PSA Renal and Hepatic Prescribing

Question 1

A patient with CrCl 20 mL/min requires gentamicin therapy. What is the most appropriate dose adjustment strategy?

Accepted Answer

Reduce dose and extend the dosing interval

Answer

Increase dose frequency while maintaining dose size

Answer

Maintain standard dose with increased monitoring only

Answer

Give a higher loading dose with standard intervals

Question 2

Which of the following drugs does NOT typically require dose reduction in renal impairment?

Accepted Answer

Rifampicin

Answer

Metformin

Answer

Gabapentin

Answer

Digoxin

Question 3

A patient with Child-Pugh Class C cirrhosis requires sedation. Which benzodiazepine is most appropriate?

Accepted Answer

Lorazepam

Answer

Diazepam

Answer

Chlordiazepoxide

Answer

Midazolam

Question 4

Which opioid is considered relatively safest for analgesia in a patient with severe renal impairment (eGFR <15 mL/min)?

Accepted Answer

Fentanyl

Answer

Morphine

Answer

Codeine

Answer

Tramadol

Question 5

A patient with stage 4 CKD (eGFR 20 mL/min) is currently taking metformin for type 2 diabetes. What is the most appropriate action?

Accepted Answer

Stop metformin immediately

Answer

Continue metformin at the standard dose

Answer

Reduce metformin dose by 50%

Answer

Switch to a sulfonylurea

Question 6

Which of the following antihypertensives requires the greatest dose reduction in severe renal impairment compared to normal renal function?

Accepted Answer

Atenolol

Answer

Amlodipine

Answer

Losartan

Answer

Verapamil

Question 7

In hepatic impairment, what change occurs to the first-pass effect of orally administered drugs with high hepatic extraction ratios?

Accepted Answer

It is decreased, increasing oral bioavailability

Answer

It is increased, reducing oral bioavailability

Answer

It is unchanged as hepatocyte number remains constant

Answer

It increases bioavailability only for acidic drugs