Ambulatory Care Test Ambulatory Care Ambulatory Care Pharmacology 4 — Questions and Answers
Question 1: A patient with type 2 diabetes on metformin has an A1C of 8.5%. Which add-on agent would be most appropriate for a patient who also has established ASCVD?
- Sulfonylurea (glipizide)
- DPP-4 inhibitor (sitagliptin)
- GLP-1 receptor agonist (semaglutide) (Correct answer)
- Thiazolidinedione (pioglitazone)
Correct answer: GLP-1 receptor agonist (semaglutide)
GLP-1 receptor agonists like semaglutide have proven cardiovascular benefit in patients with established ASCVD per ADA guidelines.
Question 2: A patient prescribed spironolactone for heart failure should avoid concurrent use of which over-the-counter medication?
- Acetaminophen
- NSAIDs (ibuprofen) (Correct answer)
- Antacids containing aluminum
- Diphenhydramine
Correct answer: NSAIDs (ibuprofen)
NSAIDs reduce renal prostaglandins, decrease GFR, and worsen hyperkalemia risk in patients on spironolactone.
Question 3: Which opioid analgesic is contraindicated in patients with renal failure due to accumulation of a toxic metabolite?
- Hydromorphone
- Fentanyl
- Morphine (Correct answer)
- Oxycodone
Correct answer: Morphine
Morphine-6-glucuronide, an active metabolite, accumulates in renal failure causing prolonged CNS and respiratory depression.
Question 4: A patient taking lithium develops polyuria and polydipsia. Which drug is most likely responsible for this adverse effect?
- Propranolol
- Thiazide diuretics
- Lithium itself causing nephrogenic DI (Correct answer)
- ACE inhibitors
Correct answer: Lithium itself causing nephrogenic DI
Long-term lithium therapy can cause nephrogenic diabetes insipidus by interfering with vasopressin-mediated water reabsorption.
Question 5: Which medication used for osteoporosis must the patient remain upright for at least 30 minutes after taking to prevent esophageal injury?
- Raloxifene
- Denosumab
- Alendronate (Correct answer)
- Teriparatide
Correct answer: Alendronate
Oral bisphosphonates like alendronate can cause esophagitis or esophageal ulcers if the patient lies down after taking the tablet.
Question 6: A patient with HIV on antiretroviral therapy is started on rifampin for tuberculosis. What is the primary pharmacokinetic concern?
- Rifampin inhibits CYP3A4, increasing HAART drug levels
- Rifampin induces CYP3A4, significantly reducing protease inhibitor levels (Correct answer)
- Rifampin causes additive hepatotoxicity
- Rifampin reduces renal clearance of tenofovir
Correct answer: Rifampin induces CYP3A4, significantly reducing protease inhibitor levels
Rifampin is a potent CYP3A4 inducer that dramatically lowers protease inhibitor plasma levels, risking virologic failure.
Question 7: Which parameter best determines the appropriate dose interval for an antibiotic that exhibits time-dependent (not concentration-dependent) bactericidal activity?
- Peak/MIC ratio
- AUC/MIC ratio
- Time above MIC (Correct answer)
- Cmax/MIC ratio
Correct answer: Time above MIC
Beta-lactams exhibit time-dependent killing; efficacy correlates with the percentage of time drug concentrations remain above the MIC.
Ambulatory Care Test Ambulatory Care Ambulatory Care Pharmacology 4
A patient with type 2 diabetes on metformin has an A1C of 8.5%.
Which add-on agent would be most appropriate for a patient who also has established ASCVD?