Saudi Prometric Pharmacist Clinical Pharmacy and Therapeutics

Question 1

A patient with type 2 diabetes has HbA1c of 9.5% and is on maximum dose metformin. What is the most appropriate next step?

Accepted Answer

Add a second agent — SGLT2 inhibitor or GLP-1 agonist preferred if cardiovascular disease present

Answer

Switch from metformin to insulin immediately

Answer

Add a sulfonylurea as second-line regardless of comorbidities

Answer

Continue metformin alone and recheck HbA1c in 6 months

Question 2

A patient with newly diagnosed atrial fibrillation (AF) requires anticoagulation. Which direct oral anticoagulant (DOAC) is the preferred choice over warfarin?

Accepted Answer

DOACs (apixaban, rivaroxaban, dabigatran, edoxaban) are preferred due to predictable pharmacokinetics and no routine monitoring

Answer

Warfarin is always preferred due to reversibility

Answer

Aspirin alone is sufficient for AF stroke prevention

Answer

Enoxaparin is the preferred long-term option

Question 3

A pharmacist counsels a patient starting a statin for the first time. Which side effect should the patient be specifically instructed to report?

Accepted Answer

Muscle pain, weakness, or dark urine — possible myopathy or rhabdomyolysis

Answer

Dry cough — a common statin side effect

Answer

Hyperkalemia — common with statins

Answer

Hair loss — requires statin discontinuation

Question 4

Which agent is preferred for acute treatment of status epilepticus in an adult?

Accepted Answer

IV lorazepam or IV diazepam (benzodiazepine first-line)

Answer

Oral phenytoin 300 mg loading dose

Answer

IV magnesium sulfate

Answer

Oral levetiracetam

Question 5

A patient is on long-term proton pump inhibitor (PPI) therapy. Which complication should the pharmacist monitor for?

Accepted Answer

Hypomagnesemia, vitamin B12 deficiency, and increased risk of Clostridioides difficile infection

Answer

Hypercalcemia and vitamin D toxicity

Answer

Hypermagnesemia and metabolic alkalosis

Answer

Increased iron absorption causing hemochromatosis

Question 6

Which therapeutic drug monitoring (TDM) parameter is most important for aminoglycoside dosing to prevent nephrotoxicity?

Accepted Answer

Trough level (pre-dose concentration) — trough >2 mg/L increases nephrotoxicity risk with multiple daily dosing

Answer

Peak level only — peak predicts efficacy

Answer

AUC/MIC only (not used clinically)

Answer

Volume of distribution — not used for TDM