MTM Chronic Disease Management 3 — Questions and Answers
Question 1: A patient with rheumatoid arthritis on methotrexate reports new onset of cough and shortness of breath. The pharmacist's FIRST concern should be:
- Methotrexate-induced pneumonitis requiring immediate evaluation (Correct answer)
- Worsening of underlying rheumatoid arthritis lung involvement only
- Common cold unrelated to medication therapy
- Need to increase methotrexate dose for better disease control
Correct answer: Methotrexate-induced pneumonitis requiring immediate evaluation
Methotrexate-induced pneumonitis is a serious, potentially life-threatening adverse effect that must be ruled out whenever a patient on MTX develops new respiratory symptoms.
Question 2: Which self-monitoring goal for fasting blood glucose is recommended by the ADA for most non-pregnant adults with diabetes?
- 80–130 mg/dL (Correct answer)
- 60–100 mg/dL
- 140–180 mg/dL
- 100–150 mg/dL
Correct answer: 80–130 mg/dL
ADA Standards of Care recommend a fasting/preprandial glucose target of 80–130 mg/dL for most non-pregnant adults with diabetes.
Question 3: A 68-year-old patient with COPD and atrial fibrillation requires anticoagulation. Which factor should be assessed before prescribing a DOAC?
- Creatinine clearance to determine appropriate dosing (Correct answer)
- Baseline spirometry FEV1/FVC ratio
- Fasting lipid panel to assess cardiovascular risk
- Thyroid stimulating hormone level
Correct answer: Creatinine clearance to determine appropriate dosing
DOACs require dose adjustment or are contraindicated in severe renal impairment, so creatinine clearance must be calculated before initiation and monitored periodically.
Question 4: In patients with chronic heart failure, daily weight monitoring is recommended to detect:
- Fluid retention indicating potential decompensation (Correct answer)
- Muscle mass loss from cardiac cachexia exclusively
- Effectiveness of antiplatelet therapy
- Adequate caloric intake to prevent malnutrition
Correct answer: Fluid retention indicating potential decompensation
A weight gain of 2–3 pounds overnight or 5 pounds in a week signals fluid accumulation and possible decompensation, prompting early intervention.
Question 5: Which oral diabetes medication should be held 24–48 hours before and after administration of iodinated contrast media?
- Metformin (Correct answer)
- Glipizide
- Sitagliptin
- Pioglitazone
Correct answer: Metformin
Metformin is held around iodinated contrast procedures because contrast-induced nephropathy can reduce metformin clearance, increasing the risk of lactic acidosis.
Question 6: The GOLD classification of COPD severity is primarily determined by:
- Post-bronchodilator FEV1 percent predicted (Correct answer)
- Resting oxygen saturation on room air
- Number of hospitalizations in the past 2 years
- Score on the CAT (COPD Assessment Test) alone
Correct answer: Post-bronchodilator FEV1 percent predicted
GOLD grades 1–4 are defined by post-bronchodilator FEV1 % predicted, with Grade 1 ≥80%, Grade 2 50–79%, Grade 3 30–49%, and Grade 4 <30%.
Question 7: A patient with osteoporosis is prescribed alendronate. Which counseling point is MOST critical for drug efficacy and safety?
- Take with a full glass of water and remain upright for 30 minutes after ingestion (Correct answer)
- Take with food to improve gastrointestinal tolerability
- Take at bedtime to reduce daytime side effects
- Take with calcium-rich dairy products for enhanced absorption
Correct answer: Take with a full glass of water and remain upright for 30 minutes after ingestion
Oral bisphosphonates must be taken with plain water on an empty stomach, and the patient must stay upright for at least 30 minutes to prevent esophageal irritation and ensure absorption.
MTM Chronic Disease Management 3
A patient with rheumatoid arthritis on methotrexate reports new onset of cough and shortness of breath.
The pharmacist's FIRST concern should be: