BCPS Therapeutic Decision-Making & Patient Management 5

Question 1

A patient with moderate persistent asthma is inadequately controlled on low-dose ICS. According to GINA guidelines, what is the preferred step-up therapy?

Accepted Answer

Add a long-acting beta-agonist (LABA) to low-dose ICS

Answer

GINA Step 3 recommends adding a LABA to low-dose ICS as the preferred step-up for uncontrolled moderate persistent asthma, providing superior outcomes versus increasing ICS dose.

Question 2

A 70-year-old patient with CKD (eGFR 22 mL/min) and hyperkalemia (K+ 5.9 mEq/L) is on lisinopril for diabetic nephropathy. What is the MOST appropriate intervention?

Accepted Answer

Add patiromer and continue lisinopril with close monitoring

Answer

Patiromer is a GI potassium binder that allows continuation of ACE inhibitor therapy (which provides critical renoprotection in diabetic CKD) by managing hyperkalemia without the risks of sodium polystyrene sulfonate.

Question 3

An oncology patient receiving cisplatin-based chemotherapy develops acute kidney injury (SCr doubles from baseline). Which antiemetic should be AVOIDED due to its renal elimination?

Accepted Answer

Ondansetron

Answer

Ondansetron undergoes significant renal elimination; its clearance is reduced in severe renal impairment, necessitating dose adjustment or use of hepatically cleared alternatives.

Question 4

A patient with treatment-resistant depression has failed two adequate trials of SSRIs. What pharmacogenomic factor most commonly explains SSRI non-response?

Accepted Answer

CYP2D6 ultrarapid metabolizer status

Answer

CYP2D6 ultrarapid metabolizers rapidly metabolize many SSRIs, leading to subtherapeutic drug levels and apparent treatment failure, making pharmacogenomic testing clinically actionable.

Question 5

In the management of status epilepticus refractory to benzodiazepines, which second-line agent is preferred based on efficacy and safety evidence from the ESETT trial?

Accepted Answer

All three showed similar efficacy and safety in ESETT

Answer

The ESETT trial found no significant difference in efficacy or safety among levetiracetam, fosphenytoin, and valproate for benzodiazepine-refractory status epilepticus, making agent selection patient-specific.

(BCPS) Board Certified Pharmacotherapy Specialist Practice Test

(BCPS) Board Certified Pharmacotherapy Specialist Practice Test

BCPS Therapeutic Decision-Making & Patient Management 5