BCACP Medication Management 3 — Questions and Answers
Question 1: A patient with type 2 diabetes and a history of heart failure with reduced ejection fraction (HFrEF) is not at goal A1c on metformin alone. Which agent is most preferred to add?
- Glipizide
- Pioglitazone
- Empagliflozin (Correct answer)
- Sitagliptin
Correct answer: Empagliflozin
SGLT2 inhibitors like empagliflozin have demonstrated cardiovascular mortality reduction in HFrEF and are preferred by major guidelines for this patient profile.
Question 2: Which bisphosphonate formulation requires the patient to remain upright for 30 minutes after administration?
- Zoledronic acid IV infusion
- Alendronate oral tablet (Correct answer)
- Ibandronate IV injection
- Pamidronate IV infusion
Correct answer: Alendronate oral tablet
Oral alendronate must be taken with a full glass of water on an empty stomach, and the patient must remain upright for at least 30 minutes to prevent esophageal irritation.
Question 3: A pharmacist is counseling a patient starting isotretinoin. Which program must the patient be enrolled in before dispensing?
- REMS with ETASU
- iPLEDGE program (Correct answer)
- Clozapine REMS
- TIRF REMS Access program
Correct answer: iPLEDGE program
iPLEDGE is the mandatory REMS program for isotretinoin due to its severe teratogenic potential, requiring monthly pregnancy testing for females of reproductive potential.
Question 4: When converting a patient from oral oxycodone 30 mg every 4 hours to an IV morphine infusion, which step is critical?
- Use a 1:1 conversion ratio
- Apply equianalgesic tables and then reduce by 25-50% for cross-tolerance (Correct answer)
- Double the calculated equianalgesic dose for breakthrough pain
- Always start at the lowest possible dose regardless of prior opioid use
Correct answer: Apply equianalgesic tables and then reduce by 25-50% for cross-tolerance
Equianalgesic conversion followed by a 25-50% dose reduction accounts for incomplete cross-tolerance and individual variation, reducing overdose risk during opioid rotation.
Question 5: A patient on phenytoin for seizure disorder is started on oral contraceptives. What counseling point is most critical?
- Phenytoin increases OCP effectiveness
- Phenytoin induces CYP enzymes, reducing OCP plasma levels and efficacy (Correct answer)
- OCPs increase phenytoin levels, raising toxicity risk
- No interaction exists between phenytoin and OCPs
Correct answer: Phenytoin induces CYP enzymes, reducing OCP plasma levels and efficacy
Phenytoin is a potent CYP3A4 inducer that accelerates metabolism of ethinyl estradiol and progestin, potentially leading to contraceptive failure.
Question 6: Which beta-blocker is considered cardioselective and preferred in a patient with mild asthma requiring treatment for hypertension?
- Carvedilol
- Propranolol
- Metoprolol succinate (Correct answer)
- Sotalol
Correct answer: Metoprolol succinate
Metoprolol succinate is cardioselective (beta-1 selective) at recommended doses, making it preferable over non-selective beta-blockers in patients with reactive airway disease, though caution is still warranted.
Question 7: A patient reports taking St. John's Wort daily. Which prescribed medication is most at risk for therapeutic failure due to this interaction?
- Ibuprofen
- Cyclosporine (Correct answer)
- Lisinopril
- Atorvastatin
Correct answer: Cyclosporine
St. John's Wort is a potent inducer of CYP3A4 and P-glycoprotein, dramatically reducing cyclosporine levels and risking acute organ rejection in transplant patients.
BCACP Medication Management 3
A patient with type 2 diabetes and a history of heart failure with reduced ejection fraction (HFrEF) is not at goal A1c on metformin alone.
Which agent is most preferred to add?