Question 1

A 56-year-old male patient has diagnoses of essential hypertension, hypothyroidism, and Type II diabetes of 5 years duration. Medications include metformin, glyburide, levothyroxine, and atenolol. Recent labs report an A₁c of 5.8%, TSH of 31.7, Hgb of 6.3. A physical exam reveals a blood pressure of 128/76 and a resting heart rate of 58. Which of the following medications may need adjustment? I. Levothyroxine II. Atenolol III. Metformin

Accepted Answer

The patient is showing signs of hypothyroidism as evidenced by the high TSH and low resting heart rate. A₁c is within acceptable range as is the blood pressure. The dose of levothyroxine should be adjusted.

Question 2

A 56-year-old female patient has diagnoses of GERD, mild hypertension, hyperthyroidism, hypercholesterolemia, and Type II diabetes of 5 years duration. Medications include metformin, glyburide, propylthiouracil, lansoprazole, atorvastatin, and hydrochlorothiazide. Recent labs report an A₁c of 9.8%, TSH of 2.7, Hgb of 12.2 and an LDL cholesterol of 130mg/dL. A physical exam reveals a blood pressure of 128/76 and a resting heart rate of 98. The patient is complaining of muscle cramps, fatigue, and thirst. Which of the following medications may need adjustment?

Accepted Answer

The patient is showing signs and symptoms of uncontrolled diabetes (A₁c increased thirst) and an adverse effect of statin use (muscle cramps, fatigue). Thyroid tests are within normal limits. The hypoglycemics and statin dosages should be adjusted.

Question 3

When discussing medroxyprogesterone treatment with a patient, which of the following is important to bring into the conversation?
I. There are no adverse effects to be concerned about with medroxyprogesterone.
II. Potential weight gain
III. Pulmonary emboli
IV. Current controversies concerning synthetic progestins and cancer

Accepted Answer

Medroxyprogesterone has a number of potential adverse effects including weight gain, pulmonary emboli, papilledema, and controversies over the potential cancer risk.

Question 4

Which of the following are possible signs/symptoms/complications of an anagrelide overdose or adverse effect?

Accepted Answer

The only symptom listed that is associated with an anagrelide overdose or adverse effect is increased intracranial pressure (ICP)-anagrelide in an antiplatelet drug and increased ICP may be indicative in a cerebral hemorrhage.

Question 5

What are the differences between Spiriva and Atrovent?
I. Atrovent has fewer side effects than Spiriva.
II. Atrovent has more side effects than Spiriva.
III. Spiriva is a dry powder and is taken once daily.
IV. Atrovent is taken once daily.

Accepted Answer

Atrovent (ipratropium) and Spiriva (tiotropium) have essentially the same side effect profile, so I and II are incorrect. Spiriva is a dry powder used once daily because it has a longer duration of action. Atrovent is used qid. Both are parasympathetic acetylcholine blockers.

Question 6

Which of the following conditions would call for the use of flumazenil?
I. Benzodiazepine overdose
II. H1N1 infection
III. Community acquired viral pneumonia

Accepted Answer

Flumazenil is an antidote for benzodiazepine overdose.

Question 7

Which of the following would include information on the solubility of a parenteral drug solution?

Accepted Answer

Trissel's Handbook on Injectable Drugs provides a single-source reference for drug stability and solubility information. Goodman and Gilman's text is a medical pharmacology text. The PDR (Physician's Desk Reference) gives dosing information and various other information but is not a good source for drug solutions. The Merck Manual describes signs and symptoms of specific conditions and diseases.

Question 8

Which of the following is likely to be true of a Phase I clinical trial?

Accepted Answer

Phase I clinical trials are most often done with small groups of patients with a variety of diseases or cancers-the main thrust of a Phase I clinical trial is to determine the safe dose range of an agent and if there is a rationale to continue testing and main side effects. Phase I clinical trials are not retrospective (historic) in nature.

Question 9

Which of the following is/are potential side effect(s) of phenylephrine?
I. Photophobia
II. Arrhythmias
III. Asthmatic episodes
IV. Thrombocytopenia

Accepted Answer

All of the listed adverse effects occur with phenylephrine, a sympathomimetic alpha adrenergic agonist.

Question 10

Which of the following are possible adverse effects of citalopram?
I. Arrhythmias
II. Leukopenia
III. Increased suicidal ideation

Accepted Answer

Of the adverse effects listed, only increased suicidal ideation is commonly associated with citalopram use. Citalopram is an SSRI.

Question 11

Which of the following statement(s) about isoproterenol is/are untrue?

Accepted Answer

Isoproterenol is available as an injection only and is not used in sublingual form. The other statements are correct.

Question 12

A 42-year-old female is on the following medications: HCTZ, 25mg PO qd and Lisinopril 10mg, PO qd. Which of the following tests would be most vital to follow?

Accepted Answer

HCTZ (the diuretic hydrochlorothiazide) and lisinopril (an ACE inhibitor) indicate the woman is being treated for hypertension. The most important test is blood pressure monitoring. The medications given do not affect liver function, blood glucose, or clotting (INR is the International Normalized Ratio used to follow clotting function).

Question 13

A patient is prescribed nimodipine 60mg PO, q 4 hours for 21 days. What is the likely diagnosis?

Accepted Answer

Nimodipine is a calcium channel blocker used as a cerebral vasodilator in patients with subarachnoid hemorrhages.

Question 14

A patient comes into the pharmacy and asks what you think about taking ginkgo biloba. She is on a number of medications including warfarin and an ACE inhibitor. What would be a reasonable statement for her?

Accepted Answer

Ginkgo has reported interactions with hypoglycemics, antihypertensives and with anticoagulants. She should speak to her physician and be aware of possible interactions.

Question 15

Which of the following is likely a potential side effect of Liotrix (Thyrolar)?

Accepted Answer

Liotrix (Thyrolar) is a synthetic thyroid hormone replacement. The most likely side effect is arrhythmias. Suicidal ideation is not known to be associated with liotrix use. Diarrhea is more likely than constipation and diaphoresis (sweating) is more likely than dry skin. Both dry skin and constipation tend to be more closely associated with hypothyroidism and not hyperthyroidism.

Question 16

Which of the following are possible adverse effects of tegaserod?
I. Circulatory depression
II. Ischemic colitis
III. Constipation

Accepted Answer

Tegaserod (Zelnorm) is a partial serotonin-type 4 receptor agonist. It is used to treat IBS with constipation and idiopathic constipation. Circulatory depression or diarrhea is not associated with tegaserod use, but ischemic colitis is.

Question 17

Which of the following statements is false?

Accepted Answer

Accuracy is a measure of how close a value is to an expected value, while precision is a measure of how close a series of measured values are to each other. The other statements are true.

Question 18

Which of the following is false concerning confidence intervals?

Accepted Answer

A 95% confidence interval indicates that an event other than the expected event is expected to occur 5 out of every 100 times or 1 out of every 20 times.

Question 19

A patient is newly diagnosed with exercise-induced bronchospasm. Cromolyn has been prescribed. What is the appropriate dosage for a child younger than 5 years old?

Accepted Answer

A child less than 5 years old should get no more than 20 mg, qid via nebulization. The other dosages are appropriate for treating adults and children older than 5 for exercise induced bronchospasm (A), for adults and children over 13 for the treatment of mastocytosis (B) and for the treatment of patients older than 4 years of age with keratoconjunctivitis, conjunctivitis or keratitis (D).

Question 20

What might sulfisoxazole be prescribed for?

Accepted Answer

Sulfisoxazole would be used to treat urinary tract infections. It is a sulfonamide anti-infective agent and inhibits synthesis of bacterial folic acid. It would not likely be used for peritoneal abscess-these are generally treated with combination antibiotics (e.g. gentamicin and metronidazole).

Quiz 2: Clinical

Which of the following are possible signs/symptoms/complications of an anagrelide overdose or adverse effect?

What are the differences between Spiriva and Atrovent? I. Atrovent has fewer side effects than Spiriva. II. Atrovent has more side effects than Spiriva. III. Spiriva is a dry powder and is taken once daily. IV. Atrovent is taken once daily.

Which of the following conditions would call for the use of flumazenil? I. Benzodiazepine overdose II. H1N1 infection III. Community acquired viral pneumonia