SPEX SPEX Assessment Exam 5 — Questions and Answers
Question 1: A patient asks about the difference between 'use by' and 'expiration date' on their prescription. Which statement is most accurate?
- Both terms are interchangeable and mean the drug is unsafe after that date
- The expiration date guarantees potency and safety when stored properly; beyond this date, efficacy cannot be assured (Correct answer)
- Drugs remain fully potent for 5 years beyond the expiration date if refrigerated
- Expiration dates apply only to liquid formulations
Correct answer: The expiration date guarantees potency and safety when stored properly; beyond this date, efficacy cannot be assured
The expiration date marks the point through which the manufacturer guarantees potency and safety under proper storage conditions; use beyond this date is not recommended.
Question 2: Which parameter is used to assess how much of the body a drug distributes into, with high values suggesting extensive tissue binding?
- Bioavailability
- Clearance
- Volume of distribution (Vd) (Correct answer)
- Protein binding percentage
Correct answer: Volume of distribution (Vd)
A high volume of distribution (Vd) indicates that a drug distributes extensively into tissues beyond the bloodstream, often reflecting lipophilicity or tissue binding.
Question 3: A patient stabilized on warfarin begins taking St. John's Wort for depression. What is the expected pharmacokinetic outcome?
- Increased warfarin levels due to enzyme inhibition
- Decreased warfarin levels due to CYP450 induction, increasing clotting risk (Correct answer)
- No clinically significant interaction
- Increased bleeding risk from additive anticoagulation
Correct answer: Decreased warfarin levels due to CYP450 induction, increasing clotting risk
St. John's Wort is a potent CYP3A4 and P-glycoprotein inducer, increasing warfarin metabolism and reducing anticoagulant effect.
Question 4: Which condition requires the pharmacist to report to a state health department as a notifiable disease when identified through a prescription?
- Type 2 diabetes newly diagnosed
- Active tuberculosis (TB) (Correct answer)
- Hypertension requiring combination therapy
- Chronic kidney disease stage 3
Correct answer: Active tuberculosis (TB)
Tuberculosis is a nationally notifiable disease; health professionals including pharmacists may be required to report suspected or confirmed cases to public health authorities.
Question 5: When counseling a patient about a new inhaled corticosteroid (ICS) for asthma, which adverse effect should be specifically mentioned and mitigated?
- Systemic corticosteroid effects like osteoporosis from a single inhaler
- Oral candidiasis, prevented by rinsing the mouth after each use (Correct answer)
- Bronchoconstriction requiring a rescue inhaler before each dose
- Irreversible adrenal suppression after the first month of use
Correct answer: Oral candidiasis, prevented by rinsing the mouth after each use
Inhaled corticosteroids can cause oral candidiasis (thrush) due to oropharyngeal deposition; rinsing and spitting after use effectively prevents this.
Question 6: A pharmacist is asked to compound a preparation not commercially available. Which USP chapter governs non-sterile compounding standards?
- USP <797>
- USP <795> (Correct answer)
- USP <800>
- USP <1160>
Correct answer: USP <795>
USP <795> sets standards for non-sterile pharmaceutical compounding, covering stability, labeling, and beyond-use dating.
Question 7: Which counseling statement about metronidazole (Flagyl) is most important to include?
- Take with antacids to improve absorption
- Avoid alcohol during therapy and for 48 hours after the last dose (Correct answer)
- Refrigerate all dosage forms to maintain potency
- May be taken during the first trimester of pregnancy without concern
Correct answer: Avoid alcohol during therapy and for 48 hours after the last dose
Metronidazole inhibits aldehyde dehydrogenase, causing a disulfiram-like reaction (flushing, nausea, vomiting) if alcohol is consumed during or shortly after therapy.
SPEX SPEX Assessment Exam 5
A patient asks about the difference between 'use by' and 'expiration date' on their prescription.
Which statement is most accurate?