Ambulatory Care Test Ambulatory Care Ambulatory Care Pharmacology 2 — Questions and Answers
Question 1: A patient with type 2 diabetes is started on metformin. Which adverse effect should be monitored most closely in a patient with CKD stage 3b?
- Hypoglycemia
- Lactic acidosis (Correct answer)
- Hepatotoxicity
- QT prolongation
Correct answer: Lactic acidosis
Metformin is contraindicated in advanced CKD due to risk of lactic acidosis from drug accumulation.
Question 2: Which drug interaction requires close monitoring when a patient on warfarin is prescribed trimethoprim-sulfamethoxazole?
- Decreased INR due to enzyme induction
- Increased INR due to CYP2C9 inhibition (Correct answer)
- Reduced warfarin absorption
- Increased renal clearance of warfarin
Correct answer: Increased INR due to CYP2C9 inhibition
TMP-SMX inhibits CYP2C9, reducing warfarin metabolism and increasing INR.
Question 3: A patient presents with a serum potassium of 6.2 mEq/L while taking lisinopril. Which medication class is most likely contributing?
- Thiazide diuretics
- Loop diuretics
- Potassium-sparing diuretics (Correct answer)
- Carbonic anhydrase inhibitors
Correct answer: Potassium-sparing diuretics
Potassium-sparing diuretics like spironolactone combined with ACE inhibitors significantly increase hyperkalemia risk.
Question 4: Which of the following is the preferred initial treatment for mild persistent asthma in an ambulatory patient?
- Daily oral corticosteroids
- As-needed short-acting beta agonist only
- Low-dose inhaled corticosteroid daily (Correct answer)
- Long-acting beta agonist monotherapy
Correct answer: Low-dose inhaled corticosteroid daily
NAEPP guidelines recommend low-dose ICS as first-line controller therapy for mild persistent asthma.
Question 5: A patient taking simvastatin 40 mg is prescribed clarithromycin for a respiratory infection. What is the most appropriate action?
- Continue both medications as prescribed
- Temporarily hold simvastatin during clarithromycin course (Correct answer)
- Reduce clarithromycin dose by half
- Switch simvastatin to a higher dose
Correct answer: Temporarily hold simvastatin during clarithromycin course
Clarithromycin is a strong CYP3A4 inhibitor that markedly increases simvastatin levels, raising myopathy risk; statin should be held.
Question 6: Which antihypertensive class is preferred in a patient with hypertension and a new diagnosis of heart failure with reduced ejection fraction (HFrEF)?
- Calcium channel blockers (dihydropyridine)
- Beta-blockers (carvedilol, metoprolol succinate) (Correct answer)
- Alpha-1 blockers
- Direct vasodilators
Correct answer: Beta-blockers (carvedilol, metoprolol succinate)
Evidence-based beta-blockers such as carvedilol and metoprolol succinate reduce mortality in HFrEF.
Question 7: A patient on long-term proton pump inhibitor therapy should be monitored for deficiency of which nutrient?
- Vitamin D
- Magnesium (Correct answer)
- Zinc
- Vitamin K
Correct answer: Magnesium
Chronic PPI use reduces gastric acid needed for magnesium absorption, leading to hypomagnesemia.
Ambulatory Care Test Ambulatory Care Ambulatory Care Pharmacology 2
A patient with type 2 diabetes is started on metformin.
Which adverse effect should be monitored most closely in a patient with CKD stage 3b?