FPGEE FPGEE MCQ Exam 4 — Questions and Answers
Question 1: A pharmacist receives a prescription for oxycodone 5 mg #30. The DEA schedule of oxycodone requires how many days' supply maximum per prescription in most US states?
- 7 days
- 30 days
- 90 days
- No federal day-supply limit exists for Schedule II (Correct answer)
Correct answer: No federal day-supply limit exists for Schedule II
Federally, the DEA does not impose a day-supply limit on Schedule II prescriptions; however, individual states may set their own limits.
Question 2: Which mechanism explains the therapeutic action of metformin in type 2 diabetes?
- Stimulates pancreatic beta-cell insulin secretion
- Activates AMPK, reducing hepatic glucose output (Correct answer)
- Inhibits DPP-4 enzyme
- Blocks SGLT-2 in renal tubules
Correct answer: Activates AMPK, reducing hepatic glucose output
Metformin primarily activates AMP-activated protein kinase (AMPK), suppressing hepatic gluconeogenesis and glycogenolysis to lower blood glucose.
Question 3: A patient on warfarin begins taking high-dose vitamin E supplements. What is the expected effect on INR?
- Decreased INR due to enzyme induction
- Increased INR due to inhibition of vitamin K-dependent clotting factors (Correct answer)
- No effect on INR
- Decreased INR due to increased vitamin K production
Correct answer: Increased INR due to inhibition of vitamin K-dependent clotting factors
High-dose vitamin E impairs vitamin K–dependent carboxylation of clotting factors II, VII, IX, and X, potentiating warfarin's anticoagulant effect and raising INR.
Question 4: Which isomer of albuterol is responsible for its bronchodilatory therapeutic effect?
- R-albuterol (levalbuterol) (Correct answer)
- S-albuterol
- Both isomers equally
- Neither; the metabolite is active
Correct answer: R-albuterol (levalbuterol)
R-albuterol (levalbuterol) is the eutomer that binds beta-2 receptors and causes bronchodilation; S-albuterol may contribute to bronchoconstriction.
Question 5: A patient with Parkinson's disease taking levodopa/carbidopa develops end-of-dose wearing off. Which add-on agent BEST extends levodopa effect?
- Amantadine
- Entacapone (COMT inhibitor) (Correct answer)
- Trihexyphenidyl
- Selegiline MAO-B inhibitor
Correct answer: Entacapone (COMT inhibitor)
Entacapone inhibits COMT, preventing peripheral breakdown of levodopa and extending its duration of action to reduce wearing-off.
Question 6: What is the primary mechanism of resistance to beta-lactam antibiotics in MRSA?
- Beta-lactamase enzyme production
- Altered penicillin-binding protein (PBP2a) encoded by mecA gene (Correct answer)
- Efflux pump overexpression
- Reduced outer membrane permeability
Correct answer: Altered penicillin-binding protein (PBP2a) encoded by mecA gene
MRSA resistance is mediated by mecA gene–encoded PBP2a, a modified penicillin-binding protein with low affinity for all beta-lactam antibiotics.
Question 7: A 28-year-old woman with epilepsy who wants to become pregnant is on valproic acid. Which alternative AED is preferred to minimize teratogenicity?
- Phenobarbital
- Carbamazepine
- Lamotrigine (Correct answer)
- Topiramate
Correct answer: Lamotrigine
Lamotrigine has the lowest teratogenic risk among common AEDs and is preferred for women of childbearing age when seizure control allows.
FPGEE FPGEE MCQ Exam 4
A pharmacist receives a prescription for oxycodone 5 mg #30.
The DEA schedule of oxycodone requires how many days' supply maximum per prescription in most US states?