BCACP Medication Management 2

Question 1

A patient with CKD stage 3b (eGFR 38 mL/min/1.73m²) is prescribed metformin. What is the most appropriate action?

Accepted Answer

Reduce metformin dose and monitor renal function every 3 months

Answer

Metformin can be continued with dose reduction at eGFR 30-45 mL/min/1.73m² with close monitoring, but should be discontinued if eGFR falls below 30.

Question 2

Which fluoroquinolone interaction most significantly prolongs the QT interval and requires monitoring?

Accepted Answer

Moxifloxacin with amiodarone

Answer

Moxifloxacin combined with amiodarone poses a serious additive QT prolongation risk that can lead to torsades de pointes.

Question 3

A patient on warfarin begins fluconazole therapy for a vaginal yeast infection. What is the expected pharmacokinetic effect?

Accepted Answer

Increased warfarin levels due to CYP2C9 inhibition

Answer

Fluconazole is a potent CYP2C9 inhibitor that dramatically increases warfarin exposure, requiring INR monitoring and likely dose reduction.

Question 4

Which medication requires a REMS program due to risk of serious dermatologic reactions, including Stevens-Johnson syndrome?

Accepted Answer

Carbamazepine in patients of Asian ancestry

Answer

Carbamazepine carries a REMS and Black Box Warning for SJS/TEN, particularly in patients of Asian ancestry who may carry the HLA-B*1502 allele.

Question 5

A 68-year-old patient is taking simvastatin 40 mg and is started on diltiazem for rate control. What is the most appropriate intervention?

Accepted Answer

Reduce simvastatin dose or switch to a non-CYP3A4-metabolized statin

Answer

Diltiazem inhibits CYP3A4 and significantly increases simvastatin levels, raising myopathy risk; switching to pravastatin or rosuvastatin avoids this interaction.

BCACP - Board Certified Ambulatory Care Pharmacist Exam Practice Test

BCACP - Board Certified Ambulatory Care Pharmacist Exam Practice Test

BCACP Medication Management 2