Treatment Planning Flashcards
7 cards from real PEBC practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.
Read the first 7 Treatment Planning flashcards as text
A patient with HIV is initiated on an antiretroviral regimen containing tenofovir disoproxil fumarate (TDF). Which organ function requires close monitoring?
Answer: Renal function (serum creatinine, eGFR) and bone density
TDF is associated with nephrotoxicity and decreased bone mineral density; renal function and bone density monitoring are key components of TDF-based regimen follow-up.
A 60-year-old man with gout has a serum uric acid of 620 µmol/L and recurrent flares. He is started on allopurinol. What is the most important counselling point about starting allopurinol?
Answer: Gout flares may paradoxically increase in the first months of therapy; prophylactic colchicine or NSAID is recommended
Mobilization flares commonly occur when starting urate-lowering therapy as urate crystals are mobilized; low-dose colchicine or NSAID prophylaxis for 3–6 months is recommended.
A pharmacist is assessing a patient's medication adherence. The patient reports taking their antihypertensive medications only 3–4 days per week. What is the MOST appropriate first intervention?
Answer: Explore barriers to adherence through motivational interviewing before modifying the regimen
Identifying and addressing patient-specific barriers through motivational interviewing is the foundational first step before making any therapeutic changes.
A patient on amiodarone for atrial fibrillation is also taking warfarin. What adjustment to warfarin dosing is typically required?
Answer: Reduce warfarin dose by approximately 30–50% as amiodarone inhibits its metabolism
Amiodarone inhibits CYP2C9 (and CYP3A4), significantly reducing warfarin metabolism and increasing INR; warfarin dose reduction of 30–50% is typically required.
A 45-year-old patient with moderate persistent asthma continues to have frequent symptoms despite low-dose ICS. What is the recommended step-up therapy per GINA guidelines?
Answer: Add a long-acting beta-2 agonist (LABA) to the existing ICS
GINA guidelines recommend adding a LABA to ICS (forming an ICS/LABA combination) as the preferred step-up for uncontrolled moderate persistent asthma.
A patient receiving vancomycin for MRSA bacteremia requires therapeutic drug monitoring. Which pharmacokinetic/pharmacodynamic target guides vancomycin dosing optimization?
Answer: AUC24/MIC ratio of 400–600 mg·h/L
Current ASHP/IDSA/SIDP guidelines (2020) recommend AUC-guided vancomycin monitoring with a target AUC24/MIC of 400–600 to optimize efficacy and minimize nephrotoxicity.
A pharmacist notices that a prescription for clarithromycin has been written for a patient taking simvastatin 40 mg daily. What is the most appropriate action?
Answer: Contact the prescriber to withhold simvastatin during clarithromycin therapy to prevent rhabdomyolysis
Clarithromycin is a potent CYP3A4 inhibitor that dramatically increases simvastatin exposure, raising the risk of myopathy and rhabdomyolysis; simvastatin should be suspended during therapy.