BCPS Therapeutic Decision-Making & Patient Management 3

Question 1

A 72-year-old male with a history of stroke 3 months ago is started on dual antiplatelet therapy (aspirin + clopidogrel). He is a CYP2C19 poor metabolizer. What is the BEST therapeutic recommendation?

Accepted Answer

Switch clopidogrel to ticagrelor or prasugrel

Answer

CYP2C19 poor metabolizers cannot adequately convert clopidogrel to its active metabolite; ticagrelor or prasugrel are preferred alternatives for adequate P2Y12 inhibition.

Question 2

When counseling a patient starting clozapine therapy, which monitoring parameter is MOST critical to establish at baseline and continue regularly?

Accepted Answer

Absolute neutrophil count (ANC)

Answer

Clozapine carries a black box warning for agranulocytosis; ANC must be monitored weekly for 6 months, then every 2 weeks for 6 months, then monthly thereafter.

Question 3

A patient with COPD (GOLD Group D) is currently on LABA/LAMA. Their exacerbation rate remains high. What is the most appropriate intensification strategy?

Accepted Answer

Add inhaled corticosteroid (ICS) to the regimen

Answer

For GOLD Group D patients with persistent exacerbations on LABA/LAMA, adding ICS (triple therapy) reduces exacerbation frequency, especially if eosinophils ≥300 cells/µL.

Question 4

An elderly patient with benign prostatic hyperplasia (BPH) requires antihistamine therapy for seasonal allergies. Which agent is MOST appropriate?

Accepted Answer

Cetirizine 10 mg daily

Answer

Cetirizine is a second-generation antihistamine with minimal anticholinergic activity, reducing the risk of urinary retention in patients with BPH.

Question 5

A 45-year-old HIV-positive patient on dolutegravir/abacavir/lamivudine is started on rifampin for TB. What adjustment is required?

Accepted Answer

Double the dolutegravir dose to 50 mg twice daily

Answer

Rifampin induces UGT1A1 and reduces dolutegravir AUC by ~54%; doubling the dolutegravir dose to 50 mg BID compensates for this induction.

(BCPS) Board Certified Pharmacotherapy Specialist Practice Test

(BCPS) Board Certified Pharmacotherapy Specialist Practice Test

BCPS Therapeutic Decision-Making & Patient Management 3