Question 1

Which of the following medications would be a contraindication in a patient on bosentan?

Accepted Answer

Bosentan (Tracleer) is a vasodilator (an endothelin-receptor antagonist) used to treat pulmonary hypertension. It is contraindicated for a patient on glyburide or cyclosporin.

Question 2

Which of the following drugs is contraindicated in a pregnant woman?
I. Isotretinoin
II. Raloxifene
III. Misoprostol
IV. Loperamide

Accepted Answer

All are Pregnancy Category X drugs except loperamide and are contraindicated during pregnancy.

Question 3

A patient on warfarin comes into your pharmacy asking about fish oils. What can you tell the patient about the use of fish oils?

Accepted Answer

Fish oils contain a high amount of omega-3 fatty acids. Patients on anticoagulant therapy need to be cautious about taking more than 3 grams a day.

Question 4

A woman tells you she suffers migraines and her friend told her about an herb that can be very useful. Which of the following is the herb she is most likely referring to?

Accepted Answer

Feverfew is often taken for migraines. Echinacea is often taken to boost immunity and St John's Wort is taken for depression. It's probably best not to tell anyone to get out, whether you know the answer to the question or not!

Question 5

A patient using nortriptyline (Aventyl) approaches you asking what possible side effects there might be. What could you tell him?
I. Arrhythmias
II. Paralytic ileus
III. Stevens-Johnson Syndrome

Accepted Answer

Nortriptyline is associated with both arrhythmias and paralytic ileus, but not with Stevens-Johnson syndrome. Nortriptyline is also associated with seizures, suicidal ideation, MIs, CVAs, and hepatotoxicity.

Question 6

Which of the following medications is associated with the risk of Stevens-Johnson Syndrome or Toxic Epidermal Necrolysis?
I. Allopurinol
II. Fluconazole
III. Lamotrigine
IV. Clindamycin

Accepted Answer

All the agents listed are associated with Stevens-Johnson Syndrome and/or Toxic Epidermal Necrolysis except for clindamycin. Clindamycin has been associated with relatively milder maculopapular and morbilliform skin rashes.

Question 7

A patient is diagnosed with MRSA (Methicillin Resistant Staphylococcus Aureus). Of the following antibiotics, which would be a likely candidate to use with this patient?
I. trimethoprim-sulfamethoxazole
II. vancomycin
III. linezolid

Accepted Answer

Currently, trimethoprim-sulfamethoxazole, vancomycin, and linezolid, are all effective against MRSA. Ideally, antibiotic susceptibility cultures should be run on the individual, but any of these three would be a reasonable first choice.

Question 8

What is the most common serious adverse effect of escitalopram?
I. Increased risk of suicide
II. Neutropenia
III. Hematuria

Accepted Answer

Escitalopram carries an increased risk of suicidal ideation and suicide. The other major side effect associated with any SSRI is serotonin syndrome. Escitalopram is not associated with neutropenia or hematuria.

Question 9

Which of the following is considered the "drug of choice" for Klebsiella pneumoniae?

Accepted Answer

3rd generation cephalosporins are generally considered effective against K. pneumonia as are carbapenems, aminoglycosides, and quinolones. Erythromycin is a macrolide, Ketoconazole is an antifungal, and minocycline is a tetracycline and they are not effective against K. pneumonia.

Question 10

Of the following, which are symptoms to be watchful for in a patient being treated for Restless Leg Syndrome with pramipexole?
I. Repetitive facial grimacing
II. Possible addictive behavior
III. Choreatic movements

Accepted Answer

Pramipexole is a dopamine agonist used to treat Parkinson's disease. A serious adverse effect is tardive dyskinesia (including repetitive facial grimacing and choreatic (snake-like) movement. Some addictive behaviors have also been shown to increase with the use of dopamine agonists.

Question 11

Data suggests that over 20% of adults in the US have used a natural product at least once in the preceding 12 months. Which of the following supplements is often recommended to use in conjunction with statins?

Accepted Answer

CoQ 10 is depleted by statin use as it is synthesized along the HMG-CoA reductase pathway. Black cohosh is often used for perimenopausal symptoms. St John's Wort is used to treat depression. Chondroitin sulfate is a supplement often used in treating osteoarthritis.

Question 12

Which of the following herbs is used to treat nausea and vomiting in cancer patients?

Accepted Answer

Ginger is used as an antiemetic and antidyspeptic. Saw palmetto is used mainly for BPH (Benign Prostatic Hypertrophy). Fenugreek is used as a hypoglycemic and Echinacea is used as an immune modulator.

Question 13

Which of the following must be excluded before a pharmacist can appropriately recommend a decongestant?
I. Uncontrolled hypertension
II. Underlying chronic cardiac or pulmonary disease
III. Shortness of breath
IV. Concurrent use of MAOIs

Accepted Answer

All of the information listed must be excluded before a pharmacist can recommend a decongestant.

Question 14

A woman comes into the pharmacy and tells you she has heartburn. Which of the following is true about an assessment before recommending a PPI (Proton Pump Inhibitor)?

Accepted Answer

Statements B and C are correct and are useful for ruling out gastric and duodenal ulcers, necessary to do before any PPI treatment is recommended.

Question 15

Which is true concerning cough and cough suppressants?

Accepted Answer

All the statements are true. Cough is a side effect of both ACE inhibitors and beta-adrenergic blockers. Guaifenesin is an expectorant and increased fluid volumes aid in decreasing viscosity and therefore the ease of increasing a productive cough.

Question 16

A pregnant patient is being treated for hypertension. Which of the following anti-hypertensives would be considered safe to use in pregnancy?

Accepted Answer

Methyldopa is a pregnancy category B agent and is thus the safest antihypertensive of those listed to use in pregnancy. Diuretics such a metolazone, ACE inhibitors such as lisinopril and alpha-1 receptor antagonists such as doxazosin are not recommended for use in pregnant women.

Question 17

Which of the following disorders is a contraindication for the use of hydralazine?

Accepted Answer

Hydralazine is an antihypertensive that is contraindicated in mitral valve or coronary artery disease (CAD).

Question 18

Of the following typical antipsychotics, which has a "Black Box Warning" for altered cardiac conduction?

Accepted Answer

Thioridazine is a typical antipsychotic with a Black Box Warning concerning aberrant cardiac conduction. None of the other typical antipsychotics listed carry such a warning.

Question 19

Which of the following, when used in combination, is likely to carry the risk of inducing serotonin syndrome?

Accepted Answer

Escitalopram is an SSRI (Selective Serotonin Reuptake Inhibitor) and hydralazine is a non-selective MAOI and a vasodilator. Venlafaxine and hydralazine in combination could theoretically increase levels of serotonin, resulting in Serotonin Syndrome. Orlistat is a GI lipase inhibitor. Atenolol is an adrenergic antagonist. Albuterol is a bronchodilator. Alendronate is a bisphosphonate. None of the drugs listed besides venlafaxine and hydralazine are likely to affect serotonin pathways.

Question 20

Which of the following drugs may be considered hepatotoxic?
I. Isoniazid, ceftizoxime, phenytoin
II. Anakinra, captopril, escitalopram, esmolol
III. Dobutamine, tamoxifen, temozolomide
IV. Cefoxitin, acetaminophen, delavirdine

Accepted Answer

Cefoxitin is a 2nd generation cephalosporin, acetaminophen is an NSAID, delavirdine is a NNRTI (non-nucleoside reverse transcriptase inhibitor), and are all associated with hepatotoxicity. Isoniazid is an antitubercular, ceftizoxime is a 3rd generation cephalosporin, and phenytoin is an anticonvulsant. All are associated with hepatotoxicity. The drugs listed in choices II and III are not associated with hepatotoxicity. Anakinra is an Interleukin-1 blocker. Captopril is an ACE inhibitor. Escitalopram is an SSRI. Esmolol is a cardioselective beta blocker. Dobutamine is a sympathomimetic. Tamoxifen is a SERM (Selective Estrogen Receptor Modulator).Temozolomide is an alkylating agent.

Quiz 2: Clinical

Which of the following medications would be a contraindication in a patient on bosentan?

Which of the following drugs is contraindicated in a pregnant woman? I. Isotretinoin II. Raloxifene III. Misoprostol IV. Loperamide

A patient on warfarin comes into your pharmacy asking about fish oils. What can you tell the patient about the use of fish oils?

A woman tells you she suffers migraines and her friend told her about an herb that can be very useful. Which of the following is the herb she is most likely referring to?

A patient using nortriptyline (Aventyl) approaches you asking what possible side effects there might be. What could you tell him? I. Arrhythmias II. Paralytic ileus III. Stevens-Johnson Syndrome

Which of the following medications is associated with the risk of Stevens-Johnson Syndrome or Toxic Epidermal Necrolysis? I. Allopurinol II. Fluconazole III. Lamotrigine IV. Clindamycin

A patient is diagnosed with MRSA (Methicillin Resistant Staphylococcus Aureus) . Of the following antibiotics, which would be a likely candidate to use with this patient? I. trimethoprim-sulfamethoxazole II. vancomycin III. linezolid

What is the most common serious adverse effect of escitalopram? I. Increased risk of suicide II. Neutropenia III. Hematuria

Which of the following is considered the "drug of choice" for Klebsiella pneumoniae?

Of the following, which are symptoms to be watchful for in a patient being treated for Restless Leg Syndrome with pramipexole? I. Repetitive facial grimacing II. Possible addictive behavior III. Choreatic movements