KAPS Clinical Procedures and Protocols 2 — Questions and Answers
Question 1: A pharmacist is reviewing a medication order for vancomycin. Which pharmacokinetic parameter is most important to monitor for efficacy in serious infections?
- Peak serum concentration
- AUC/MIC ratio (Correct answer)
- Trough serum concentration
- Volume of distribution
Correct answer: AUC/MIC ratio
Vancomycin efficacy is best predicted by the AUC/MIC ratio, with a target AUC24/MIC ≥400 recommended by current guidelines.
Question 2: When preparing a sterile IV admixture in a horizontal laminar airflow workbench (LAFW), the pharmacist should work at least how far inside the hood?
- 3 inches
- 6 inches (Correct answer)
- 9 inches
- 12 inches
Correct answer: 6 inches
USP <797> requires that all critical manipulations be performed at least 6 inches inside the LAFW to ensure sterile airflow protection.
Question 3: A patient on warfarin is started on fluconazole. What INR monitoring adjustment is most appropriate?
- Decrease warfarin dose preemptively and check INR in 2 weeks
- Increase warfarin dose and check INR in 1 week
- Check INR more frequently and adjust warfarin based on results (Correct answer)
- Discontinue warfarin for the duration of fluconazole therapy
Correct answer: Check INR more frequently and adjust warfarin based on results
Fluconazole inhibits CYP2C9 and significantly increases warfarin levels, so more frequent INR monitoring with dose adjustment is required.
Question 4: Which of the following is the correct procedure for reconstituting a lyophilized powder for injection?
- Add diluent rapidly to maximize dissolution
- Direct the diluent stream onto the powder cake
- Direct the diluent stream against the vial wall (Correct answer)
- Shake vigorously immediately after adding diluent
Correct answer: Direct the diluent stream against the vial wall
Directing diluent against the vial wall prevents foaming and protein denaturation, ensuring proper reconstitution.
Question 5: A 70 kg patient with a creatinine clearance of 15 mL/min requires gentamicin. Which dosing strategy is most appropriate?
- Standard dose at standard interval
- Reduced dose at standard interval
- Standard dose at extended interval
- Reduced dose at extended interval (Correct answer)
Correct answer: Reduced dose at extended interval
Severe renal impairment requires both dose reduction and interval extension for aminoglycosides to prevent accumulation and nephrotoxicity.
Question 6: During a medication use evaluation (MUE), what is the PRIMARY purpose of establishing criteria before data collection?
- To reduce the time required for chart review
- To ensure unbiased, objective assessment of drug therapy (Correct answer)
- To limit the number of patients included in the study
- To satisfy Joint Commission accreditation requirements
Correct answer: To ensure unbiased, objective assessment of drug therapy
Pre-established criteria ensure that the evaluation is objective and unbiased, forming the benchmark against which actual practice is measured.
Question 7: A nurse reports that a patient's IV line has become infiltrated during a vesicant infusion. What is the pharmacist's FIRST recommended action?
- Apply warm compresses to the site
- Administer the appropriate antidote subcutaneously
- Stop the infusion and disconnect the IV tubing (Correct answer)
- Notify the physician immediately
Correct answer: Stop the infusion and disconnect the IV tubing
The first step is to stop the infusion immediately and disconnect tubing to prevent further extravasation of the vesicant agent.
KAPS Clinical Procedures and Protocols 2
A pharmacist is reviewing a medication order for vancomycin.
Which pharmacokinetic parameter is most important to monitor for efficacy in serious infections?