Clinical Pharmacy and Therapeutics Flashcards

A patient with peptic ulcer disease positive for H. pylori is prescribed triple therapy. Which regimen is standard first-line?

Answer: PPI + clarithromycin + amoxicillin for 14 days

Standard first-line H. pylori eradication is triple therapy: PPI + clarithromycin + amoxicillin (or metronidazole if penicillin allergy) for 10–14 days. 14 days provides higher eradication rates. Quadruple therapy (with bismuth) is used in areas with high clarithromycin resistance.

A pharmacist is reviewing a patient with systolic heart failure (HFrEF). Which four drug classes have mortality benefit in HFrEF?

Answer: ACE inhibitor/ARB/ARNI + beta-blocker + MRA + SGLT2 inhibitor (now 'fantastic four')

Evidence-based therapy for HFrEF (EF <40%) with mortality benefit: (1) ACE inhibitor/ARB or ARNI (sacubitril/valsartan), (2) beta-blocker (carvedilol/bisoprolol/metoprolol succinate), (3) mineralocorticoid receptor antagonist (spironolactone/eplerenone), (4) SGLT2 inhibitor (dapagliflozin/empagliflozin). Loop diuretics reduce symptoms but not mortality.

A patient with COPD is on a long-acting beta-2 agonist (LABA). Which combination is recommended to further reduce exacerbations in severe COPD?

Answer: LABA + long-acting muscarinic antagonist (LAMA) combination inhaler

For moderate-severe COPD, LABA + LAMA dual bronchodilation is the cornerstone of maintenance therapy, providing superior bronchodilation and exacerbation reduction compared to either alone. ICS is added (triple therapy: ICS/LABA/LAMA) in patients with frequent exacerbations or eosinophilia.

A 70-year-old patient is on warfarin (INR 2.5) and develops a significant GI bleed. What is the most rapid reversal option?

Answer: 4-factor prothrombin complex concentrate (PCC) plus IV vitamin K

For life-threatening warfarin-related bleeding, 4-factor PCC (contains factors II, VII, IX, X, and proteins C and S) provides rapid (minutes) INR reversal and is preferred over FFP (which requires large volumes and 30–60 min). IV vitamin K ensures sustained reversal after PCC.

A patient is prescribed lithium for bipolar disorder. Which drug interaction can precipitously raise lithium levels and cause toxicity?

Answer: NSAIDs and thiazide diuretics — reduce renal lithium excretion

NSAIDs reduce renal prostaglandin synthesis, causing sodium retention and reduced renal lithium excretion. Thiazide diuretics cause sodium depletion; the kidney compensates by reabsorbing more sodium (and lithium together) in the proximal tubule. Both dramatically raise lithium levels.

A pharmacist reviews a prescription for a patient with gout flare. What is the first-line treatment for an acute gout attack?

Answer: Colchicine (within 12–24 hours of onset), NSAIDs, or corticosteroids

Acute gout is treated with anti-inflammatory agents: colchicine (most effective if started within 12–24 hours), NSAIDs (e.g., indomethacin), or corticosteroids. Allopurinol should NOT be started during an acute attack (can prolong or worsen it) — it is initiated 2–4 weeks after resolution for chronic urate lowering.