Pharmacy Clinical Pharmacy 3

Question 1

A 68-year-old diabetic patient on metformin develops acute kidney injury (eGFR 28 mL/min/1.73m²). What is the recommended action?

Accepted Answer

Discontinue metformin due to lactic acidosis risk

Answer

Reduce metformin dose by 50%

Answer

Continue metformin with increased monitoring

Answer

Switch to insulin only if eGFR falls below 15

Question 2

Which antibiotic class is associated with QT prolongation and should be used cautiously with antiarrhythmics?

Accepted Answer

Fluoroquinolones

Answer

Penicillins

Answer

Aminoglycosides

Answer

Carbapenems

Question 3

A patient on phenytoin requires total parenteral nutrition (TPN). What drug interaction is clinically important?

Accepted Answer

Phenytoin is absorbed by the TPN tubing, reducing serum levels

Answer

TPN increases CYP2C9 activity, accelerating phenytoin metabolism

Answer

Phenytoin displaces albumin in TPN, increasing free drug

Answer

TPN has no effect on phenytoin pharmacokinetics

Question 4

A 45-year-old woman is prescribed isotretinoin. Which risk management program must be followed?

Accepted Answer

REMS with iPLEDGE

Answer

MedGuide distribution only

Answer

Black Box Counseling Protocol

Answer

TIRF REMS Access program

Question 5

Which parameter is used to assess aminoglycoside efficacy in concentration-dependent killing?

Accepted Answer

Peak concentration to MIC ratio (Cmax/MIC)

Answer

Time above MIC (T>MIC)

Answer

Area under the curve to MIC ratio (AUC/MIC)

Answer

Trough concentration

Question 6

A patient receiving heparin develops a drop in platelet count from 280,000 to 90,000 on day 8. What condition should be suspected?

Accepted Answer

Heparin-induced thrombocytopenia (HIT)

Answer

Disseminated intravascular coagulation

Answer

Immune thrombocytopenic purpura

Answer

Thrombotic thrombocytopenic purpura

Question 7

Which hepatic condition requires dose reduction of drugs that are high-extraction-ratio drugs administered orally?

Accepted Answer

Cirrhosis with significantly reduced hepatic blood flow

Answer

Mild hepatitis with normal albumin

Answer

Non-alcoholic fatty liver with preserved function

Answer

Hepatic steatosis without portal hypertension