FPGEE Pharmacy Practice 4 — Questions and Answers
Question 1: A patient with renal impairment (CrCl 20 mL/min) is prescribed vancomycin. How should the dosing be adjusted?
- Increase dose frequency
- Decrease dose or increase dosing interval (Correct answer)
- No adjustment needed
- Switch to oral route only
Correct answer: Decrease dose or increase dosing interval
Vancomycin is primarily renally eliminated; reduced CrCl requires dose reduction or extended dosing intervals to prevent accumulation and nephrotoxicity.
Question 2: Which immunization is CONTRAINDICATED in a patient who is 28 weeks pregnant?
- Influenza (inactivated)
- Tdap
- MMR (Correct answer)
- COVID-19 mRNA vaccine
Correct answer: MMR
MMR is a live attenuated vaccine and is contraindicated during pregnancy due to theoretical risk of fetal infection.
Question 3: A patient fills a prescription for sildenafil and also takes isosorbide mononitrate. What is the primary concern?
- Increased risk of priapism
- Severe hypotension due to additive vasodilation (Correct answer)
- Reduced efficacy of sildenafil
- Increased risk of QT prolongation
Correct answer: Severe hypotension due to additive vasodilation
Both sildenafil (PDE-5 inhibitor) and nitrates cause vasodilation; combined use produces severe, potentially fatal hypotension.
Question 4: According to USP <797>, what is the beyond-use date (BUD) for a compounded sterile preparation assigned Category 1?
- 12 hours at room temperature or 24 hours refrigerated
- 12 hours at controlled room temperature or 24 hours refrigerated (Correct answer)
- 24 hours at room temperature or 72 hours refrigerated
- 30 days refrigerated
Correct answer: 12 hours at controlled room temperature or 24 hours refrigerated
USP <797> Category 1 CSPs have a BUD of 12 hours at controlled room temperature (CRT) or 24 hours refrigerated.
Question 5: A pharmacist is reviewing a medication profile and notices a patient on methotrexate is also prescribed trimethoprim-sulfamethoxazole (TMP-SMX). What is the clinical concern?
- TMP-SMX increases methotrexate renal clearance
- Both drugs inhibit dihydrofolate reductase, increasing methotrexate toxicity (Correct answer)
- TMP-SMX reduces methotrexate oral bioavailability
- No clinically relevant interaction exists
Correct answer: Both drugs inhibit dihydrofolate reductase, increasing methotrexate toxicity
TMP-SMX and methotrexate both inhibit dihydrofolate reductase, causing additive antifolate toxicity (myelosuppression, mucositis).
Question 6: A pharmacist counsels a patient starting levothyroxine. When is the BEST time to take this medication?
- With breakfast to enhance absorption
- 30–60 minutes before breakfast on an empty stomach (Correct answer)
- At bedtime with a full glass of water
- With the largest meal of the day
Correct answer: 30–60 minutes before breakfast on an empty stomach
Levothyroxine should be taken 30–60 minutes before breakfast on an empty stomach to maximize absorption, as food reduces bioavailability.
Question 7: Which measurement is used to assess insulin dosing effectiveness in a diabetic patient over the past 2–3 months?
- Fasting plasma glucose
- Random blood glucose
- HbA1c (Correct answer)
- C-peptide level
Correct answer: HbA1c
HbA1c reflects average blood glucose over the prior 2–3 months by measuring glycosylated hemoglobin, providing a long-term efficacy assessment.
FPGEE Pharmacy Practice 4
A patient with renal impairment (CrCl 20 mL/min) is prescribed vancomycin.
How should the dosing be adjusted?