FPGEE Pharmacy Practice 3 — Questions and Answers
Question 1: A patient is prescribed lithium for bipolar disorder. Which condition increases the risk of lithium toxicity?
- Hypertension
- Dehydration (Correct answer)
- Hyperglycemia
- Hyperthyroidism
Correct answer: Dehydration
Dehydration reduces renal lithium clearance, causing accumulation and toxicity since lithium is renally excreted without protein binding.
Question 2: Which schedule of controlled substances has the HIGHEST accepted medical use but LOWEST potential for abuse?
- Schedule I
- Schedule II
- Schedule IV
- Schedule V (Correct answer)
Correct answer: Schedule V
Schedule V substances (e.g., cough preparations with <200 mg codeine per 100 mL) have low abuse potential and accepted medical uses.
Question 3: A pharmacist checks a new prescription for ciprofloxacin and notes the patient is also taking sucralfate. What interaction should be addressed?
- Sucralfate increases ciprofloxacin bioavailability
- Sucralfate chelates ciprofloxacin, reducing its absorption (Correct answer)
- Ciprofloxacin increases sucralfate toxicity
- No clinically significant interaction exists
Correct answer: Sucralfate chelates ciprofloxacin, reducing its absorption
Sucralfate forms insoluble chelates with ciprofloxacin, significantly reducing its oral bioavailability by up to 90%.
Question 4: What is the maximum daily acetaminophen dose recommended for a healthy adult to avoid hepatotoxicity?
- 2,000 mg
- 3,000 mg
- 4,000 mg (Correct answer)
- 5,000 mg
Correct answer: 4,000 mg
The FDA-recommended maximum acetaminophen dose for healthy adults is 4,000 mg per day, though 3,000 mg is advised for chronic use.
Question 5: Which route of administration completely bypasses first-pass hepatic metabolism?
- Oral
- Rectal
- Intravenous (Correct answer)
- Sublingual
Correct answer: Intravenous
Intravenous administration delivers drugs directly into systemic circulation, completely bypassing first-pass hepatic metabolism.
Question 6: A patient taking phenytoin is started on valproic acid. What pharmacokinetic effect should the pharmacist anticipate?
- Decreased free phenytoin levels due to induction
- Increased free phenytoin levels due to protein binding displacement (Correct answer)
- Decreased valproic acid levels due to renal clearance
- No significant pharmacokinetic interaction
Correct answer: Increased free phenytoin levels due to protein binding displacement
Valproic acid displaces phenytoin from protein binding sites and inhibits its metabolism, increasing free phenytoin levels and toxicity risk.
Question 7: A pharmacist receives a telephone prescription for a Schedule III controlled substance. Which of the following is true?
- Telephone orders are never permitted for any controlled substance
- Telephone orders are permitted and can be filled immediately (Correct answer)
- Telephone orders require written confirmation within 7 days
- Telephone orders require DEA Form 222
Correct answer: Telephone orders are permitted and can be filled immediately
Schedule III and IV controlled substances may be received by telephone; the prescription can be filled based on the verbal order.
FPGEE Pharmacy Practice 3
A patient is prescribed lithium for bipolar disorder.
Which condition increases the risk of lithium toxicity?