A 55 year-old male patient with hypertension was started on lisinopril. He developed severe swelling of his mouth, with trouble breathing. Choose the correct statement:

1. The patient should be switched to Vasotec therapy.
2. The patient should be switched to Atacand therapy.
3. The patient should be switched to Lotrel therapy.
4. The patient should be switched to Exforge therapy.
5. None of the above.

Answer: E. Vasotec (enalapril), Atacand (candesartan),Lotrel (amlodipine/benazepril),Exforge (amlodipine/valsartan)

 

A patient has high BP, but a slow HR. The patient occasionally suffers from orthostatic hypotension and syncope. The physician is concerned and does not wish to use a blood pressure medication which may lower heart rate. Choose an agent that does not significantly lower heart rate:

1. Nadolol
2. Amlodipine
3. Diltiazem
4. Verapamil
5. Atenolol

Answer: B. Beta blockers (without ISA activity) and the non-DHP CCBs are anti-hypertensive agents that lower heart rate. This can be useful in a patient with a fast heart rate.

 

Fred comes to the clinic for a follow up visit for his HTN and DM management. He has been taking 3 medications to control his blood pressure for a long time. Today, the pharmacist notices a butterfly rash across Frank's nose and upper cheeks. Which of the following medications is most likely to cause this side effect?

1. Hydrochlorothiazide
2. Enalapril
3. Hydralazine
4. Eplerenone
5. Verapamil

Answer: C. Hydralazine (Apresoline) can cause lupus-like syndrome which is dose and duration related.

 

A patient presented a prescription for Accupril 40 mg PO daily. Which of the following is an appropriate generic substitution for Accupril?

1. Fosinopril
2. Ramipril
3. Triamterene
4. Clonidine
5. Quinapril

Answer: E. The generic name of Accupril is quinapril, fosinopril (Monopril), ramipril (Altace), triamterene (Dyrenium), clonidine (Catapres)

 

What is the mechanism of action of clonidine?

1. Acts as an alpha-1 agonist, resulting in a decrease in norepinephrine release
2. Acts as an alpha-1 antagonist, resulting in an increase in norepinephrine release
3. Acts as an alpha-2 agonist, resulting in a decrease in norepinephrine release
4. Acts as an alpha-2 antagonist, resulting in a decrease in norepinephrine release
5. Acts as an alpha-1 and alpha-2 antagonist, resulting in an increase in norepinephrine release

Answer: C. 

 

Fred has been diagnosed with heart failure and was told to begin Toprol XL 12.5 mg daily. The pharmacist dispensed a 25 mg tablet and instruct the patient to cut at the score line. Which of the following statements are true regarding Toprol XL? (Select ALL that apply.)

1. This is an extended-release formulation and cannot be cut.
2. This medication can be taken without regard to food.
3. The dose is likely to be titrated every 2 weeks, if tolerated.
4. This medication should be stored in the refrigerator.
5. Toprol XL can be cut at the score line; they should use a tablet cutter.

Answer: B, C, E. Toprol XL tablets have a score line and can be cut. They remain long-acting if cut only at the score line. They cannot be crushed or chewed. metoprolol succinate (Toprol XL): PO, IV. IV:PO ratio 1:2.5. target dose 200mg daily

 

Fred is a systolic heart failure patient on carvedilol 12.5 mg twice daily. To improve medication adherence, the primary physician wants to convert him to the once daily Coreg CR. What is the equivalent daily dose of Coreg CR for GT?

1. 10 mg
2. 20 mg
3. 40 mg
4. 80 mg
5. 160 mg

Answer: C. The conversion of immediate release carvedilol to Coreg CR is not on a direct mg per mg basis due to the formulation. Immediate release carvedilol 12.5 mg BID = Coreg CR 40 mg daily.

 

A patient is taking Humalog 75/25, 10 units BID. How many units of insulin lispro does the patient inject in the morning?

1. 10 units
2. 7.5 units
3. 5 units
4. 2.5 units
5. 1 unit

Answer: D. Humalog 75/25 contains 75% insulin lispro protamine suspension and 25% insulin lispro. The patient is getting an injection of 10 units of this combination product. 25% of the 10 units = 2.5 units.

 

Charles is taking pioglitazone for his diabetes management. Which of the following are possible risks when taking this medication? (Select ALL that apply.)

1. Pancreatitis
2. Weight gain
3. Edema
4. Fractures
5. Bladder cancer

Answer: B, C, D, E. Thiazolidinediones (TZDs): PPARy-agonists, increase peripheral insulin sensitivity. Pioglitazone (Actos) – do not use in patients with bladder CA. Rosiglitazone (Avandia): Boxed warning: Class III/IV heart failure (can worsen HF or cause HF), SEs: peripheral edema, wt gain, edema, increase fracture risk

 

 

Frank is a 50 year-old white male with DM. His BP reads from 140-152/88-93 mmHg. He has a SCr of 2.8 mg/dL and BUN of 55 mg/dL. Which of the following would be appropriate to treat his HTN according to the JNC 8 guidelines? (Select ALL that apply.)

1. Enalapril
2. Losartan
3. Amlodipine
4. Begin lifestyle therapy
5. He does not require any intervention at this time

Answer: A, B, D. According to JNC 8, initial therapy for diabetes should begin with an ACE inhibitor or angiotensin receptor blocker since the patient has chronic kidney disease. Thiazide-like diuretics and DHP CCBs are generally used for additional BP control in most patients.

 

 

Metformin therapy is contraindicated in the following clinical situations:

1. A patient who will receive non-iodinated IV radio-contrast dye
2. NYHA Class I heart failure
3. Serum creatinine of 1.7 mg/dL
4. Pregnancy
5. Children 10 - 16 years old

Answer: C. Metformin (Glucophage) is contraindicated with Scr ≥ 1.5 mg/dL (males) or ≥ 1.4 mg/dL (females). Metformin only need to be stopped prior to the use of iodinated contrast dyes, but not contraindicated. Caution in heart failure, but can be used in heart failure unless they decompensated

 

A patient is using propranolol for hypertension. She has just begun therapy with glipizide. The patient may not be able to recognize the following symptoms of hypoglycemia: (Select ALL that apply.)

1. Shakiness
2. Anxiety
3. Hunger
4. Sweating
5. Palpitations

Answer: A, B, E. Beta blockers, particularly the non-selective, lipophilic agents can block shakiness, anxiety and palpitations, but not sweating and hunger.

 

What is the estimated average glucose (eAG) of a patient with a hemoglobin A1C value of 9%?

1. 132 mg/dL
2. 128 mg/dL
3. 368 mg/dL
4. 212 mg/dL
5. 272 mg/dL

Answer: D. Just remember that A1C of 7% is 154mg/dL, every 1% change in A1C is about 30mg/dL change in glucose

 

A pharmacist receives a prescription for Bydureon. Which of the following statements are correct regarding Bydureon? (Select ALL that apply.)

1. A patient needs to be started on Byetta first in order to be started on Bydureon.
2. Bydureon is given once per week.
3. Patients can expect a weight loss of 2-6 pounds
4. The reconstituted solution can be stored up to 8 hours prior to injection.
5. Bydureon has a black box warning for thyroid cancer, which was seen in rats.

Answer: B, C, E. (GLP-1) Agonist: analogs of GLP-1 which increase insulin secretion, and decrease glucagon, and slow gastric emptying

 

Andrea is a 23 y/o female ( 5'4", 100 lbs) who was just diagnosed with type 1 diabetes. She eats 2 meals per day. The physician writes for an initial daily dose of insulin of 0.6 units/kg/day. Using a NPH-regular insulin dosing strategy, calculate the amount of NPH insulin and the amount of regular insulin Andrea should take.

1. Take NPH 18 units BID and Regular 9 units BID before meals
2. Take NPH 9 units BID and Regular 18 units BID before meals
3. Take NPH 9 units BID and Regular 4 units BID before meals
4. Take NPH 22 units BID and Regular 5 units BID before meals
5. Take NPH 15 units BID and Regular 3 units BID before meals

Answer: C. When using NPH and Regular insulin, it is initiated by taking the total daily dose of insulin and giving 2/3 (67%) of the insulin as the NPH dose and 1/3 (33%) as the Regular insulin dose. NPH is generally given BID and the Regular insulin is divided BID or TID with meals. Type 1 Insulin Initiation: 0.6 units/kg/day = TDD; If using basal-bolus insulin, give ½ as basal and ½ as bolus

 

Tammy is beginning insulin therapy. Proper advice on injection technique should include: (Select ALL that apply.)

1. The abdomen is the preferred site for injection.
2. The injection site should be cleansed with soap and water prior to injection.
3. All insulins require a prescription.
4. Injection site should be rotated.
5. Unused insulin vials or cartridges should be kept refrigerated; once in use can be kept at room temperature.

Answer: A, D, E. NPH and Regular insulins do not require a prescription. Always wipe injection site with an alcohol swab before administration.

 

Jessica is a patient with type 1 diabetes who takes NPH 12 units BID and regular insulin 10 units BID. She likes to stay well controlled and uses her glucometer often. She is at a wedding and just tested her blood glucose. Her glucometer shows 220 mg/dL. Jessica's target BG is 120 mg/dL and her correction factor is 50. Calculate Jessica's correction dose.

1. 10 units
2. 6 units
3. 5 units
4. 4 units
5. 2 units

 Answer: E. [(blood glucose now) – (target blood glucose)]/(correction factor) = correction dose; Correction factor/dose: used to correct high BG

1800 rule is 1800/TDD = correction factor (rapid-acting insulin)

1500 rule is 1500/TDD = correction factor for (regular insulin)

 

Adian is a 19 y/o male ( 5'11", 176 lbs) who was just diagnosed with type 1 diabetes. Adian eats 3 meals per day. The physician writes for an initial daily dose of insulin of 0.6 units/kg/day. Using a basal-bolus dosing strategy, calculate the amount of Lantus and the amount of Humalog Adian should take.

1. Take Lantus 32 units at bedtime and Humalog 5 units before meals
2. Take Lantus 24 units at bedtime and Humalog 8 units before meals
3. Take Lantus 5 units at bedtime and Humalog 32 units before meals
4. Take Lantus 16 units at bedtime and Humalog 10 units before meals
5. Take Lantus 8 units at bedtime and Humalog 24 units before meals 

Answer: B. When using basal and meal-time insulin (called bolus) dosing strategy, it is initiated by taking the total daily dose of insulin and giving 50% of the insulin as the basal dose and 50% as the bolus, or mealtime, dose.

 

A patient comes to the pharmacy with a new prescription for emtricitabine. Choose the correct drug class for emtricitabine:

1. Nucleoside Reverse Transcriptase Inhibitor
2. Non-Nucleoside Reverse Transcriptase Inhibitor
3. CCR5 Receptor Antagonist
4. Integrase Inhibitor
5. Protease Inhibitor

Answer: A. Emtricitabine (Emtriva) is a nucleoside reverse transcriptase inhibitor. 

 

A patient gave the pharmacist a prescription for Prezista. Which of the following is an appropriate generic substitution for Prezista?

1. Tipranavir
2. Maraviroc
3. Emtricitabine
4. Darunavir
5. Fosamprenavir

Answer: D. Tipranavir (Aptivus), Maraviroc (Selzentry), Emtricitabine (Emtriva), Fosamprenavir (Lexiva)

 

A patient gave the pharmacist a prescription for Viread 300 mg po daily. Which of the following is an appropriate generic substitution for Viread?

1. Tenofovir
2. Atazanavir
3. Emtricitabine
4. Emtricitabine and tenofovir
5. Nevirapine

Answer: A. Atazanavir (Reyataz), Emtricitabine (Emtriva), Emtricitabine and tenofovir (Truvada), Nevirapine (Viramune)

 

A pharmacist receives a prescription for Combivir. What medications are in this product?

1. Emtricitabine + tenofovir
2. Lopinavir + ritonavir
3. Emtricitabine + tenofovir + rilpivirine
4. Zidovudine + lamivudine
5. Zidovudine + abacavir

Answer: D. Combivir contains zidovudine (Retrovir) + lamivudine (Epivir).

emtricitabine (Emtriva) + tenofovir (Viread) = Truvada, lopinavir + ritonavir (Norvir) = Kaletra, rilpivirine (Edurant) + Truvada = Complera - take with food, zidovudine (Retrovir) + abacavir (Ziagen) + lamivudine (Epivir) = Trizivir

 

A physician is considering starting abacavir on a patient diagnosed with HIV. Which of the following statements regarding abacavir is correct? (Select ALL that apply.)

1. This medication can cause a severe hypersensitivity reaction.
2. Patients must be screened for the HLA-B 1502 allele. If positive, the medication should not be given.
3. When combined with lamivudine, the brand name is Truvada.
4. Abacavir is a protease inhibitor.
5. The brand name is Ziagen.

Answer: A, E. Abacavir (Ziagen) has a boxed warning regarding the risk of serious, and possibly fatal, hypersensitivity reaction. Every patient should be screened for the HLA-B*5701 allele. If the test is positive, the patient should not receive the drug. Abacavir plus lamivudine is Epzicom. Abacavir is a NRTI.

 

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