BCACP Medication Management 5 — Questions and Answers
Question 1: A patient with HIV is started on rifampin for TB co-infection and is also taking raltegravir. What effect does rifampin have on raltegravir?
- Increases raltegravir levels by inhibiting UGT1A1
- Decreases raltegravir levels by inducing UGT1A1, requiring dose doubling (Correct answer)
- No significant pharmacokinetic interaction
- Decreases raltegravir levels by inhibiting P-glycoprotein
Correct answer: Decreases raltegravir levels by inducing UGT1A1, requiring dose doubling
Rifampin induces UGT1A1, the primary metabolic pathway for raltegravir, requiring the raltegravir dose to be doubled to 800 mg twice daily during co-administration.
Question 2: Which antidiabetic medication class is associated with the highest risk of hypoglycemia when used as monotherapy?
- SGLT2 inhibitors
- DPP-4 inhibitors
- Sulfonylureas (Correct answer)
- GLP-1 receptor agonists
Correct answer: Sulfonylureas
Sulfonylureas stimulate insulin secretion independent of glucose levels, resulting in the highest hypoglycemia risk among oral antidiabetic classes when used as monotherapy.
Question 3: A patient prescribed clozapine develops an absolute neutrophil count (ANC) of 450 cells/µL. What is the most appropriate action?
- Continue clozapine and recheck ANC in 1 week
- Reduce clozapine dose by 50%
- Immediately discontinue clozapine and monitor ANC daily (Correct answer)
- Add G-CSF and continue clozapine at current dose
Correct answer: Immediately discontinue clozapine and monitor ANC daily
An ANC below 500 cells/µL indicates severe neutropenia requiring immediate clozapine discontinuation per the Clozapine REMS program requirements.
Question 4: A 55-year-old woman with postmenopausal osteoporosis and a history of deep vein thrombosis asks about raloxifene. What is the most important contraindication to address?
- Raloxifene is contraindicated in postmenopausal women
- Raloxifene is contraindicated in patients with active or past VTE (Correct answer)
- Raloxifene cannot be used without concurrent bisphosphonate therapy
- Raloxifene is contraindicated in patients over age 50
Correct answer: Raloxifene is contraindicated in patients with active or past VTE
Raloxifene, a SERM, increases the risk of VTE and is contraindicated in patients with a history of venous thromboembolism.
Question 5: Which drug interaction most significantly increases the risk of serotonin syndrome in a patient on sertraline?
- Adding metoprolol for hypertension
- Adding tramadol for pain management (Correct answer)
- Adding lisinopril for heart failure
- Adding atorvastatin for hyperlipidemia
Correct answer: Adding tramadol for pain management
Tramadol inhibits serotonin reuptake and, combined with an SSRI like sertraline, creates a significant risk of serotonin syndrome.
Question 6: A patient with COPD is prescribed tiotropium via HandiHaler. Which counseling point is most critical for proper use?
- Inhale quickly and forcefully to aerosolize the medication
- Inhale slowly and deeply, hold breath for 10 seconds, and do not swallow the capsule (Correct answer)
- Use with a spacer device for optimal lung deposition
- Rinse mouth after each use to prevent candidiasis
Correct answer: Inhale slowly and deeply, hold breath for 10 seconds, and do not swallow the capsule
Tiotropium HandiHaler requires slow deep inhalation to ensure dry powder deposition in the airways; capsules are perforated in the device and must never be swallowed.
Question 7: A patient on chronic prednisone therapy is being evaluated for bone health. Which combination of preventive therapies is most appropriate per guidelines?
- Calcium 500 mg daily and alendronate 35 mg weekly
- Calcium 1000-1200 mg daily, vitamin D 600-800 IU daily, and bisphosphonate therapy if fracture risk is high (Correct answer)
- Vitamin D 2000 IU daily alone
- Bisphosphonate therapy alone without calcium or vitamin D
Correct answer: Calcium 1000-1200 mg daily, vitamin D 600-800 IU daily, and bisphosphonate therapy if fracture risk is high
Guidelines recommend calcium and vitamin D supplementation for all patients on chronic glucocorticoids, with bisphosphonate therapy added based on FRAX-calculated fracture risk.
BCACP Medication Management 5
A patient with HIV is started on rifampin for TB co-infection and is also taking raltegravir.
What effect does rifampin have on raltegravir?