Ambulatory Care Test Ambulatory Care Ambulatory Care Pharmacology 5 — Questions and Answers
Question 1: A patient prescribed amiodarone long-term requires monitoring of which organ systems due to serious adverse effects?
- Kidneys and bladder
- Thyroid, lungs, and liver (Correct answer)
- Pancreas and adrenal glands
- Bone marrow and spleen
Correct answer: Thyroid, lungs, and liver
Amiodarone can cause thyroid dysfunction, pulmonary toxicity, and hepatotoxicity, all requiring periodic monitoring.
Question 2: Which antidepressant class is associated with the highest risk of serotonin syndrome when combined with tramadol?
- Bupropion (NDRI)
- SSRIs and SNRIs (Correct answer)
- Mirtazapine
- Tricyclic antidepressants via CYP2D6 only
Correct answer: SSRIs and SNRIs
SSRIs and SNRIs combined with tramadol (which also increases serotonin) create additive serotonergic risk leading to serotonin syndrome.
Question 3: A patient with benign prostatic hyperplasia and hypertension is prescribed tamsulosin. Which antihypertensive combination increases the risk of orthostatic hypotension most significantly?
- Amlodipine
- Lisinopril
- Phosphodiesterase-5 inhibitors (sildenafil) (Correct answer)
- Hydrochlorothiazide
Correct answer: Phosphodiesterase-5 inhibitors (sildenafil)
Combining alpha-1 blockers (tamsulosin) with PDE-5 inhibitors causes additive vasodilation and severe orthostatic hypotension.
Question 4: Which vaccine is recommended annually for all ambulatory patients regardless of age or risk factors?
- Pneumococcal polysaccharide vaccine (PPSV23)
- Recombinant zoster vaccine (Shingrix)
- Influenza vaccine (Correct answer)
- Meningococcal conjugate vaccine
Correct answer: Influenza vaccine
Annual influenza vaccination is recommended for all persons aged 6 months and older by ACIP.
Question 5: A patient on warfarin reports recently starting a diet high in leafy green vegetables. What effect should the pharmacist anticipate?
- Increased INR due to vitamin K competition
- Decreased INR due to increased vitamin K intake (Correct answer)
- No effect since diet does not affect INR
- Increased bleeding risk from salicylate content
Correct answer: Decreased INR due to increased vitamin K intake
Leafy greens are high in vitamin K, which promotes clotting factor synthesis and decreases the anticoagulant effect of warfarin.
Question 6: Which medication used in the treatment of COPD works primarily as a long-acting muscarinic antagonist (LAMA)?
- Salmeterol
- Formoterol
- Tiotropium (Correct answer)
- Montelukast
Correct answer: Tiotropium
Tiotropium (Spiriva) is a LAMA that provides bronchodilation by blocking M3 muscarinic receptors in airway smooth muscle.
Question 7: A patient on phenytoin for epilepsy is found to have a low total phenytoin level but is asymptomatic. The patient has a serum albumin of 2.0 g/dL. What is the most appropriate next step?
- Increase phenytoin dose immediately
- Calculate the free (unbound) phenytoin level or use a correction formula (Correct answer)
- Switch to valproic acid
- Discontinue phenytoin and monitor
Correct answer: Calculate the free (unbound) phenytoin level or use a correction formula
Phenytoin is highly protein-bound; in hypoalbuminemia, a larger free fraction exists and the Sheiner-Tozer correction formula should be applied.
Ambulatory Care Test Ambulatory Care Ambulatory Care Pharmacology 5
A patient prescribed amiodarone long-term requires monitoring of which organ systems due to serious adverse effects?