SPEX SPEX Assessment Exam 3 — Questions and Answers
Question 1: A pharmacist receives a prescription for oxycodone 80 mg tablets with no diagnosis noted. The dose seems unusually high. What is the most appropriate first step?
- Dispense the medication as written since the prescriber has authority
- Refuse to fill and document the refusal in the patient file
- Contact the prescriber to verify the prescription and clarify clinical intent (Correct answer)
- Call the state board of pharmacy immediately
Correct answer: Contact the prescriber to verify the prescription and clarify clinical intent
The pharmacist's professional responsibility includes verifying clinical appropriateness by contacting the prescriber when a prescription raises concern.
Question 2: What is the mechanism of action of proton pump inhibitors (PPIs)?
- Blocking H2 histamine receptors on parietal cells
- Neutralizing gastric acid in the stomach lumen
- Irreversibly inhibiting the H+/K+-ATPase enzyme on parietal cells (Correct answer)
- Stimulating prostaglandin synthesis in the gastric mucosa
Correct answer: Irreversibly inhibiting the H+/K+-ATPase enzyme on parietal cells
PPIs irreversibly block the H+/K+-ATPase (proton pump) on gastric parietal cells, suppressing acid secretion.
Question 3: Which electrolyte imbalance is most commonly associated with loop diuretic use?
- Hyperkalemia
- Hypokalemia (Correct answer)
- Hypernatremia
- Hypermagnesemia
Correct answer: Hypokalemia
Loop diuretics increase urinary excretion of potassium, sodium, and chloride, with hypokalemia being the most clinically significant electrolyte disturbance.
Question 4: Under HIPAA, which situation allows a pharmacist to disclose patient health information without authorization?
- A patient's employer requests medication history for insurance purposes
- A law enforcement officer presents a valid court order (Correct answer)
- A family member requests the patient's prescription list for convenience
- A pharmaceutical company requests data for marketing research
Correct answer: A law enforcement officer presents a valid court order
HIPAA permits disclosure to law enforcement when a valid court order, warrant, or subpoena is presented.
Question 5: Lithium toxicity is MOST likely to occur when a patient on stable lithium therapy begins taking which drug?
- Acetaminophen
- Ibuprofen (Correct answer)
- Diphenhydramine
- Omeprazole
Correct answer: Ibuprofen
NSAIDs like ibuprofen reduce renal prostaglandin synthesis, decreasing lithium clearance and increasing lithium levels to potentially toxic concentrations.
Question 6: A pharmacist notices a prescription for amoxicillin in a patient whose profile shows a documented allergy to penicillin. What is the most appropriate action?
- Dispense amoxicillin since allergy severity is unknown
- Substitute ampicillin as an alternative beta-lactam
- Contact the prescriber to discuss the allergy and recommend an alternative antibiotic (Correct answer)
- Fill the prescription and counsel the patient to watch for reactions
Correct answer: Contact the prescriber to discuss the allergy and recommend an alternative antibiotic
Amoxicillin is a penicillin-class antibiotic; a documented penicillin allergy requires the pharmacist to contact the prescriber for a safer alternative.
Question 7: Which counseling point is most important for a patient newly prescribed methotrexate for rheumatoid arthritis?
- Take on an empty stomach for best absorption
- Avoid all physical activity during therapy
- Take folic acid supplementation to reduce toxicity risk, and avoid alcohol (Correct answer)
- Use antacids 2 hours before each dose
Correct answer: Take folic acid supplementation to reduce toxicity risk, and avoid alcohol
Folic acid supplementation reduces methotrexate-associated toxicities (mucositis, hepatotoxicity), and alcohol must be avoided due to additive hepatotoxicity.
SPEX SPEX Assessment Exam 3
A pharmacist receives a prescription for oxycodone 80 mg tablets with no diagnosis noted.
The dose seems unusually high.
What is the most appropriate first step?