FPGEE FPGEE MCQ Exam 3

Question 1

A 65-year-old patient requires a loading dose of digoxin. Which factor most significantly affects the volume of distribution (Vd) of digoxin?

Accepted Answer

Lean body weight and tissue binding

Answer

Digoxin has a very large Vd (~7 L/kg) due to extensive binding to skeletal muscle and other tissues; lean body weight is used to dose it.

Question 2

Which enzyme is responsible for the first-pass metabolism of morphine to morphine-6-glucuronide?

Accepted Answer

UGT2B7 (UDP-glucuronosyltransferase)

Answer

Morphine undergoes extensive glucuronidation by UGT2B7 in the liver and intestinal wall, producing morphine-6-glucuronide (active) and morphine-3-glucuronide.

Question 3

A patient taking phenytoin for seizures is started on valproic acid. What is the expected net effect on phenytoin?

Accepted Answer

Decreased total phenytoin with possible increased free phenytoin levels

Answer

Valproic acid displaces phenytoin from protein binding (decreasing total levels) while also inhibiting its metabolism, often raising free (active) phenytoin.

Question 4

Under the OBRA '90 regulations, pharmacists are required to perform which activities when dispensing medications to Medicaid patients?

Accepted Answer

Drug utilization review (DUR), patient counseling, and maintaining medication records

Answer

OBRA '90 mandates prospective DUR, patient counseling offers, and maintenance of patient medication records for Medicaid outpatient prescriptions.

Question 5

Which antihypertensive agent is absolutely contraindicated in bilateral renal artery stenosis?

Accepted Answer

Lisinopril

Answer

ACE inhibitors like lisinopril block angiotensin II–mediated efferent arteriolar constriction, which is the compensatory mechanism maintaining GFR in bilateral renal artery stenosis.

FPGEE Exam Practice Test

FPGEE Exam Practice Test

FPGEE FPGEE MCQ Exam 3