MTM Drug Therapy Monitoring & Clinical Decision-Making 4

Question 1

A patient with COPD and atrial fibrillation is prescribed theophylline. Which newly added medication would MOST increase the risk of theophylline toxicity?

Accepted Answer

Ciprofloxacin

Answer

Ciprofloxacin is a potent CYP1A2 inhibitor that can increase theophylline concentrations by 30-50%, leading to toxicity including seizures and arrhythmias.

Question 2

In monitoring a patient on methotrexate for rheumatoid arthritis, which laboratory finding most directly signals hepatotoxicity?

Accepted Answer

AST/ALT >3× upper limit of normal on two consecutive tests

Answer

Persistently elevated transaminases (>3× ULN on two tests 4-6 weeks apart) are the primary signal for methotrexate hepatotoxicity requiring dose reduction or discontinuation.

Question 3

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?

Accepted Answer

Add metoprolol succinate and titrate to HR 55-60 bpm

Answer

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.

Question 4

Which finding on a medication therapy review would MOST appropriately trigger a recommendation to decrease a medication dose rather than add a new drug?

Accepted Answer

INR of 6.2 on warfarin 5 mg daily with no bleeding

Answer

A supratherapeutic INR of 6.2 requires warfarin dose reduction, not addition of another drug, to bring anticoagulation back into therapeutic range.

Question 5

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?

Accepted Answer

Hold digoxin and check electrolytes, particularly potassium

Answer

Digoxin toxicity symptoms (GI symptoms, visual disturbances) require immediate drug hold and electrolyte assessment since hypokalemia potentiates toxicity.

(MTM) Medication Therapy Management Certification for Pharmacists Practice Test

(MTM) Medication Therapy Management Certification for Pharmacists Practice Test

MTM Drug Therapy Monitoring & Clinical Decision-Making 4