DHA Pharmacist 2

Question 1

A patient is prescribed simvastatin 40mg and is started on clarithromycin for a respiratory infection. What is the most significant drug interaction concern?

Accepted Answer

Increased risk of myopathy/rhabdomyolysis due to elevated simvastatin levels

Answer

Clarithromycin is a potent inhibitor of CYP3A4, which metabolizes simvastatin. Co-administration dramatically increases simvastatin plasma levels, increasing the risk of severe myopathy and rhabdomyolysis. Simvastatin should be temporarily suspended or switched to a non-CYP3A4-metabolized statin (e.g., pravastatin, rosuvastatin).

Question 2

Under UAE Federal Law No. 14 of 1995 and DHA regulations, which category of medications requires a special permit for import and is subject to strict quantity limits on prescriptions?

Accepted Answer

Controlled substances (Schedule 1 narcotics/psychotropics such as morphine, tramadol, alprazolam)

Answer

UAE Federal Law No. 14/1995 on Narcotics and Psychotropic Substances strictly regulates Schedule 1 controlled substances including opioids (morphine, codeine, tramadol), benzodiazepines, and other psychotropics. Special prescriptions, quantity limits, and import permits are required. DHA pharmacists must comply with these requirements.

Question 3

A 70-year-old patient with atrial fibrillation is on warfarin. The pharmacist reviewing the medication list notices the patient was recently started on amiodarone. What action should the pharmacist take?

Accepted Answer

Alert the prescriber about the significant drug interaction — amiodarone inhibits warfarin metabolism, increasing bleeding risk, and INR monitoring must be intensified

Answer

Amiodarone is a potent inhibitor of CYP2C9 (and other enzymes) which metabolizes warfarin. This interaction significantly increases warfarin levels and INR. The pharmacist should alert the prescriber, recommend more frequent INR monitoring, and anticipate a warfarin dose reduction of 30–50%.

Question 4

What is the maximum number of days' supply for which a community pharmacist in Dubai can dispense a Schedule H (prescription-only) medication without a valid prescription for a known regular patient in an emergency?

Accepted Answer

A 1-day supply (enough to continue until a prescription is obtained)

Answer

Emergency supply provisions in UAE/DHA allow pharmacists to dispense a limited quantity (typically 1 day or minimum necessary to bridge until a prescription is obtained) of a prescription medication in a genuine emergency where the patient cannot obtain a prescription and risk of harm from stopping is established. Controlled substances cannot be supplied this way.

Question 5

A patient with renal impairment (eGFR 20 mL/min) is prescribed a medication. Which of the following drugs is LEAST likely to require dose adjustment in renal failure?

Accepted Answer

Atorvastatin

Answer

Atorvastatin is primarily metabolized by the liver (CYP3A4) and excreted via bile with minimal renal elimination. No dose adjustment is required for renal impairment. Metformin, digoxin, and gentamicin are renally cleared and require dose reduction or avoidance in renal failure.

DHA - Dubai Health Authority Practice Test

DHA - Dubai Health Authority Practice Test

DHA Pharmacist 2