MTM Renal Dosing & Adjustments 5

Question 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?

Accepted Answer

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

Answer

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.

Question 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?

Accepted Answer

Reduce lisinopril dose and add a loop diuretic to manage potassium

Answer

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

Question 3

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

Accepted Answer

Inhibition of prostaglandin-mediated afferent arteriole dilation

Answer

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

Question 4

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

Accepted Answer

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

Answer

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

Question 5

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

Accepted Answer

ACE inhibitor + NSAID

Answer

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

(MTM) Medication Therapy Management Certification for Pharmacists Practice Test

(MTM) Medication Therapy Management Certification for Pharmacists Practice Test

MTM Renal Dosing & Adjustments 5