FPGEE FPGEE Exam 4 — Questions and Answers
Question 1: A patient on lithium therapy presents with tremor, polyuria, and serum lithium of 1.8 mEq/L. Which intervention is MOST appropriate?
- Immediately discontinue lithium and switch to valproate
- Hold the dose and recheck levels in 24 hours
- Reduce lithium dose and ensure adequate sodium and fluid intake (Correct answer)
- Administer sodium bicarbonate to enhance lithium excretion
Correct answer: Reduce lithium dose and ensure adequate sodium and fluid intake
A lithium level of 1.8 mEq/L is above the therapeutic range (0.6–1.2 mEq/L) and causes mild-moderate toxicity; dose reduction combined with adequate sodium and fluid intake to avoid dehydration-induced lithium retention is appropriate.
Question 2: Which dosage form provides the most consistent and prolonged drug absorption via the transdermal route?
- Transdermal cream
- Transdermal ointment
- Reservoir-type transdermal patch (Correct answer)
- Matrix-type transdermal patch
Correct answer: Reservoir-type transdermal patch
Reservoir-type transdermal patches contain a drug reservoir and a rate-controlling membrane that delivers the drug at a consistent, zero-order rate over the dosing interval.
Question 3: Under HIPAA, which of the following is a permissible disclosure of protected health information (PHI) WITHOUT patient authorization?
- Sharing prescription history with an employer for insurance purposes
- Disclosing information to a patient's attorney without a signed release
- Reporting a communicable disease to the state health department (Correct answer)
- Providing prescription data to a pharmaceutical marketing company
Correct answer: Reporting a communicable disease to the state health department
HIPAA permits disclosure of PHI without authorization for public health activities, including mandatory reporting of communicable diseases to authorized public health authorities.
Question 4: A patient asks about switching from brand-name Synthroid to generic levothyroxine. Which counseling point is MOST accurate?
- Generic levothyroxine is identical to Synthroid and can be switched freely without monitoring
- Even FDA-approved generics may have minor bioavailability differences; TSH should be rechecked 6–8 weeks after switching (Correct answer)
- Generic levothyroxine should never be used due to narrow therapeutic index concerns
- The patient must get a new prescription since generics are not AB-rated for Synthroid
Correct answer: Even FDA-approved generics may have minor bioavailability differences; TSH should be rechecked 6–8 weeks after switching
Levothyroxine has a narrow therapeutic index; even minor bioavailability differences between formulations can affect TSH levels, so thyroid function should be monitored 6–8 weeks after any brand change.
Question 5: Which pharmacodynamic interaction describes the combination of aspirin and clopidogrel in acute coronary syndrome management?
- Antagonism — they compete for the same receptor
- Synergism — they inhibit platelet aggregation via complementary mechanisms (Correct answer)
- Potentiation — aspirin amplifies clopidogrel's mechanism of action
- Summation — both drugs work by identical mechanisms
Correct answer: Synergism — they inhibit platelet aggregation via complementary mechanisms
Aspirin inhibits platelet COX-1 (blocking thromboxane A2) while clopidogrel blocks P2Y12 ADP receptors; their complementary mechanisms produce synergistic antiplatelet effects.
Question 6: A prescription is written for amoxicillin 500 mg capsules #30, sig: 1 cap PO TID × 10 days. How many capsules are needed for the complete course?
- 20 capsules
- 30 capsules (Correct answer)
- 21 capsules
- 28 capsules
Correct answer: 30 capsules
Three times daily for 10 days = 3 × 10 = 30 capsules, which matches the dispensing quantity (#30) on the prescription.
Question 7: Which type of medication error involves a patient receiving a correct drug but via the wrong route of administration?
- Prescribing error
- Dispensing error
- Administration error (Correct answer)
- Monitoring error
Correct answer: Administration error
Administration errors include giving the right drug but by the wrong route (e.g., IV magnesium given IM), which occur during the administration phase of medication use.
FPGEE FPGEE Exam 4
A patient on lithium therapy presents with tremor, polyuria, and serum lithium of 1.8 mEq/L.
Which intervention is MOST appropriate?