Ambulatory Care Test Ambulatory Care Ambulatory Care Pharmacology 3 — Questions and Answers
Question 1: A 65-year-old patient with atrial fibrillation and a CrCl of 30 mL/min needs anticoagulation. Which direct oral anticoagulant requires the most significant dose adjustment?
- Apixaban
- Rivaroxaban
- Dabigatran (Correct answer)
- Edoxaban
Correct answer: Dabigatran
Dabigatran is predominantly renally cleared (80%) and is generally avoided in severe renal impairment.
Question 2: Which medication used for smoking cessation carries an FDA black box warning for neuropsychiatric events?
- Nicotine patch
- Bupropion SR
- Varenicline (Correct answer)
- Nortriptyline
Correct answer: Varenicline
Varenicline (Chantix) carried a black box warning for serious neuropsychiatric events including depression, suicidal ideation, and behavior changes.
Question 3: A patient with gout is prescribed allopurinol. What is the recommended goal for serum uric acid to prevent recurrent attacks?
- Less than 9 mg/dL
- Less than 7 mg/dL
- Less than 6 mg/dL (Correct answer)
- Less than 4 mg/dL
Correct answer: Less than 6 mg/dL
ACR guidelines recommend a serum uric acid target of less than 6 mg/dL for most gout patients on urate-lowering therapy.
Question 4: Which fluoroquinolone is associated with the highest risk of QT interval prolongation?
- Ciprofloxacin
- Levofloxacin
- Moxifloxacin (Correct answer)
- Ofloxacin
Correct answer: Moxifloxacin
Moxifloxacin has the greatest QTc-prolonging effect among fluoroquinolones and is avoided with other QT-prolonging drugs.
Question 5: An ambulatory patient with hypothyroidism should take levothyroxine at which time to optimize absorption?
- With breakfast
- 30-60 minutes before breakfast on an empty stomach (Correct answer)
- With the evening meal
- Immediately after any meal
Correct answer: 30-60 minutes before breakfast on an empty stomach
Levothyroxine absorption is maximized when taken 30-60 minutes before breakfast without food or other medications.
Question 6: A patient on methotrexate for rheumatoid arthritis should take folic acid supplementation primarily to prevent which adverse effect?
- Hepatotoxicity
- Pulmonary toxicity
- Mucositis and GI toxicity (Correct answer)
- Bone marrow suppression from nephrotoxicity
Correct answer: Mucositis and GI toxicity
Folic acid supplementation reduces methotrexate-induced mucositis and GI adverse effects without compromising efficacy.
Question 7: Which beta-blocker is considered cardioselective at low doses and preferred in patients with mild to moderate COPD?
- Carvedilol
- Propranolol
- Metoprolol succinate (Correct answer)
- Labetalol
Correct answer: Metoprolol succinate
Metoprolol succinate is a beta-1 selective blocker that is preferred over non-selective agents in COPD patients.
Ambulatory Care Test Ambulatory Care Ambulatory Care Pharmacology 3
A 65-year-old patient with atrial fibrillation and a CrCl of 30 mL/min needs anticoagulation.
Which direct oral anticoagulant requires the most significant dose adjustment?