralopecia.Valproicacidhasbeen
linkedtoboththeseeffects.
122)SPwasdiagnosedwithParkinsondisease7yearsago.Originally,shewastakingcarbidopa/levodopa
25/100mgpotid,whichhassincebeenincreasedto50/250mgpoqid.Nonmotorsymptomsinclude
constipationandinsomnia,andshealsohasarthritisforwhichshetakesacetaminophen650mgpotid.
Assuminganothermedicationistobeaddedatthistime,whichmedicationwouldyousuggestavoiding
basedonherhistoryofpresentillness?
A.PramipexoleB.RasagilineC.Ropinirole
D.Selegiline
Feedback:
AnswerDiscorrect.
Selegilinehasanamphetaminemetaboliteandhasbeenassociatedwithanincreasedincidenceof
insomnia.Dosesshouldbegivennolaterthanearlyafternoontohelppreventthissideeffectinapatient
forwhomitisindicated.Inapatientwithuncontrolledinsomnia,thedrugisbestavoided.
AnswerAisincorrect.
Theadditionofadopamineagonisttosupplementcarbidopa/levodopaisalogicalstrategy.Thereappearto
benocontraindicationsorconcernswiththeadditionofthismedicationtoSPsprofile.
AnswerBisincorrect.
RasagilineisalogicaladditiontoSPsregimen.ThedruginhibitsMAOBtherebyincreasingtheamount
ofavailabledopamineinthebrain.Thereappeartobenocontraindicationsorconcernswiththeadditionof
thismedicationtoSPsprofile.
AnswerCisincorrect.
Theadditionofadopamineagonisttosupplementcarbidopa/levodopaisalogicalstrategy.Thereappearto
benocontraindicationsorconcernswiththeadditionofthismedicationtoSPsprofile.
123)ForwhichParkinsondiseasesymptomareanticholinergicsprimarilyused?
A.BradykinesiaB.PosturalInstabilityC.RigidityD.Tremor
Feedback:
AnswerDiscorrect.
Anticholinergicshelpcorrecttherelativeoveractivityofacetylcholinethatexistsduetodopamine
deficiency.ItisthisimbalancethatisresponsibleforthetremorofParkinsondisease.
AnswerAisincorrect.
Anticholinergicsarenotusefulforpatientswithsignificantbradykinesia.
AnswerBisincorrect.
Anticholinergicsdonothelpcorrectposturalinstability.
AnswerCisincorrect.
Anticholinergicsarenotusefulforpatientswithsignificantrigidity.
124)ABisalongtermpatientwithParkinsondisease.Hisneurologisthaswrittenanewprescriptionfor
tolcapone100mgpotid.Whatlaboratoryvaluesneedtobemonitoredwiththeadditionofthis
medication?
A.HematocritB.LiverfunctiontestsC.PlateletcountD.Serumglucose
Feedback:
AnswerBiscorrect.
Becauseoftheemergenceofseveralcasesoffulminantliverfailureinpatientsreceivingtolcapone,
monitoringofliverfunctiontestsisrecommendedatbaseline,every2to4weeksforthenext6months,
andthenperiodicallyforthedurationoftherapy.
AnswerAisincorrect.
Routinemonitoringofhematocritisnotrequiredwithtolcaponeuse.
AnswerCisincorrect.
Routinemonitoringofplateletcountisnotrequiredwithtolcaponeuse.
AnswerDisincorrect.
Routinemonitoringofserumglucoseisnotrequiredwithtolcaponeuse.
125)Whichdrugshouldbedosedsimultaneouslywithlevodopa?
A.Amantadine
B.EntacaponeC.PramipexoleD.Rasagiline
Feedback:
AnswerBiscorrect.
EntacaponeinhibitstheactionofcatecholOmethyltransferaseintheperipherytoavoidthebreakdownof
levodopaanddopaminebeforelevodopacrossesthebloodbrainbarrier.Itmustbepresentwithlevodopa
toachievethisoutcome.
AnswerAisincorrect.
Amantadineistypicallydosedtwicedailyandmaybeadministeredtopatientsnotreceivinglevodopa
therapy.
AnswerCisincorrect.
Pramipexolestimulatesdopaminereceptorsindependentoflevodopaandmaybeusedasmonotherapy.
AnswerDisincorrect.
Rasagilineinhibitsthebreakdownofdopamineinthebrainandmaybeusedasmonotherapywithout
levodopa.
126)Apatientwhocurrentlytakesoralsumatriptanoftenexperiencesheadacherecurrence,wherethe
headachecomesbackwithin24hoursafterapositiveresponsetothemedication.Herphysicianwouldlike
arecommendationofaselective5HT1receptoragonist(triptan)withalongerhalflife.Whichofthe
followingwouldyourecommend?
A.FrovatriptanB.RizatriptanC.Zolmitriptan
D.Almotriptan
Feedback:
AnswerAiscorrect.
Hercurrentmedication,sumatriptan(Imitrex)hasaneliminationhalflifeof2.5hours.Frovatriptan(Frova)
hasaneliminationhalflifeof26hours.Thelongerhalflifeproductsmaybenefitapatientwhois
responsivetotriptansbutrequiresalongeractingmedicationtolastthedurationoftheheadache.
AnswerBisincorrect.
Rizatriptan(Maxalt)hasasimilareliminationhalflifeof2to3hours.
AnswerCisincorrect.
Zolmitriptan(Zomig)hasasimilareliminationhalflifeof3hours.
AnswerDisincorrect.
Almotriptan(Axert)hasasimilareliminationhalflifeof3.1hours.
127)Treximetisacombinationheadachemedicationmadeupofwhichofthefollowing?
A.SumatriptanandnaproxenB.Acetaminophen,aspirin,andcaffeineC.Acetaminophen,
isometheptenemucate,anddichloralphenazoneD.Acetaminophen,butalbital,andcaffeine
Feedback:
AnswerAiscorrect.
Treximetcontainssumatriptanandnaproxen.
AnswerBisincorrect.
Acetaminophen,aspirin,andcaffeineareExcedrinMigraine.
AnswerCisincorrect.
Acetaminophen,isometheptenemucate,anddichloralphenazoneareMidrin.
AnswerDisincorrect.
Acetaminophen,butalbital,andcaffeineareFioricet.
128)ITisa74yearoldmanwithseverechronicpain.Hehasbeenpreviouslytreatedwithnonopioid
analgesics,butisprescribedmorphinetoday.Thepatientwillbereceivingmorphinechronically.Selectthe
medicationthatITshouldreceiveinadditiontomorphine.
A.IbuprofenB.Gabapentin
C.CapsaicinD.Bisacodyl
Feedback:
AnswerDiscorrect.
Patientsreceivingopioids,especiallyforchronictherapy,shouldreceiveastimulantlaxativebecauseofthe
constipation.Examplesofstimulantlaxativesincludesenna,cascara,andbisacodyl.
AnswerAisincorrect.
IThasbeenreceivingnonopioidanalgesicsinthepastandtheyhavenotbeeneffective.Wearenotgiven
enoughinformationtoknowifhehastakenanNSAID;however,evenifhehad,thatdoesnotprecludeuse
ofanNSAIDwithanopioid.CombinationanalgesictherapywithanopioidandNSAIDmayproduce
betterpainreliefthananopioidalone;however,itisnotrequiredtousecombinationanalgesicstotreat
pain.
AnswerBisincorrect.
Gabapentinisusedforneuropathictypesofpain.Wearenotgivenenoughinformationaboutthetypeof
paintobeabletomakearecommendationforgabapentinorothermedicationsthatareeffectiveagainst
neuropathicpain.
AnswerCisincorrect.
Capsaicinisusedforneuropathictypesofpain.Wearenotgivenenoughinformationaboutthetypeof
paintobeabletomakearecommendationforcapsaicinorothermedicationsthatareeffectiveagainst
neuropathicpain.
129)SQisapatientfromamotorvehiclecollision.Shesufferedabrokenlegduringtheaccidentandwas
givenopioidsforpainmanagement.SQhasdevelopedrespiratorydepression.Selectthemedicationthat
canreverserespiratorydepressioncausedbyopioids.
A.FlumazenilB.Naloxone
C.AcetylcysteineD.Mesna
Feedback:
AnswerBiscorrect.
Naloxone(Narcan)isanopioidantagonistthatreversesrespiratorydepression.
AnswerAisincorrect.
Flumazenil(Romazicon)isabenzodiazepineantagonistandreversesthesedativeeffectsof
benzodiazepinesusedinconscioussedationandgeneralanesthesia.
AnswerCisincorrect.
Acetylcysteine(Mucomyst)isanantidoteforacetaminophentoxicity.
AnswerDisincorrect.
Mesnaisusedforthepreventionofhemorrhagiccystitisassociatedwithcyclophosphamide.
130)Selectthedosingmethodthatshouldbeemployedwhentreatingacuteseverepain.
A.IntermittentB.ScheduleddosingC.DirectlyobservedtherapyD.Asneeded
Feedback:
AnswerBiscorrect.
Scheduleddosingoraroundtheclockisthepreferredmethodforcontrollingseverepain.
AnswerAisincorrect.
Intermittent,orasneeded(prn),isusedforpatientsonscheduleddosingofanalgesicsandexperiencing
breakthroughpain.Forexample,apatientreceivingoxycodone20mgevery12hoursandisexperiencing
painrelief,butitdoesnotlasttheentiredosinginterval,maybeprescribedashortactingopioidfor
breakthroughpainonanasneededbasis.
AnswerCisincorrect.
Directlyobservedtherapyisutilizedinpatientswithtuberculosisandisnotrelatedtopainmanagement.
AnswerDisincorrect.
Asneeded(prn)isusedforpatientsonscheduleddosingofanalgesicsandexperiencingbreakthroughpain.
131)Bettyisapatientwithmajordepressivedisordercurrentlytakingphenelzine.Shehasbeen
experiencingpainfulsinuspressure,headaches,andcongestion.Sheapproachesyourpharmacyandasksif
shecantakeadecongestantforthecongestion.Youinformherthatshecannottakethedecongestantwith
herantidepressantmedicationduetotheriskofwhatsideeffect?
A.Serotonin
syndromeB.HypertensivecrisisC.SexualdysfunctionD.Orthostatichypotension
Feedback:
AnswerBiscorrect.
HypertensivecrisisisassociatedwithconcurrentuseofMAOIsandsympathomimeticsandtyraminerich
foods.
AnswerAisincorrect.
SerotoninsyndromeisassociatedwithconcurrentuseofMAOIsandserotonergicantidepressants,
meperidine,dextromethorphan,andtramadol.
AnswerCisincorrect.
Sexualdysfunctionisasideeffectofantidepressantsthathaveactivityonserotonin,butthisdysfunctionis
unrelatedtothecombineduseofantidepressantsanddecongestants.
AnswerDisincorrect.
Orthostatichypotensionisacommonsideeffectofantidepressantsthathavealpha1adrenergicreceptor
blockade.
132)JAisbeingtransitionedfromolanzapinetolithiumforthemanagementofbipolardisorder.Youhave
beenaskedtoprovideacounselingsessiononmedicationadversedrugreactionsafterJAinquiredabout
commonandexpectedadversedrugreactionsoflithium.Selectthecounselingpointthatshouldbe
discussed.
A.AlopeciaB.IncreasedurinationC.Hyperammonemia
D.HyperthyroidismE.Diplopia
Feedback:
AnswerBiscorrect.
Lithiumcausespolyuria,whichisamanifestationofnephrogenicdiabetesinsipidus.Italsocauses
associatedpolydipsia,increasedthirst.
AnswerAisincorrect.
Alopeciamostlikelyassociatedwithvalproate.
AnswerCisincorrect.
Hyperammonemiaisassociatedwithvalproate.
AnswerDisincorrect.
Lithiumisclearlyassociatedwithcausinghypothyroidism,nothyperthyroidism;althoughtherehavebeen
fewparadoxicalreportsofhyperthyroidismandlithium.
AnswerEisincorrect.
Diplopiahasbeenassociatedwithcarbamazepine.
133)Youareaskedtostarta25yearoldpatientonlithiumforthemaintenancetreatmentofbipolar
disorder.ThepatientsrenalfunctioniswithinnormallimitsandBMIis23.Whatisthestartingdoseand
frequencyoflithiumthatyouwillrecommendforthispatient?
A.300mgtidB.15
mgqhsC.200mgbidD.500mgbidE.50mgeveryday
Feedback:
AnswerAiscorrect.
Therecommendedstartingdoseis300mgtidorless,dependingonthepatientsageandweight.
AnswerBisincorrect.
Therecommendedstartingdoseof15mgqhsisassociatedwitholanzapine.
AnswerCisincorrect.
200mgbidisassociatedwithcarbamazepine.
AnswerDisincorrect.
500mgbidisagoodstartingdosefordivalproexsodium.
AnswerEisincorrect.
50mgqdisastartingdoseoflamotrigineiftakenwithcarbamazepine.
134)Theteratogenicityassociatedwithlithiumuseinthefirsttrimesterofpregnancyis:
A.CardiovascularB.RenalC.HepaticD.NeuromuscularE.Dermatological
Feedback:
AnswerAiscorrect.
LithiumisassociatedwithcausingEbsteinanomaly,acardiacabnormality.Thisisaconditioninwhichthe
tricuspidvalveisabnormalwithsecondarydilationoftherightventricularoutflowtract.
AnswerBisincorrect.
Lithiumcancauserenalimpairmenttothepersonusinglithium,butthereisnoassociationofrenalrelated
birthdefectsinthenewborn.
AnswerCisincorrect.
Lithiumisnotassociatedwithcausingliverdamage.
AnswerDisincorrect.
Carbamazepineandvalproateareassociatedwithcausingspinabifidainpregnancyuse.
AnswerEisincorrect.
Lithiumcancauserashtothepersontakingit,butthiswouldnotbeateratogeniceffect.
135)Apatientbringsinanewprescriptionforalprazolamtoday.Heiscurrentlytakingphenytoinand
carbamazepineforseizures,citalopramfordepression,acetaminophenwithcodeineforlowbackpainand
warfarinforarecentDVT.Whichofthefollowingismostlikelytohaveasignificantpharmacokinetic
drugdruginteractionwiththenewprescription?
A.CitalopramB.Carbamazepine
C.CodeineD.PhenytoinE.Warfarin
Feedback:
AnswerBiscorrect.
CarbamazepineisapotentCYP3A4inducerandcandecreasetheeffectsofalprazolam,whichisa
CYP3A4substrate.
AnswerAisincorrect.
CitalopramdoesnothavesignificantCYPenzymeinhibitoryorinducingeffects.
AnswerCisincorrect.
CodeineismetabolizedbyCYP2D6anddoesnothaveappreciableCYP3A4interactions.
AnswerDisincorrect.
PhenytoinisapotentCYP2C9and2C19inducer;therefore,doesnotsignificantlyaffectalprazolam
metabolism.
AnswerEisincorrect.
WarfarinismostlymetabolizedbyCYP2C9and2C19,soitdoesnothaveasignificantinteractionwith
alprazolam.
136)A29yearoldmalepresentstotheEDwithelevatedbloodpressureandheartrate,confusion,
sweating,andagitation.Hecannotprovideanadequatehistoryandhasnoidentificationwithhim.His
urinetoxicologyscreenhastracesofbenzodiazepinesandbloodalcoholisnegative.Whichofthe
followingismostlikelytocausethispresentationofwithdrawal?
A.Clonazepam
B.DiazepamC.OxazepamD.MidazolamE.Triazolam
Feedback:
AnswerEiscorrect.
Triazolamhastheshortesthalflifeandisassociatedwithsignificantwithdrawalsymptomsifdiscontinued
abruptly.
AnswerAisincorrect.
Bothclonazepamanddiazepamhavelonghalflives;therefore,awithdrawalsyndromewouldnotbeas
likely.
AnswerBisincorrect.
Bothclonazepamanddiazepamhavelonghalflives;therefore,awithdrawalsyndromewouldnotbeas
likely.
AnswerCisincorrect.
Oxazepamhasanintermediatehalflife;therefore,awithdrawalsyndromewouldnotbeaslikely.
AnswerDisincorrect.
Midazolamisnotavailableasanoralformulationandisonlyusedinahospitalsettingasasedativeagent.
137)SWisa45yearoldwomanwitha15yearhistoryofschizophrenia.SWwasonantipsychotic
treatment;however,about2weeksagoshestoppedtakingherantipsychotic,becauseshelostherjoband
couldnotaffordhermedication.SWspsychiatristhasnowprescribedhaloperidolwhichshestartedtaking
2daysago.SWpresentstodaywithastiffneckandmusclespasms.Herpsychiatristhasidentifiedthis
reactionasdystonia.WhichofthefollowingagentsmaybeusedtotreatSWsEPS?
A.CyclobenzaprineB.AsenapineC.BenztropineD.Clozapine
Feedback:
AnswerCiscorrect.
Benztropineisananticholinergicthatcanbeusedtotreatdystonicreactions.Anticholinergicssuchas
benztropineanddiphenhydramineareusuallythepreferreddrugsofchoiceforthetreatmentofthistypeof
EPS.
AnswerAisincorrect.
CyclobenzaprineisamusclerelaxantthatisnotrecommendedforthetreatmentofEPS.
AnswerBisincorrect.
AsenapineisanSGA.
AnswerDisincorrect.
ClozapineisanSGA.
138)MJwasrecentlystartedonfluphenazineforthetreatmentofschizophrenia.Hehasbeentakingthe
fluphenazinefor3daysnowandisnotfeelingwellonthistreatment.MJisexperiencingmusclerigidity,
hyperthermia,hypertension,andpresentswithanalteredlevelofconsciousness.Whichofthefollowingis
MJexperiencing?
A.TardivedyskinesiaB.DystoniaC.Neurolepticmalignant
syndromeD.SerotoninsyndromeE.Hypertensivecrisis
Feedback:
AnswerCiscorrect.
Neurolepticmalignantsyndrome(NMS)mayoccurwithinthefirst24to72hoursafterantipsychotic
treatment.NMSmayoccurwithFGAandSGAtreatment.SignsandsymptomsassociatedwithNMS
includehyperthermia,hypertension,analteredlevelofconsciousness,rigidity,andincreasedcreatine
kinase.
AnswerAisincorrect.
TardivedyskinesiaisatypeofEPSandisdescribedasabnormalinvoluntarymovementsthatdevelopafter
monthsoryearsofantipsychotictreatment.
AnswerBisincorrect.
DystoniaisatypeofEPS.Dystonicreactionsaredescribedasmusclespasms.Thesemusclespasms,or
contractions,usuallyoccurintheneck,head,andtrunkareas.Dystonicreactionsmayoccurwithinafew
daysofantipsychotictreatment.
AnswerDisincorrect.
SerotoninsyndromeandNMShavesimilarpresentations;however,serotoninsyndromeusuallyoccurs
whentwoormoreserotonergicdrugsarecombined.Serotoninsyndromeencompassesaspectrumof
symptoms.Mentalstatuschangescanincludeanxiety,agitateddelirium,restlessness,anddisorientation.
Autonomicmanifestationscanincludediaphoresis,tachycardia,hyperthermia,hypertension,vomiting,and
diarrhea.Neuromuscularhyperactivitycanmanifestastremor,musclerigidity,myoclonus,and
hyperreflexia.Hyperreflexiaandclonusareparticularlycommon.
AnswerEisincorrect.
Ahypertensivecrisisoccurswhenamonoamineoxidaseinhibitor(MAOI)iscombinedwithtyramine
containingfoods.
139)CJisa55yearoldmalewhowasdiagnosedwithschizophrenia30yearsago.Sincehisdiagnosis,CJ
hasalwaysbeenonanFGA;however,overthepastseveralmonths,hehasstartedtoshowsignsoftardive
dyskinesia.CJstreatingpsychiatristfeelsthatitmaybebestforCJtotryaSGAatthispoint.CJhasa
historyofcardiacdisease,and,therefore,hispsychiatristwouldliketoavoidmedicationsthatmaybe
associatedwithQTcprolongation.Whichofthefollowingantipsychoticsshouldbeavoidedduetotherisk
ofQTcprolongation?
A.AripiprazoleB.OlanzapineC.ZiprasidoneD.Quetiapine
Feedback:
AnswerCiscorrect.
ZiprasidonehasbeenassociatedwithQTcprolongation.
AnswerAisincorrect.
ThereisalowriskofQTcprolongationwitharipiprazole.
AnswerBisincorrect.
ThereisalowriskofQTcprolongationwitholanzapine.
AnswerDisincorrect.
ThereisalowriskofQTcprolongationwithquetiapine.
140)MNisa23yearoldobesefemalediagnosedwithPTSDafteracaraccidentseveralyearsago.
AlthoughMNhasbeentreatedwithaSSRIandotheragents,shestillhasrecurrent,disturbingdreamsof
theeventwithminordaytimehallucinations.Herpsychiatristwantstoprescribeanatypicalantipsychotic
foraugmentationtherapyandwouldliketoavoidamedicationwithweightgain.Whichagentareyou
mostlikelytorecommendasaclinicalpharmacist?
A.RisperidoneB.Quetiapine
C.OlanzapineD.Haloperidol
Feedback:
AnswerAiscorrect.
Amongtheantipsychotics,risperidonecarriestheleastamountofweightgainandhasdatatosupportits
useinPTSDtreatment.
AnswerBisincorrect.
Quetiapinealsocarriessignificantweightgain.
AnswerCisincorrect.
Olanzapineistheantipsychoticwiththehighestpropensitytocauseweightgain/metabolicchanges.
AnswerDisincorrect.
Secondgeneration(atypical)neurolepticsareutilizedforaugmentationtherapy.
141)Whichofthefollowingistrueregardingtheactionofinsulin?
A.Enhancesketone
productionB.StimulatesglucoseuptakeintheperipheryC.Itactivatesperoxisomeproliferatoractivated
receptor(PPAR)D.Increasesamylinproduction
Feedback:
AnswerBiscorrect.
Insulinstimulatesglucoseuptakeintomusclesandadiposetissue.
Stimulateshepaticglucoseuptake.
Stimulatesaminoaciduptakeandproteinsynthesis.
Inhibitshepaticglucoseproduction.
Inhibitsbreakdownoftriglyceridesinadiposetissue.
Inhibitsproteindegradation.
AnswerAisincorrect.
Insulininhibitsketoneproduction.
AnswerCisincorrect.
ThisisamechanismofactionforTZDs.
AnswerDisincorrect.
Insulindoesnotincreaseamylinproduction.
142)Whichdrugtherapymaymaskthesignsofhypoglycemia?
A.Atenolol
B.ValsartanC.HydrochlorothiazideD.Pioglitazone
Feedback:
AnswerAiscorrect.
Blockershavebeenknowntomasksignsorsymptomsofhypoglycemia.Theonesignthatitmaynot
maskisdiaphoresisorsweatypalms.
AnswerBisincorrect.
Valsartanisnotassociatedwithmaskedhypoglycemia.
AnswerCisincorrect.
Hydrochlorothiazideisnotnotedtomaskhypoglycemia;however,transientlymayworsenglucosecontrol.
AnswerDisincorrect.
Pioglitazoneisnotassociatedwithmaskedhypoglycemia.
143)GBisa55yearoldfemalerecentlydiagnosedwithhypothyroidism.Whichsymptomsmightshebe
experiencing?
A.BradycardiaandcoldintoleranceB.Anxietyandnervousness
C.WeightlossandinsomniaD.Frequentbowelmovementsandedema
Feedback:
AnswerAiscorrect.
Thedecreasedconcentrationofthyroidhormonesinthebodyduetohypothyroidismdecreasesheartrate.
Patientsalsopresentwithcoldintoleranceduetoaslowermetabolism.
AnswerBisincorrect.
Anxietyandnervousnessarecommonsymptomsofhyperthyroidismthatoccurduetoincreasedadrenergic
activity.
AnswerCisincorrect.
Patientswithhypothyroidismwilltypicallygainweightduetoaslowermetabolism.Sleepdisturbancesare
morelikelytooccurinhyperthyroidism,particularlyinsomnia.Patientswithhypothyroidismmay
experiencemorefatigue.
AnswerDisincorrect.
Constipationisamorecommonproblemwithhypothyroidismwhilefrequentbowelmovementsoccur
moreofteninhyperthyroidism.Edemadoesoccurinhypothyroidism,butusuallyafteralonghistoryof
hypothyroidismduetolowcardiacoutput.
144)WhichofthefollowinglabresultswouldindicatehypothyroidisminGB?
A.IncreasedTSH,increasedthyroidhormonesB.DecreasedTSH,increasedthyroidhormones
C.IncreasedTSH,decreasedthyroidhormonesD.DecreasedTSH,decreasedthyroidhormones
Feedback:
AnswerCiscorrect.
Hypothyroidismoccurswhensufficientconcentrationsofthyroidhormonesarenotavailableinthebody.
Asaresult,TSHconcentrationsincreasetocompensateandproducemorethyroidhormones.
AnswerAisincorrect.
TSHconcentrationswillincreaseinhypothyroidismduetoinsufficientconcentrationsofthyroid
hormones,butthyroidhormonelevelswillbedecreased.
AnswerBisincorrect.
Thesethyroidfunctiontestsmoreaccuratelydepicthyperthyroidism.TSHconcentrationsdecreasein
hyperthyroidismduetoexcessconcentrationsofthyroidhormones.
AnswerDisincorrect.
Thyroidhormoneslevelswillbedecreasedinhypothyroidism,butTSHconcentrationsshouldincreaseto
stimulateproductionofmorethyroidhormones.
145)GBsdoctorhasbeenconcernedaboutnewtrendsinthetreatmentofhypothyroidism.Herequests
yourrecommendationforthemostappropriatetherapyforGB.
A.Desiccatedthyroid
hormoneB.LiothyronineC.LevothyroxineD.Thecombinationofliothyronineandlevothyroxine
Feedback:
AnswerCiscorrect.
Levothyroxineisthepreferredthyroidreplacementdrugforhypothyroidism.Levothyroxinenotonly
replacesT4concentrationsbutwillthenundergoperipheralconversioninthebodytoreplaceT 3.
AnswerAisincorrect.
Desiccatedthyroidhormonewasoneofthefirsttreatmentsavailableforhypothyroidism,butisrarelyused
becauseofthedifficultyinstandardizingconcentrationsandmaintainingaeuthyroidstateforthepatient.It
containsacombinationofT4andT3alongwithT1andT2derivedfrompigsthyroids.
AnswerBisincorrect.
Liothyronine(T3)doesnotreplaceT4concentrations.
AnswerDisincorrect.
Thecombinationoflevothyroxineandliothyroninehasnotproventobesignificantlybeneficial.
146)GBisa55yearoldfemalerecentlydiagnosedwithhypothyroidism.Whichsymptomsmightshebe
experiencing?
A.BradycardiaandcoldintoleranceB.Anxietyandnervousness
C.WeightlossandinsomniaD.Frequentbowelmovementsandedema
Feedback:
AnswerAiscorrect.
Thedecreasedconcentrationofthyroidhormonesinthebodyduetohypothyroidismdecreasesheartrate.
Patientsalsopresentwithcoldintoleranceduetoaslowermetabolism.
AnswerBisincorrect.
Anxietyandnervousnessarecommonsymptomsofhyperthyroidismthatoccurduetoincreasedadrenergic
activity.
AnswerCisincorrect.
Patientswithhypothyroidismwilltypicallygainweightduetoaslowermetabolism.Sleepdisturbancesare
morelikelytooccurinhyperthyroidism,particularlyinsomnia.Patientswithhypothyroidismmay
experiencemorefatigue.
AnswerDisincorrect.
Constipationisamorecommonproblemwithhypothyroidismwhilefrequentbowelmovementsoccur
moreofteninhyperthyroidism.Edemadoesoccurinhypothyroidism,butusuallyafteralonghistoryof
hypothyroidismduetolowcardiacoutput.
147)WhichofthefollowinglabresultswouldindicatehypothyroidisminGB?
A.IncreasedTSH,increasedthyroidhormonesB.DecreasedTSH,increasedthyroidhormones
C.IncreasedTSH,decreasedthyroidhormonesD.DecreasedTSH,decreasedthyroidhormones
Feedback:
AnswerCiscorrect.
Hypothyroidismoccurswhensufficientconcentrationsofthyroidhormonesarenotavailableinthebody.
Asaresult,TSHconcentrationsincreasetocompensateandproducemorethyroidhormones.
AnswerAisincorrect.
TSHconcentrationswillincreaseinhypothyroidismduetoinsufficientconcentrationsofthyroid
hormones,butthyroidhormonelevelswillbedecreased.
AnswerBisincorrect.
Thesethyroidfunctiontestsmoreaccuratelydepicthyperthyroidism.TSHconcentrationsdecreasein
hyperthyroidismduetoexcessconcentrationsofthyroidhormones.
AnswerDisincorrect.
Thyroidhormoneslevelswillbedecreasedinhypothyroidism,butTSHconcentrationsshouldincreaseto
stimulateproductionofmorethyroidhormones.
148)GBsdoctorhasbeenconcernedaboutnewtrendsinthetreatmentofhypothyroidism.Herequests
yourrecommendationforthemostappropriatetherapyforGB.
A.Desiccatedthyroid
hormoneB.LiothyronineC.LevothyroxineD.Thecombinationofliothyronineandlevothyroxine
Feedback:
AnswerCiscorrect.
Levothyroxineisthepreferredthyroidreplacementdrugforhypothyroidism.Levothyroxinenotonly
replacesT4concentrationsbutwillthenundergoperipheralconversioninthebodytoreplaceT 3.
AnswerAisincorrect.
Desiccatedthyroidhormonewasoneofthefirsttreatmentsavailableforhypothyroidism,butisrarelyused
becauseofthedifficultyinstandardizingconcentrationsandmaintainingaeuthyroidstateforthepatient.It
containsacombinationofT4andT3alongwithT1andT2derivedfrompigsthyroids.
AnswerBisincorrect.
Liothyronine(T3)doesnotreplaceT4concentrations.
AnswerDisincorrect.
Thecombinationoflevothyroxineandliothyroninehasnotproventobesignificantlybeneficial.
149)JEhasbeenwithoutacigarettefor3dayswiththehelpofthenicotinepatch.Onthefourthday,JEis
underagreatdealofstressandneedstogooutsideforacigarette.Sinceheisstillwearingthenicotine
replacementpatch,whatadverseeventswillhemostlikelyexperience?
A.Excess
fatigueB.LowerextremitycrampingC.Nausea,vomiting,andheadacheD.Tinnitus
Feedback:
AnswerCiscorrect.
Someofthemostcommonsignsandsymptomsofnicotinetoxicityincludenausea,vomiting,headaches,
increasedbloodpressure,andtachycardia.BecauseJEisalreadyreceivingacontinuoussupplyofnicotine
viathepatch,thequickreleaseofnicotinefromthecigarettewillonlyincreasehischancesoftheseside
effects.
AnswerAisincorrect.
Mostlikely,JEwillbegintoexperiencesymptomsconsistentwithanxietyandnervousness.
AnswerBisincorrect.
Nicotinereplacementtherapywhileapatientissmokingappearstomimicasympatheticoverload.JEs
lowerextremitiesmayfeelanxiousoroveractive,butshouldnotexhibitsymptomsoftraditionalcramping.
AnswerDisincorrect.
Nicotinetoxicitywillnotcausetinnitusand/orotherhearingdisturbances.
150)LKisa62yearoldwomanwithosteoporosis,chronicallergicrhinitis,anda50packyearhistoryof
smokingcigarettes.Atarecenttriptothedentist,shewastoldthatduetopoororalhygieneandtooth
decay,sheneedsherteethremovedandfittedfordentures.Healsorecommendsthatshequitsmoking
duringthistimeperiodasitmostlikelycontributedtohercurrentpredicament.Whichagentlistedbelow
wouldbethebestagentforLKtochoose?
A.NicotinepolacrilexgumB.Nicotine
lozengeC.NicotinenasalinhalerD.Nicotinetransdermalpatch
Feedback:
AnswerDiscorrect.
Becausetheotherthreeoptionsfortherapywerenotappropriategiventhewomansmedicalconditionsand
limitations,shecouldbetriedonthenicotinepatch.Thefirstdosewouldbeusedforapproximately6
weeksandthenshewouldbegintostepdownwithhertherapy.Ifshestartedwiththe21mgpatch,then
shewouldfollowupwith2weeksofthe14mgpatchand2weeksofthe7mgpatch.Ifshestartedwith
the14mgpatch,shewouldonlyneedtofollowupwiththe7mgpatchfor2weeks.
AnswerAisincorrect.
Becausethepatientishavingherteethextractedandfittedtodentures,theuseofnicotinegumisnotideal.
Thegummaysticktothedenturesandpullthemoutofplaceduringtheday.
AnswerBisincorrect.
Whilethelozengeoffersthebenefitsofthegumwithouttheneedtochew,italsoincreasesthechanceof
nicotinetoxicityinthissituation.IfLKusedthenicotinelozengeimmediatelyafterherprocedureorduring
thehealingprocess,thereisachancethatshewillabsorbtoomuch,tooquickly,giventheinflamedstateof
hermouthandgums.
AnswerCisincorrect.
Becausethepatienthasahistoryofchronicallergicrhinitis,thenicotinenasalspraymaycause
unacceptablelocalsideeffectstothepatientcausingirritationtothenasalpassage.
151)AIisa28yearoldwomanwithapastmedicalhistorysignificantforpolycysticovariansyndrome
(PCOS),hypertriglyceridemia,epilepsy,hyperthyroidism,andtobaccoabuseforthelast9years.Whichof
hermedicalconditionsisconsideredaprecautionforusingbupropiontherapy?
A.PolycysticovariansyndromeB.HypertriglyceridemiaC.EpilepsyD.Hyperthyroidism
Feedback:
AnswerCiscorrect.
Epilepsyorseizuresisaprecautionforbupropionuse.Theuseofthismedicationwilldecreasetheseizure
thresholdandmaymakeiteasierforapersontoexperienceaseizure.Usingthemedicationconcurrently
withothermedicationsthathavethesameeffectontheseizurethresholdfurtherincreasestheriskof
seizure.
AnswerAisincorrect.
BupropionwillnothaveaneffectonPCOS.
AnswerBisincorrect.
Usingbupropionhasnotdemonstratedachangeinserumtriglyceridelevelsandwouldnotaffectthis
womansfreefattyacidlevels.
AnswerDisincorrect.
Whilebupropionmayworsensomeofthesymptomsofhyperthyroidism,itisnotacontraindication.
Personswithoverthyperthyroidismexhibitingsymptomsshouldmostlikelynotstarttobaccocessation
therapywithbupropion,butmayconsideraftersurgeryormedicalmanagement.
152)HowoftenisoneNuvaRinginsertedvaginally?
A.1weekB.3weeksC.2weeks
D.4weeks
Feedback:
AnswerBiscorrect.
Onevaginalcontraceptiveringshouldbeinsertedfor3weeks.
AnswerAisincorrect.
Onevaginalcontraceptiveringshouldbeinsertedfor3weeksnotfor1week.
AnswerCisincorrect.
Onevaginalcontraceptiveringshouldbeinsertedfor3weeksnotfor2weeks.
AnswerDisincorrect.
Onevaginalcontraceptiveringshouldbeinsertedfor3weeksnotfor4weeks.
153)BWisa28yearoldobese,womanwhodeliveredababy1weekagoviaCsection.Shedoesnotplan
tobreastfeedandwouldliketostartacombinedoralcontraceptiveassoonaspossible.Whenisthe
earliestshecanstarttakingcombinedoralcontraceptiveswithoutanincreasedriskofbloodclots?
A.ImmediatelyB.2weekspostpartumC.6weekspostpartumD.6monthspostpartum
Feedback:
AnswerCiscorrect.
Thereisahigherriskofbloodclotsifcombinedoralcontraceptivesaretakenlessthan6weeks
postpartum.AwomanmaystartCOC/CHCsat3weekspostpartumifshehasnoriskfactorsforVTEand
isnotbreastfeedingbecauseCOC/CHCsmayaffectbreastmilkinawomanwithdifficultyproducing
milk.Itisrecommendedtowaituntil6weekspostpartumifthepatienthasriskfactorsforVTE.BW
recentlyhadaCsectionandisobeseputtingheratriskforaVTE;therefore,startingaCOC/CHCat6
weeksisthebestrecommendation.
AnswerAisincorrect.
Thereisahigherriskofbloodclotsifcombinedoralcontraceptivesaretakenlessthan3to6weeks
postpartum.
AnswerBisincorrect.
Thereisahigherriskofbloodclotsifcombinedoralcontraceptivesaretakenlessthan3to6weeks
postpartum.IfBWtakesCOCs2weekspostpartum,shemayhaveanincreasedriskofclotting.
AnswerDisincorrect.
Thereisnoneedtowaitfor6months.ThepatientmaystartCOC/CHCsassoonas6weekspostpartumif
shechooses.
154)RRisa26yearoldwomanwhohasjustbeendiagnosedwithpremenstrualdysphoricdisorder
(PMDD)andisalsoseekingcontraception.Sheisotherwisehealthyandisnotobeseoroverweight.Which
ofthefollowingproductsisbesttorecommendforRR?
A.YAZB.OrthoTri
CyclenC.EstrostepD.MircetteE.Yasmin
Feedback:
AnswerAiscorrect.
YAZisFDAapprovedforPMDD.
AnswerBisincorrect.
OrthoTriCyclenisnotFDAapprovedforPMDD,butisapprovedforacnetreatment.
AnswerCisincorrect.
EstrostepisnotFDAapprovedforPMDD,butisapprovedforacnetreatment.
AnswerDisincorrect.
MircetteisnotFDAapprovedforPMDD.
AnswerEisincorrect.
YasminisnotFDAapprovedforPMDD.
155)Whichofthefollowingantiviralagentsisavailableinparenteral,oralandimplantformulations?
A.ValganciclovirB.GanciclovirC.ValacyclvoirD.Acyclovir
Feedback:
AnswerBiscorrect.
Ganciclovirisutilizedforthetreatmentofcytomegalovirusretinitisandisavailableinintravenous,oral,
andintravitrealimplants.
AnswerAisincorrect.
Valganciclovirisavailableorally.
AnswerCisincorrect.
Valacyclovirisavailableastablets.
AnswerDisincorrect.
Acyclovirisavailableastabletsandcapsules.
156)Whichofthefollowingisresponsibleforincreasedprostategrowth?
A.PSA
B.DHTC.5alphareductaseD.Testosterone
Feedback:
AnswerBiscorrect.
Androgens,specificallydihydrotestosterone,bindtoandrogenreceptorsandincreaseexpressionofgenes
thatcontrolprostategrowth.Forthisreason,useof5reductaseinhibitors(5ARIs),whichinhibitthe
conversionoftestosteronetodihydrotestosterone,aretherapeutictargetstopreventthisprocess.
AnswerAisincorrect.
AsPSAisproducedbytheprostate,itmaybehighinpatientswithanenlargedprostate.However,itdoes
notdirectlycauseanincreaseinprostategrowth.
AnswerCisincorrect.
While5reductasefacilitatestheconversionoftestosteronetoDHT,itissimplytheenzymeandisnot
directlyresponsibleforincreasingprostategrowth.Asstatedabove,byinhibiting5reductase,production
ofDHTisreducedandthelatteriswhatisdirectlyresponsibleforprostategrowth.
AnswerDisincorrect.
Testosteronebindstoandrogenreceptors;however,itfreelydissociatesaswell.DHTisthechiefandrogen
involvedinprostategrowthandthetargetof5ARItherapy.
157)Selectthestatementthatcorrectlydescribeserectiledysfunction.
A.IndividualswithdiabetesareathigherriskB.ItisuncommonintheUnitedStatesC.Itgenerally
afflictsyoungermen.D.IndividualswithabovenormalbloodpressureareprotectedE.Smokersareless
likelytodevelopthecondition.
Feedback:
AnswerAiscorrect.
IndividualswithdiabetesarethreetimesmorelikelytodevelopED.EDdevelopsindiabeticsbecauseof
thevascularandneurologicchangesthatmayoccur.
AnswerBisincorrect.
ItisverycommonintheUnitedStates,withasmanyas20millionmenaffected.
AnswerCisincorrect.
TheprevalenceofEDincreaseswithincreasingage.At40yearsofage,upto5%ofmenareafflictedwith
completetoseveredysfunction.Thisincreasesto15%to25%inmenover65.
AnswerDisincorrect.
HypertensionisconsideredariskfactorforthedevelopmentofED.
AnswerEisincorrect.
SmokingincreasesthelikelihoodofED.
158)Selectthebrandnameforlevocetirizine.
D.Singulair
A.ClarinexB.ZaditorC.Xyzal
Feedback:
AnswerCiscorrect.
Thisisthebrandnameforlevocetirizine.
AnswerAisincorrect.
Thisisthebrandnamefordesloratadine.
AnswerBisincorrect.
Thisisthebrandnameforketotifenfumarate.
AnswerDisincorrect.
Thisisthebrandnameformontelukast.
159)Whichofthefollowingallergenavoidancetechniqueswouldbeappropriatetohelpreduceallergic
symptomscausedbyragweedpollen?
A.Encasepillowandmattressinallergenproof
cover.B.Keepwindowsclosedandminimizeoutdooractivities.C.Reduceindoorhumidityto<50%.
D.Washbeddinginhotwater.
Feedback:
AnswerBiscorrect.
Thispreventspollenfromenteringthehouseandminimizesthesubjectsexposure.
AnswerAisincorrect.
Pollenisanoutdoorallergenandcannotbeminimizedthroughtheuseofallergenproofcoversonbedding.
AnswerCisincorrect.
Thiscanhelpwithindoormoldallergies,butdoesnotassistwithoutdoorallergenssuchaspollen.
AnswerDisincorrect.
Thiscanassistpatientswithindoordustmiteallergies,butdoesnotassistwithoutdoorallergenssuchas
pollen.
160)CWisan8yearoldboywithseasonalallergicrhinitisandmildpersistentasthma.Whichofthe
followingmedicationswouldbeappropriatetomanagesymptomsofbothhisasthmaandallergicrhinitis?
A.IntranasalbeclomethasoneB.IntranasalcromolynC.CetirizineD.Montelukast
Feedback:
AnswerDiscorrect.
Montelukastiseffectiveforthemanagementofbothallergicrhinitisandasthma.
AnswerAisincorrect.
Intranasalcorticosteroidsare,atbest,marginallyefficaciousforasthmaandshouldnotbesubstitutedfor
inhaledcorticosteroidsand/orothermethodsofasthmamanagement.
AnswerBisincorrect.
Althoughinhaledcromolynsodiumisusedasanadjuncttoasthmatreatment,theintranasalcromolyn
sodiumisnotindicatedforthemanagementofasthma.
AnswerCisincorrect.
Oralantihistaminesarenotrecommendedforthetreatmentofasthma.
161)ESisa84y/o,200lbmalethatpresentstotheemergencydepartmentafteraccidentallytakingfourof
hismetoprolol200mgtabletsduetoanerrorinvolvinghisweeklypillorganizer.Whichofthefollowingis
afirstlineagentinthemanagementofmetoprololtoxicityassociatedwithahighincidenceofnauseaand
vomiting?
A.AtropineB.CalciumgluconateC.GlucagonD.Milrinone
Feedback:
AnswerCiscorrect.
Glucagonistheagentofchoiceforblockertoxicitynotresponsivetoatropineandfluidadministration.
adrenergicreceptorsandglucagonarebothcoupledtoGproteinsthat,uponstimulation,resultin
increasedadenylcyclaseandresultantcAMP.Thisprovidesthepositiveinotropicandchronotropiceffects
of1receptorstimulation.Inblockerpoisoning,administrationofglucagonprovidesaneffective
bypassofantagonizedreceptors.Glucagonshouldinitiallybegivenasa3to5mgintravenousbolusand
repeateduntilresponse,uponwhichtimeacontinuousinfusionshouldbeinitiatedatthecumulative
responsedoseperhour.Nauseaandvomitingarefrequentadverseeffectsfollowingadministrationofthe
higherdosesutilizedtotreatblockertoxicity,andcloseattentionshouldbepaidtotheriskofaspiration
orobstructionfollowingemesisinpatientswithdecreasedlevelsofconsciousness.Additionally,patients
shouldbeobservedforhypoglycemiaorhyperglycemiaandhypokalemia.Glucagonhasashortdurationof
actioncomparedtothatofthemajorityofantagonist.Thiscombinedwithhigherdosetherapymay
depleteentirehospitalsuppliesfollowingsignificantoverdose.
AnswerAisincorrect.
Atropineisutilizedasafirstlineagentforbradycardiaduetoreceptorantagonism.Inthemajorityof
moderatetosevereblockerpoisonings,atropinewillfailtosignificantlyincreaseheartrate,andinotropic
therapyisnecessary.Effectsfromatropineadministrationwouldbeanticholinergicinnatureandnot
nauseaandvomiting.
AnswerBisincorrect.
Calciumsaltadministrationmayimprovebloodpressurebutnotheartrateinthesettingof blocker
poisoningandisnotconsideredafirstlinetherapy.
AnswerDisincorrect.
Milrinoneisaphosphodiesteraseinhibitor(PDI)anddecreasesthebreakdownofcAMPallowingfor
increasedintracellularcAMPlevelsandimprovedmyocardialfunction.PDIwillincreasecardiacoutputas
evidenceoftheirutilityinthetreatmentofadvancedcardiacfailure,butuseofPDIinthemanagementof
blockertoxicityisreservedforpatientsfailingmoreproventherapies.Hypotensionanddifficultyin
titrationandlonghalflifearepropertiesthatsignificantlylimitPDIuse.
162)An18yearoldpatienthasbeendiagnosedwithapneumonicformofYersiniapestis.Whatisthebest
courseofactionfortheindividual(s)exposedtothepatient?
A.Startciprofloxacin500
mgevery12hoursoncesymptomsappear.B.Startdoxycycline100mgevery12hoursfor7daysinall
individualsexposedduringthepatientsclinicalcourse.C.Awaitthepatientscultureandsensitivity
resultsandstartthemostappropriateantibioticasprophylaxisintheexposedindividuals.D.Prophylaxis
isnotbeneficial.
Feedback:
AnswerBiscorrect.
Doxycycline100mgevery12hoursfor7daysinan18yearoldisanappropriateregimen.
AnswerAisincorrect.
Ciprofloxacinisanappropriateantibioticchoice,butwaitingforsymptomstoappeariswrong.Allpatients
suspectedtohaveanexposureshouldbetreatedassoonaspossibleregardlessofsignsandsymptoms.
AnswerCisincorrect.
AwaitingculturesandsensitivitywithaninvasiveorganismsuchasYersiniapestisisinappropriate,when
anexposureisknown.
AnswerDisincorrect.
Prophylaxiscanbebeneficialforexposedpatients.
163)Apharmacistworkinginlocalretailpharmacyreceivesacallduringabioterrorismdrillfroman
emergencydepartmentphysician.Hestatestheyhaveaconfirmedcaseofpneumonictularemia.The
patientstatesaformercoworkerthreatenedeveryoneintheworkplace.Uponquestioningfromthepoliceit
wasdeterminedthecoworkerhadreleasedFrancisellatularensisintotheairductsofhisformerworkplace
approximately3daysprior.Therearesixindividualsinthatareaandhehaswrittenthemeacha
prescriptionforciprofloxacin500mgevery12hoursfor7daysasprophylaxis.Howevertheairduct
systemissharedwithadaycareandeightchildrenhavebeenpotentiallyexposed.Allofthechildrenare
A.Doxycycline50mgevery12hoursfor7daysB.Doxycycline2.2mg/kgevery12
hoursfor7daysC.Ciprofloxacin500mgoncedailyfor7daysD.Ciprofloxacin25mg/kgevery12hours
for7days
Feedback:
AnswerBiscorrect.
Doxycycline2.2mg/kgevery12hoursfor7daysisanappropriatedoseforchildrenlessthan30kg.
AnswerAisincorrect.
Thedoseofdoxycyclineispotentiallytoohighinsomeandtolowinothers.Weightbaseddosingof
doxycyclineshouldbeutilized.
AnswerCisincorrect.
Ciprofloxacinisanappropriateantibioticchoice,butthedoseistoohighforchildren30kgorless.The
doseshouldbeCiprofloxacin10to15mg/kgevery12hoursfor7days.
AnswerDisincorrect.
Ciprofloxacin25mg/kgevery12hoursisanexcessivedoseforchildren30kgorless.Thedoseshouldbe
Ciprofloxacin10to15mg/kgevery12hoursfor7days.
164)TwelvepatientswithtypeGbotulismhavebeendiagnosedintheUnitedStatesinthepast24hours.
AllhadrecentlyflownthroughTorontoPearsonInternationalAirportinthelast72hoursfromvarious
destinations.Allareexperiencingarapiddescendingparalysis.Whatisthemostlikelyreasonforthe
outbreak?
A.ContaminatedseafoodatanairportvendorB.Deliberatereleaseoftoxin
withintheairportC.PersontopersoncontaminationD.Serendipity
Feedback:
AnswerBiscorrect.
TypeGisunusualinhumans.MultiplecasesoftypeGinfectionwithasinglesourceofcontact(airport)is
adeliberatereleaseuntilotherwiseruledout.
AnswerAisincorrect.
Althoughafoodvendorcouldbeimplicated,theseafoodsuggeststypeE.
AnswerCisincorrect.
Botulismisnotspreadfrompersontopersoncontamination.
AnswerDisincorrect.
AvirtualstatisticalimpossibilityconsideringitistypeG.
165)WhatispresentlythebestcourseoftreatmentforEbola?
A.Fluidreplacement,
ventilation,andadditionalsupportivecareasneededB.HighdoseribavirinC.Cryotherapytodropthe
coretemperatureto<95FD.Acocktailofacyclovir,proteaseinhibitor,andinterferon
Feedback:
AnswerAiscorrect.
Althoughsupportivecarewithfluidreplacement,ventilation,andadditionalcareasneededisthe
managementforEbola.
AnswerBisincorrect.
Ribavirincanbeusedforothertypesofhemorrhagicfever.ItisineffectiveforEbola.
AnswerCisincorrect.
Nothingtosupportdroppingthecoretemperature.
AnswerDisincorrect.
Noevidencetosupportthis.
166)Whichofthefollowingpediatricvaccinesisadministeredorally?
A.IPVB.PCV
C.RVD.Varicella
Feedback:
AnswerCiscorrect.
RVistheonlyvaccinelistedthatisadministeredorally.
AnswerAisincorrect.
IPVcanbeadministeredIMorSC.Itcannotbeadministeredorally.
AnswerBisincorrect.
PCVisadministeredIM,notorally.
AnswerDisincorrect.
ThevaricellavaccineisadministeredSC,notorally.
167)5.A69yearoldmalecomesintoyourpharmacyafterreceivingaletteradvertisingyour
immunizationprogram.Hehasdiabetesandhypertensionandsmokesapackofcigarettesaday.Hedoes
nothaveanymedicationorvaccineallergies.Hisvaccinationrecordshowsthathecompletedallofhis
childhoodvaccinations(DTaP,Hib,PCV,IPV,andMMR)aswellastheHepBseries,hehadthe
chickenpoxwhenhewas5yearsoldandreceivedhislastTdbooster11yearsago.Whichvaccinesshould
thispatientreceive?
A.Td,Zoster,PPSV,andHepAB.Tdap,Varicella,andPPSV
C.Td,Zoster,andPPSVD.Tdap,Zoster,andPPSV
Feedback:
AnswerDiscorrect.
Thispatientneedsatetanusdiphtheriapertussisboosterbecauseithasbeenover10yearssincehislast
tetanusboosterandACIPnowrecommendsuseofTdapinpatients65yearsandolder.Heisacandidate
forzosterandPPSVvaccinesbecauseheisovertheageof60and65,respectfully.
AnswerAisincorrect.
tetanusboosterandACIPnowrecommendsuseofTdapinpatients65yearsandolder.Heisalsoa
candidateforthezostervaccineaswellasthePPSVvaccinesinceheisover60and65yearsold,
respectfully.HeisnotacandidateforHepAvaccinationbecauseheisnotachildanddoesnothaveany
riskfactorsforHepAinfection.
AnswerBisincorrect.
Thispatientdoesneedatetanusdiphtheriapertussisboosterbecauseithasbeenover10yearssincehislast
tetanusboosterandACIPnowrecommendsuseofTdapinpatients65yearsandolder.Varicellais
indicatedinchildrengreaterthan12monthsandadultswithoutdocumentedevidenceofvaricellaimmunity
(egpreviousvaccinationordocumentedcaseofchickenpox).Sincehehashadthechickenpox,heisnota
candidateforvaricellavaccination.HeisacandidateforPPSVbecauseheisovertheageof65.
AnswerCisincorrect.
tetanusboosterandACIPnowrecommendsuseofTdapinpatients65yearsandolder.Heisacandidate
forzosterandPPSVvaccinesbecauseheisovertheageof60and65,respectfully.
168)Whichofthefollowingdiphtheriaandtetanusvaccinesshouldbeusedinadultsasaonetimebooster
dose?
A.TdB.DTC.TdapD.DTaP
Feedback:
AnswerCiscorrect.
Adolescentsandadultswillrequireaboosterdoseofthepertussisvaccineonceintheirlifetime.Itis
recommendedthatoneTdboosterbereplacedbyaTdapboosteronceinpatientsovertheageof7years.
PregnantfemalesaretheonlypatientswhoreceiverepeatdosingofTdaptheyreceiveonedoseintheir
thirdtrimesterwitheachpregnancy.
AnswerAisincorrect.
AdultswillrequireaTdboosterevery10years.
AnswerBisincorrect.
DTisonlyindicatedforchildrenlessthan7yearsofagewhohaveacontraindicationtothepertussis
vaccine.
AnswerDisincorrect.
DTaPisonlyindicatedforchildrenlessthan7yearsofage.
169)IdentifytheArabicvalueofDCXXIV.
A.624B.626C.1024D.1026
Feedback:
AnswerAiscorrect.
D=500,C=100,X=10,I=1,V=5(500+100+10+101+5=624).
AnswerBisincorrect.
TheRomannumeralfor626wouldbeDCXXVI.
AnswerCisincorrect.
TheRomannumeralfor1024wouldbeMXXIV.
AnswerDisincorrect.
TheRomannumeralfor1026wouldbeMCCVI.
170)Selectthedefinitionofspecificgravity.
A.Ratiooftheweightofamaterialtothe
weightofthesamevolumeofstandardmaterial.B.Themixingofsolutionsorsolidspossessingdifferent
percentagestrengths.C.Theexpressionoftworatioswhichareequal.D.Gramsofingredientin100gof
product;assumedformixturesofsolidsandsemisolids.
Feedback:
AnswerAiscorrect.
Specificgravityisdefinedasratiooftheweightofamaterialtotheweightofthesamevolumeofstandard
material.
AnswerBisincorrect.
Alligation:Themixingofsolutionsorsolidspossessingdifferentpercentagestrengthspresentsa
calculationproblemwhichmaybesolvedusinganarithmeticmethodcalledalligation.
AnswerCisincorrect.
Aproportionistheexpressionoftworatioswhichareequal.Itisusuallywritteninoneoftwoways:two
equalfractions(a/b=c/d)orusingacolon(a:b=c:d).
AnswerDisincorrect.
Percentweightinweight:%(w/w)=gramsofingredientin100gofproduct;assumedformixturesof
solidsandsemisolids.
171)A27yearoldfemalewhois36weeksgestationhasapositivescreeningtestforcolonizationwith
GroupBStreptococcus.Shedisplaysnoacutesymptomsandhasnoknowndrugallergies.Whichofthe
followingtherapiesismostappropriateduringlaboranddelivery?
A.Intravenous
cefazolinB.IntravenouspenicillinGC.OralampicillinD.Notherapyiswarrantedsincesheisafebrile
Feedback:
AnswerBiscorrect.
IntravenouspenicillinGadministeredfromthetimeofmembranerupturethroughdeliveryisthepreferred
therapyforGroupBStreptococcus.
AnswerAisincorrect.
IntravenouscefazolinisanalternativetopenicillinGinpenicillinallergicpatientswhohavedonothavea
historyofsevereallergicreactiontopenicillin.
AnswerCisincorrect.
AlthoughampicillinisanalternativetopenicillinGforGroupBStreptococcus,oraltherapyisnot
indicatedinthissituation.
AnswerDisincorrect.
WomenwhohaveapositivescreeningtestforGroupBStreptococcusshouldbetreatedregardlessof
symptoms.
172)Apatientwhois24weeksgestationissufferingfromoccasionalmildheartburn.Whichofthe
followingisthemostappropriatetherapy?
A.Antacidcontainingaluminumhydroxide
B.AntacidcontainingcalciumcarbonateC.OmeprazolesodiumbicarbonateD.Ranitidine
Feedback:
AnswerBiscorrect.
Antacidsthatcontaincalciumarefirstlinetherapyformildheartburnsymptomsinpregnancy.Theyhave
theaddedbenefitofprovidingcalciumsupplementationthatmaybeneededinpregnancy.
AnswerAisincorrect.
Antacidscontainingaluminumshouldbeavoidedinpregnancyduetothepotentialforfetalneurotoxicity.
AnswerCisincorrect.
Protonpumpinhibitorssuchasomeprazolemaybeusedinpregnancy.However,theyarebestusedfor
moderatetoseveresymptomsnotrelievedbyantacids.Also,sodiumbicarbonateshouldbeavoided,since
thesodiumcanexacerbatewaterretentioninpregnancy.
AnswerDisincorrect.
RanitidineisFDApregnancycategoryBandmaybeusedforthemanagementofheartburnsymptoms.It
maybeusedifthepatientdoesnotobtainreliefwithfirstlineantacids.
173)Whichofthefollowingdescribesappropriatepharmacotherapyofachronicmedicalconditionin
pregnancy?
A.DiabetespioglitazoneB.Dyslipidemiapravastatin
C.HypothyroidismlevothyroxineD.Venousthromboembolismwarfarin
Feedback:
AnswerCiscorrect.
LevothyroxineisFDApregnancycategoryA.Itisimportanttocorrecthypothyroidisminpregnancy,asit
mayresultinimpairedneurologicaldevelopmentinthefetus.
AnswerAisincorrect.
Insulinisthepreferredtherapyforthemanagementofdiabetesinpregnancy.Metforminandglyburideare
alternativesfortype2diabetes.
AnswerBisincorrect.
StatinsareFDApregnancycategoryXandshouldnotbeadministeredinpregnancy.Bileacidresinsarean
alternative.
AnswerDisincorrect.
WarfarinisFDApregnancycategoryXandshouldbeavoidedinpregnancy(withtheexceptionofhigh
riskwomenwithmechanicalheartvalves).Lowmolecularweightheparinispreferred,andunfractionated
heparinisanalternative.
174)TWisa32yearoldfemalewhoisbreastfeedingher4weekoldinfantevery3hourswithout
difficulty.Sheissufferingfromacoldandwouldliketotakeadecongestant.Whichofthefollowing
recommendationsisbest?
A.Phenylephrine15mgpoq6hB.Pseudoephedrine30mg
poq6hC.Oxymetazoline2sprayseachnostrilq12hfor3daysD.Nodecongestantissafeforusewhile
breastfeeding
Feedback:
AnswerCiscorrect.
Oxymetazolineisatopicaldecongestantthatwillnotadverselyaffectthemilksupply.Itisrecommended
forthetreatmentofcongestionfor3to4daysinamotherwhoisbreastfeeding.
AnswerAisincorrect.
Phenylephrineisnotrecommendedbecauseitmayresultinadecreaseinmilksupply.Thisisespecially
importantinmotherswherebreastfeedingisnotestablished.
AnswerBisincorrect.
Pseudoephedrinemayalsoresultinadecreaseinmilksupplyandisnotrecommended.
AnswerDisincorrect.
Mothersthatarebreastfeedingmaysafelyuseoxymetazolineforashortduration.
175)ApharmacyresidentinSouthCarolinaischargedwithevaluatingdaptomycinasherresearchproject
fortheyear.Sheisevaluatingallpatientswithin18monthsandcomparingthemtovancomycin.The
primaryoutcomeisclinicalresponseasdefinedbyclearanceofbacteremiawithin5days.Herdata
collectionsheethastwoboxesfortheprimaryoutcome(yesandno).Whattypeofmeasurementscaleis
theresidentcollecting?
A.nominalB.ordinalC.intervalD.ratio
Feedback:
AnswerAiscorrect.
Anominalscaleconsistsofcategoriesthathavenoimpliedrankororder(maleversusfemale;orabsence
versuspresence).Thepatientcanfitintoonlyonecategory;thatis,thedatapointsaremutuallyexclusive.
AnswerBisincorrect.
Anordinalscalehasallofthecharacteristicsofanominalvariable;however,thedataareplacedintorank
orderedcategories.Intervalscalesincreasetheinformationprovidedbyanordinalscalebyallowing
researcherstoquantifyameaningfuldistancebetweentwounits(eg,temperature).Ratioscalesdifferfrom
intervalscalesinthattheyhaveanabsolutezero(eg,bloodpressure).
AnswerCisincorrect.
AnswerDisincorrect.
176)Astudyisevaluatingthecostassociatedwithemergencyroomvisits.Whattypeofcostwould
emergencyroomvisitsrepresent?
A.DirectmedicalB.DirectnonmedicalC.Indirect
D.Intangible
Feedback:
AnswerAiscorrect.
Directmedicalcostsarethemedicallyrelatedinputsuseddirectlyinprovidingthetreatment.Examplesof
directmedicalcostsincludecostsassociatedwithpharmaceuticalproducts,physicianvisits,emergency
roomvisits,andhospitalizations.
AnswerBisincorrect.
Theexampleaboverepresentsadirectmedicalcost;however,studiesofanillnessmayincludeallfour
typesofcosts.Forexample,thecostofaprocedurewouldincludethedirectmedicalcostsoftheprocedure
(medication,laboratorytests,andphysicianservices),directnonmedicalcosts(travelandlodgingif
required),indirectcosts(costduetothepatientmissingwork),andintangiblecosts(fearaboutprocedure).
AnswerCisincorrect.
AnswerDisincorrect.
177)Astudyisevaluatingthecostassociatedwithhotelandmealexpensesforapatienttravelingtoseea
subspecialist.Whattypeofcostwouldhotelandmealexpensesrepresent?
A.Direct
medicalB.DirectnonmedicalC.IndirectD.Intangible
Feedback:
AnswerBiscorrect.
Directnonmedicalcostsarenotmedicalinnature,butaredirectlyassociatedwithtreatment.Examples
includethecostoftravelingtoandfromthephysician'sofficeorhospital,babysittingforthechildrenofa
patient,andfoodandlodgingrequiredforpatientsandtheirfamiliesduringoutoftowntreatment.
AnswerAisincorrect.
Moststudiesonlyreportthedirectmedicalcosts.Thismaybeappropriatedependingontheobjectiveof
thestudyortheperspectiveofthestudy.However,anillnessmay(andmostlikelydoes)includeallfour
typesofcosts.Itdependsupontheperspectiveastowhichcostswillbeevaluated.
AnswerCisincorrect.
AnswerDisincorrect.
178)Whatisthebrandnameofclonidine?
A.ChantixB.PamelorC.Aventyl
D.Catapress
Feedback:
AnswerDiscorrect.
ThebrandnameforclonidineisCarapress.
AnswerAisincorrect.
ThebrandnameforvareniclineisChantix.
AnswerBisincorrect.
ThebrandnamesfornortriptylinearePamelorandAventyl.
AnswerCisincorrect.
ThebrandnamesfornortriptylinearePamelorandAventyl.
179)CommerciallyavailableSymlinshouldbeadministeredbywhichroute?
A.IntravenouslyB.IntramuscularlyC.SubcutaneouslyD.ViaInsulinpump
Feedback:
AnswerCiscorrect.
OnlyFDAapprovedrouteofadministration.
AnswerAisincorrect.
NotFDAapprovedfortheseroutesofadministration.
AnswerBisincorrect.
AnswerDisincorrect.
180)Whichofthefollowingcelltypescanpresentpeptidefragmentsfromanengulfedpathogenin
associationwithMHCclassIItoTlymphocytes?
A.NeutrophilsB.Basophils
C.DendriticcellD.Eosinophils
Feedback:
AnswerCiscorrect.
DendriticcellsareapotentAPC.
AnswerAisincorrect.
Neutrophilssimplyengulfanddestroythepathogen.TheycannotpresentantigentoTlymphocytes.
AnswerBisincorrect.
Basophilsplayaroleinallergicreactions,likeothergranulocytes,theycannotpresentantigen.
AnswerDisincorrect.
Eosinophilsplayanimportantroleinparasiticinfectionsandallergicdisorders.Likeothergranulocytes,
theycannotpresentantigentoTlymphocytes.
181)Whichofthefollowingcelltypesplaysacriticalroleinparasiticinfections?
A.BasophilB.MacrophageC.PlasmacellD.Eosinophil
Feedback:
AnswerDiscorrect.
Eosinophilsplayamajorroleinparasiticinfections.
AnswerAisincorrect.
Basophilsplayamajorroleinallergicreactions.
AnswerBisincorrect.
MacrophagesalsoengulfpathogensandpresentfragmentsofthepathogentoTlymphocytes.Theydonot
playamajorroleinparasiticinfections.
AnswerCisincorrect.
PlasmacellsareactivatedBlymphocytesthatsecreteantibody.
182)KTisa45yearoldfemalewithnewlydiagnosedStage3melanoma;KTstumorwassurgically
resectedbutwasfoundtohave(+)lymphnodeinvolvement(4outof10lymphnodes).KTisinclinic
todaytodiscussadjuvanttreatment,whichofthefollowingisthebesttreatmentoptionforKT?
A.IpilimumabB.Interleukin2(IL2)C.Interferonalpha2bD.Procarbazine
E.Trametinib
Feedback:
AnswerCiscorrect.
Highdoseinterferon2biscurrentlytheonlyFDAapprovedagentforuseintheadjuvantsettingforthe
treatmentofmelanoma.
AnswerAisincorrect.
Ipilimumab(Yervoy)isamonoclonalantibodythattargetsthecytotoxicTlymphocyteantigen4(CTLA
4)receptor,resultinginanimmuneresponsedirectedagainstmelanoma.IpilimumabisFDAapprovedfor
thetreatmentofmetastaticorunresectablemelanoma.
AnswerBisincorrect.
Highdoseinterleukin2isanimmunotherapythatisFDAapprovedforthetreatmentofmetastatic
melanomainselectedpatientswithgoodperformancestatus.
AnswerDisincorrect.
ProcarbazineisachemotherapyagentFDAapprovedforuseincombinationwithotherchemotherapeutic
agentsinMOPPregimenforthetreatmentofHodgkinlymphoma.
AnswerEisincorrect.
Trametinib(Mekinist)isaMEKinhibitorwithFDAapprovalforthetreatmentofmetastaticor
unresectablemelanomawithBRAFV600EorV600Kmutations.Trametinibisaselectiveandreversible
mitogenactivatedextracellularkinase(MEK)inhibitorwithactivitydownstreamtoBRAF.
183)HMisa52yearoldmalewithnewlydiagnosedBRAFV600Emutation(+)unresectablemelanoma.
HMhasuntreatedCNSinvolvement,withpoorperformancestatus.Whichofthefollowingtreatment
optionisappropriateforHM?
A.Interleukin2(IL2)B.Temozolomide
C.VemurafenibD.DacabazineE.Ipilimumab
Feedback:
AnswerCiscorrect.
Vemurafenib(Zelboraf)isaBRAFkinaseinhibitorFDAapprovedforthetreatmentofmetastaticor
unresectablemelanomawithBRAFV600Emutation(+)disease.Theuseofvemurafenibisconsideredthe
firstlinetreatmentinanewlydiagnosedpatientwithunresectablemelanomawithBRAFV600Emutation
(+)disease,untreatedbraininvolvement,andwithpoorperformancestatus.
AnswerAisincorrect.
Highdoseinterleukin2hasbeenusedinthetreatmentofmetastaticmelanomainselectpatientswithgood
performancestatusandnoCNSinvolvementastreatmentwithIL2isassociatedwithmanysevereside
effectsrequiringcontinuousmonitoring.
AnswerBisincorrect.
Temozolomide(Temodar)isanoralalkylatingagentwithofflabeledindicationinthetreatmentof
metastaticorunresectablemelanoma.Myelosuppression(eg,leukopeniaandthrombocytopenia)isthe
doselimitingtoxicityassociatedwithtemozolomide.Theuseofchemotherapyisconsideredthefourthline
treatmentinanewlydiagnosedpatientwithunresectablemelanomawithBRAFV600Emutation(+)
disease,untreatedbraininvolvement,andwithpoorperformancestatus.
AnswerDisincorrect.
Dacarbazine(DTIC)isanalkylatingagentFDAapprovedforthetreatmentofmetastaticmelanomaas
singleorcombinationtherapy.Aswithotherchemotherapyagent,theuseofdacarbazineisassociatedwith
manysideeffects(eg.myelosuppression,highemetogenicpotential,flulikesymptoms,andphlebitis).The
useofchemotherapyisconsideredthefourthlinetreatmentinanewlydiagnosedpatientwithunresectable
melanomawithBRAFV600Emutation(+)disease,untreatedbraininvolvement,andwithpoor
performancestatus.
AnswerEisincorrect.
Ipilimumab(Yervoy)isanimmunotherapyusedinthetreatmentofmetastaticorunresectablemelanomain
patientswithgoodorpoorperformancestatuswhoisnotcandidateforIL2astreatmentwithipilimumab
isassociatedwithimmunemediatedadverseeventsrequiringcontinuousmonitoringpriortotreatment.
Theuseofipilimumabisconsideredthethirdlinetreatmentinanewlydiagnosedpatientwithunresectable
melanomawithBRAFV600Emutation(+)disease,untreatedbraininvolvement,andwithpoor
performancestatus.
184)BKisreceivingFOLFOXchemotherapy.WhichofthefollowingshouldBKavoidmostintheshort
termforthepurposeofavoidingacuteneurotoxicityexacerbationscausedbyoxaliplatin?
A.DirectsunlightB.ColdC.HeatD.TightfittingclothingE.OTCacnetreatments
Feedback:
AnswerBiscorrect.
Oxaliplatincommonlycausesanacutesensoryneuropathythatisprecipitatedorexacerbatedbycold
temperatures.
AnswerAisincorrect.
BKshouldstillavoiddirectsunlightoruseprotectivecreamsbecausefluorouracilcancause
photosensitivity.
AnswerCisincorrect.
Extremeheatshouldbeavoidedwithinfusionalfluorouraciladministrationtominimizecomplicationswith
palmarplantarerythrodysesthesia(PPE)thatcanbeworsenedbyextremeheat.PPEismorecommonwith
capecitabineorprolongedinfusionsoffluorouracil.
AnswerDisincorrect.
TightfittingclothingcanpredisposethatareatoPPErash.
AnswerEisincorrect.
OTCacnetreatmentspotentiallyareusedinappropriatelyinpatientsreceivingEGFR1agentssuchas
cetuximaborpanitumumabduetotherashresemblingacne.
185)Whichoffollowingconditionswouldbeacontraindicationforprescribinganaromataseinhibitor?
A.thedevelopmentofarthralgiasandmyalgiasB.apatientwithahistoryof
thromboemboliceventsC.apremenopausalpatientD.apostmenopausalpatientwithahistoryof
thromboemboliceventsE.therearenocontraindicationsfortheadministrationofaromataseinhibitors.
Feedback:
AnswerCiscorrect.
Theadministrationofaromataseinhibitorstopremenopausalwomenwithbreastcanceriscontraindicated
becausetheyareineffectiveindepletingestrogenproductioninwomenwithfunctioningovaries.
AnswerAisincorrect.
Arthralgiasandmyalgiasisadocumentedadverseeffectofthearomataseinhibitors.Ifapatientdevelops
thesetoxicities,atrialofanalternativearomataseinhibitorisindicated.
AnswerBisincorrect.
Apatientwithahistoryofthromboemboliceventsisnotacontraindicationfortheadministrationof
aromataseinhibitors.
AnswerDisincorrect.
Theadministrationofaromataseinhibitorsarenotcontraindicatedforpostmenopausalpatientswitha
historyofthromboembolicevents.
AnswerEisincorrect.
Theadministrationofaromataseinhibitorsiscontraindicatedinpremenopausalwomenandinwomenwith
aknownhypersensitivitytotheseagentsoranyoftheirexcipients.
186)Selectthebrandnameforletrozole.
A.ArimidexB.NolvadexC.Avastin
D.EvistaE.Femara
Feedback:
AnswerEiscorrect.
Femaraisthetradenameforletrozole.
AnswerAisincorrect.
Arimidexisthetradenameforanastrozole.
AnswerBisincorrect.
Nolvadexisthetradenamefortamoxifen.
AnswerCisincorrect.
Avastinisthetradenameforbevacizumab.
AnswerDisincorrect.
Evistaisthetradenameforraloxifene.
187)Selectthetaxaneeffectiveintreatingadvancedbreastcancerthatisformulatedasanalbumin
nanoparticleproduct.
A.AbraxaneB.TaxolC.JevtanaD.Taxotere

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