FPGEE Clinical Pharmacy 2 — Questions and Answers
Question 1: A patient with CKD stage 4 is prescribed metformin. What is the most appropriate action?
- Continue at full dose
- Reduce dose by 50%
- Discontinue metformin (Correct answer)
- Switch to insulin only
Correct answer: Discontinue metformin
Metformin is contraindicated in CKD stage 4 (eGFR <30 mL/min/1.73m²) due to risk of lactic acidosis.
Question 2: Which parameter is most important to monitor in a patient receiving vancomycin for MRSA bacteremia?
- Peak serum concentration
- AUC/MIC ratio (Correct answer)
- Time above MIC
- Cmax/MIC ratio
Correct answer: AUC/MIC ratio
Current ASHP/IDSA guidelines recommend AUC/MIC-guided monitoring (target AUC 400–600 mg·h/L) for vancomycin efficacy and nephrotoxicity avoidance.
Question 3: A 68-year-old patient on warfarin for atrial fibrillation develops a UTI and is prescribed trimethoprim-sulfamethoxazole. What is the expected INR effect?
- INR will decrease
- INR will increase (Correct answer)
- INR will remain unchanged
- INR effect is unpredictable
Correct answer: INR will increase
TMP-SMX inhibits CYP2C9, reducing warfarin metabolism and raising the INR.
Question 4: A patient presents with symptoms of serotonin syndrome. Which combination is the most likely cause?
- Lisinopril + amlodipine
- Linezolid + sertraline (Correct answer)
- Metoprolol + amiodarone
- Omeprazole + clopidogrel
Correct answer: Linezolid + sertraline
Linezolid has MAO-inhibitor activity; combining it with an SSRI like sertraline can precipitate serotonin syndrome.
Question 5: Which diuretic is most appropriate for a patient with heart failure and a serum potassium of 3.1 mEq/L?
- Furosemide
- Hydrochlorothiazide
- Metolazone
- Spironolactone (Correct answer)
Correct answer: Spironolactone
Spironolactone is a potassium-sparing diuretic that also reduces morbidity and mortality in heart failure.
Question 6: A patient taking phenytoin for seizures is started on fluconazole. What is the expected outcome?
- Phenytoin levels decrease due to induction
- Phenytoin levels increase due to inhibition (Correct answer)
- No significant interaction occurs
- Phenytoin is converted to a toxic metabolite
Correct answer: Phenytoin levels increase due to inhibition
Fluconazole inhibits CYP2C9, decreasing phenytoin metabolism and increasing its serum levels.
Question 7: When counseling a patient on sublingual nitroglycerin for angina, what is the maximum number of doses to take before calling emergency services?
- 1 dose
- 2 doses
- 3 doses (Correct answer)
- 4 doses
Correct answer: 3 doses
Patients should take up to 3 sublingual nitroglycerin doses 5 minutes apart; if pain is unrelieved after the third dose, call 911.
FPGEE Clinical Pharmacy 2
A patient with CKD stage 4 is prescribed metformin.
What is the most appropriate action?