AP Pharmacology & Medication Management 3 — Questions and Answers
Question 1: Under Florida law, which schedule of controlled substances may an AP dispense if licensed to do so?
- Schedules I and II only
- Schedules III, IV, and V only
- No controlled substances under any circumstances (Correct answer)
- All schedules with DEA registration
Correct answer: No controlled substances under any circumstances
Florida APs are not authorized to prescribe or dispense controlled substances; their scope does not include controlled substance authority.
Question 2: Which herbal formula is classically contraindicated in pregnancy due to its emmenagogue and uterotonic properties?
- Bu Zhong Yi Qi Tang
- Tao Hong Si Wu Tang (Correct answer)
- Liu Wei Di Huang Wan
- Si Jun Zi Tang
Correct answer: Tao Hong Si Wu Tang
Tao Hong Si Wu Tang contains Tao Ren and Hong Hua, which have emmenagogue and uterotonic effects contraindicated in pregnancy.
Question 3: A patient taking cyclosporine after a kidney transplant wants to add echinacea for immune support. The AP should:
- Approve it since echinacea is a natural immune booster
- Strongly advise against it as echinacea's immunostimulant effect may promote organ rejection (Correct answer)
- Recommend a low dose to balance immune function
- Suggest substituting with astragalus instead
Correct answer: Strongly advise against it as echinacea's immunostimulant effect may promote organ rejection
Echinacea stimulates immune function, which directly opposes the immunosuppressive goal of cyclosporine and can risk transplant rejection.
Question 4: What is the primary reason grapefruit juice is clinically significant for many medications?
- It raises gastric pH, reducing ionization of drugs
- It inhibits intestinal CYP3A4, increasing bioavailability of affected drugs (Correct answer)
- It chelates divalent cations needed for drug transport
- It induces P-glycoprotein efflux pumps
Correct answer: It inhibits intestinal CYP3A4, increasing bioavailability of affected drugs
Grapefruit juice contains furanocoumarins that irreversibly inhibit intestinal CYP3A4, increasing the bioavailability and plasma levels of many drugs.
Question 5: A patient on SSRIs asks about using 5-HTP supplements. The main risk is:
- Reduced serotonin synthesis causing depression
- Serotonin syndrome due to additive serotonergic effects (Correct answer)
- Hyponatremia from SIADH exacerbation
- QT prolongation and cardiac arrhythmia
Correct answer: Serotonin syndrome due to additive serotonergic effects
5-HTP is a direct precursor to serotonin; combined with SSRIs it can cause serotonin syndrome characterized by agitation, hyperthermia, and autonomic instability.
Question 6: Which of the following Chinese herbs is classified as a Category X equivalent in pregnancy due to proven teratogenicity?
- Bai Shao (White Peony)
- Ban Mao (Cantharis) (Correct answer)
- Fu Ling (Poria)
- Huang Qi (Astragalus)
Correct answer: Ban Mao (Cantharis)
Ban Mao (cantharidin) is a toxic substance with severe teratogenic and abortifacient properties, absolutely contraindicated in pregnancy.
Question 7: When counseling a patient about potential hepatotoxicity from herbal supplements, which herb should be of HIGHEST concern?
- Milk thistle (Silybum marianum)
- Kava (Piper methysticum) (Correct answer)
- Ginger (Zingiber officinale)
- Peppermint (Mentha piperita)
Correct answer: Kava (Piper methysticum)
Kava has been associated with severe hepatotoxicity including fulminant liver failure and has been banned or restricted in several countries.
AP Pharmacology & Medication Management 3
Under Florida law, which schedule of controlled substances may an AP dispense if licensed to do so?