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FPGEE MCQ Exam Flashcards

7 cards from real FPGEE practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.

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  1. A 65-year-old patient requires a loading dose of digoxin. Which factor most significantly affects the volume of distribution (Vd) of digoxin?

    Answer: Lean body weight and tissue binding

    Digoxin has a very large Vd (~7 L/kg) due to extensive binding to skeletal muscle and other tissues; lean body weight is used to dose it.

  2. Which enzyme is responsible for the first-pass metabolism of morphine to morphine-6-glucuronide?

    Answer: UGT2B7 (UDP-glucuronosyltransferase)

    Morphine undergoes extensive glucuronidation by UGT2B7 in the liver and intestinal wall, producing morphine-6-glucuronide (active) and morphine-3-glucuronide.

  3. A patient taking phenytoin for seizures is started on valproic acid. What is the expected net effect on phenytoin?

    Answer: Decreased total phenytoin with possible increased free phenytoin levels

    Valproic acid displaces phenytoin from protein binding (decreasing total levels) while also inhibiting its metabolism, often raising free (active) phenytoin.

  4. Under the OBRA '90 regulations, pharmacists are required to perform which activities when dispensing medications to Medicaid patients?

    Answer: Drug utilization review (DUR), patient counseling, and maintaining medication records

    OBRA '90 mandates prospective DUR, patient counseling offers, and maintenance of patient medication records for Medicaid outpatient prescriptions.

  5. Which antihypertensive agent is absolutely contraindicated in bilateral renal artery stenosis?

    Answer: Lisinopril

    ACE inhibitors like lisinopril block angiotensin II–mediated efferent arteriolar constriction, which is the compensatory mechanism maintaining GFR in bilateral renal artery stenosis.

  6. A patient develops QT prolongation after starting a new antibiotic. Which agent is MOST likely responsible?

    Answer: Azithromycin

    Azithromycin (and other macrolides) block hERG potassium channels, prolonging the QT interval and increasing the risk of Torsades de Pointes.

  7. Which parameter describes the fraction of a drug excreted unchanged in the urine?

    Answer: Fraction excreted renally (fe)

    The fraction excreted renally (fe) represents the proportion of absorbed drug eliminated unchanged by the kidneys and determines how much renal impairment affects drug clearance.