Pharmacy Clinical Pharmacy 5

Question 1

A hospitalized patient on IV ciprofloxacin is transitioned to oral ciprofloxacin for continued treatment. The physician asks if a dose adjustment is needed. What is the best response?

Accepted Answer

No adjustment needed; ciprofloxacin has approximately 70–80% oral bioavailability

Answer

Reduce the dose by 50% because oral absorption is poor

Answer

Double the oral dose to compensate for first-pass metabolism

Answer

Avoid oral ciprofloxacin in hospitalized patients

Question 2

A patient with heart failure is started on carvedilol. Which counseling point is most important regarding initial therapy?

Accepted Answer

Start at low doses and titrate slowly to avoid acute decompensation

Answer

Take with antacids to prevent GI upset

Answer

Expect immediate improvement in ejection fraction within one week

Answer

Discontinue if resting heart rate falls below 80 bpm

Question 3

Which drug interaction mechanism explains the combination of simvastatin and amiodarone causing myopathy?

Accepted Answer

Amiodarone inhibits CYP3A4, increasing simvastatin exposure and myopathy risk

Answer

Amiodarone induces CYP3A4, reducing simvastatin levels

Answer

Simvastatin inhibits amiodarone metabolism via CYP2D6

Answer

Pharmacodynamic synergism with no kinetic component

Question 4

A patient presents with opioid overdose. Which agent is first-line reversal therapy and what is its mechanism?

Accepted Answer

Naloxone — competitive opioid receptor antagonist

Answer

Flumazenil — benzodiazepine receptor antagonist

Answer

Physostigmine — acetylcholinesterase inhibitor

Answer

Protamine sulfate — heparin antagonist

Question 5

Which monitoring parameter is most important during the first month of ACE inhibitor therapy in a hypertensive patient with CKD?

Accepted Answer

Blood pressure, serum potassium, and serum creatinine

Answer

Serum sodium and hemoglobin

Answer

Urine culture and sensitivity

Answer

LFTs and serum albumin

Question 6

A patient's phenytoin free fraction increases when albumin drops from 4.0 to 2.0 g/dL. What clinical consequence is most likely?

Accepted Answer

Toxicity despite a 'normal' total phenytoin level on lab report

Answer

Therapeutic failure due to reduced total drug level

Answer

No clinical impact because free drug levels remain stable

Answer

Reduced seizure threshold requiring dose increase

Question 7

A pharmacist identifies that a patient is taking two drugs that both prolong the QT interval: haloperidol and azithromycin. What is the most appropriate action?

Accepted Answer

Contact the prescriber to discuss the additive risk and explore alternatives

Answer

Dispense both and document in the patient record

Answer

Substitute azithromycin with clarithromycin, which lacks QT effects

Answer

Reduce haloperidol dose by 50% without prescriber notification