Pharm.D. Doctor of Pharmacy Doctor of Pharmacy General 5 — Questions and Answers
Question 1: A Type 2 diabetic patient with eGFR of 25 mL/min/1.73m² should avoid which antidiabetic medication?
- Insulin glargine
- Sitagliptin (with dose adjustment)
- Metformin (Correct answer)
- Empagliflozin
Correct answer: Metformin
Metformin is contraindicated when eGFR falls below 30 mL/min/1.73m² due to risk of lactic acidosis from drug accumulation.
Question 2: Which immunosuppressant requires monitoring of blood pressure and serum creatinine due to nephrotoxicity?
- Mycophenolate mofetil
- Azathioprine
- Cyclosporine (Correct answer)
- Hydroxychloroquine
Correct answer: Cyclosporine
Cyclosporine causes vasoconstriction of renal afferent arterioles leading to nephrotoxicity and hypertension.
Question 3: What is the pharmacodynamic basis for combining a beta-lactam with an aminoglycoside for serious infections?
- They share the same receptor to maximize effect
- Synergistic bactericidal activity through dual mechanisms (Correct answer)
- Reduced nephrotoxicity when combined
- Broader activity by competitive inhibition
Correct answer: Synergistic bactericidal activity through dual mechanisms
Beta-lactams weaken the cell wall, enhancing aminoglycoside penetration, resulting in synergistic killing, especially against Pseudomonas and enterococci.
Question 4: A pharmacist receives a prescription for a Schedule II controlled substance. Which is NOT permitted?
- Dispensing a partial fill under certain circumstances
- Dispensing up to a 90-day supply at once (Correct answer)
- Accepting oral prescriptions in emergency situations only
- Requiring a written or electronic prescription
Correct answer: Dispensing up to a 90-day supply at once
Schedule II controlled substances may not be refilled; most states limit supply to 30 days, though some allow longer supplies for specific conditions.
Question 5: Which anticoagulant reversal agent specifically reverses dabigatran?
- Vitamin K
- Protamine sulfate
- Idarucizumab (Correct answer)
- Andexanet alfa
Correct answer: Idarucizumab
Idarucizumab is a monoclonal antibody fragment that binds dabigatran with high affinity, reversing its anticoagulant effect.
Question 6: What is the most important counseling point for patients receiving fluoroquinolone antibiotics?
- Take with antacids to improve absorption
- Avoid prolonged sun exposure and report tendon pain immediately (Correct answer)
- Take with milk to reduce GI side effects
- Double the dose if a dose is missed
Correct answer: Avoid prolonged sun exposure and report tendon pain immediately
Fluoroquinolones carry FDA black box warnings for tendinopathy/tendon rupture and photosensitivity, requiring immediate reporting of tendon pain.
Question 7: A patient's theophylline level is supratherapeutic. Which recently added medication most likely caused this toxicity?
- Rifampin
- Ciprofloxacin (Correct answer)
- Phenytoin
- Carbamazepine
Correct answer: Ciprofloxacin
Ciprofloxacin inhibits CYP1A2, the primary enzyme metabolizing theophylline, causing drug accumulation and toxicity.
Pharm.D. Doctor of Pharmacy Doctor of Pharmacy General 5
A Type 2 diabetic patient with eGFR of 25 mL/min/1.73m² should avoid which antidiabetic medication?