Ambulatory Care Test Ambulatory Care Ambulatory Care Pharmacology 2

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?

Accepted Answer

Lactic acidosis

Answer

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?

Accepted Answer

Increased INR due to CYP2C9 inhibition

Answer

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?

Accepted Answer

Potassium-sparing diuretics

Answer

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?

Accepted Answer

Low-dose inhaled corticosteroid daily

Answer

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?

Accepted Answer

Temporarily hold simvastatin during clarithromycin course

Answer

Clarithromycin is a strong CYP3A4 inhibitor that markedly increases simvastatin levels, raising myopathy risk; statin should be held.

Ambulatory Care Test Practice Test