PEBC Treatment Planning 2

Question 1

A 68-year-old patient with type 2 diabetes and CKD stage 3 (eGFR 35 mL/min/1.73m²) is poorly controlled on metformin 1000 mg BID. Which adjustment is most appropriate?

Accepted Answer

Discontinue metformin and initiate insulin

Answer

Metformin is contraindicated when eGFR falls below 30 and should be used with caution below 45; at eGFR 35 with poor control, transitioning to insulin is the safest option.

Question 2

A patient on warfarin for atrial fibrillation requires short-term analgesia. Which agent poses the LEAST risk of significant drug interaction?

Accepted Answer

Acetaminophen 500 mg Q6H PRN

Answer

Acetaminophen at low-to-moderate doses is the preferred analgesic in warfarin patients as NSAIDs increase bleeding risk through antiplatelet effects and GI irritation.

Question 3

Which pharmacokinetic parameter is most relevant when designing a dosing regimen to maintain drug concentrations above the MIC for a time-dependent antibiotic like amoxicillin?

Accepted Answer

Time above MIC (%T>MIC)

Answer

Beta-lactams like amoxicillin exhibit time-dependent killing, so the pharmacodynamic target is the percentage of the dosing interval that free drug concentrations exceed the MIC.

Question 4

A 55-year-old woman with osteoporosis and GERD is prescribed alendronate. What counselling point is MOST critical for effective treatment?

Accepted Answer

Take on an empty stomach with plain water and remain upright for 30 minutes

Answer

Bisphosphonates must be taken on an empty stomach with 8 oz of plain water, and the patient must remain upright for at least 30 minutes to prevent esophageal irritation.

Question 5

A patient with heart failure (EF 35%) and hypertension is already on an ACE inhibitor and beta-blocker. Which additional agent has the strongest evidence for reducing mortality in this population?

Accepted Answer

Spironolactone 25 mg daily

Answer

Aldosterone antagonists like spironolactone have demonstrated mortality reduction in HFrEF patients already on ACE inhibitors and beta-blockers in landmark trials such as RALES.

PEBC - Pharmacy Examining Board of Canada Practice Test

PEBC - Pharmacy Examining Board of Canada Practice Test

PEBC Treatment Planning 2