FPGEE Clinical Pharmacy 4 — Questions and Answers
Question 1: A patient with severe penicillin allergy (anaphylaxis) requires treatment for a gram-negative infection. Which beta-lactam has the lowest cross-reactivity risk?
- Amoxicillin-clavulanate
- Cefazolin
- Aztreonam (Correct answer)
- Imipenem
Correct answer: Aztreonam
Aztreonam is a monobactam with a different ring structure and exhibits negligible cross-reactivity with penicillins.
Question 2: A 55-year-old patient has a calculated 10-year ASCVD risk of 12%. Which statin intensity is recommended per ACC/AHA guidelines?
- No statin indicated
- Low-intensity statin
- Moderate-intensity statin (Correct answer)
- High-intensity statin
Correct answer: Moderate-intensity statin
A 10-year ASCVD risk ≥7.5% in patients aged 40–75 without clinical ASCVD warrants a moderate- to high-intensity statin; 12% falls in the moderate-to-high discussion zone with moderate typically initiated first.
Question 3: Which finding on a patient's medication history would prompt a pharmacist to question the appropriateness of prescribing an NSAID?
- Concurrent use of a PPI
- History of peptic ulcer disease (Correct answer)
- Use of a topical corticosteroid
- Concurrent acetaminophen use
Correct answer: History of peptic ulcer disease
A history of peptic ulcer disease is a major contraindication to NSAID use due to risk of GI bleeding and ulcer recurrence.
Question 4: A patient is taking carbamazepine and is prescribed oral contraceptives. What counseling should be provided?
- No interaction; proceed with standard dosing
- Carbamazepine increases OC efficacy
- Carbamazepine may reduce OC effectiveness; use backup contraception (Correct answer)
- Separate administration by 2 hours to avoid interaction
Correct answer: Carbamazepine may reduce OC effectiveness; use backup contraception
Carbamazepine is a potent CYP3A4 inducer that accelerates metabolism of estrogen and progestin, reducing contraceptive efficacy.
Question 5: What is the primary mechanism of action of proton pump inhibitors (PPIs)?
- H2 receptor antagonism
- Neutralization of gastric acid
- Irreversible inhibition of H+/K+-ATPase (Correct answer)
- Prostaglandin-mediated mucosal protection
Correct answer: Irreversible inhibition of H+/K+-ATPase
PPIs covalently and irreversibly bind the H+/K+-ATPase enzyme on the parietal cell, blocking the final step of acid secretion.
Question 6: A hospitalized patient receiving total parenteral nutrition (TPN) develops hyperglycemia. What is the initial recommended intervention?
- Discontinue TPN immediately
- Reduce the dextrose concentration in TPN and add insulin to the bag (Correct answer)
- Switch to enteral nutrition
- Administer oral hypoglycemic agents
Correct answer: Reduce the dextrose concentration in TPN and add insulin to the bag
Reducing dextrose in TPN and adding regular insulin to the bag is the standard approach to managing TPN-induced hyperglycemia.
Question 7: A patient with Clostridium difficile infection (CDI) that has recurred twice is best treated with which regimen?
- Metronidazole oral
- Vancomycin oral standard course
- Fidaxomicin or vancomycin taper/pulse (Correct answer)
- IV metronidazole
Correct answer: Fidaxomicin or vancomycin taper/pulse
For multiple recurrent CDI, IDSA guidelines recommend fidaxomicin or a vancomycin taper and pulse regimen to reduce further recurrence.
FPGEE Clinical Pharmacy 4
A patient with severe penicillin allergy (anaphylaxis) requires treatment for a gram-negative infection.
Which beta-lactam has the lowest cross-reactivity risk?