Physician Assistant Pharmaceutical Therapeutics 4 — Questions and Answers
Question 1: A child with otitis media has a penicillin allergy documented as hives. Which antibiotic is most appropriate?
- Cefdinir (Correct answer)
- Cephalexin
- Azithromycin
- Amoxicillin-clavulanate
Correct answer: Cefdinir
Cross-reactivity between penicillins and cephalosporins is low (<2%); cefdinir is acceptable for non-anaphylactic penicillin allergy in otitis media.
Question 2: Which drug used for HIV is a protease inhibitor known to cause hyperlipidemia, lipodystrophy, and hyperglycemia as metabolic side effects?
- Tenofovir
- Emtricitabine
- Ritonavir (Correct answer)
- Raltegravir
Correct answer: Ritonavir
Ritonavir and other protease inhibitors are associated with significant metabolic complications including dyslipidemia, fat redistribution, and insulin resistance.
Question 3: A patient on SSRIs is started on tramadol. Which serious drug interaction could result?
- Neuroleptic malignant syndrome
- Serotonin syndrome (Correct answer)
- Anticholinergic crisis
- QT prolongation
Correct answer: Serotonin syndrome
Tramadol inhibits serotonin reuptake; combined with SSRIs this can precipitate serotonin syndrome presenting with hyperthermia, agitation, and clonus.
Question 4: A patient with gout and hyperuricemia is started on allopurinol. When should urate-lowering therapy ideally begin relative to an acute gout flare?
- Immediately during the acute attack
- Only after the acute flare has resolved, typically 2-4 weeks later (Correct answer)
- Six months after the last flare
- Only after two confirmed flares
Correct answer: Only after the acute flare has resolved, typically 2-4 weeks later
Initiating urate-lowering therapy during an acute flare can prolong or worsen symptoms; it is generally started 2-4 weeks after resolution.
Question 5: Which pharmacological mechanism accounts for the anticoagulant action of direct oral anticoagulants (DOACs) such as apixaban?
- Inhibition of vitamin K epoxide reductase
- Direct inhibition of factor Xa (Correct answer)
- Inhibition of thrombin (factor IIa) only
- Platelet glycoprotein IIb/IIIa blockade
Correct answer: Direct inhibition of factor Xa
Apixaban and rivaroxaban are direct factor Xa inhibitors that prevent conversion of prothrombin to thrombin without requiring a cofactor like antithrombin.
Question 6: A patient is prescribed doxycycline for Lyme disease. Which counseling point is most important?
- Take with a full glass of milk
- Avoid prolonged sun exposure due to photosensitivity (Correct answer)
- Take at bedtime only
- Avoid all exercise during therapy
Correct answer: Avoid prolonged sun exposure due to photosensitivity
Tetracyclines including doxycycline cause photosensitivity reactions; patients should use sunscreen and avoid prolonged UV exposure.
Question 7: Which inhaled corticosteroid side effect is most concerning for long-term use in pediatric patients?
- Oral candidiasis
- Growth suppression (Correct answer)
- Adrenal insufficiency
- Bronchospasm
Correct answer: Growth suppression
Long-term systemic absorption of inhaled corticosteroids, even at low doses, may suppress growth hormone and reduce linear growth velocity in children.
Physician Assistant Pharmaceutical Therapeutics 4
A child with otitis media has a penicillin allergy documented as hives.
Which antibiotic is most appropriate?