MTM Renal Dosing & Adjustments 4

Question 1

A patient with CrCl of 15 mL/min develops a urinary tract infection. Which antibiotic should be AVOIDED due to inadequate urinary concentrations in severe renal failure?

Accepted Answer

Nitrofurantoin

Answer

Nitrofurantoin is ineffective in severe renal failure because it cannot achieve adequate urinary concentrations and may accumulate to cause toxicity.

Question 2

Which aminoglycoside monitoring strategy is most appropriate in a patient with fluctuating renal function?

Accepted Answer

Traditional multiple daily dosing with peak/trough levels

Answer

Patients with unstable renal function require traditional dosing with frequent peak and trough monitoring to safely individualize therapy.

Question 3

A pharmacist reviews a patient's regimen and notes they are on apixaban 5 mg BID with a CrCl of 25 mL/min. What action is most appropriate?

Accepted Answer

Discontinue apixaban and switch to warfarin

Answer

While apixaban has limited renal elimination, patients with severe CKD (CrCl < 25 mL/min) were excluded from ARISTOTLE trial; switching to warfarin is often recommended.

Question 4

Which electrolyte abnormality is most commonly associated with progressive CKD and affects drug therapy choices?

Accepted Answer

Hyperkalemia

Answer

Hyperkalemia is common in CKD and restricts use of drugs that increase potassium, such as ACE inhibitors, ARBs, and potassium-sparing diuretics.

Question 5

A patient on hemodialysis three times weekly needs pain management. Which opioid is considered SAFEST in this population?

Accepted Answer

Fentanyl

Answer

Fentanyl is preferred in dialysis patients because it has inactive metabolites and is not significantly renally eliminated.

(MTM) Medication Therapy Management Certification for Pharmacists Practice Test

(MTM) Medication Therapy Management Certification for Pharmacists Practice Test

MTM Renal Dosing & Adjustments 4