Pharm.D. Doctor of Pharmacy Clinical Pharmacy and Patient Care 1 — Questions and Answers
Question 1: Which parameter is used to assess kidney function most commonly in clinical practice for drug dosing?
- Blood urea nitrogen (BUN)
- Creatinine clearance (CrCl) estimated by Cockcroft-Gault (Correct answer)
- Serum albumin
- Urine osmolality
Correct answer: Creatinine clearance (CrCl) estimated by Cockcroft-Gault
The Cockcroft-Gault equation is the most widely used method to estimate creatinine clearance for drug dosing adjustment in clinical practice.
Question 2: A patient on warfarin is started on ciprofloxacin. What interaction should the clinical pharmacist anticipate?
- Decreased INR due to enzyme induction
- Increased INR due to reduced warfarin metabolism and gut flora suppression (Correct answer)
- No clinically significant interaction
- Decreased warfarin absorption
Correct answer: Increased INR due to reduced warfarin metabolism and gut flora suppression
Ciprofloxacin inhibits CYP1A2 and suppresses gut flora that produce vitamin K, leading to increased warfarin effect and elevated INR.
Question 3: Which medication reconciliation step is MOST critical at hospital discharge?
- Verifying the patient's insurance
- Comparing discharge medications to pre-admission medications and counseling the patient (Correct answer)
- Ordering refills for all home medications
- Documenting all allergies in the chart
Correct answer: Comparing discharge medications to pre-admission medications and counseling the patient
At discharge, comparing the new medication list to pre-admission medications and counseling the patient prevents inadvertent duplication, omission, or errors.
Question 4: Which clinical pharmacy service is MOST associated with reducing hospital readmissions for heart failure patients?
- Compounding sterile preparations
- Medication therapy management (MTM) and adherence counseling (Correct answer)
- Investigational drug services
- Drug information consultation
Correct answer: Medication therapy management (MTM) and adherence counseling
MTM with adherence counseling helps heart failure patients understand their complex regimens, improving adherence and reducing readmissions.
Question 5: A patient presents with signs of digoxin toxicity. Which electrolyte abnormality most potentiates this toxicity?
- Hyperkalemia
- Hypokalemia (Correct answer)
- Hypernatremia
- Hypermagnesemia
Correct answer: Hypokalemia
Hypokalemia potentiates digoxin toxicity because low potassium increases digoxin binding to Na+/K+-ATPase, enhancing its toxic effects.
Question 6: In anticoagulation management, which lab value is used to monitor unfractionated heparin therapy?
- INR
- Anti-Xa level only
- aPTT (Correct answer)
- Platelet count only
Correct answer: aPTT
Activated partial thromboplastin time (aPTT) is the standard laboratory test used to monitor unfractionated heparin therapy, targeting 1.5–2.5 times the control value.
Pharm.D. Doctor of Pharmacy Clinical Pharmacy and Patient Care 1
Which parameter is used to assess kidney function most commonly in clinical practice for drug dosing?