Drug Therapy Management Flashcards
7 cards from real CCP practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.
Read the first 7 Drug Therapy Management flashcards as text
A nursing home patient on long-term phenytoin therapy has a serum phenytoin level of 8 mcg/mL (therapeutic range 10-20 mcg/mL). However, the patient has hypoalbuminemia (albumin 2.0 g/dL). What should the pharmacist do?
Answer: Order a free phenytoin level to assess true drug exposure
In hypoalbuminemia, total phenytoin levels are falsely low because less drug is protein-bound; measuring free phenytoin provides the most accurate assessment of drug exposure.
Which statement best describes the concept of deprescribing in geriatric pharmacotherapy?
Answer: The systematic process of identifying and discontinuing drugs where potential harms outweigh benefits
Deprescribing is a patient-centered process of tapering or stopping medications when their risks outweigh benefits, particularly in older adults with polypharmacy.
A patient with a sulfa allergy asks about taking celecoxib. What should the consultant pharmacist advise?
Answer: Celecoxib contains a sulfonamide moiety and should be used cautiously with careful monitoring
Celecoxib contains a sulfonamide group, and while cross-reactivity risk is debated, it should be used cautiously and monitored in patients with documented sulfa allergy.
When monitoring a patient on lithium therapy for bipolar disorder, which combination of conditions most significantly increases the risk of lithium toxicity?
Answer: Dehydration and concurrent NSAID use
Dehydration decreases renal clearance of lithium, and NSAIDs reduce renal prostaglandin synthesis, both leading to lithium accumulation and toxicity.
A consultant pharmacist reviews a patient with COPD who is prescribed a non-selective beta-blocker for heart failure. What is the most appropriate recommendation?
Answer: Switch to a cardioselective beta-blocker such as metoprolol or bisoprolol
Cardioselective beta-blockers have less effect on beta-2 receptors in the lungs and are safer in COPD patients compared to non-selective agents.
A patient with atrial fibrillation and a CHA₂DS₂-VASc score of 5 is on apixaban. The patient's eGFR drops to 18 mL/min. What adjustment is recommended for apixaban?
Answer: Continue apixaban at reduced dose (2.5 mg twice daily) based on renal and clinical criteria
Apixaban can be used in severe renal impairment at a reduced dose of 2.5 mg BID if the patient meets dose-reduction criteria; it is preferred over warfarin in this setting.
A long-term care patient develops a rash and Stevens-Johnson syndrome after starting allopurinol. Which genetic marker is most associated with this severe hypersensitivity reaction?
Answer: HLA-B*5801
The HLA-B*5801 allele, most prevalent in Asian populations, is strongly associated with allopurinol-induced severe cutaneous adverse reactions including Stevens-Johnson syndrome.