SPEX SPEX Assessment Exam 4 — Questions and Answers
Question 1: Which pharmacokinetic parameter describes the fraction of an administered dose that reaches systemic circulation unchanged?
- Volume of distribution
- Clearance
- Bioavailability (Correct answer)
- Half-life
Correct answer: Bioavailability
Bioavailability (F) represents the proportion of administered drug that reaches systemic circulation in active form.
Question 2: A patient taking phenytoin develops nausea, diplopia, and ataxia. These symptoms are most consistent with:
- A hypersensitivity reaction requiring immediate discontinuation
- Phenytoin toxicity due to elevated serum levels (Correct answer)
- Therapeutic failure requiring a dose increase
- An idiosyncratic reaction unrelated to serum concentration
Correct answer: Phenytoin toxicity due to elevated serum levels
Nausea, diplopia, and ataxia are classic signs of phenytoin toxicity, typically occurring at serum levels above 20 mcg/mL.
Question 3: Which medication requires a Risk Evaluation and Mitigation Strategy (REMS) program due to risks of severe birth defects?
- Metformin
- Isotretinoin (Correct answer)
- Lisinopril
- Sertraline
Correct answer: Isotretinoin
Isotretinoin (iPLEDGE REMS) requires strict pregnancy prevention measures due to its extreme teratogenicity.
Question 4: What is the primary reason insulin glargine should NOT be mixed with other insulins in the same syringe?
- It causes chemical degradation of short-acting insulins
- Mixing alters its pH and destroys its prolonged-action formulation (Correct answer)
- It contains preservatives incompatible with other insulin types
- It increases the risk of hypoglycemia unpredictably
Correct answer: Mixing alters its pH and destroys its prolonged-action formulation
Glargine's extended action depends on its acidic pH (4.0), which is disrupted by mixing, eliminating its long-acting profile.
Question 5: A pharmacy technician accepts a faxed prescription for a Schedule II controlled substance. What is the pharmacist's appropriate response?
- Verify the DEA number and dispense the faxed prescription
- Dispense only if the prescriber is a known provider at the pharmacy
- Inform the technician that Schedule II drugs require an original written or electronic prescription, with limited emergency exceptions (Correct answer)
- Fill the prescription and request the original within 72 hours
Correct answer: Inform the technician that Schedule II drugs require an original written or electronic prescription, with limited emergency exceptions
Federal law requires Schedule II controlled substances to be dispensed only with an original written or valid electronic prescription; faxes serve only as a record with limited emergency exceptions.
Question 6: Which antibiotic class is associated with QT interval prolongation and is used with caution in patients on antiarrhythmic drugs?
- Penicillins
- Fluoroquinolones
- Tetracyclines
- Macrolides — specifically azithromycin (Correct answer)
Correct answer: Macrolides — specifically azithromycin
Macrolides, particularly azithromycin, are associated with QT prolongation and risk of torsades de pointes, especially combined with antiarrhythmics.
Question 7: According to standard medication reconciliation practice, which setting is MOST critical for performing medication reconciliation?
- Annual wellness visits
- Hospital admission and discharge transitions of care (Correct answer)
- Monthly refill appointments
- Telephone consultations for minor ailments
Correct answer: Hospital admission and discharge transitions of care
Hospital admission and discharge are highest-risk transitions where medication discrepancies most commonly cause preventable harm.
SPEX SPEX Assessment Exam 4
Which pharmacokinetic parameter describes the fraction of an administered dose that reaches systemic circulation unchanged?