Question 1

Which of the following drugs is contraindicated in a 25-year-old female taking oral contraceptives?

Accepted Answer

All the drugs listed have known interactions with oral contraceptives. Each interferes with Phase I and Phase II reactions. Macrolides, antiretrovirals, and barbiturates are all associated with decreased oral contraceptive efficacy.

Question 2

An elderly patient comes to you saying that she is being treated for hypertension and wants you to answer some questions about adverse effects, but she cannot remember which drug she is taking. She only remembers that it is a pretty little pink, oval pill. Which of the following is most likely her medication?

Accepted Answer

Of the drugs listed, only Diovan HCT (Valsartan/Hydrochlorothiazide) is an antihypertensive and comes as a small, oval pink pill. Glucotrol (glipizide) is a hypoglycemic agent, Amoxil (Amoxicillin) is an antibiotic, and Adderall (Amphetamine sulfate) is an amphetamine.

Question 3

Which of the following life-threatening adverse effects is most important to discuss with a patient who is prescribed lovastatin (Mevacor/Altocor)?

Accepted Answer

Rhabdomyolysis is the rapid breakdown of skeletal muscle fiber and is associated with statin use. Mortality can rise to 20% in some patients. Asthenia indicates muscular weakness and may be important as an early indication of rhabdomyolysis, but is not of itself life threatening. Pruritus is itching and is non-life threatening. Flatulence is an increase in bowel gases; unpleasant, but non-life-threatening.

Question 4

If a patient is considering switching from Catapres tablets to the Catapres patch, which of the following is the best suggestion you would give them?

Accepted Answer

Since the patches are applied weekly, the patient should overlap the two delivery systems. A patient should not be advised to stop taking the medication immediately. The Catapres patch has been shown to be effective and increase patient compliance.

Question 5

Which of the following drugs can be used prophylactically for migraines?

Accepted Answer

Antidepressants may be used as prevention (prophylaxis) for migraines. OTC products with caffeine may exacerbate migraines and OTC migraine analgesics may treat migraines symptomatically, but they are not indicated for prevention. Antipsychotics are not used for migraine prophylaxis.

Question 6

A patient on Seasonale should be counseled that her periods will come every:

Accepted Answer

Seasonale, a combination contraceptive, changes the menstrual cycle from an average of 28 days to approximately every three months. Patients take the active form for 84 days and the inactive form for 7 days, after which menses should begin.

Question 7

Rosiglitazone (Avandia) is a thiazolidinedione hypoglycemic agent. One of its off-label uses is for:

Accepted Answer

The thiazolidinediones (and metformin) are used off-label to treat polycystic ovary syndrome (PCOS). While aC_ne may occur in PCOS, it is generally not treated with a thiazolidinedione. Hypernatremia (high serum sodium) and fatigue are not treated with thiazolidinediones.

Question 8

A patient with COPD is also determined to be H1N1 positive. Which of the following drugs would likely be recommended?

Accepted Answer

Tamiflu (Oseltamivir) is recommended for the treatment of H1N1 infection. Relenza (Zanamivir) is an anti-influenza agent, but is a nasal spray and in contraindicated in COPD. Zidovudine (Retrovir) is an antiretroviral and not effective against H1N1. Amantadine (Symmetrel) is useful in COPD patients as a prophylactic and not after diagnosis.

Question 9

A patient arrives and asks you to fill his Xanax prescription. Which of the following is important to determine and why?

Accepted Answer

Alcohol increases the effect of Xanax (Alprazolam) and smoking decreases its effectiveness.

Question 10

A patient is on iron supplements. They ask if they should take it with food. Your response is:

Accepted Answer

Iron is best absorbed in an acidic environment, but can cause stomach upset on an empty stomach. Therefore, the best advice is that Iron should be given with food for maximum absorption and patient comfort.

Question 11

A patient on Lithium complains of stomach pains, stomach upset, and diarrhea. You can safely suggest to him to:

Accepted Answer

Lithium can cause stomach distress and is thought to destroy normal gut flora. Taking yogurt can restore gut bacteria and taking Lithium with food and water minimizes gastric distress.

Question 12

Which of the following conditions would indicate a need for caution in a patient on tamsulosin?

Accepted Answer

Tamsulosin, an alpha blocker, has been associated with exacerbation of cataracts and with increased adverse events following cataract surgery.

Question 13

A woman comes into your pharmacy carrying a screaming baby. She has just started taking Xanax and is concerned about whether it is safe. Which of the following adverse effects would not be mentioned during your counseling session with her?

Accepted Answer

All of the listed adverse events except for hyperkalemia and hyponatremia are associated with Xanax (alprazolam) use and must be discussed with the woman.

Question 14

A clinic specializing in congestive heart failure has a number of elderly patients and has asked you to monitor their outcomes. They have used both nesiritide and bosentan and would like your input on these drugs. You feel comfortable telling them:

Accepted Answer

Both statements A and B are correct. Nesiritide is contraindicated in obstructive cardiomyopathy and in hypotensive patients with systolic pressures less than 90mm Hg. Bosentan should be used cautiously in patients with mitral stenosis.

Question 15

A hospital pharmacist is asked to monitor an elderly dialysis patient on IV Amphotericin B. Which of the following lab parameters needs to be determined to appropriately monitor the patient?

Accepted Answer

Amphotericin B can affect electrolytes, kidney, and clotting functions. All of the listed parameters should be monitored, particularly in an elderly patient with kidney dysfunction.

Question 16

A patient is taking 40 mg PO of lovastatin with his evening meal. He comes to you saying that for the last 2-3 weeks, his legs feel like they are cramping. Which of the following tests would be recommended?

Accepted Answer

A patient on a statin complaining of muscle cramping should have his liver function tested and CPK-MM tested for evidence of muscle damage. One of the serious adverse effects of a statin is rhabdomyolysis and the patient's cramping may be symptomatic. CPK-MM levels are a good indicator of skeletal muscle damage occurring during rhabdomyolysis.

Question 17

Which of the following medications would be appropriate to treat a Pseudomonas aeruginosa infection in a child of 12 years?

Accepted Answer

Tobramycin in high doses is effective against Pseudomonas aeruginosa. Fluconazole is an azole antifungal and ampicillin is an aminopenicillin and ineffective against Pseudomonas aeruginosa. Clindamycin is effective against Gram (+) bacteria and Pseudomonas aeruginosa is a Gram (-) bacteria.

Question 18

Which of the following is considered the "drug of choice" for Clostridium difficile?

Accepted Answer

Metronidazole is the drug of choice against Clostridium difficile due to its lower price and good clinical efficacy. Fluconazole and Ketoconazole are azole antifungals. Ciprofloxacin is fluoroquinolone without high efficacy against Clostridium difficile.

Question 19

Of the following organisms, which would be susceptible to Clindamycin?
I. Clostridia perfringens
II. Bacteroides fragilis
III. Pseudomonas aeruginosa

Accepted Answer

Clindamycin is a lincosamide anti-infective and has activity mainly against Gram (-) rods such as Bacteroides, Gram (+) rods such as Clostridia and anaerobes. Clindamycin does not have activity against Pseudomonas.

Question 20

For which of the following conditions would QVAR be indicated?
I. COPD
II. Asthma
III. Tuberculosis

Accepted Answer

QVAR is a corticosteroid in an inhaled form and is only indicated for the treatment of asthma.

Quiz 2: Clinical