Pharmacotherapy Self Assessment Test with FADIC

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Pharmacotherapy Self Assessment Test with FADIC

Pharmacotherapy Self Assessment Test with FADIC

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Answer the Following Questions (Passing Score is 75%):

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1.Which one of the following drug pairs would most likely significantly decrease a high-risk patient’s intraglomerular pressure, possibly leading to acute kidney injury (AKI)?
Gentamicin and allopurinol
Benazepril and ketorolac
Foscarnet and ceftaroline
Lisinopril and sulindac
In this patient, we must consider the combination of ACEI and NSAID therapy that can decrease intraglomerular pressure (Answer A and Answer C are incorrect). Both Answer B and Answer D have an ACEI and NSAID combination. However, Answer D is incorrect because sulindac is the NSAID of choice with a lesser effect on prostaglandin synthesis than the other NSAIDS (Answer B is correct⁦)
2.A patient has recurrent calcium oxalate stones; the 24-hour urine collection shows that the patient has elevated urinary uric acid concentrations. Which one of the following would best prevent recurrent stones in this patient?
Allopurinol
Febuxostat
Hydrochlorothiazide
Potassium citrate
The patient has recurrent calcium oxalate stones in the setting of hyperuricosuria. This is because urinary solubility of calcium is decreased with uric acid in the urine. Inhibiting xanthine oxidase to reduce uric acid production with allopurinol has shown favorable results with hyperuricosuria (Answer A is correct). Febuxostat could have a potential role in treating this patient, but data have not yet supported its use in preventing stone recurrence (Answer B is incorrect). Hydrochlorothiazide can help prevent calcium oxalate stones, but its role is limited to patients with hypercalciuria rather than hyperuricosuria (Answer C is incorrect). Potassium citrate is better utilized with uric acid stones (Answer D is incorrect).
3.A trial measures the effectiveness of an intervention in increasing 30-day adherence to daily medication regimens. The primary outcome is number of doses missed (e.g., 0 to 30). Which one of the following best represents the data types from this primary outcome?
Ordinal
Ratio
Interval
Nominal
In this example, the primary outcome represents counting the number of missed doses per week and comparing them between groups. This “counting” represents continuous data, as the space between the values is equivalent. As nominal and ordinal data are both discrete (vs. continuous) in nature, Answer A and Answer D are incorrect. Ratio and interval data differ on the significance of “zero,” with ratio data reflecting zero meaning the absence of whatever is being measured or evaluated. In this example, because “zero” missed doses would be the absence of missed doses, ratio is the correct response (Answer B is correct; Answer C is incorrect).
4.A 2-year-old girl with cough, low-grade temperature (37.2°C), and wheezes on chest examination is thought to have acute bronchitis. She has no known drug allergies and is up to date on her vaccinations. Which one of the following is best to recommend for this patient?
Amoxicillin
Dextromethorphan
Diphenhydramine
Honey
Honey has shown to be better than no treatment in acute bronchitis in children older than 1 year (Answer D is correct). Antibiotics are not recommended (Answer A is incorrect). After the FDA warning, OTC anti-tussives and antihistamines are not recommended for children younger than 4 years old (Answer B and Answer C are incorrect).
5.Physical examination reveals skin eruptions dyspnea, pleuritic pain, and confusion. Physical examination reveals skin eruptions on his extremities. The patient is thought to have CAP. Which one of the following is the most likely infecting organism?
C. pneumoniae
Influenza virus type A
M. pneumoniae
S. pneumoniae
M. pneumoniae is an atypical pathogen responsible for up to 22% of cases of CAP in combination with the other atypical pathogens. Clinical presentation of M. pneumoniae in CAP can include skin manifestations such as Stevens-Johnson syndrome or erythema multiforme (Answer C is correct). C. pneumoniae may present with upper respiratory symptoms, but is not associated with skin symptoms (Answer A is incorrect). Although both influenza and S. pneumoniae are common causes of CAP, neither is associated with skin manifestations upon presentation of CAP (Answer B and Answer D are incorrect).
6.A 22-year-old patient with no drug allergies or signifcant medical history presents with acute appendicitis and will have an appendectomy. There is no evidence of perforation of the appendix. A dose of antibiotic will be given for prophylaxis within 60 minutes of the incision. Which one of the following intravenous antibiotics is best to recommend for this patient?
Cefazolin
Cefriaxone
Cefoxitin
Levoﬂoxacin
This patient requires antibiotic prophylaxis before appendectomy for non-perforated appendicitis. The organisms implicated in surgical site infection (SSI) afer appendectomy include obligate anaerobes in addition to aerobic enteric gram negative organisms such as Escherichia coli and Klebsiella spp. and skin ﬂora. Terefore, an antibiotic with anaerobic coverage should be chosen. The IDSA recommends cefoxitin as an option (Answer C is correct). Cefazolin is an option in the IDSA guidelines, but only when combined with metronidazole for anaerobic coverage (Answer A is incorrect). Similarly, cefriaxone and levoﬂoxacin lack anaerobic coverage and are not options recommended by IDSA (Answer B and Answer D are incorrect).
7.Which one of the following agents has the highest risk of fatal bleeding related to the competitor in acute coronary syndrome (ACS) in patients receiving PCI?
Prasugrel 10 mg versus clopidogrel 75 mg/day.
Rivaroxaban 2.5 mg twice daily versus placebo.
Rivaroxaban 5 mg twice daily versus placebo.
Vorapaxar 40 mg load; then 2.5 mg/day versus placebo
Answer B, Answer C, and Answer D are incorrect because in their respective phase 3 clinical trials, rivaroxaban and vrapaxar did not increase the risk of fatal bleeding related to the comparator group. Answer A is correct based on data from the landmark TRITON trial. In this study, prasugrel signifcantly increased the risk of fatal bleeding compared with clopidogrel.
8.A 24-year-old man had a significant rash while taking phenytoin. Pharmacogenomic testing showed that he carries the HLAB15:02 allele. Which one of the following is best to recommend for this patient?
Lamotrigine
Carbamazepine
Oxcarbazepine
Zonisamide
Carbamazepine (Answer oxcarbazepine (Answer C) have been associated with risk with the HLA-B15:02 allele. Lamotrigine (Answer A) has been associated with aromatic reactions and rash, so general caution is warranted. Zonisamide (Answer D) has not been linked with the HLA-B*15:02 allele.
9.R.T. is a 26-year-old woman who wishes to begin planning for pregnancy. She takes lamotrigine 100 mg twice daily and has been seizure free for 13 months. Which one of the following is best to recommend for L.T. now, before pregnancy?
Change to the least teratogenic AED.
Discontinue lamotrigine.
Begin folic acid.
Avoid alcohol
Planning for a pregnancy improves outcomes. Changing drugs (Answer A) would not be best because the patient is currently seizure free, and lamotrigine is already one of the lower-risk drugs. Discontinuing drugs (Answer is not recommended because seizures can be problematic during pregnancy. Avoiding alcohol is recommended (Answer D), but ensuring adequate folic acid (Answer C) is the priority of the planning steps.
10.In a trial comparing alteplase and placebo, 71 patients in the alteplase group had CNS hemorrhage compared with 13 in the placebo group. Each group contained 1200 patients. Which one of the following results best represents the number needed to harm for this treatment?
4.8
5.9
20
27
The number needed to harm is equivalent to the inverse of the absolute risk increase. The absolute risk increase is the absolute difference between the control event rate and the experimental event rate. Using the findings from the trial comparing alteplase and placebo, the absolute risk increase is 0.048. The number needed to harm is 20 (1/0.048 = 20.8; Answer C is correct). The answer was rounded down to avoid underestimating the harm. Answer A is incorrect because it is the absolute risk increase expressed as a percentage. Answer B is incorrect because 5.9 is the experimental event rate expressed as a percentage. If the inverse of the experimental event rate were used instead of the absolute risk increase, the calculated value would be 27 (Answer D is incorrect).
11.A 9-year-old girl presents to the clinic for follow-up treatment of depression. She had a suboptimal response to 8 weeks of cognitive behavioral therapy, and her pediatrician would like to initiate an antidepressant. The physician defers medication selection to you. Which one of the following is best to recommend for this patient?
Escitalopram monotherapy
Escitalopram and continue psychotherapy
Fluoxetine monotherapy
Fluoxetine and continue psychotherapy
Fluoxetine is FDA indicated for treating MDD in youths 8 years of age and carries the most evidence for safety and efficacy in the pediatric population. Studies have also shown the significant value of psychotherapy in the pediatric population in addition to pharmacotherapy making Answer D correct and Answers A and C, antidepressant monotherapy, incorrect. Escitalopram is approved for youths 12 years and older but has a smaller level of evidence for efficacy than fluoxetine, eliminating Answers A and B.
12.Your pharmacy and therapeutics committee wants you to perform a pharmacoeconomic analysis of a new drug available to treat decompensated HF. This drug works through a unique mechanism of action. Unlike other available inotropic therapies that can increase mortality, this drug appears to reduce long-term mortality. However, the cost is 10-fold greater than that of other available drugs. Which pharmacoeconomic analysis would be best to determine whether this new drug is a better formulary choice than currently available agents?
Cost minimization analysis.
Cost-effectiveness analysis.
Cost-beneft analysis.
Cost-utility analysis
Because the pharmacy and therapeutics committee wants to discover whether the new drug is worth the extra cost for the added mortality benefts it can provide for patients with decompensated HF compared with available therapies, a cost-effectiveness analysis (Answer B is correct) is the best pharmacoeconomic analysis to perform. Cost-minimization analysis (Answer A is incorrect) is used to determine whether a therapeutically equivalent drug within a class that provides the same therapeutic outcome as other available drugs can be used for less cost. Cost-utility analysis (Answer D is incorrect) is used to determine whether a drug can improve the quality of a patient’s life more than other available therapies. Cost-beneft analysis (Answer C is incorrect) is used to evaluate new programs or services to determine whether they provide enough beneft to justify the cost of running the program
13.A 65-year-old man with metastatic non–small cell lung cancer is brought to the clinic by his family because he is lethargic and fatigued. Pertinent laboratory values include serum calcium concentration 12 mg/dL and albumin concentration 2 g/dL. Which therapy is best for this patient’s lethargy and fatigue as the result of hypercalcemia of malignancy?
Calcitonin 4 units/kg every 12 hours.
Furosemide 20 mg orally.
Dexamethasone 10 mg orally two times a day.
Zoledronic acid 4 mg intravenously
The corrected calcium is 13.6 mg/dL. Corrected calcium concentrations greater than 12 g/dL should be treated with a bisphosphonate (either pamidronate or zoledronic acid) in addition to hydration with normal saline(Answer D is correct). Furosemide may be needed during hydration, but not before hydration because the patient is probably dehydrated (Answer B is not correct). This patient does not need rapid reversal of hypercalcemia; therefore, calcitonin is not needed (Answer A is not correct). Dexamethasone may be used in patients with lymphoma or myeloma, but it has no effect on metastatic non–small cell lung cancer (Answer C is not correct)
14.An 18-year-old man is about to begin chemotherapy with curative intent for acute lymphoblastic leukemia. On today’s complete blood cell count (CBC), his hemoglobin (Hgb) is 7 g/dL, and he is experiencing fatigue. Which is the best treatment recommendation?
Initiate epoetin.
Administer transfusion of packed red blood cells (RBCs).
Delay chemotherapy treatment until Hgb recovers.
Reduce chemotherapy dosages to prevent further decreases in Hgb.
This anemia is not attributable to treatment because chemotherapy has not yet begun. Epoetin and darbepoetin are indicated only for noncurative chemotherapy-associated anemia in non-myeloid tumors (answer A is not correct). Chemotherapy should not be delayed, nor should chemotherapy dosages be reduced in the setting of a potentially curable malignancy (Answer C and D are not correct). Therefore, the patient should receive a transfusion of packed RBCs because his hemoglobin is less than 8 g/dL and he is fatigued (Answer B is correct).
15.A 60-year-old woman with breast cancer is to begin chemotherapy with AC (doxorubicin and cyclophosphamide). Laboratory values today include sodium 140 mEq/L, potassium 3.8 mEq/L, glucose 100 mg/dL, serum creatinine 1.1 mg/dL, aspartate aminotransferase 6 IU/L, alanine aminotransferase 35 IU/L, and total bilirubin 2 mg/dL. Which statement is most appropriate?
The dosage of doxorubicin should be decreased.
The dosage of cyclophosphamide should be decreased.
Both chemotherapy drugs should be given at standard dosages.
Both chemotherapy drugs should be given at decreased dosages.
Doxorubicin undergoes hepatic clearance (by the biliary tract), and there are recommendations for dosage reduction based on bilirubin (Answer A is correct). There is no reason to reduce the cyclophosphamide dosage (Answer B is not correct). Because only doxorubicin requires reduction, both agents should not be adjusted based on the laboratory values given (AnsweD is not correct). Both agents shouldn’t be continued at the current dose as doxorubicin must be adjusted in patients with elevated total bilirubin (Answer D is not correct)
16.An investigator wants to establish a causal relationship between the use of ceftriaxone in premature neonates and the incidence of kernicterus. Which study design is best to use?
Case series.
Randomized controlled.
Retrospective cohort.
Crossover
A case series does not reliably establish a causal relationship, but it suggests a potential hypothesis to be studied further (Answer A is incorrect). Given the current knowledge about the potential risk of kernicterus related to ceftriaxone use, obtaining investigational review board approval for a randomized controlled or a crossover trial design would be diffcult, given ethical considerations, although this study design is the gold standard for establishing a causal relationship (Answers B and D are incorrect). Therefore, a retrospective cohort would be best to investigate a causal relationship in this instance (Answer C is correct).
17.A 7-year-old child with absence seizures is having breakthrough episodes on ethosuximide. Which is the most appropriate alternative therapy?
Valproic acid
Phenytoin
Phenobarbital
Gabapentin
Valproic acid is considered a frst-line therapy for treating absence seizures. If the patient is having breakthrough seizures on ethosuximide - also a frst-line therapy—and the dose has been maximized, it is reasonable to switch to valproic acid (Answer A is correct). Phenytoin, phenobarbital, and gabapentin have not been shown effective in treating absence seizures (Answer B, C, and D are incorrect).
18.A pharmacist is asked to give a presentation to a group of physical therapists regarding new methods of pain management. Of the topic areas indicated in the following, which would likely be of most interest to this audience?
Mechanism of action and adverse events
Cost and formulary
Pharmacology and pharmacokinetics
Dosage and administration
Whereas health care professionals typically learn at least some of the aspects of medication therapy, audiences are usually most interested in information related to their job responsibilities. Physical therapists would want to know the neuromuscular effects of a medication and their potential impact on patient movement. For example, the adverse effects of dizziness, hypotension, or sedation might impair a patient’s ability to participate in physical therapy sessions. Because these professionals are typically not responsible for prescribing or administering pain-related medications, they would usually be less interested in cost, dosing, formulary status, or pharmacokinetics. Thus the most correct option would be Answer A.
19.In performing medication reconciliation for a patient, the pharmacist detected a discrepancy in the dosage of insulin glargine between the prescriber’s medication orders and the patient’s list. After clarifying the dosage with the prescriber, which would be the most appropriate way to document the correct dose and frequency of insulin in the patient’s medical record?
Inject 15 units daily at bedtime
Inject 15 U QD at HS
Inject 15 units QD at HS
Inject 15 U daily at bedtime
U is listed on the ISMP error-prone abbreviations list and should not be used if possible. Units is the preferred way to note the insulin dose. The term QD (daily) is also listed on the ISMP list and is often mistaken as QID (four times a day) and should not be used; daily is preferred. The Joint Commission does not state a preference with respect to HS versus bedtime; however, ISMP lists this on the error-prone list because it is often confused with half-strength and, in general, these abbreviations should be avoided.
20.A MEDLINE search using the MeSH terms for stroke and aspirin is conducted to fnd information on whether every woman over the age of 55 years should take low-dose aspirin for stroke prevention. In addition to this approach, which search strategy would best minimize the retrieval of erroneous data?
Using the keyword word search of “aspirin AND stroke”.
Using the subheading “therapeutic use”.
Limiting the sex to “female”.
Restricting the publication type to “review”.
The best step to take to limit erroneous data is to limit the sex to female. This would limit the MeSH for aspirin AND stroke to only those studies that included females. Using the subheading “therapeutic use” (Answer would not limit the data as much as restricting the search to the female gender since the question was specific to information in women. A restriction to publication type of “review” (Answer D) may limit the search too much and cause one to miss pertinent articles. Using a keyword search provides too many hits that are irrelevant and is not time efficient (Answer A)
21.A physician requests a brief summary of a new antidepressant, vilazodone. The pharmacist answering this question has not heard of this drug. Which one of the following resources is best to consult for this information?
MEDLINE, in-process
IDIS
PubMed
IPA
MEDLINE, in-process is the best answer because this source contains those records that are not yet indexed with Medical Subject Heading (MeSH) terms. Since the pharmacist has not heard of the drug and the physician states the drug is new, one can assume that any information contained in MEDLINE is new. IDIS, PubMed and IPA do not publish in-process papers and posts papers once publication occurs
22.A medical resident has requested information on a recent news story regarding the depletion of magnesium by proton pump inhibitors. She requests more information as to the clinical presentation as well as the incidence of this depletion in patients. Which one of the following would be the best Internet source to fnd this information?
www.clinicaltrials.gov.
www.fda.gov.
www.mayoclinic.com.
www.clinicalevidence.com
Answer B is correct because the FDA Web site is going to have the most current ADR information that is either being reported by manufacturers or is detected via the pharmacovigilance program. The FDA site is a good site as a clinician to have e-mail alerts sent when new ADRs are reported. http://www.fda.gov/Drugs/DrugSafety/ucm245011.htm Answer A, www.clinicaltrials.gov, is not the best answer because usually these ADRs are not reported through a clinical trial. Although clinicaltrials.gov does have safety trials and this would be a good source to look at later in your searching strategy but it is incorrect because it is not considered a frst-line resource for this question. For the PPIs and magnesium, there are case series and observational studies published in the literature starting in 2006 so a Medline search would show results but none were clinical trials and a search of clinicaltrials.gov through June 2011 results no trials found. Answer C, www.mayoclinic.com, is incorrect because this site is meant for health care consumers versus information for the health care professional. Answer D, www.clinicalevidence.com, would be incorrect because clinicalevidence.com provides guidelines and does not have cutting edge safety data on the site
23.A student pharmacist is completing an Advance Practice Rotation and has been assigned the task of seeing if any additional studies have been published on selenium and cancers since the most recent Cochrane Review has been published. Which one of the following is the best resource for the student to use?
PubMed
UpToDate
Google
www.fda.gov
Answer A is the best answer because this Cochrane Review was published in May 2011 and stated in the review that the studies were up-to-date through April 5, 2011. The student would know to search the literature from that point on. PubMed offers the best choice to look for the most recent studies since it offers the in process feature as it adds studies and publications to the database(. http://www.ncbi.nlm.nih.gov/pubmed/). Answer B is incorrect because UpToDate would not necessarily be updating the system to include recently published studies on all topics in the database in a timely fashion. There is no guarantee that this would be updated for selenium with the latest information. Answer C is incorrect because Google is not set up to search for the latest studies on a topic and it can be diffcult to search because it does not provide the same searching strategies and limits strategies that PubMed offers. Also, Google does not offer an in process option. Answer D is incorrect because the FDA web site is not designed to provide the latest publication on a specifc topic especially this type of topic
24.Which mobile application for a personal digital assistant (PDA) or smart phone would most efficiently and effectively identity if simvastatin, benazepril, hydrochlorothiazide, and omeprazole will interact with clarithromycin?
MobileMicromedex
Clinical Pharmacology OnHand
Epocrates
Lexi-Drugs
MobileMicromedex contains all features of the desk top version of Micromedex. The other mobile platforms for Clinical Pharmacology, Epocrates (Answer , Epocrates (Answer C), and Lexi-Drugs (Answer D) are currently limited and do not contain a specifc drug interaction tool.
25.A new enzyme immunoassay for HCV RNA has a reported sensitivity of 95% and a specifcity of 92%. If the prevalence of HCV in a cohort of 500 patients is 40%, which value best represents the positive predictive value of this new test?
75%
89%
92%
96%
Positive predictive value gives the proportion of patients with a disease when the presence of the disease is indicated by a diagnostic test. It is affected by disease prevalence; thus, as disease prevalence falls, so does the positive predictive value of the test. Using the sensitivity, specifcity, and prevalence, a 2 × 2 table can be constructed. The positive predictive value is calculated by dividing the true positives by the sum of the true and false positives. In this case, that would be 190/ (190 + 24) × 100 = 89% (Answer . The total number of patients who tested positive divided by the number who tested negative, 75% (Answer A), does not indicate the positive predictive value of a test. Specifcity deals with the proportion of patients without the disease who have a negative test result; it can be calculated by taking the number of patients not having the disease using the gold standard who tested negative with the new test (true negatives = 276). Next, divide this by the number of patients who truly had no disease using the gold standard, 300, which incorporates the 24 patients who tested positive with the new test but truly had no disease (i.e., false positives). Specifcity = 276/(276 + 24) = 92% (Answer C). The number of patients who tested negative and had no infection divided by the total number of patients with no infection does not illustrate positive predictive value 276/(276 + 10) = 96% (Answer D).

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Pharmacotherapy Self Assessment Test with FADIC

Pharmacotherapy Self Assessment Test with FADIC

Test Yourself NOW with FADIC

Answer the Following Questions (Passing Score is 75%):

Test Time: No Time

00:00:00

1.Which one of the following drug pairs would most likely significantly decrease a high-risk patient’s intraglomerular pressure, possibly leading to acute kidney injury (AKI)?

2.A patient has recurrent calcium oxalate stones; the 24-hour urine collection shows that the patient has elevated urinary uric acid concentrations. Which one of the following would best prevent recurrent stones in this patient?

3.A trial measures the effectiveness of an intervention in increasing 30-day adherence to daily medication regimens. The primary outcome is number of doses missed (e.g., 0 to 30). Which one of the following best represents the data types from this primary outcome?

4.A 2-year-old girl with cough, low-grade temperature (37.2°C), and wheezes on chest examination is thought to have acute bronchitis. She has no known drug allergies and is up to date on her vaccinations. Which one of the following is best to recommend for this patient?

5.Physical examination reveals skin eruptions dyspnea, pleuritic pain, and confusion. Physical examination reveals skin eruptions on his extremities. The patient is thought to have CAP. Which one of the following is the most likely infecting organism?

7.Which one of the following agents has the highest risk of fatal bleeding related to the competitor in acute coronary syndrome (ACS) in patients receiving PCI?

8.A 24-year-old man had a significant rash while taking phenytoin. Pharmacogenomic testing showed that he carries the HLAB*15:02 allele. Which one of the following is best to recommend for this patient?

9.R.T. is a 26-year-old woman who wishes to begin planning for pregnancy. She takes lamotrigine 100 mg twice daily and has been seizure free for 13 months. Which one of the following is best to recommend for L.T. now, before pregnancy?

10.In a trial comparing alteplase and placebo, 71 patients in the alteplase group had CNS hemorrhage compared with 13 in the placebo group. Each group contained 1200 patients. Which one of the following results best represents the number needed to harm for this treatment?

14.An 18-year-old man is about to begin chemotherapy with curative intent for acute lymphoblastic leukemia. On today’s complete blood cell count (CBC), his hemoglobin (Hgb) is 7 g/dL, and he is experiencing fatigue. Which is the best treatment recommendation?

16.An investigator wants to establish a causal relationship between the use of ceftriaxone in premature neonates and the incidence of kernicterus. Which study design is best to use?

17.A 7-year-old child with absence seizures is having breakthrough episodes on ethosuximide. Which is the most appropriate alternative therapy?

18.A pharmacist is asked to give a presentation to a group of physical therapists regarding new methods of pain management. Of the topic areas indicated in the following, which would likely be of most interest to this audience?

20.A MEDLINE search using the MeSH terms for stroke and aspirin is conducted to fnd information on whether every woman over the age of 55 years should take low-dose aspirin for stroke prevention. In addition to this approach, which search strategy would best minimize the retrieval of erroneous data?

21.A physician requests a brief summary of a new antidepressant, vilazodone. The pharmacist answering this question has not heard of this drug. Which one of the following resources is best to consult for this information?

24.Which mobile application for a personal digital assistant (PDA) or smart phone would most efficiently and effectively identity if simvastatin, benazepril, hydrochlorothiazide, and omeprazole will interact with clarithromycin?

25.A new enzyme immunoassay for HCV RNA has a reported sensitivity of 95% and a specifcity of 92%. If the prevalence of HCV in a cohort of 500 patients is 40%, which value best represents the positive predictive value of this new test?

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Copyright ©: All content on FADIC Website, including medical opinion and any other health-related information, and drug Informtation is for informational purposes only