FPGEE Clinical Pharmacy 3 — Questions and Answers
Question 1: A patient receiving heparin for DVT develops a 50% drop in platelet count on day 8. What is the most likely diagnosis?
- Immune thrombocytopenic purpura
- Heparin-induced thrombocytopenia (HIT) (Correct answer)
- Disseminated intravascular coagulation
- Drug-induced thrombocytopenia from a different agent
Correct answer: Heparin-induced thrombocytopenia (HIT)
A platelet drop of ≥50% occurring 5–14 days after heparin initiation is the hallmark presentation of HIT.
Question 2: Which class of medications is first-line for reducing cardiovascular mortality in patients with reduced ejection fraction heart failure?
- Loop diuretics
- Calcium channel blockers
- ACE inhibitors or ARBs (Correct answer)
- Digoxin
Correct answer: ACE inhibitors or ARBs
ACE inhibitors (and ARBs as alternatives) are first-line for HFrEF due to proven reductions in mortality and hospitalization.
Question 3: A pharmacist reviews a prescription for sildenafil in a patient using isosorbide mononitrate. What should the pharmacist do?
- Dispense with a dosage reduction
- Dispense and monitor blood pressure
- Refuse to dispense due to a life-threatening interaction (Correct answer)
- Recommend separating the doses by 4 hours
Correct answer: Refuse to dispense due to a life-threatening interaction
Concurrent use of PDE-5 inhibitors with any nitrate is absolutely contraindicated due to severe, potentially fatal hypotension.
Question 4: A patient with type 2 diabetes and established ASCVD is inadequately controlled on metformin. Which add-on agent provides both glycemic control and cardiovascular mortality reduction?
- Glipizide
- Pioglitazone
- Empagliflozin (Correct answer)
- Acarbose
Correct answer: Empagliflozin
SGLT-2 inhibitors like empagliflozin have demonstrated significant reductions in cardiovascular death in patients with established ASCVD.
Question 5: What is the mechanism by which aminoglycosides cause nephrotoxicity?
- Blockade of renal tubular secretion transporters
- Accumulation in proximal tubular cells causing necrosis (Correct answer)
- Immune-mediated glomerulonephritis
- Reduction in renal blood flow via vasoconstriction
Correct answer: Accumulation in proximal tubular cells causing necrosis
Aminoglycosides are taken up by proximal tubular cells where they accumulate and cause tubular necrosis.
Question 6: A patient on lithium is started on ibuprofen for arthritis pain. Which monitoring parameter is most urgent?
- Serum sodium
- Serum lithium level (Correct answer)
- Thyroid function tests
- ECG
Correct answer: Serum lithium level
NSAIDs reduce renal prostaglandin synthesis, decreasing lithium clearance and raising serum lithium to potentially toxic levels.
Question 7: Which anticoagulant requires no routine laboratory monitoring for dose adjustment in a patient with normal renal function?
- Warfarin
- Heparin (unfractionated)
- Rivaroxaban (Correct answer)
- Fondaparinux
Correct answer: Rivaroxaban
Direct oral anticoagulants (DOACs) like rivaroxaban have predictable pharmacokinetics and do not require routine monitoring in patients with normal renal function.
FPGEE Clinical Pharmacy 3
A patient receiving heparin for DVT develops a 50% drop in platelet count on day 8.
What is the most likely diagnosis?