FPGEE Clinical Pharmacy 5 — Questions and Answers
Question 1: A patient with asthma is initiated on a long-acting beta-agonist (LABA) as monotherapy. What is the primary safety concern?
- Increased risk of paradoxical bronchospasm
- Increased asthma-related mortality without concomitant ICS (Correct answer)
- Risk of cardiac arrhythmia at therapeutic doses
- Development of tolerance within one week
Correct answer: Increased asthma-related mortality without concomitant ICS
LABAs carry a black-box warning for increased risk of asthma-related death when used without an inhaled corticosteroid.
Question 2: A patient on chronic corticosteroid therapy undergoes elective surgery. What perioperative consideration is most critical?
- Discontinue steroids 48 hours before surgery
- Administer stress-dose steroids perioperatively (Correct answer)
- Switch to topical corticosteroids
- Increase the oral steroid dose by 25%
Correct answer: Administer stress-dose steroids perioperatively
Chronic steroid use suppresses the HPA axis; surgical stress requires supplemental (stress-dose) corticosteroids to prevent adrenal crisis.
Question 3: Which laboratory value is the most sensitive early marker of acetaminophen-induced hepatotoxicity?
- Serum bilirubin
- ALT/AST levels (Correct answer)
- Prothrombin time/INR
- Serum albumin
Correct answer: ALT/AST levels
Serum transaminases (ALT and AST) rise early in acetaminophen-induced hepatic injury, often before clinical symptoms appear.
Question 4: A pharmacist is verifying a prescription for amiodarone. Which baseline assessment is NOT required before initiating therapy?
- Thyroid function tests
- Pulmonary function tests
- Liver function tests
- Renal function tests (Correct answer)
Correct answer: Renal function tests
Amiodarone monitoring focuses on thyroid, pulmonary, hepatic, and ocular toxicity; renal function is not a primary baseline requirement.
Question 5: A patient with type 1 diabetes is given glucagon for a severe hypoglycemic episode at home. What should be done immediately after recovery?
- Administer a second glucagon dose
- Give oral carbohydrates and notify a healthcare provider (Correct answer)
- Inject regular insulin to prevent rebound hyperglycemia
- Restrict food intake for 2 hours
Correct answer: Give oral carbohydrates and notify a healthcare provider
After glucagon restores consciousness, oral carbohydrates replenish glycogen stores and the event should be reported to a provider.
Question 6: Which counseling point is most important for a patient newly prescribed bisphosphonates for osteoporosis?
- Take with food to improve absorption
- Lie down for 30 minutes after taking
- Remain upright for at least 30 minutes and take with a full glass of water (Correct answer)
- Take at bedtime for best effect
Correct answer: Remain upright for at least 30 minutes and take with a full glass of water
Oral bisphosphonates must be taken on an empty stomach with water, and the patient must remain upright for ≥30 minutes to prevent esophageal irritation.
Question 7: A patient with schizophrenia is switched from haloperidol to clozapine. Which unique and mandatory monitoring is required?
- Weekly ECG for QTc prolongation
- Regular absolute neutrophil count (ANC) monitoring (Correct answer)
- Monthly renal function panels
- Daily blood pressure measurements
Correct answer: Regular absolute neutrophil count (ANC) monitoring
Clozapine carries a risk of life-threatening agranulocytosis, requiring mandatory ANC monitoring through the REMS program.
FPGEE Clinical Pharmacy 5
A patient with asthma is initiated on a long-acting beta-agonist (LABA) as monotherapy.
What is the primary safety concern?