Pharmacotherapeutics (Accumlative Exam)

Plasma protein binding

Obesity

Presence of edema

All of the above

Fentanyl transdermal patch

Conjugated estrogens 0.625 oral tablet

Oxymetazoline nasal spray

Sublingual nitrogylcerin tablet

potentiates the activity of the receptor.

is less likely to elicit an adverse drug effect than a receptor agonist.

interacts with the receptor and does not allow other substances to bind with it, thus blocking the receptor.

has a stronger receptor affinity than a receptor agonist.

are responsible for oxidative metabolism.

are often the mechanism behind drug-drug interactions.

are predominantly found in the intestine.

A and B

it has low bioavailability.

it has a greater bioavailability than the intravenous (IV) form of the drug.

a high fraction of the drug will reach the bloodstream.

None of the above is correct.

Any noxious or unintended reaction to a drug that is administered at standard doses by the proper route for the purposes of prophylaxis, diagnosis, or treatment.

Very uncommon in everyday medical practice.

The action of a drug on the effectiveness or toxicity of another drug.

Always severe and life-threatening.

Study of absorption, distribution, metabolism, and excretion of a drug.

Study of the biochemical and physiologic effects of drugs on the function of living organisms and their component parts.

Study of how much of the drug is administered reaches its site of action.

Study of how much and how fast the drug leaves its site of administration.

The medication indication should be clearly documented in the medical record.

The patient should be provided with a medication list only if they are taking greater than 5 medications.

The patient's medication regimen should be routinely reviewed for potential problems such as inappropriate dosing and drug interactions.

The provider should review the medication list at each visit and assess whether proper monitoring is occurring for each of the patient's medications.

5 hours

10 hours

20 hours

40 hours

Infants and young children have a thin stratum and larger body surface in relation to size, so they may absorb topical agents more readily than adults.

Newborns have a much lower percentage of total body water, which may impact the volume of distribution, Vd.

Newborns and infants less than 6 months old have a higher rate of renal excretion than adults.

All of the hepatic metabolic pathways are fully developed and functional at the time of birth.

Discontinue amlodipine, begin hydrochlorothiazide 12.5mg PO daily

Discontinue amlodipine, begin nifedipine immediate-release 10mg PO TID

Discontinue amlodipine, begin valsartan 40mg PO daily

Discontinue lisinopril, increase amlodipine to 10mg PO daily

Atorvastatin

Pravastatin

Simvastatin

Rosuvastatin

Are recommended to be used in combination with an angiotensin converting enzyme inhibitor and angiotensin receptor blocker

Should be avoided in patients with chronic liver failure

Should only be given to patients with severe heart failure (NYHA functional class IV)

Should not be used in patients with a potassium level ≥ 5.0 mEq/L

Check thyroid function and vitamin D level

Hold simvastatin, and check a fasting lipid panel

Hold simvastatin, and check thyroid function and vitamin D level

Lower the simvastatin dose to 10mg PO daily

Are recommended as initial or add-on therapy in hypertensive patients with chronic kidney disease

Can increase serum phosphorus levels

Inhibit re absorption of sodium and chloride in the ascending loop of Henle and distal renal tubule

May lose efficacy in a patient who uses a lot of salt in their diet

Aspirin is often used with other antiplatelet or anticoagulant medications and concomitant use does not increase the risk for bleeding.

Increasing the dose of aspirin from 81mg to 325mg will improve outcomes for all vascular disorders.

NSAIDs (ibuprofen, naproxen, ketoprofen, etc) may limit aspirin's cardioprotective effects; therefore, concomitant use of aspirin and NSAIDs is contraindicated regardless of the timing of administration.

Using the lowest dose of aspirin shown to be effective for an indication will help reduce the risk of adverse events such as bleeding.

Aldosterone antagonists

Angiotensin converting enzyme inhibitors

Beta-blockers (bisoprolol, carvedilol, extended-release metoprolol succinate)

Digoxin

Atorvastatin 80mg PO daily (High-dose statin intensity)

Life-style modifications only

Niacin 1500mg PO daily

Pravastatin 10mg PO daily (Low-dose statin intensity)

Continue the current dose of enoxaparin therapy.

Decrease the current dose of enoxaparin to 1mg/kg SQ every 24 hours due to her poor renal function.

Decrease the current dose of enoxaparin to 40mg SQ daily to be used for DVT prophylaxis.

Increase the current dose of enoxaparin to 1.5mg/kg SQ every 12 hours due to her weight.

All oral anticoagulants cost about the same price.

All oral anticoagulants have an acute reversal agent.

All oral anticoagulants may be used for stroke prophylaxis for non-valvular atrial fibrillation.

All oral anticoagulants require INR monitoring for safety and efficacy.

Methylprednisolone

Theophylline

Levocetirizine

Singulair®

Nicotine, Wellbutrin

Menthol, Chantix® (varenicline tartrate)

Nicotine, Chantix® (varenicline tartrate)

Nicotine, Clonidine

Reduction of renal function

Frog in the throat

Candidiasis

Group A Streptococcus

Exercise or Seasonal asthma

Mild, intermittent asthma

Severe, persistent asthma

Post nasal drip

Inflammation, Inhaled corticosteroids

Bronchospasm, SABA

Dry Cough, Accolate®

Shortness of Breath, Albuterol

Smoking reduces theophylline clearance

Theophylline creates an increased urge to smoke or increase use nicotine replacement

Smoking increases the theophylline clearance

The statement is FALSE, no monitoring is required

Albuterol

Duoneb®

Xopenex®

A & C

Oseltamivir

Zanamivir

rimantidine

A & B are both correct

Sulfonamides

Macrolides

Tetracyclines

Penicillins

Prescribe levofloxacin 500mg PO daily x 7 days, recheck INR in 2 days.

Prescribe trimethoprim/sulfamethoxazole DS 1 tab PO BID x 7 days, recheck INR in 2 days.

Prescribe trimethoprim/sulfamethoxazole DS 1 tab PO BID x 7 days, no need to check INR since it is a short course of antibiotics.

Based on CC’s presentation and urinalysis, no antibiotic prescription is required.

It is contraindicated in this patient population.

The pediatric treatment regimen is half as long as the adult treatment regimen.

It should not be used for influenza prophylaxis in pediatric patients.

They should be monitored closely for neuropsychiatric symptoms while on therapy.

Hydrochlorothiazide is increasing the clearance of the doxycycline.

Calcium carbonate is inhibiting the absorption of doxycycline.

Lisinopril is interfering with the metabolism of doxycycline.

Aspirin is inhibiting the absorption of doxycycline.

Macrolides

Penicillin beta-lactams

Fluoroquinolones

Tetracyclines

It has the potential to interact with serotonergic agents resulting in serotonin syndrome.

Patients should adhere to a low-tyramine diet while taking linezolid.

Myelosuppression may occur, especially with a prolonged treatment course (>14 days).

It is the treatment of choice for methicillin susceptible Staphylococcus aureus (MSSA).

clarithromycin

cephalexin

cefpodoxime

augmentin

It is primarily eliminated from the body through hepatic metabolism.

It achieves high concentration in skin and soft tissue.

It should not be prescribed to patients with renal impairment, CrCl <50ml/min.

It interferes with bacterial DNA gyrase.

administration should be separated from oral divalent cation administration (i.e. calcium, iron, etc.) by at least two hours.

does not require dose adjustment in severe renal dysfunction.

is a macrolide antibiotic.

is poorly absorbed when given orally compared to the intravenous route (i.e. low bioavailability).

A 32 year old pregnant woman

A 45 year old nurse who works on an orthopedic surgery floor

A 4 year old boy

All of the above patients may receive the intranasal live-attenuated influenza vaccine.

It is a urinary analgesic.

If her urinary pain is not gone at the end of her trimethoprim/sulfamethoxazole course, LK should just continue to take phenazopyradine until her symptoms are better.

It may turn the urine a red-orange color and the patient should not be alarmed.

It should help relieve her symptoms within 24 hours.

Ampicillin 2 grams PO TID x 24 hours prior to procedure

Clindamycin 600mg PO x 1 dose taken 4 hours prior to procedure

Amoxicillin 2 grams PO x 1 dose taken 1 hour prior to procedure

B and C are both correct

It should not be administered to hospitalized patients as they are unable to mount an adequate immune response.

Community influenza vaccine campaigns should begin annually in mid-October.

Patients should no longer be vaccinated after December 1st as the vaccine will not have enough time to induce an immune response.

Most adults have antibody protection against influenza virus 2 to 3 days after receiving the vaccine.

MZ is not a candidate for a pneumococcal vaccine at this visit. Do not immunize.

Recommend that MZ receive 23-valent pneumococcal polysaccharide vaccine today and again in 6-12 months

Recommend that MZ receive the 13-valent pneumococcal conjugate vaccine today and again in 6-12 months

Recommend that MZ receive the 13-valent pneumococcal conjugate vaccine today and receive the 23-valent pneumococcal polysaccharide vaccine in 6 months

Tell TR to be alert and try to identify the spider. Prescribe cephalexin 500mg TID x 5 days.

Drain the abscess and send TR home.

Drain the abscess & send for culture. Tell TR that his teammates should see their providers for evaluation for community-associated MRSA infection. Prescribe doxycycline 100mg PO BID x 7 days.

Drain the abscess & send for culture. Tell TR that his teammates should see their providers for evaluation for community-associated MRSA

A 62 year old man with a prosthetic heart valve who will be undergoing a minor genitourinary procedure.

A 12 year old boy with congenital heart disease who will be seeing an orthodontist for placement of braces.

A 47 year old woman with history of bacterial endocarditis 2 years ago, who will be seeing a periodontist for gingival grafting.

None of the patients above require prophylaxis.

A 5 year old child receiving the flu vaccine for the first time.

A 3 month old infant.

A 12 year old child receiving the flu vaccine for the first time.

None of the above patients should receive two doses of vaccine.

Penicillin

Levofloxacin

Oseltamivir

Linezolid

Injectable influenza vaccine

Measles-Mumps-Rubella (MMR)

Pneumonia vaccine

Tetanus toxoid

Finasteride

Oxybutinin

Tolterodine

An estrogen preparation

Headache

Priapism

Visual changes

All of the above

9 million

19 million

29 million

19 thousand

It contains both Estrogen and Progesterone.

It must be inserted by a healthcare professional.

It is inserted once each month.

None of the above is FALSE.

1300 mg

1200 mg

1250 mg

1100 mg

Metronidazole

Azithromycin

Doxycycline

A and C

Women over 70 y/o who have an independent risk for fracture.

Women over 75 y/o with 2 or more risk factors.

Women over 65 y/o with confirmed osteoporosis.

All of the above.

Syphilis

Gonorrhea with probable Chlamydia

Trichomonas

Chlamydia

Progestin-only oral contraceptives have a higher failure rate than estrogen-based contraceptives when taken exactly as prescribed.

They have a higher risk of clotting associated with them versus those containing both estrogen and progestin.

There are no progestin-only oral contraceptive products on the market.

All of the above are true.

Doxycycline 100mg BID x 14 days

Ceftriaxone 1gm IV daily x 14 days

Doxycycline 100mg BID x 28 days

Both A and B are appropriate treatment

Increase total daily insulin dose by 10 units

Increase total daily insulin dose by 20 units

Increase total daily insulin dose by 40 units

Increase total daily insulin dose by 60 units

Glipizide: Hold for 48 hours prior to contrast dye procedures (i.e. cardiac catheterizations)

Repaglinide: Decreases post-prandial glucose

Metformin: Highest incidence of hypoglycemia with this oral agent

Pioglitazone: Undergoes primarily renal elimination with no hepatic metabolism

Pioglitazone

Metformin

Glipizide

Acarbose

A 60 y.o. female, weight 80kg, SCr = 1.4 mg/dl

A 42 y.o. male, weight 120kg, SCr = 0.9 mg/dl

A 64 y.o. female, weight 68kg, SCr = 1.1 mg/dl

A 56 y.o. male, weight 92kg, SCr = 1.4 mg/dl

It is a drug of choice for the treatment of hyperthyroidism.

It is a synthetic derivative of T3.

It has a half-life of approximately a week, and therefore should be titrated slowly in order to make sure a full dose-response has been realized.

Its use is contraindicated in pregnancy.

The class includes agents such as ranitidine and famotidine.

They are considered superior to the proton-pump inhibitor class for treating erosive esophagitis.

They are available as over-the-counter (OTC) preparations.

Most require dose adjustment in severe renal dysfunction.

50 units per day; half of the dose should be a long-acting analog and the other half a short-acting analog

100 units per day; 2/3 of the dose should be a long-acting analog and 1/3 should be a short-acting analog

90 units per day; half of the dose should be a long-acting analog and the other half a short-acting analog

150 units per day; 2/3 of the dose should be a long-acting analog and 1/3 should be a short-acting analog

Bisacodyl: stool softener

Lactulose: Adsorbant antidiarrheal

Psyllium: stimulant laxative

Senna: stimulant laxative

Alosetron

Loperamide

Vicodin prn pain

Selective Serotonin Reuptake Inhibitor (SSRI)

Insulin aspart, regular insulin, NPH insulin, insulin glargine

Regular insulin, insulin aspart, insulin glargine, NPH insulin

Insulin aspart, insulin glargine, regular insulin, NPH insulin

Insulin aspart, insulin glargine, NPH insulin, regular insulin

can result in rebound ocular congestion if used for greater than 5 days.

cause vasodilation and increased blood flow to the eye.

should be used for at least a week to achieve maximum efficacy.

A & B are correct.

Absolute neutrophil count

Electrocardiogram

Electroencephalogram

Serum clozapine level

Imipramine (Tofranil®)

Paroxetine (Paxil®)

Phenelzine (Nardil®)

Sertraline (Zoloft®)

Creams are oil-based preparations.

Those that contain alcohol can be drying and irritating to the skin.

Ointments are the best delivery system in terms of drug penetration.

B and C

Amantadine (Symmetrel®)

Benztropine (Cogentin®)

Diphenhydramine (Benadryl®)

Propranolol (Inderal®)

Fluoxetine (Prozac®)

Mirtazapine (Remeron®)

Paroxetine (Paxil®)

Phenelzine (Nardil®)

1 week

2 weeks

4 weeks

6 weeks

2-8 hours

2-8 days

2-8 weeks

2-8 months

Aripiprazole (Abilify®)

Clozapine (Clozaril®)

Olanzapine (Zyprexa®)

Quetiapine (Seroquel®)

Bupropion (Wellbutrin®)

Duloxetine (Cymbalta®)

Fluoxetine (Prozac®)

Vortioxetine (Brintellix®)

The pain lasts from hours to days.

The pain has minimal effects on the patients social and work activities.

Anxiety and depression are associated with the pain in a majority of patients.

Treatment often consists of short term analgesic medication.

Shortness of breath

Constipation

Dry mouth

Postural hypertension

should be applied to the same location on the body with each new application

will have decreased bioavailability/concentration if heat is applied over the patch

is a long-acting opioid medication delivery system

A and C

Medication taken Daily

Medication taken only if needed

Medication to treat an acute attack

Medication is only taken at the onset of any headache

carbamazepine

valproic acid

phenytoin

lamotrigine

Naproxen and Nexium®

Aspirin and acetaminophen

Butalbital and Acetaminophen

Sumatriptan and naproxen

Celecoxib (Celebrex®)

Valdecoxib (Bextra®)

Meloxicam (Mobic®)

A and C

Oxcarbazepine

Phenytoin

Levitiracetam

A and B

B and C

is used only to treat epilepsy

levels may increase if patients drink significant amounts of grapefruit juice

has sedation as one of it’s more common side effects

B and C

It is a live vaccine.

A patient who recently underwent bone marrow transplantation is a good candidate for the intranasal vaccine.

It is a quadrivalent vacccine.

It is contraindicated in patients with anaphylactic egg allergy.

Primary syphilis : Injectable benzathine penicillin 2.4 million units IM

Chlamydia: Azithromycin 1g PO x 1 dose

Trichomoniasis : Metronidazole 2g PO x 1 dose

All of the above are correct

Dry mouth

Urinary retention

Insomnia

Blurred vision

Angiotensin converting enzyme inhibitors

Beta-blockers

Thiazide diuretics

None of the above

It is the preservative used in the intranasal live-attenuated influenza vaccine.

It is the preservative used in multi-dose vials of influenza vaccine.

There are no influenza vaccine preparations available that are thimerosal-free.

A & B are correct

Keep MM on low-dose inhaled steroids and add salmeterol to the regimen.

Start MM on prednisone 5mg PO daily.

Discontinue the low dose steroid inhaler and replace it with salmeterol.

Add a second inhaled steroid agent to CH’s regimen.

For dry powder inhalers, even patients with very low inspiratory drive can achieve optimal medication delivery to the lungs.

If a patient has a poor inspiratory drive, a nebulizer will be an ineffective way to deliver medication.

For patients with poor inspiratory drive, the use of a spacer will worsen medication delivery to the lungs.

None of the above is true.

Infants and young children have a thicker stratum and larger body surface in relation to size, so topical absorption is more difficult than in adults.

Newborns and infants less than 6 months old have a higher rate of renal excretion than adults.

Newborns have a much higher percentage of total body water, which may impact the volume of distribution, Vd.

All of the hepatic metabolic pathways are fully developed and functional at the time of birth.

Aspirin is often used with other antiplatelet or anticoagulant medications and concomitant use does not increase the risk for bleeding.

Increasing the dose of aspirin from 81mg to 325mg will improve outcomes for all vascular disorders.

NSAIDs (ibuprofen, naproxen, ketoprofen, etc) may limit aspirin's cardioprotective effects; therefore, concomitant use of aspirin and NSAIDs is contraindicated regardless of the timing of administration.

Using the lowest dose of aspirin shown to be effective for an indication will help reduce the risk of adverse events such as bleeding.

All COPD patients should be maintained on daily, low-dose oral steroids.

If systemic steroid use is necessary to control an exacerbation, at least 6 weeks of oral steroid should be prescribed.

Chronic use of systemic steroids has been associated with an unfavorable risk to benefit ratio in COPD patients.

None of the above is true.

Decrease felodipine to 5mg PO daily and increase enalapril to 20mg PO twice daily

Decrease enalapril to 10mg PO daily and increase felodipine to 20mg PO daily

Discontinue enalapril and begin losartan 50mg PO daily

Refer to RS to a hypertension specialist

is a firstline agent for treating community acquired pneumonia.

is structurally related to macrolide antibiotics.

is rarely prescribed due to concern for hepatotoxicity.

B & C

azithromycin

doxycycline

amoxicillin

ciprofloxacin

does not require dose adjustment in severe renal dysfunction.

is a beta lactam antibiotic.

administration should be separated from oral divalent cation administration (i.e. calcium, iron, etc.) by at least two hours.

is poorly absorbed when given orally compared to the intravenous route (i.e. low bioavailability).

A 65 year-old man should receive the 23-valent conjugate vaccine.

A 1 year-old patient should receive the 23-valent vaccine.

The 7-valent vaccine has superior immunogenicity in elderly patients and is the vaccine of choice for this population.

The vaccines are interchangeable and can be given to any age group.

cephalexin

azithromycin

trimethoprim/sulfamethoxazole

ciprofloxacin

Clonidine 0.1 mg/24-hour patch

Metoprolol 2.5mg IV push

Nifedipine XL 60mg tablet

Nitroglycerin 0.4mg sublingual tablet

Steady state concentration of drug

Route of administration (i.e. oral, buccal, rectal, etc.)

Gastric pH for certain oral medications

Presence of food in the gut for certain oral medications

A 32 year old pregnant woman

A 45 year old nurse who works on an orthopedic surgery floor

A 9 year old boy

All of the above patients may receive the intranasal live-attenuated influenza vaccine.

3 hours

6 hours

24 hours

72 hours

A 24 year old woman with history of an eating disorder

A 36 year old man who is also taking phenytoin for seizure control

A 48 year old man with depression

A 32 year old pregnant woman who is making her first quit attempt

Ampicillin 2 grams PO TID x 24 hours prior to procedure

Clindamycin 600mg PO x 1 dose taken 4 hours prior to procedure

Amoxicillin 2 grams PO x 1 dose taken 1 hour prior to procedure

B & C are both correct

Therapeutic drug monitoring (obtaining drug levels) is usually unnecessary.

The provider needs to screen the patient’s regimen for CYP450 mediated drug-drug interactions if prescribing theophylline.

Theophylline monotherapy is a recommended first line treatment for asthma in adults.

The therapeutic range is 20 – 25 mg/L (or mcg/ml).

Plasma concentration

Adverse drug reaction

Receptor affinity

Nonlinear kinetics

Atorvastatin 80mg PO daily (High-dose statin intensity)

Life-style modifications only

Niacin 1500mg PO daily

Pravastatin 10mg PO daily (Low-dose statin intensity)

Aldosterone antagonists

Angiotensin converting enzyme inhibitors

Beta-blockers

Loop diuretics

It is an inactivated vaccine.

It should only be administered via the subcutaneous route.

It is contraindicated in patients with anaphylactic egg allergy.

It vaccinates against selected annual strains of influenza A and B.

Prescribe amoxicillin 500mg orally three times daily.

Explain that since her symptoms have only been going on for 2 days, she may have a viral illness and does not yet require an antibiotic prescription – she should call you if she is not better at 7 days.

Obtain a chest x-ray.

Prescribe azithromycin, 500mg PO x 1, then 250mg daily x 4 days.

albuterol inhaler: oral candidiasis

theophylline: bradycardia

ipratropium: hypersalivation

montelukast: headache

must, by law, be given to a patient or parent/guardian prior to the provider administering a vaccination.

are available in multiple languages on the CDC website.

contain information regarding possible adverse effects the patient may experience from the vaccine.

All of the above are true about vaccine information statements.

Clopidogrel use in a patient with active peptic ulcer disease.

Prasugrel use in a patient ≥ 75 years old.

Ticagrelor use with concomitant aspirin 325mg PO daily.

All of the above

should not be prescribed in the third trimester of pregnancy.

are bacteriostatic.

prevent bacteria that synthesize folic acid from reproducing.

All of the above are true.

It should be chewed in the same fashion as one would use a piece of chewing gum.

A new piece should be used every 5 minutes.

It cannot be used as monotherapy for smoking cessation.

It is associated with gastrointestinal side effects such as nausea and stomach ache.

Atorvastatin

Pravastatin

Simvastatin

Rosuvastatin

It is available by prescription only.

A common side effect is anxiety or feeling jittery.

It should be avoided in patients with severe skin conditions, such as eczema or psoriasis.

Patients should rotate the site of patch placement.

It occurs only in elderly patients.

An example is prescribing a new drug to treat a side effect caused by another drug the patient is taking.

It results in cost-savings for many patients.

It usually reduces the number of adverse drug reactions that a patient will experience.

Varenicline

Nicotine patch

Nicotine nasal spray

Nicotine lozenge

It allows for fast control of symptoms

The patient should continue to use scheduled inhalers while on a steroid burst

A steroid taper is required for a short (5 to 7 days) course of oral steroids

None of the above is false

inhibits protein synthesis in susceptible organisms.

has poor penetration into abscess fluid.

has very minimal GI side effects when compared to other antibiotic classes.

lacks activity against anaerobes.

A 5 year old child receiving the flu vaccine for the first time.

A 3 month old infant.

A 12 year old child receiving the flu vaccine for the first time.

None of the above patients should receive two doses of vaccine.

Category A: Studies have failed to show risk to the fetus if the drug is given during pregnancy.

Category B: These drugs should never be given in pregnancy.

Category X: These drugs are contraindicated only in the first trimester of pregnancy.

Category D: Studies have shown these drugs to be safe throughout pregnancy.

is dosed four times daily due to its short half-life.

is appropriate to use as monotherapy in asthma patients.

is the treatment of choice for an acute asthma exacerbation.

is an agonist at beta-2 receptors and increases cAMP.

Medium-potency inhaled steroid + albuterol MDI for rescue

Albuterol inhaler use PRN

Monotherapy with leukotriene receptor antagonist

Low-potency inhaled steroid + albuterol MDI for rescue

Valacyclovir is a prodrug of acyclovir.

If used correctly, the antivirals will eradicate the virus from the body and cure the patient’s
infection.

Acyclovir does not require dose adjustment for severe renal dysfunction.

Topical antivirals are the treatment of choice for genital herpes infection outbreaks

Injectable influenza vaccine

Injectable polio vaccine

Varicella vaccine

Tetanus toxoid

Anaphylaxis

Local irritation at site of injection of medication

Hives

Angioedema

AL should rinse her mouth after using this inhaler.

AL should bring her inhaler with her to every visit so you can assess her technique.

AL should use the beclomethasone as her rescue inhaler.

AL may use a spacer with this inhaler in order to improve technique and delivery to the lungs.

Amlodipine

Hydralazine plus isosorbide dinitrate

Hydralazine plus lisinopril

Hydrochlorothiazide

Elderly patients have an increased baroreceptor response.

Elderly patients have decreased sensitivity to medications affecting the central nervous system.

Beta agonists and antagonists usually have an increased effect in elderly patients.

All of the above statements are incorrect.

It is used primarily for its activity against aerobic bacteria.

Patients who drink alcohol need to be counseled for potential disulfuram reaction.

It has coverage against some anaerobic gram positive organisms.

It interferes with bacterial DNA synthesis.

Cefpodoxime

Moxifloxacin

Levofloxacin

Clarithromycin

cephalexin

cefpodoxime

doxycycline

dicloxacillin

there is a high percentage of free drug in the body

it always has a narrow therapeutic index

it will likely undergo first-pass metabolism

free drug concentration may be increased in patients with low albumin

Rimantadine

Oseltamivir

Zanamivir

B and C

Check thyroid function and vitamin D level

Hold simvastatin, and check a fasting lipid panel

Hold simvastatin, and check thyroid function and vitamin D level

Lower the simvastatin dose to 10mg PO daily

The potential risk appears to be independent of the steroid dose.

For severe persistent asthma, high dose inhaled steroids are likely to have less impact on growth than oral steroids.

Studies have consistently shown that low dose inhaled steroids are associated with significant growth delay.

Children should not be prescribed inhaled corticosteroids due to the risk of growth delay.

is a short-acting beta-2 receptor agonist.

should be prescribed as rescue therapy for asthmatic patients.

has a higher risk of systemic side effects compared to inhaled epinephrine.

A and B

Varicella vaccine

Injectable polio vaccine

Rabies immune globulin

MMR vaccine

all of the azole antifungal are renally eliminated and will require dose adjustment in renal dysfunction

the patient's medication list should be screened to evaluate for potential CYP450 mediated drug interactions

most infections can be treated with a single dose

None of the above need to be considered

Desired digoxin levels are between 0.5-2 ng/mL

Digoxin has a negative inotropic effect in heart failure

Patients with digoxin toxicity may present with visual disturbances or bradycardia

All of the above

Linezolid

Trimethoprim/sulfamethoxazole

Cephalexin

A & C are correct

Patients taking high dose statin therapy

Patients taking concomitant fibrate therapy

Patients with baseline liver disease

All of the above

Because they are administered by injection, LMWHs are more effective for treating VTE than warfarin; therefore they should be used when anticoagulant therapy is initiated.

Patients may tolerate LMWHs and warfarin differently. It's important to see which agent the patient tolerates best before choosing a single agent to treat VTE.

The initial protein C and S deficiency that occurs with initiation of warfarin therapy results in a temporary hypercoaguable state, and the LMWH provides anticoagulation coverage during this time.

Warfarin inhibits vitamin K dependent clotting factors which all have very short half-lives which delays the onset of warfarin's anticoagulation effect so LMWH is required at the initiation of therapy.

An 87 year-old man prescribed ibuprofen 800 mg PO TID for muscle aches.

Diazepam 10 mg PO BID for a 76 year-old woman with anxiety.

Discontinuing aspirin 81 mg PO daily with intention of reducing GI bleeding risk in a 67 year-old woman who had an MI 5 years ago.

All of the above are inappropriate scenarios.