CCP Clinical Care in Long-Term Care 2

Question 1

A 78-year-old LTC resident with stage 3 chronic kidney disease has an eGFR of 28 mL/min. Which antibiotic requires the most significant dose reduction for a urinary tract infection?

Accepted Answer

Nitrofurantoin

Answer

Nitrofurantoin is contraindicated when eGFR <45 mL/min because it fails to achieve adequate urinary concentrations and can cause peripheral neuropathy due to drug accumulation.

Question 2

Which of the following is the MOST appropriate first-line pharmacological treatment for pain management in a non-verbal LTC resident with moderate osteoarthritis pain?

Accepted Answer

Scheduled low-dose acetaminophen

Answer

Scheduled acetaminophen up to 3 g/day is the preferred first-line analgesic in older adults due to its favorable safety profile compared to NSAIDs and opioids.

Question 3

A consultant pharmacist reviews a resident's medication list and notes she is receiving both warfarin and fluconazole. What is the primary pharmacokinetic concern?

Accepted Answer

Fluconazole inhibits CYP2C9, increasing warfarin levels

Answer

Fluconazole is a potent CYP2C9 inhibitor that dramatically reduces warfarin metabolism, leading to significantly elevated INR and bleeding risk.

Question 4

Under the CMS F-tag F758 regulations, which of the following constitutes an unnecessary antipsychotic use in a LTC setting?

Accepted Answer

Antipsychotic for behavioral symptoms of dementia without safety risk

Answer

F758 prohibits antipsychotics for behavioral symptoms of dementia (wandering, repetitive behaviors) unless a specific diagnosis justifies use and non-pharmacological interventions have failed.

Question 5

A LTC resident with heart failure is started on carvedilol. The consultant pharmacist should monitor for which electrolyte disturbance that is especially common in heart failure patients on diuretics?

Accepted Answer

Hypokalemia from loop diuretics

Answer

Loop diuretics commonly used in heart failure cause urinary potassium wasting, leading to hypokalemia, which can increase the risk of cardiac arrhythmias.

(CCP) Certified Consultant Pharmacist Practice Test

(CCP) Certified Consultant Pharmacist Practice Test

CCP Clinical Care in Long-Term Care 2