Practice Test Geeks(MTM) Medication Therapy Management Certification for Pharmacists Practice Test
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Renal Dosing & Adjustments 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 Renal Dosing & Adjustments flashcards as text

  1. An MTM pharmacist identifies that a patient with CrCl of 20 mL/min is prescribed colchicine 0.6 mg BID for gout prophylaxis. What is the recommended approach?

    Answer: Switch to a maximum dose of 0.6 mg once daily with close monitoring

    Colchicine dose should be reduced to 0.3 mg once daily (or 0.6 mg every other day) in severe renal impairment to prevent neuromuscular toxicity.

  2. A patient with CKD stage 3b (CrCl 35 mL/min) is on lisinopril 10 mg daily. Serum potassium rises to 5.8 mEq/L. What is the BEST MTM recommendation?

    Answer: Reduce lisinopril dose and add a loop diuretic to manage potassium

    Dose reduction of the ACE inhibitor combined with a potassium-wasting diuretic addresses both renal protection and hyperkalemia management.

  3. Which NSAID-related mechanism is most responsible for acute kidney injury in patients with pre-existing CKD?

    Answer: Inhibition of prostaglandin-mediated afferent arteriole dilation

    NSAIDs block prostaglandins that dilate the afferent arteriole, reducing GFR critically in CKD patients who depend on this mechanism.

  4. A patient with ESRD on hemodialysis is prescribed pregabalin for neuropathic pain. The standard dose is 150 mg BID. What adjustment is needed?

    Answer: Reduce to 25-75 mg once daily with supplemental dose after dialysis

    Pregabalin is renally cleared and removed by hemodialysis; patients with ESRD require significant dose reduction and a supplemental post-dialysis dose.

  5. When evaluating a medication list for a CKD patient, which drug interaction specifically WORSENS renal function and requires immediate attention?

    Answer: ACE inhibitor + NSAID

    ACE inhibitors reduce efferent arteriole tone while NSAIDs reduce afferent arteriole tone, together severely dropping GFR and worsening CKD.

  6. Which statement about trimethoprim (TMP) and serum creatinine is clinically important for MTM pharmacists?

    Answer: TMP blocks tubular creatinine secretion, raising serum creatinine without true GFR change

    Trimethoprim competitively inhibits tubular creatinine secretion, causing a rise in serum creatinine that does not reflect actual GFR decline.

  7. A pharmacist is performing MTM for a patient with CrCl of 40 mL/min taking rivaroxaban 20 mg daily for atrial fibrillation. What recommendation is appropriate?

    Answer: Reduce to 15 mg daily with the evening meal

    For non-valvular AF patients with CrCl 15–50 mL/min, rivaroxaban should be reduced to 15 mg once daily with the evening meal.