Drug Therapy Monitoring & Clinical Decision-Making Flashcards
7 cards from real MTM practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.
Read the first 7 Drug Therapy Monitoring & Clinical Decision-Making flashcards as text
A patient with COPD and atrial fibrillation is prescribed theophylline. Which newly added medication would MOST increase the risk of theophylline toxicity?
Answer: Ciprofloxacin
Ciprofloxacin is a potent CYP1A2 inhibitor that can increase theophylline concentrations by 30-50%, leading to toxicity including seizures and arrhythmias.
In monitoring a patient on methotrexate for rheumatoid arthritis, which laboratory finding most directly signals hepatotoxicity?
Answer: AST/ALT >3× upper limit of normal on two consecutive tests
Persistently elevated transaminases (>3× ULN on two tests 4-6 weeks apart) are the primary signal for methotrexate hepatotoxicity requiring dose reduction or discontinuation.
A patient with chronic stable angina on amlodipine 5 mg reports continued chest pain with exertion. HR is 68 bpm and BP is 145/88 mmHg. What is the most appropriate clinical decision?
Answer: Add metoprolol succinate and titrate to HR 55-60 bpm
Adding a beta-blocker to reduce heart rate to 55-60 bpm addresses both uncontrolled angina and elevated blood pressure, following ACC/AHA angina guidelines.
Which finding on a medication therapy review would MOST appropriately trigger a recommendation to decrease a medication dose rather than add a new drug?
Answer: INR of 6.2 on warfarin 5 mg daily with no bleeding
A supratherapeutic INR of 6.2 requires warfarin dose reduction, not addition of another drug, to bring anticoagulation back into therapeutic range.
A patient on digoxin for heart failure with reduced ejection fraction has a level of 1.8 ng/mL. The patient reports nausea and sees yellow halos. What is the most important next step?
Answer: Hold digoxin and check electrolytes, particularly potassium
Digoxin toxicity symptoms (GI symptoms, visual disturbances) require immediate drug hold and electrolyte assessment since hypokalemia potentiates toxicity.
Which clinical scenario best represents a drug therapy problem of 'unnecessary drug therapy' in an MTM encounter?
Answer: A patient on aspirin 81 mg for primary prevention who is 45 years old with 8% 10-year ASCVD risk
Current USPSTF guidelines recommend against initiating aspirin for primary prevention in adults ≥60 years, and the benefit-risk balance is unfavorable at 8% ASCVD risk in younger patients without established CVD.
During therapeutic drug monitoring for aminoglycosides using extended-interval dosing (once-daily), what is the primary parameter used to guide dosing adjustments?
Answer: 6-hour post-dose level plotted on a Hartford nomogram
The Hartford nomogram uses a single drug level drawn 6-14 hours post-dose to determine the appropriate dosing interval for extended-interval aminoglycoside therapy.