example Q Flashcards
Question 1 of 17
A 41-year-old woman with ulcerative colitis (UC) affecting most of her colon (pancolitis) has been taking balsalazide 6.75 g/d orally for 2 years and prednisone 40 mg/d orally for 1 year. When the dose of prednisone is reduced to less than 40 mg, the patient develops fever, abdominal pain, and five or six bloody bowel movements a day. Which modification to this patient’s drug regimen is the most appropriate at this time?
A- Initiate therapy with methotrexate 25 mg intramuscularly once weekly.
B-Initiate infliximab 5 mg/kg intravenous infusion.
C-Change balsalazide to sulfasalazine orally 6 g/d.
D- Add mesalamine suppository 1000 mg rectally once daily.
Patient is experiencing steroid dependence and would benefit from starting Infliximab - B
A 38-year-old man with moderate to severe Crohn disease (CD) has been experiencing numerous relapses on his current medication regimen. He is taking azathioprine and infliximab for maintenance therapy. What changes would be best to make to his maintenance regimen?
A-Stop infliximab and initiate intravenous cyclosporine.
B- Stop infliximab and azathioprine and initiate dexamethasone.
C- Stop infliximab and azathioprine and initiate vedolizumab.
D- Continue azathioprine and infliximab and begin natalizumab.
C
Vendolizumab is a biologic that can be used for patient who have failed Infliximab
Vendolizumab is an anti-integrin used in CD and UC
A 29-year-old patient with moderate-to-severe Crohn disease has been treated with infliximab 5 mg/kg for 4.5 years. Infliximab was his first and only treatment for his Crohn disease. In the past three cycles of infliximab, the patient has reported a “wearing off” effect of infliximab 10 days prior to the next dose. These increased symptoms include diarrhea, aphthous ulcers, and abdominal pain 6-7 (out of 10, with 10 being the worst pain he has ever felt). He undergoes a colonoscopy 1 week prior to his next scheduled infliximab dose, which reveals deep ulcers in the ileum, distal, and proximal colon. There is a mild stricture of the valve connecting the ileum and colon. Labs are also performed on the same day and demonstrate subtherapeutic levels of infliximab, elevated levels of antidrug antibodies to infliximab present, and high levels of inflammatory markers. What is the best strategy in this patient?
A-Supplement with both oral and rectal mesalamine products to induce remission, then decrease to just rectal mesalamine.
B-Discontinue infliximab and start golimumab.
C-Discontinue infliximab and start adalimumab.
D- increase infliximab to 7.5 mg/kg and redraw trough level before next infusion.
C
Patient has low PKA of drug that they once responded to and high dose of antidrug antibodies which means increasing the dose would not work so D is incorrect
B is incorrect because golimumab is only for UC
A is incorrect because mesalamine is not used in CD
Question 10 of 17
A 38-year-old male patient is newly diagnosed with mild to moderate Crohn disease (CD) confined to the ileum and ascending colon. What is the best recommendation for this patient?
A-Mesalamine enema 1 g PR at bedtime
B-Prednisone 40 mg orally daily
C-Certolizumab pegol 400 mg subcutaneously
D-Budesonide 9 mg orally daily
D
Mesalamine enema would be a good treatment option for mild to moderate UC left sided disease
Prednisone should be used for Moderate to severe CD
Certolizumab - TNF-α antagonists are reserved for the induction of remission for patients with moderate to severe CD or who are unresponsive to corticosteroid or therapy.
RJ comes to clinic two months after their ischemic stroke. They reports some limitations on his activities of daily living, which have slightly improved, but is frustrated they are not functioning as they was before the stroke.
PMH: GERD, COPD, depression, recent ischemic stroke
Vitals: BP 150/72 mmHg, HR 82 bpm, RR 16 bpm
Labs: A1c 5.6%, LDL 130
ECG: normal sinus rhythm
Current outpatient medications (verified by you the pharmacist):
Amlodipine 10 mg PO daily
Aspirin 325 mg PO daily
Breo Elipta 200/25 mCg inhaled once daily
Esomeprazole 20 mg PO daily
Rosuvastatin 10 mg PO QHS
At his two month follow-up, what is your recommendation for lipid lowering therapy for RJ?
D/C Rosuvastatin and Initiate Atorvastatin 80mg PO QHS
When evaluating for potential use of tPA, what exclusion categories are trying to be AVOIDED to minimize complications? Select the option which ALL are exclusion criteria.
Current anticoagulant use, hypertension (> 185/110 mmHg), AND thrombocytopenia
RJ comes to clinic two months after their ischemic stroke. They reports some limitations on his activities of daily living, which have slightly improved, but is frustrated they are not functioning as they was before the stroke.
PMH: GERD, COPD, depression, recent ischemic stroke
Vitals: BP 150/72 mmHg, HR 82 bpm, RR 16 bpm
Labs: A1c 5.6%, LDL 130
ECG: normal sinus rhythm
Current outpatient medications (verified by you the pharmacist):
Amlodipine 10 mg PO daily
Aspirin 325 mg PO daily
Breo Elipta 200/25 mCg inhaled once daily
Esomeprazole 20 mg PO daily
Rosuvastatin 10 mg PO QHS
At their two month follow-up, what is your recommendation for reducing future strokes for RJ?
D/C ASA 325mg PO daily and Inititate ASA 81mg PO daily
CL is a 71 year old male brought to the hospital by his wife left sided weakness, with symptoms first occurring two hours ago.
PMH: hypertension
Social history: patient lives at home
Allergies: NKDA
Home medications: Amlodipine 5 mg PO daily
Vitals: BP – 175/105 mmHg, HR – 99 bpm, WT – 75 kg, HT– 5’9”
Labs: Na 141 mEq/L, K 3.8 mEq/L, Cl 106 mmol/L, CO2 20 mmol/L, BUN 15 mg/dL, SCr 0.9 mg/dL, Glucose 102 mg/dL, Ca 10.2 mg/dL, WBC 2.4/mm3, Hgb 15.2 g/dL, Hct 45.0%, MCV 88 mm3, Plts 160/mm3, INR 1.0
CT findings: acute subarachnoid hemorrhagic stroke
ECG: NSR
How would you classify CL’s stroke?
Acute Hemorrhagic stroke
RJ is an 80 year old female who is brought to the hospital by her family due to her facial droop and trouble speaking, which has been occurring over the past two hours
PMH: GERD, COPD, depression
Social history: social drinker, 50 pack year history of smoking and denies illicit drugs; lives with daughter since her husband passed away 5 years ago.
Medications prior to admission:
Breo Elipta 200/25 mCg inhaled once daily
esomeprazole 20 mg PO daily
Vitals from the ER: BP – 206/94 mmHg, HR – 110 bpm, WT – 90 kg, HT– 5’6”
Labs: Na 145 mEq/L, K 3.8 mEq/L, Cl 106 mmol/L, CO2 16 mmol/L, BUN 18 mg/dL, SCr 0.9 mg/dL, Glucose 92 mg/dL, Ca 8.2 mg/dL, WBC 4.7/mm3, Hgb 12.2 g/dL, Hct 35%, MCV 89 mm3, Plts 303/mm3, INR 1.1
CT findings: acute ischemic stroke
ECG: normal sinus rhythm
What is the most accurate classification for RJs stroke
Atherosclerotic ischemic stroke
RJ comes to clinic two months after their ischemic stroke. They reports some limitations on his activities of daily living, which have slightly improved, but is frustrated they are not functioning as they was before the stroke.
PMH: GERD, COPD, depression, recent ischemic stroke
Vitals: BP 150/72 mmHg, HR 82 bpm, RR 16 bpm
Labs: A1c 5.6%, LDL 130
ECG: normal sinus rhythm
Current outpatient medications (verified by you the pharmacist):
Amlodipine 10 mg PO daily
Aspirin 325 mg PO daily
Breo Elipta 200/25 mCg inhaled once daily
Esomeprazole 20 mg PO daily
Rosuvastatin 10 mg PO QHS
At their two month follow-up, what is your recommendation for RJ’s blood pressure?
A. Discontinue amlodipine and do nothing else at this time as the patient doesn’t have a PMH of hypertension
B.Discontinue amlodipine 10 mg, add metoprolol succinate 25 mg PO daily
C.Continue amlodipine 10 mg
D.Continue amlodipine 10 mg, add lisinopril 10 mg PO daily
D
RJ is an 80 year old female who is brought to the hospital by her family due to her facial droop and trouble speaking, which has been occurring over the past two hours
PMH: GERD, COPD, depression
Social history: social drinker, 50 pack year history of smoking and denies illicit drugs; lives with daughter since her husband passed away 5 years ago.
Medications prior to admission:
Breo Elipta 200/25 mCg inhaled once daily
esomeprazole 20 mg PO daily
Vitals from the ER: BP – 206/94 mmHg, HR – 110 bpm, WT – 90 kg, HT– 5’6”
Labs: Na 145 mEq/L, K 3.8 mEq/L, Cl 106 mmol/L, CO2 16 mmol/L, BUN 18 mg/dL, SCr 0.9 mg/dL, Glucose 92 mg/dL, Ca 8.2 mg/dL, WBC 4.7/mm3, Hgb 12.2 g/dL, Hct 35%, MCV 89 mm3, Plts 303/mm3, INR 1.1
CT findings: acute ischemic stroke
ECG: normal sinus rhythm
What is MOST appropriate regarding administration of tPA for RJ’s stroke?
A. Use labetalol to lower BP and if able, administer alteplase via 9 mg IV bolus followed by 81 mg IV infusion over 60 minutes
B. Use labetalol to lower BP and if able, administer alteplase via 8.1 mg IV bolus followed by 72.9 mg IV infusion over 60 minutes
C. Administer tenecteplase via 18 mg IV bolus followed by 162 mg IV infusion over 60 minutes
D. Do not administer tPA due to elevated blood pressure
B
Need to get patients blood pressure under 185/110
for doings patient is under 100kg so take their weight times 0.9mg/kg which gives us 81mg and then do 10% in 1minute IV bolus and 90% in IV infusion over 60 minutes
CL is a 71 year old male brought to the hospital by his wife left sided weakness, with symptoms first occurring two hours ago.
PMH: hypertension
Social history: patient lives at home
Allergies: NKDA
Home medications: Amlodipine 5 mg PO daily
Vitals: BP – 175/105 mmHg, HR – 99 bpm, WT – 75 kg, HT– 5’9”
Labs: Na 141 mEq/L, K 3.8 mEq/L, Cl 106 mmol/L, CO2 20 mmol/L, BUN 15 mg/dL, SCr 0.9 mg/dL, Glucose 102 mg/dL, Ca 10.2 mg/dL, WBC 2.4/mm3, Hgb 15.2 g/dL, Hct 45.0%, MCV 88 mm3, Plts 160/mm3, INR 1.0
CT findings: acute subarachnoid hemorrhagic stroke
ECG: NSR
What is your acute recommendation regarding tPA for CL?
tPA is contraindicated in Hemorrhagic strokes
CL is a 71 year old male brought to the hospital by his wife left sided weakness, with symptoms first occurring two hours ago.
PMH: hypertension
Social history: patient lives at home
Allergies: NKDA
Home medications: Amlodipine 5 mg PO daily
Vitals: BP – 175/105 mmHg, HR – 99 bpm, WT – 75 kg, HT– 5’9”
Labs: Na 141 mEq/L, K 3.8 mEq/L, Cl 106 mmol/L, CO2 20 mmol/L, BUN 15 mg/dL, SCr 0.9 mg/dL, Glucose 102 mg/dL, Ca 10.2 mg/dL, WBC 2.4/mm3, Hgb 15.2 g/dL, Hct 45.0%, MCV 88 mm3, Plts 160/mm3, INR 1.0
CT findings: acute subarachnoid hemorrhagic stroke
ECG: NSR
After acute management and stabilization of the stroke, during the hospitalization, what other supportive therapy/therapies would be appropriate to evaluate for initiation for CL?
A. Levetiracetam + sertraline
B.None of the above
C.Sertraline
D. Levetiracetam
C
JC is an 85 year old female brought to the hospital by her daughter with facial droop and aphasia, with symptoms first occurring one hour ago.
PMH: hypertension, CKD
Social history: patient lives at home
Allergies: NKDA
Home Medications:
Lisinopril 20 mg PO daily
Vitals: BP – 200/115 mmHg, HR – 130 bpm, WT – 85 kg, HT– 5’5”
Labs: Na 145 mEq/L, K 4.2 mEq/L, Cl 105 mmol/L, CO2 20 mmol/L, BUN 35 mg/dL, SCr 2.2 mg/dL, Glucose 122 mg/dL, Ca 10.2 mg/dL, WBC 3.4/mm3, Hgb 13.2 g/dL, Hct 40.0%, MCV 98 mm3, Plts 180/mm3, INR 1.0
CT findings: acute ischemic stroke
ECG: atrial fibrillation
What is the MOST APPROPRIATE plan for reducing recurring strokes for JC?
A. Initiate aspirin 325 mg PO daily on day 2 for two weeks followed by transition to aspirin 81 mg PO daily
B.Initiate aspirin 325 mg PO daily on day 2 through 7 followed by transition to warfarin (INR goal 2.5-3.5)
C. Initiate clopidogrel 75 mg PO daily indefinitely
D. Initiate aspirin 325 mg PO daily on day 2 through 7 followed by transition to apixaban 2.5 mg PO BID
D
A patient presents to your pharmacy and asks why folic acid 1 mg PO daily is often recommended along with methotrexate therapy?
A-Folic acid can prevent renal toxicity caused by methotrexate.
B-Folic acid can prevent gastrointestinal toxicity caused by methotrexate.
C-Most people with rheumatoid arthritis have folic acid deficiencies.
D-Folic acid will enhance the efficacy of methotrexate.
B
