BCACP Medication Management 4

Question 1

A patient with atrial fibrillation and a CrCl of 28 mL/min needs anticoagulation. Which DOAC requires the most significant dose adjustment in this scenario?

Accepted Answer

Dabigatran

Answer

Dabigatran is 80% renally eliminated and is contraindicated or requires the most cautious use in severe renal impairment (CrCl <30 mL/min for AF indication).

Question 2

Which medication used in ambulatory care is most associated with causing drug-induced lupus?

Accepted Answer

Hydralazine

Answer

Hydralazine is one of the most common causes of drug-induced lupus erythematosus, particularly in slow acetylators taking higher doses.

Question 3

A pharmacist reviews a prescription for clopidogrel in a patient on omeprazole. What is the clinical significance of this interaction?

Accepted Answer

Omeprazole inhibits CYP2C19, reducing conversion of clopidogrel to its active metabolite

Answer

Omeprazole inhibits CYP2C19, the enzyme responsible for converting clopidogrel to its active thiol metabolite, potentially reducing antiplatelet efficacy.

Question 4

Which monitoring parameter is most important 1-2 weeks after initiating an ACE inhibitor in a patient with bilateral renal artery stenosis?

Accepted Answer

Serum creatinine and potassium

Answer

ACE inhibitors can cause acute kidney injury and hyperkalemia in patients with bilateral renal artery stenosis due to loss of efferent arteriolar constriction, making renal function and electrolyte monitoring critical.

Question 5

A patient newly diagnosed with osteoporosis has a T-score of -3.1 at the hip. They are intolerant of oral bisphosphonates. Which therapy is most appropriate?

Accepted Answer

Zoledronic acid 5 mg IV annually

Answer

Zoledronic acid is a first-line IV bisphosphonate option that offers annual dosing with proven fracture reduction benefit, appropriate for patients intolerant of oral formulations.

BCACP - Board Certified Ambulatory Care Pharmacist Exam Practice Test

BCACP - Board Certified Ambulatory Care Pharmacist Exam Practice Test

BCACP Medication Management 4