MTM Chronic Disease Management 5

Question 1

Which medication used in chronic disease management is most likely to cause hyperkalemia when added to an ACE inhibitor in a patient with CKD stage 3?

Accepted Answer

Spironolactone

Answer

Spironolactone (a potassium-sparing diuretic/mineralocorticoid antagonist) combined with an ACE inhibitor in CKD significantly increases the risk of life-threatening hyperkalemia.

Question 2

A patient with type 2 diabetes, CKD stage 3b, and cardiovascular disease is being considered for an SGLT-2 inhibitor primarily for cardiorenal protection. Which agent has an FDA indication for this use down to eGFR 20 mL/min/1.73m²?

Accepted Answer

Dapagliflozin (Farxiga)

Answer

Dapagliflozin received FDA approval for CKD progression reduction down to eGFR ≥25 mL/min/1.73m² (and HF indication), with canagliflozin having CKD data as well — but dapagliflozin's label extends to eGFR 25.

Question 3

A patient on warfarin for atrial fibrillation begins taking amiodarone for rate/rhythm control. The pharmacist should anticipate:

Accepted Answer

Significantly increased INR requiring warfarin dose reduction of 30–50%

Answer

Amiodarone is a potent inhibitor of CYP2C9 (and other CYPs), markedly reducing warfarin metabolism and increasing anticoagulant effect, often necessitating a 30–50% empiric dose reduction.

Question 4

Which non-pharmacologic intervention has the highest level of evidence for reducing cardiovascular mortality in patients with stable coronary artery disease?

Accepted Answer

Cardiac rehabilitation program participation

Answer

Cardiac rehabilitation is supported by strong evidence showing reductions in cardiovascular mortality, hospitalizations, and improved quality of life in patients with established CAD.

Question 5

A patient with well-controlled asthma asks whether she still needs her daily inhaled corticosteroid now that she has been symptom-free for 6 months. The pharmacist's BEST response is:

Accepted Answer

Inhaled corticosteroids should be continued as they address underlying airway inflammation, and stopping abruptly often leads to relapse

Answer

ICS remains the cornerstone of persistent asthma management because symptom control does not equal resolution of underlying inflammation; abrupt discontinuation frequently leads to return of symptoms.

(MTM) Medication Therapy Management Board Certification Practice Test

(MTM) Medication Therapy Management Board Certification Practice Test

MTM Chronic Disease Management 5