Foundations 2 Flashcards by Payton Dennis

A pt brings in an Rx for orlistat. Which of the following vitamins should the pharmacist recommend the pt take while on this med?

a. Vitamin A
b. Vitamin B6
c. Vitamin D
d. Vitamin E
e. Vitamin K

a, c, d, e

Fat-soluble vitamins should be supplemented in pts on orlistat.

How well did you know this?

Not at all

Perfectly

A pt used a natural product for a cold and then lost his ability to smell. He was likely using this product, which the FDA has recommended against using d/t the risk of anosmia:

a. Echinacea
b. Zinc nasal spray
c. Elderberry
d. Vitamin C
e. Zinc lozenges

Zinc nasal sprays and swabs should not be recommended. Zinc lozenges may provide benefit, but the pt needs to use enough. They have a metallic taste.

How well did you know this?

Not at all

Perfectly

The pediatrician has told a couple that their 3-month-old infant requires vitamin D and iron supplementation. Which supplement would be a suitable product?

a. Fer-In-Sol
b. Feosol
c. Flintstones Chewable Multi-Vitamins
d. Slow-Fe
e. Poly-Vi-Sol with iron

-Fer-In-Sol and Feosol contain iron but not vitamin D.
-An infant can’t use a chewable; they need the liquid drops that can be squirted into the side of the mouth, mixed into formula, or pumped breast milk.

How well did you know this?

Not at all

Perfectly

Which natural product can be useful for UTI prophylaxis?

a. Ginger
b. Cranberry
c. Feverfew
d. Saw palmetto
e. Magnesium

How well did you know this?

Not at all

Perfectly

A pt has depression. Which natural product might be useful for this condition?

a. Ginseng
b. SAMe
c. DHEA
d. Glucosamine
e. Chondroitin

St. John’s wort, SAMe, Valerian, and 5-HTP can be used for depression.

How well did you know this?

Not at all

Perfectly

A 73 y/o male was given an Rx for tamsulosin but wishes tp use a natural product instead. Which product has claimed benefit for this indication?

a. Ginger
b. Cranberry
c. Feverfew
d. Saw palmetto
e. Magnesium

-An older male who wishes to self-treat enlarged prostate should be seen by a Dr first to make sure the condition is benign. It could cover up symptoms of prostate cancer. Saw palmetto is touted for BPH, but most evidence states it is likely not effective for symptoms.
-Lycopene is available in supplements and is used for prostate cancer prevention.

How well did you know this?

Not at all

Perfectly

A pt brings the pharmacist a bottle of “natural pain pills” that he ordered off a late-night TV show. The name of the manufacturer listed on the bottle is “Magic Cure-All.” Choose the correct statement regarding this product.

a. The manufacturer is responsible for proving efficacy.
b. The FDA is responsible for proving the product is safe.
c. The manufacturer doesn’t have to prove efficacy prior to sale.
d. The product label can claim to treat pain.
e. This product was obtained illegally.

A dietary supplement manufacturer is responsible for the supplement’s safety, but it doesn’t have to prove safety and effectiveness to the FDA before it’s marketed. Supplements can’t claim to treat or cure a condition.

How well did you know this?

Not at all

Perfectly

A pt asks if there’s a natural product that can be used for constipation. The pharmacist could recommend this product:

a. Glucosamine
b.Psyllium
c. Butterbur
d. Fish oil
e. Feverfew

Psyllium is a fiber found in barley, oat bran, and Metamucil.

How well did you know this?

Not at all

Perfectly

HPI: MS is a 39 y/o female who recently became involved in a sexual relationship and went to clinic to get advice on birth control measures and safe sex practices. Specifically, she wants to know whether she and her partner should be screened for STDs before becoming intimate. MS has some documented chronic health conditions but believes in natural healing and takes a handful of supplements daily, although she didn’t bring her meds to clinic, so there are limited details on dosing and manufacturer brands she’s using.

PMH: T2DM, dyslipidemia, osteoarthritis

Meds:
Loestrin Fe 1/20 1 tab QD
Fish oil 1000 mg QD
B vit. complex 1 tab QD
MVI QD
Vit. E 400 IU 2 caps QD
St. John’s Wort QD
Kava QD
Probiotic QD
Melatonin PRN for sleep

Which natural product is putting MS at a health risk, in particular CVD risk, for no known benefit?

a. Kava
b. St. John’s wort
c. Lactobacillus
d. Melatonin
e. Vitamin E

It’s unusual to have a vit. E deficiency, since it’s present in many foods. Vit. E in foods is considered healthy, but excess intake in supplements is considered a health risk (particularly CVD risk). Patients should not exceed 400 IU daily.

How well did you know this?

Not at all

Perfectly

PMH: T2DM, dyslipidemia, osteoarthritis

Meds:
Loestrin Fe 1/20 1 tab QD
Fish oil 1000 mg QD
B vit. complex 1 tab QD
MVI QD
Vit. E 400 IU 2 caps QD
St. John’s Wort QD
Kava QD
Probiotic QD
Melatonin PRN for sleep

Which natural product is putting MS at risk for hepatotoxicity?

a. Kava
b. St. John’s wort
c. Lactobacillus
d. Melatonin
e. Vitamin E

How well did you know this?

Not at all

Perfectly

PMH: T2DM, dyslipidemia, osteoarthritis

Meds:
Loestrin Fe 1/20 1 tab QD
Fish oil 1000 mg QD
B vit. complex 1 tab QD
MVI QD
Vit. E 400 IU 2 caps QD
St. John’s Wort QD
Kava QD
Probiotic QD
Melatonin PRN for sleep

Despite strict adherence to her birth control pill regimen, MS became pregnant. What was the most likely cause of the pregnancy?

a. Fish oils
b. St. John’s wort
c. Lactobacillus
d. Melatonin
e. High-dose vitamin E

SJW is a potent inducer of hepatic enzymes. It can’t be used with PO contraceptives, transplant drugs, warfarin, and others, as it induces CYP3A4 and other isoenzymes.

How well did you know this?

Not at all

Perfectly

PMH: T2DM, dyslipidemia, osteoarthritis

Meds:
Loestrin Fe 1/20 1 tab QD
Fish oil 1000 mg QD
B vit. complex 1 tab QD
MVI QD
Vit. E 400 IU 2 caps QD
St. John’s Wort QD
Kava QD
Probiotic QD
Melatonin PRN for sleep

Which of the following medical problems is MS potentially self-treating without a documented indication?

a. Depression
b. Migraines
c. Dyspepsia
d. Anxiety
e. Weight loss

a, d

-SJW is a common supplement used in depression and anxiety.
-Kava is used in anxiety.

How well did you know this?

Not at all

Perfectly

MO is having night sweats and can’t get a good night’s sleep. She has been told by her Dr. that she’s perimenopausal. What natural product may offer some benefit?

a. Dong quai
b. Saw palmetto
c. L-lysine
d. Glucosamine
e. Guarana

Others: Black cohosh, evening primrose oil, soy, red clover

How well did you know this?

Not at all

Perfectly

Which pt may benefit from use of pyridoxine?

a. A pt with morning sickness
b. A pt who suffers from migraines
c. A pt with insomnia
d. A pt with depression
e. A pt with cold sores

How well did you know this?

Not at all

Perfectly

A pt with scurvy is deficient in which of the following?

a. Vitamin A
b. Vitamin B6
c. Vitamin C
d. Vitamin D
e. Vitamin E

How well did you know this?

Not at all

Perfectly

A pharmacist is reviewing the medical profile for a pt and notes that the pt take turmeric, glucosamine, and SAMe. Which condition listed in the pt’s PMH would be consistent with the use of these products?

a. Osteoarthritis
b. Menopause
c. Benign prostatic hyperplasia
d. Dementia
e. Erectile dysfunction

How well did you know this?

Not at all

Perfectly

ME is a pt at the pharmacy who’s planning to take a cruise to the Bahamas. She explains that she gets really bad motion sickness and doesn’t want to take Dramamine d/t sedation. She has tried this before and doesn’t wish to sleep through her vacation. Which OTC product is best recommended to ME for nausea from motion sickness?

a. Diphenhydramine
b. Aloe vera
c. Cinnamon
d. Dimenhydrinate
e. Ginger

Peppermint may also help.

How well did you know this?

Not at all

Perfectly

A pt with recently diagnosed active TB was prescribed isoniazid (INH), rifampin, pyrazinamide, and ethambutol. Which vitamin supplement is recommended with this regimen?

a. Vitamin B1
b. Vitamin B12
c. Vitamin B2
d. Vitamin B3
e. Vitamin B6

Pyridoxine (vitamin B6) is used to reduce the risk of INH-induced peripheral neuropathy.

How well did you know this?

Not at all

Perfectly

JD is an elementary school teacher. She suffers from frequent bouts of osteoarthritis pain during the school day and only gets relief when she sits down to rest. This isn’t always possible. To get by, JD has been taking 5-6 tabs of Extra Strength Tylenol throughout the day. JD heard a news report about using excessive acetaminophen and became frightened. She’s at the pharmacy counter asking if there’s anything “natural” that might help arthritis pain. What supplement might provide a mild benefit?

a. Feverfew
b. Hawthorn
c. Chromium
d. Evening primrose oil
e. SAMe

Others: Glucosamine, chondroitin, and turmeric

How well did you know this?

Not at all

Perfectly

AS had a stent placed in a coronary artery. She has been using the following meds for many months: Clopidogrel, aspirin, rosuvastatin, amlodipine, atenolol, and the natural products arginine, coenzyme Q10, and cinnamon. AS has felt confused lately and couldn’t remember where she put her house keys. A friend recommended that she begin to use some “brain booster” natural products. About a month ago, after speaking with her friend, AS began to use gingko biloba and huperzine A. It was wintertime, and for the first time ever in the dry, indoor heat, AS began to have chronic, bothersome nosebleeds. Her husband came into the pharmacy to ask for advice. The pharmacist should recommend the following:

a. She shouldn’t be using ginkgo biloba; it’s unsafe with the rest of her meds.
b. She should switch to St. John’s wort.
c. She should consider vitamin E instead of ginkgo.
d. She should be using warfarin instead of clopidogrel.
e. She should be using warfarin instead of aspirin.

Gingko and vitamin E (both can help with memory) increase bleeding risk.

How well did you know this?

Not at all

Perfectly

MP is a pharmacist in LA who has made it a priority to increase folic acid intake among women of child-bearing age. What is MP’s motivation for this important work?

a. To reduce the risk of low bone density in young women
b. To reduce the risk of serious birth defects in children born to women with low folic acid intake
c. To reduce the risk of ovarian cancer in young women
d. To reduce the risk of endometrial cancer in young women
e. To make money for the manufacturer of folic acid

Needs to be taken at least one month before pregnancy

How well did you know this?

Not at all

Perfectly

MO has decided to use black cohosh for menopausal symptoms. Choose the correct statement concerning this popular product:

a. Can be hepatotoxic
b. More effective than estrogen for improving vasomotor symptoms
c. Available as prescription only
d. Should be combine with hormone replacement therapy
e. Contraindicated in women over the age of 50

How well did you know this?

Not at all

Perfectly

JF has self-treated acne for the past 3 years. She has tried spot treatments, facial scrubs, and exfoliation kits that contain either benzoyl peroxide or salicylic acid to help clear her skin. These are useful but leave her skin dry and sore. She’s asking for something more lubricating and “natural.” What OTC supplements might provide benefit?

a. Hawthorn
b. Milk thistle
c. Ipriflavone
d. Tea tree oil
e. Pygeum

How well did you know this?

Not at all

Perfectly

How many daily mcg of dietary folate equivalents (DFE) are recommended for a pregnant female?

a. 200
b. 300
c. 600
d. 800
e. 1000

All women of childbearing age should obtain 400 mcg/day.

How well did you know this?

Not at all

Perfectly

JB gets cold sores (herpes simplex labialis) whenever he is under stress. Which agent is sometimes recommended to help reduce this occurrence? a. Lycopene b. Lysine c. Red yeast rice d. Plant stanols/sterols e. Fish oils

JB has high cholesterol. Which of the following agents can help improve cholesterol values? a. St. John's wort b. Plant stanols/sterols c. Ginseng d. Statins e. Red yeast rice

b, d, e

A pt diagnosed with microcytic anemia would likely require tx with which supplement? a. Ferrous sulfate b. Vitamin D c. Folic acid d. Vitamin B12 e. Pyridoxine

a -Microcytic anemia (when the MCV is low) is typically caused by iron deficiency. -Macrocytic anemia - treated with vitamin B12 and/or folate

A pharmacist recently switched jobs as a result of a med error that he made. He has supportive management who will support him as he identifies similar situations that led to the previous dispensing error and implements approaches that can help reduce errors. What is the name of the analysis done prospectively that can identify pathways that lead to errors and find ways to help prevent future errors? a. Root Cause Analysis b. Prospective Error Search (PES) c. Safety-First Approach d. Failure Mode and Effects Analysis (FMEA) e. Prevention and Safety Analysis

d FMEA is a step-by-step approach for identifying all possible ways in which something might fall. In pharmacy, it's used to reduce med errors.

The Emergency Department has had 3 errors in the past 4 months involving hypertonic saline for traumatic brain injury (TBI). What measures can the hospital take to improve the use of this high-risk med? a. Move all hypertonic saline to the ADC in the ED. b. Develop a protocol for the use of hypertonic saline in TBI. c. Stock only premixed IV products. d. Allow the ED staff to prepare the hypertonic saline since they are most familiar with its safe use. e. Stock the minimum number of product options/strengths.

a, b, e

SP, a hospital pharmacist, just finished lunch and went to the restroom. Place the following hand washing steps in the correct order. a. Wet both sides of hands b. Dry hands with a paper towel and use the towel to turn off the water c. Apply soap d. Rinse hands thoroughly e. Rub hands together for at least 15 slow seconds

a - c - e - d - b

One of the largest causes of bloodborne infections is d/t the use of glucose meters in healthcare settings that are used to test many patients. Another cause is the use of medication vials, such as insulin, in more than one patient. Choose the correct statement/s. a. If a glucose meter travels from room-to-room, the nursing staff must replace the lancet tip before testing each patient. b. If the same injection vial will be used for multiple patients, it's imperative never to re-insert a used needle into the vial. c. It's preferable to avoid the use of multiple-dose vials in different patients; it's preferable to label the multiple-dose vial with one patient's name only. d. The ISMP recommends using insulin pens to avoid contamination from insulin in multiple patients. e. Glucose meter shouldn't be used in the hospital; blood sugar can be tested with the daily labs.

a, b, c

A pharmacist dispensed the wrong drug to a patient. His pharmacy manager screamed at him in front of the staff. The pharmacist got scared and quit. What is the preferred approach when a med error has occurred? a. Conducting a behavioral intervention with the staff b. Hiring more technicians to perform double checks on all prescriptions c. Conducting a Failure Mode and Effects Analysis d. Punishing everyone involved with demotion or firings e. Conducting a root cause analysis

Which of the following are benefits of patient counseling? a. Counseling ensures that the drug will cure the patient's condition b. Counseling can ensure that the patient is aware of the monitoring required for the drug c. Counseling can ensure the patient is aware of safety concerns with the use of the drug d. Counseling makes the patient aware of treatment goals e. Counseling can ensure that the patient is getting a drug for their condition (and not for a wrong indication, or for a wrong patient)

b, c, d, e

A pharmacist works in a small city hospital that has a medical Dr. who's an orthopedist. He does several hip replacements and several knee replacements at this hospital per month. The pharmacist hopes to implement patient-controlled analgesia (PCA) devices for orthopedic patients. However, the medical staff at the hospital is overburdened, and the head of the nursing team isn't interested in changing to a new system. Communication between the healthcare professionals is lacking. Choose the primary reason why PCA devices may not be appropriate in this setting: a. PCAs can't be used in small hospitals. b. PCAs require an educated, coordinated healthcare team. c. PCAs aren't used in orthopedic surgeries d/t a higher-than-normal DVT risk. d. PCAs are only used in outpatient clinics. e. The use of a PCA would increase costs too much for a small hospital to manage.

A nurse is overwhelmed with responsibility for 4 ICU patients. She provides an injection and proceeds to the red sharps container to dispose of the syringe. The sharps container is filled to the surface. She finds a large textbook and carefully uses it to press down the contents of the container to make more room. She removes the needle since the sharps container is now nearly filled, and she's concerned about the needle being close to the top of the container. Choose the correct statement: a. This isn't an acceptable practice. b. This is an acceptable practice since she compressed the contents of the sharps container. c. This is an acceptable practice since she removed the needle tip, which can transmit infection. d. This is an acceptable practice, but she should have used gloved hands to compress the contents of the sharps container. e. This is an acceptable practice, but she should have asked the pharmacist to do this.

In a healthcare setting, soap and water (as opposed to alcohol-based rubs) must be used to wash hands in the following situations: a. When hands are visibly dirty b. After caring for a patient with a C. difficile infection c. Before using the restroom d. After caring for a patient with irritable bowel syndrome e. After caring for a patient with a Pseudomonas infection

a, b

A prescriber wrote an Rx for "MS 1 gram IV" for a patient. He wanted the patient to receive magnesium sulfate, but the patient received a fatal dose of morphine. Select the correct method to reduce this error in the future: a. For morphine sulfate, do not write MS of MS04, write out morphine sulfate. b. For magnesium sulfate, do not write MS or MgS04, write out magnesium sulfate. c. Institute a tech check tech policy in the pharmacy. d. Avoid abbreviations whenever possible. e. If abbreviations are used, they must be on an approved list at your institution.

a, b, d, e

NC, an 82 y/o female, entered the hospital for orthopedic surgery. Before the surgery, NC used warfarin 3 mg daily. The warfarin was stopped, and she was bridge with enoxaparin. The day after the surgery, "warfarin 10 mg PO each evening" was ordered for NC. The pt had complications post-surgery and stayed in the hospital for ten more days. During this time, the INR was not checked, and she experienced severe bleeding. Which of the following are appropriate measures to avoid this situation? a. A baseline INR and regular (current) INR should be available for all pts receiving warfarin. b. Develop a warfarin prescribing protocol that includes an appropriate starting dose. c. Remove warfarin from the hospital formulary. d. Don't permit adjustments to the pt's home warfarin dose during the hospitalization. e. A CPOE system could have alerted the prescriber or pharmacist that the dose was high or that an INR wasn't performed.

a, b, e

Which of the following categories are considered high-alert meds? a. Anticoagulants b. Loop diuretics c. Insulin d. Sedatives e. Opioids

a, c, d, e

Which of the following procedures can help reduce med errors associated with heparin? a. Don't use the color of the syringe or packaging to verify the dose b. Provide in-services that review heparin safety c. If possible, outsource the preparation of heparin flushes d. Make sure unit nurses prepare the heparin doses e. Implement protocols to initiate and manage therapy

a, b, c, e

The Joint Commission identifies areas where significant lapses in pt safety exist and then implements National Patient Safety Goals (NPSGs). These recommend specific measures that would reduce risk and improve safety. The Joint Commission has NPSGs in which of the following areas? a. Improving the way antithrombotics are used b. Improving the use of patient identifiers c. Improving med labeling in perioperative settings d. Improving the timely reporting of critical lab results e. Compliance with CDC hand hygiene guidelines

a, b, c, d, e

When DN was an inpatient, the nursing student have her 1 dose of PO morphine that should have been administered to the pt in the room beside her. Which of the following med error-reduction programs would most likely have helped avoid the problem of administering the med to the wrong person? a. Barcoding b. CPOE c. Med Rec d. High-Risk Drug Protocols e. Staff In-services

What is meant by the Joint Commission recommendation to use "2 pt identifiers" when providing care? a. 2 nurses, or other healthcare professionals, should identify each pt before administering medication or conducting a procedure. b. 2 cognitive individuals should provide identification for a pt when they are admitted to prevent a pt from being admitted under someone else's name. c. 2 pt identifiers, such as name and pt ID number, should be checked before the administration of any drug or procedure. d. Pts should be identified by 2 physical parameters, such as eye color and hair color, or by primary language. e. The same pt should be identified twice at different times.

CO had been using carbamazepine 400 mg BID for several months. After the pharmacist dispensed a refill last month, CO developed agranulocytosis from the use of carbamazepine and almost died from a severe infection. When he recovered, he was switched to a different med. Choose the correct statement that best describes CO's experience with carbamazepine: a. It was a med error to dispense carbamazepine to this pt b. This pt had an adverse drug reaction to carbamazepine c. The pharmacist should be dismissed for dispensing the carbamazepine d. The physician should be disciplined for prescribing carbamazepine for this pt e. This pt must have taken more than the prescribed dose

A pharmacy in a hospital uses mostly unit-dose meds for the general floor pts. The unit dose meds have "barcodes" on the packaging. The pharmacy has replaced the cassettes on the floor with automated dispensing cabinets (ADCs), manufactured by ScriptPro. The ADC has barcodes on the shelves that are scanned to make sure that the correct drug is placed into the correct place in the cabinet. Before the nursing staff can administer a medication that has been removed from the ADC, the nurse scans the medication removed from the ADC and scans the pt's wristband to make sure that the correct pt is receiving the correct med. Choose the correct statement/s: a. Barcodes may be the most important med error reduction tool we currently have. b. Barcode technology isn't cost-effective for most small and medium hospitals. c. Barcodes are also used on pumps an with IV infusions. d. Barcodes are only useful in the inpatient setting. e. Barcodes follow drugs through the medication use process.

a, c, e

A pharmacist has entered a pt's room to check on the volume left in the PN bag. Upon leaving the room, she uses an alcohol-based hand rub. Which of the following statements are true concerning alcohol-based hand rubs? a. They should be avoided in healthcare settings. b. They are germicidal against many G (+) and G (-) bacteria, including MRSA. c. They do not kill or remove C. difficile. d. They are preferred when caring for pts with food allergies. e. They should not be used more than BID.

b, c

A hospital pharmacist is designing an in-service for nurses on the use of patient-controlled analgesia (PCA) devices. Which of the following points should be included in the presentation? a. Pain, sedation, and respiratory rate be assessed on a scheduled basis in all patients receiving opioids from a PCA. b. Morphine is much more potent than hydromorphone. Verify the dose to avoid mix-ups. c. A close family member should receive education on the use of the PCA in case the patient is sleeping and can't self administer a dose. d. Not all patients are appropriate candidates for PCAs. e. Barcode technology may help reduce dosing errors associated with PCAs.

a, d, e -Hydromorphone is 6x as potent as morphine. -Friends and family members can't give PCA doses; the Joint Commission does not permit it.

A wife is talking to her husband's room. Her husband has been hospitalized for decompensated heart failure. She hears the term "code blue" on the overhead, and the announcement lists her husband's room number. What is meant by the term "Code Blue?" a. Fire in the unit b. Bomb in the patient's room c. Has been an earthquake d. A patient in need of urgent medical care (usually for cardiac or respiratory arrest) e. A combative patient

Many drug errors are d/t look-alike names, such as Celebrex/Celexa, Aricept/Aciphex, and many others. What are ways to reduce errors associated with look-alike names? a. Changing the drug names (by FDA or the manufacturer's initiative) if drug mix-ups have occurred. b. Using "TALL MAN" lettering, for example, writing glipiZIDE and glyBURIDE to help avoid confusion between the two drugs. c. Including both brand and generic names on the prescription. d. Spelling out the drug name on a verbal order. e. Putting the indication on the prescription.

a, b, c, d, e

A hospital recently implemented Computerized Prescriber Order Entry (CPOE). If the CPOE system incorporates sound decision-making principles, which of the following are possible benefits that the hospital could expect from the use of CPOE? a. If designed properly, can reduce the risk of errors d/t misinterpretation of handwriting, mixed faxes, and verbal orders b. May be linked to labs and wouldn't permit certain order entries if relevant labs were at an unsafe level c. Will eliminate the need for a pharmacist at these facilities d. Can keep dosing within certain ranges unless an override is approved by a pharmacist e. Can be linked to formularies which would enable the prescriber to write for the preferred meds

a, b, d, e

What is the name of the accreditation body for more than 17,000 healthcare organizations and programs in the US including hospitals, healthcare networks, long-term care facilities, home care organizations, office-based surgery centers and independent laboratories? a. Institute of Medicine b. The Joint Commission c. Institute for Safe Medication Practices d. National Institutes of Health e. Food and Drug Administration

b -Independent, not-for-profit organization -The goal of the Joint Commission is to improve healthcare for the public by evaluating healthcare organizations

TV is a pediatric clinical pharmacist who specializes in medication use and dosing for neonates in the NICU. She's overseeing the emergency "crash cart" preparation for the neonatal unit. She advises the medical team on these safe practices for the crash carts: a. The meds should be prepared in prefilled syringes and drips, as much as possible. b. The medications should be age and weight specific, as much as possible. c. A weight-based dosing chart should be present in the crash cart. d. The crash carts should be refilled by the nursing staff in the unit after a code. e. Drug expiration dates should be frequently monitored.

a, b, c, e

Reduction, hydrolysis, and oxidation are what type of metabolic reactions? a. First-pass b. Phase I c. Michaelis-Menten d. Phase II e. Zero-order

A chemist wishes to increase the rate of gut dissolution of a new tablet formulation. Which of the following would be the most useful option to consider for most meds? a. Decrease the surface area of the tablet b. Increase the surface area of the tablet c. Add an emulsifying agent d. Alkalinize the urine e. Acidify the urine

b To increase tablet dissolution, the chemist could increase the tablet's surface area and/or decrease the size.

When a drug is administered IV, which of the following steps does not occur? a. Absorption b. Distribution c. Metabolism d. Excretion

What is a primary pathway of drug degradation in the gut? a. Sulfation b. Phase II conjugation reactions c. Hydrolysis d. Proteolysis e. P-glycoprotein efflux drug transportation

Which of the following defines pharmacodynamics? a. What the kidney does to the drug b. What the liver does to the drug c. What the body does to the drug d. What the drug does to the body e. What the drug does to the microorganism

A pt is receiving vancomycin. His drug levels and known PK parameters are provided. Vancomycin ke = 0.17 hr Vancomycin trough = 32 mcg/mL How many hours will it take for his vancomycin trough to reach 20 mcg/mL (round to the nearest WHOLE number).

3 ke = ln (C1/C2) / t 0.17 = ln (32/20) / t 0.17 (t) = 0.47 t = 2.7647 hrs = 3 hrs

Doxycycline has a clearance of 4.5 L/hr and a volume of distribution of 65 L. Calculate the half-life (in hours) of doxycycline (round to the nearest WHOLE number).

10 ke = Cl / Vd Half-life = 0.693 / ke

Following a 400 mg dose of cefpodoxime, the terminal elimination rate constant was determined to be 0.38 hr. Calculate the half-life (in hours) of cefpodoxime (round to the nearest WHOLE number).

2 Half-life = 0.693 / ke

Following a 400 mg dose of voriconazole IV, the area under the curve is measured at 38 mg x hr/L. Calculate the apparent clearance of voriconazole in L/hr (round to the nearest WHOLE number).

11 Cl = (F x dose) / AUC Cl = (1 x 400) / 38 = 11 L/hr

The process by which the body breaks down drugs into compounds that can be more readily eliminated is called: a. Dissolution b. Absorption c. Distribution d. Metabolism e. Excretion

Approximately how many half-lives are required to reach steady state (assuming a one compartment model and no loading dose)? a. 2 b. 5 c. 8 d. 10 e. 1

AUC values of drug X following IV administration of 50 mg and PO administration of 100 mg were found to be 70 mg x hr/mL and 90 mg x hr/mL, respectively. Calculate the absolute bioavailability of drug X (round to the nearest WHOLE number).

64 F = (Extravascular AUC / IV AUC) x (IV Dose / Extravascular Dose) x 100 F = 100 x (90 / 70) x (50 / 100) = 64.29%

Choose the PK term used to describe the dispersion or passage of a drug throughout the body. a. Dissolution b. Absorption c. Distribution d. Metabolism e. Excretion

Choose the PK term used to describe the process by which the body rids itself of drugs or metabolites either through the kidneys or back into the gut. a. Dissolution b. Absorption c. Distribution d. Metabolism e. Excretion

A new antibiotic for community-acquired pneumonia (CAP) was recently FDA approved. The drug was presented at the P&T Committee meeting. The drug monograph included the following information: CAP dosing (IV): 675 mg IV Q8H CAP dosing (PO): 675 mg PO TID Protein binding: 18% Metabolism: Partially hepatic Half-life (elimination): 1.6-2.1 hours What hospital policy/protocol should this drug be added to? a. The CAP Policy b. The Antibiogram Protocol c. The Therapeutic Interchange Protocol d. The Pharmacokinetic Protocol e. The High-Risk Medication Protocol

c Drugs like this are easily converted to the PO formulation of the same dose. Most hospitals have a "Therapeutic Interchange" Protocol or "IV to PO" Protocol that allows meds to be converted from IV to PO if certain criteria are met (e.g., the pt is able to take PO meds).

Data were obtained after PO and IV administration of drug X in volunteers of average weight 50 kg. Following an IV dose of 1.2 mg/kg, administered as a bolus injection, the AUC was 4.5 mg x hr/mL. Following a 4 mg/kg PO dose, administered as a solution, the AUC was 8.2 x hr/mL. Calculate the absolute bioavailability of drug X (round the final answer to the nearest WHOLE number).

55 F = 100 x [(8.2 / 4.5) x (1.2 / 4)] = 54.66 = 55%

Choose the PK term used to describe how the drug moves from the site of administration into the circulation. a. Excretion b. Dissolution c. Absorption d. Distribution e. Metabolism

A newly improved drug has a volume of distribution of 82 L and a clearance of 9.26 L/hr. Calculate the half-life (in hours) of this drug (round the final answer to the nearest TENTH).

6.1 Calculate the elimination rate constant first, then use it to calculate the half-life.

Describe the PK term used to describe PO formulations breaking up into smaller pieces in the gut. a. Disintegration b. Absorption c. Distribution d. Metabolism e. Excretion

Which formula is used to describe the rate of drug dissolution (or the rate at which the drug dissolves)? a. Michaelis-Menten b. Noyes-Whitney c. Henderson-Hasselbach d. Remington's Coefficient e. Stimmel's

What is the antidote for acetaminophen overdose? a. Naloxone b. Thiamine c. N-acetylcysteine d. Flumazenil e. Pyridoxine

A pt presents to the ED with GI perforation. A lab test reveals low WBCs, RBCs, and platelets and a high serum methotrexate level. Which of the following should be initiated? a. Methylene blue b. Hyaluronidase c. Dimethyl sulfoxide d. Dexrazoxane e. Leucovorin

e Leucovorin is folinic acid. Both leucovorin and levoleucovorin provide folate rescue.

A community in California was sprayed with an organophosphate pesticide. A child was outside when the plane flew over his yard. What symptoms of toxicity should his parents watch out for? a. Psychosis, self-hurt, anxiety, anger b. Eye tearing, salivation, vomiting, frequent bowel movements c. Agitation, HTN, tachycardia, flushing d. Tremors and seizures, ataxia, muscle spasticity e. Sedation, respiratory depression, tetanus

b -These are cholinergic SLUDD symptoms: Salivation, lacrimation, urination, diarrhea, and defecation. -The tx for organophosphate poisoning is atropine (an anticholinergic). -Pralidoxine can be used to treat muscle weakness and paralysis of respiratory muscles in severe cases.

The antidote for methanol and ethylene glycol overdose is: a. Naloxone b. Fomepizole c. N-acetylcysteine d. Flumazenil e. Cyanocobalamin

b Fomepizole is a competitive inhibitor of alcohol dehydrogenase, which is required for conversion of methanol and ethylene glycol (antifreeze) to its toxic metabolites. A second-line antidote would be ethanol.

A pt comes to the ED with a diltiazem overdose. Which of the following is an appropriate antidote to give to this pt? a. Sodium bicarbonate b. Physostigmine c. Ipecac syrup d. Calcium chloride e. Albuterol

Glucagon can be used as an antidote for overdoses of which of the following? a. Insulin b. Beta-blockers c. Oral hypoglycemics d. Local anesthetics e. Digoxin

a, b, c

Which of the following would be an expected presentation 12 hours after ingestion of a toxic acetaminophen dose? a. No symptoms b. Elevated INR c. Nausea and vomiting d. Fulminant hepatic failure e. Kidney failure

a, c -Phase 1 (1-24 hours): Asymptomatic, nausea, and vomiting -Phase 2 (24-48 hours): Elevated INR, AST/ALT -Phase 3 (48-96 hours): Fulminant hepatic failure, renal failure, and/or death -Phase 4 (> 96 hours): Patient recovers or receives a liver transplant

A 55 y/o man is doing landscaping in Arizona and is stung by a scorpion. Which of the following is the most appropriate tx? a. Crotalidae polyvalent immune FAB b. Pralidoxime c. Succimer d. Levocarnitine e. Antivenin immune FAB Centruroides

A pt comes to the ED with respiratory depression and significant sedation. Paramedics found her down in her apartment with an empty bottle of Ativan on the floor. Which of the following is the appropriate antidote to give? a. Sodium bicarbonate b. Flumazenil c. Ipecac syrup d. Sodium polystyrene sulfonate e. Dimercaprol

b Can precipitate seizures when used in BZD-dependent patients

Which of the following is an early symptom of a nicotine overdose? a. Bradycardia b. Coma c. Liver damage d. Abdominal pain e. Seizures

What is the antidote for iron overdose? a. Naloxone b. Pralidoxime c. Methylene blue d. Sodium bicarbonate e. Deferoxamine

An obtunded teenager with a possible OD is brought into the ED by EMS. The time of ingestion is unknown. The ECG shows widening of the QRS complex. Which of the following is the most appropriate tx? a. Sodium bicarbonate b. Activated charcoal c. Levocarnitine d. Methylene blue e. Sugammadex

a The teenager's mental status and widened QRS complex are concerning for a TCA overdose. Sodium bicarbonate is an appropriate tx for a widened QRS complex from a TCA overdose. Activated charcoal should not be given because he is obtunded and would be at risk for aspiration.

A patient is using dabigatran for stroke prevention in afib. Which drug would reverse the effects of dabigatran if the patient experiences serious bleeding? a. Protamine b. Idarucizumab c. Vitamin K d. Andexanet Alfa e. Argatroban

b -Dabigatran (PRAdaxa) = Idarucizumab (PRAxbind) -Apixaban, rivaroxaban = Andexanet alfa (Andexxa) -Warfarin = vitamin K -Heparin, LMWH = Protamine -Warfarin, factor Xa inhibitors = Prothrombin

A 19 y/o college student arrives to the ER extremely agitated and restless. He states he took "a lot more" of his ADHD medication, Adderall, than was prescribed. Upon exam, he is tachycardic, hypertensive, and has dilated pupils. Along with supportive care, which of the following meds can be administered? a. Dextrose b. Lorazepam c. Glucagon d. Leucovorin e. Sodium bicarbonate

The Rumack-Matthew nomogram is used to determine the need for which antidote? a. N-acetylcysteine b. Deferoxamine c. Pyridoxine d. Dimercaprol e. Pralidoxime

A hospitalized pt is using heparin. She requires immediate surgery. Which of the following agents will reverse the effects of heparin? a. Phytonadione b. Atropine c. Protamine d. Kcentra e. Idarucizumab

c -Dabigatran (PRAdaxa) = Idarucizumab (PRAxbind) -Apixaban, rivaroxaban = Andexanet alfa (Andexxa) -Warfarin = vitamin K -Heparin, LMWH = Protamine -Warfarin, factor Xa inhibitors = Prothrombin

A 5 y/o who consumed nine tabs of amitriptyline 25 mg is transported to the hospital. She's awake with no apparent symptoms. How long after the ingestion does the medical team have to administer activated charcoal and have it be effective? a. 2 hours b. 30 min c. 3 hours d. Activated charcoal isn't indicated e. 1 hour

A pt is admitted to the hospital with alcohol intoxication. What should be administered to prevent alcohol-induced encephalopathy? a. Thiamine b. Pyridoxine c. Hydroxocobalamin d. Phytonadione e. Fomepizole

Select the MOA for atropine: a. Mu-receptor antagonist b. Cholinergic (acetylcholine) agonist c. Blocks acetylcholine at the muscarinic acetylcholine receptor d. Beta-adrenergic agonist at the beta-2 receptors e. Beta-adrenergic agonist at both the beta-1 and beta-2 receptors

c By blocking acetylcholine, atropine is effective at treating "cholinergic" symptoms from organophosphate poisoning or other cholinergic drugs (in cholinergic overdoses, acetylcholine is increased).

Which of the following is/are different types of child-resistant (C-R) containers? a. Screw caps that require the user to press down while turning b. Flip caps c. Unit-dose packaging d. Card adherence packaging e. Monthly pillboxes

a c, d

CK lives in southern California. She's fair-skinned and burns easily. CK recently had a UTI and received an Rx for Bactrim. CK was counseled that she would burn even more easily when using this med. Which of the following meds also cause photosensitivity? a. Tetracyclines b. Tacrolimus c. Thiazide diuretics d. Quinolone antibiotics e. Metronidazole

a, b, c, d

TV is a 67 y/o female who was admitted to the hospital for sepsis. While in the ED, piperacillin/tazobactam was administered, and within minutes, she was noted to have a severe reaction (SOB). At that time, she was changed to aztreonam and vancomycin and transferred to the ICU. Blood cxs come back positive for Klebsiella pneumoniae, which is confirmed to an extended-spectrum beta-lactamase (ESBL) producer. The team decides to desensitize the pt to meropenem. Which of the following statements are true regarding desensitization? a. If desensitization is successful, the allergy should be removed from the pt's medical record. b. Induction of drug tolerance is another term to describe the procedure c. The procedure involves starting with very small doses and incrementally increasing to the therapeutic dose. d. The procedure is usually done at home, so the pt can lie down if they have a reaction. e. Desensitization is recommended if the pt has a hx of SJS.

b, c

NP has poorly controlled asthma. She finds that if she uses aspirin, she can't breathe easily. Which of the following drugs is the safest option for mild pain relief in this pt? a. Ibuprofen b. Acetaminophen c. Sulindac d. Indomethacin e. Naproxen

b Patients may be able to tolerate COX-2 selective agents, but don't assume this to be the case.

If a pt has a true allergy to eggs, they can't receive which of the following agents? a. Advair b. Cleviprex c. Diprivan d. Pneumovax e. Flublok

b, c Flublok is a recombinant influenza vaccine that contains no eggs.

If a pt has a true allergy to penicillin, they may have an allergic reaction to which of the following drugs? a. Zosyn b. Augmentin c. Keflex d. Primaxin e. Zithromax

a, b, c, d

JL's mother is leaving him with his aunt for the weekend. She will instruct the aunt on the proper use of the EpiPen. Put the following steps in order representing proper use of the EpiPen. a. Remove the injector and rub the area where the medicine entered the skin for 10 seconds. b. Keep the injector in place against the outer thigh slowly counting to 3. c. Hold the orange tip close to the middle of the outer thigh. Swing away from the leg, then push the auto-injector against the thigh until it "clicks." d. Remove the safety release by pulling straight up. e. Grasp the epinephrine injector in one fist with the tip pointing down. Don't touch the tip.

e, d, c, b, a

If post-marketing safety surveillance is required, in which stage does it occur? a. New Drug Application Review b. Phase I c. Phase II d. Phase III e. Phase IV

JB is a 7 y/o who has a severe allergy to peanuts that requires that he and his mother carry an EpiPen. Which of the following meds are in a soy base and must be avoided in pts with a peanut allergy? a. Albuterol inhaler b. Cleviprex c. Diprivan d. Precedex e. Morphine

b, c

A pt presents to the pharmacy to pick up a refill on his Androgel. This med requires a MedGuide. Which of the following is not true? a. FDA-approved pt handouts b. Written in non-technical language c. Not considered part of the drug labeling d. Must be dispensed with every new Rx e. Must be dispensed with every Rx refill

Which of the following are symptoms unique to a true (anaphylactic) allergic reaction (as opposed to an intolerance)? a. Mild rash b. Swollen face, lips, or tongue c. Tendency to burn more quickly when in the sun d. Trouble breathing e. Large drop in BP

b, d, e

Which of the following is true of Risk Evaluation and Mitigation Strategies (REMS)? a. A structured reporting mechanism for ADRs b. Designed by the FDA to identify the risks of a drug c. Used only when there's increased risk of hypersensitivity reactions to a medication d. Required only when there's a lab measurement that must be performed to ensure safe use of a drug e. Developed by manufacturers and approved by the FDA to ensure the benefits of a drug outweighs the risks

Which of the following best describes the utility of the Naranjo Scale? a. Used by pts to determine whether they are having an ADR b. Used to help determine causality of an ADR c. Used to report ADRs to the FDA d. Used to help determine whether a pt will be allergic to a new drug e. Used in the clinical trial setting to evaluate ADRs

A pt developed hives after using Bactrim. Choose a med that's not contraindicated with this type of allergy: a. Celecoxib b. Sulfapyridine c. Zonisamide d. Dapsone e. Sulfasalazine

Boxed warnings are one of the FDA's strictest warnings regarding medication safety aspects. Which of the following is false regarding boxed warnings? a. Are used to convey risk of serious injury or death associated with a medication b. Are always listed at the beginning of the package labeling and are set apart in a black box c. Are used only to indicate when a drug can cause increased risk of death in all patients d. Can be used to avoid prescribing or dispensing errors e. Can be used to convey risk of using a drug in certain patient populations

CD developed hives and got a swollen face from using sulfamethoxazole. CD should avoid the use of which of these drugs? a. Sulfasalazine b. Furosemide c. Zonisamide d. Celecoxib e. Morphine sulfate

a, b, c, d

Epinephrine injection now comes in a "talking" injection device that can help guide pts on how to administer the injection What is the name of the device? a. EpiPen b. Copaxone c. Lemtrada d. Arixtra e. Auvi-Q

Select the correct definition of DNA: a. Organized into 23 pairs (46 chromosomes) as a supercoiled structure b. The specific form of a gene, either wild- or variant-type c. Double-helix molecule containing noncovalently bonded nucleotides d. The set of unique genes that determines a specific trait in an individual e. A stretch of DNA that codes for a single protein

Select the correct definition of chromosome: a. Organized into 23 pairs (46 chromosomes) as a supercoiled structure b. An inherited variation in the DNA sequence c. Double-helix molecule containing noncovalently bonded nucleotides d. The building blocks of DNA, composed of 4 bases: Adenine (A), Guanine (G), Thymine (T), and Cytosine (C) e. A stretch of DNA that codes for a single protein

WL is a 12 y/o Chinese female who has epilepsy. She has been on several anticonvulsants, which have brought her seizures activity down but not under good control. The neurologist is considering a trial of carbamazepine. Which of the following statements is correct? a. She should be tested for the HLA-B*5701 allele. b. Patients with the at-risk allele are more likely to experience agranulocytosis with the use of carbamazepine. c. She should be tested for the HLA-B*1502 allele. d. If she has the at-risk allele for carbamazepine, she will be considered low risk for the anticonvulsants phenytoin, and this should be used instead. e. She doesn't need pharmacogenomic testing prior to the use of this drug because she's of Asian descent.

c Patients with this allele are more likely to experience severe skin reactions with the use of carbamazepine.

Select the correct definition of a polymorphisms: a. Organized into 23 pairs (46 chromosomes) as a supercoiled structure b. An inherited variation in the DNA sequence c. Double-helix molecule containing noncovalently bonded nucleotides d. The building blocks of DNA, composed of 4 bases: Adenine (A), Guanine (G), Thymine (T), and Cytosine (C) e. A stretch of DNA that codes for a single protein

Select the correct definition of a gene. a. Organized into 23 pairs (46 chromosomes) as a supercoiled structure b. An inherited variation in the DNA sequence c. Double-helix molecule containing noncovalently bonded nucleotides d. The building blocks of DNA, composed of 4 bases: Adenine (A), Guanine (G), Thymine (T), and Cytosine (C) e. A stretch of DNA that codes for a single protein

Which of the following statements concerning single nucleotide polymorphisms (SNPs) is correct? a. A polymorphism in a gene can cause the resultant amino acid to change or to stay the same; SNPs may or may not alter protein synthesis. b. SNPs are composed of 2, 3, or 4 base differences. c. A polymorphism is a change in the DNA caused by ultraviolet radiation or chemical exposure; it usually affects elderly people. d. SNPs are not responsible for the way an individual may respond to a medication. e. SNPs are not important in the field of pharmacogenomics.

a SNPs are composed of a single base difference

A female patient with breast cancer has received pharmacogenomic testing. She tests positive for HER2. Select the correct statement: The patient would likely receive benefit with the use of... a. Kalydeco b. Herceptin c. Hepsera d. Lupron e. Rituxan

Warfarin does not have required pharmacogenomic testing, but it can be used to identify at-risk pts. Which of the following statements are correct? a. The S isomer of warfarin is more potent than the R isomer and is metabolized primarily by the CYP2C9 enzyme. b. In addition to variations in the expression of the 2C9 alleles, the VKORC1 gene SNP is also important. c. If a person has diminished expression of the CYP2C9 enzyme, they will be at higher risk for clotting. d. If a patient produces less VKORC1, they require a higher dose of warfarin. e. Checking for these variations can help clinicians choose an appropriate starting dose of warfarin in their patients.

a, b, e

An oncologist has ordered cetuximab for a pt. Which pharmacogenomic test must be performed prior to initiating therapy? a. CD20 b. KRAS mutation c. PDL-1 d. TPMT e. VEGF