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103 Cards in this Set
- Front
- Back
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Vitamin K given IV has a risk of the following adverse reaction: Answer AAcute dystrophy BSeizures CPeripheral neuropathy DAnaphylaxis ENeuroleptic malignant syndrome |
DAnaphylaxis |
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Why is it important for hospitals to get INRs taken at about the same time in the morning? Answer AThe INR must be taken before antibiotics are administered that day. BThe INR value will be inaccurate if taken later in the day due to the effect of meals. CThe physician will have the INR value and be able to adjust that day's warfarin dose. DAll labs are taken in the morning per most hospital's policies and procedures. EWarfarin, hence the INR, is affected by the diurnal rhythm of the body. |
CThe physician will have the INR value and be able to adjust that day's warfarin dose. |
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Choose the correct antidote to use in the case of a heparin overdose: Answer AProtamine BN-acetylcysteine CVitamin K DFlumazenil ENaloxone |
AProtamine |
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What would be expected to occur if a patient on warfarin with a stable INR is started on fluconazole? (Select ALL that apply.) Answer AThe INR would increase. BThe INR would decrease. CThe patient may clot. DThe patient may experience bleeding. EThe INR would not change. |
AThe INR would increase. DThe patient may experience bleeding. |
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When heparin is administered, the following lab value must be carefully monitored: Answer AWhite blood cells BEosinophils CPlatelets DBasophils ESodium |
CPlatelets |
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Kim is a 58 year-old female who is usually well-controlled on a warfarin regimen of 5 mg daily. Kim has been sick for the past week but feels better today. She ate little during her illness. Kim presents to the anticoagulation clinic to have her INR checked. Her INR is elevated today at 5.8. There is no noticeable bleeding and she is a low bleeding risk. Choose the preferred course of action: Answer AHold warfarin x 1 and administer phytonadione 1 to 2.5 mg orally. BOmit the next few doses, monitor frequently, and resume therapy at a lower dose when the INR is in the therapeutic range. CHold warfarin and administer phytonadione 2 mg by SC injection. DHold warfarin and administer vitamin K 5 mg orally. EHold warfarin and administer phytonadione 2 mg by IM injection. |
BOmit the next few doses, monitor frequently, and resume therapy at a lower dose when the INR is in the therapeutic range. |
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The pharmacist will counsel a patient on the correct self-administration technique for enoxaparin. Which of the following are correct counseling statements? (Select ALL that apply.) Answer AThis medication can cause you to bruise and/or bleed more easily. BChoose an area on the right or left side of your abdomen, but not within two inches from the belly button. CDo not expel the air bubble in the syringe prior to injection. DStore this medication in the refrigerator until just prior to each use. EIt is best to rub the injection site after administration to ensure quick absorption |
AThis medication can cause you to bruise and/or bleed more easily. BChoose an area on the right or left side of your abdomen, but not within two inches from the belly button. CDo not expel the air bubble in the syringe prior to injection. |
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A patient is being started on Pradaxa. Choose the correct statement regarding Pradaxa: Answer AOnce a bottle of Pradaxa is opened, the capsules must be used within 15 days. BOnce a bottle of Pradaxa is opened, the capsules must be used within 60 days. COnce a bottle of Pradaxa is opened, the capsules must be used within 90 days. DOnce a bottle of Pradaxa is opened, the capsules must be used within 120 days. EIf Pradaxa capsules are transferred to an amber container, they are good up to 2 months. |
DOnce a bottle of Pradaxa is opened, the capsules must be used within 120 days. |
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What routes of administration can heparin be given? (Select ALL that apply.) Answer AIntravenous administration BBuccal administration CIntramuscular administration DOral administration ESubcutaneous administration |
AIntravenous administration
ESubcutaneous administration |
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Which of the following organizations set the guidelines for the management of antithrombotics? Answer AThe American Society of Hypertension Physicians, published in JNC 8 BThe American Association of Clinical Endocrinologists, published in the AACE journal CThe American College of Chest Physicians: Evidence-Based Clinical Practice Guidelines, published in CHEST DThe Anticoagulation Practice Guidelines, published in Coagulation journal ENone of the above |
CThe American College of Chest Physicians: Evidence-Based Clinical Practice Guidelines, published in CHEST |
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Low molecular weight heparins have a black-box warning concerning this risk: Answer AStevens Johnson syndrome BSpinal/epidural hematoma formation CPancreatitis DSevere bleeding EAcute renal failure |
BSpinal/epidural hematoma formation |
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Annabelle is a new patient to your pharmacy. She is using enoxaparin therapy for "bridging" until the INR level is therapeutic. Annabelle brings the following over-the-counter medicines to the pharmacy window for payment: DHEA,Women's 50+ multivitamin, Advil Migraine, coenzyme Q10 and a B-Complex vitamin. The pharmacist should offer the following advice: (Select ALL that apply.) Answer ADHEA contains vitamin K and may make the warfarin ineffective. BVitamine B-complexes cannot be used with warfarin. CAdvil Migraine is not safe to use with warfarin; acetaminophen is safer. DWomen's 50+ multivitamin may increase the INR. ECoenzyme Q10 may decrease the effectiveness of warfarin. |
CAdvil Migraine is not safe to use with warfarin; acetaminophen is safer.
ECoenzyme Q10 may decrease the effectiveness of warfarin. |
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Patients may use the following non-pharmacological method to reduce the risk of venous thromboembolism: Answer AIncrease their intake of green leafy vegetables. BDo several reps of 10 deep squats daily, if the physician approves this type of exercise. CConsume lots of water. DUse intermittent pneumatic compression devices. EConsume more olive oil and green tea. |
DUse intermittent pneumatic compression devices. |
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Which of the following procedures can help reduce medication errors associated with heparin? (Select ALL that apply.) Answer ADo not use the color of the syringe or packaging to verify the dose. BProvide inservices that review heparin safety, including the lower heparin flush concentrations to the higher treatment doses. CIf possible, outsource the preparation of heparin flushes. DMake sure unit nurses prepare the heparin doses. EHave the pharmacist verify the heparin concentration for the patient's indication. |
ADo not use the color of the syringe or packaging to verify the dose. BProvide inservices that review heparin safety, including the lower heparin flush concentrations to the higher treatment doses. CIf possible, outsource the preparation of heparin flushes.
EHave the pharmacist verify the heparin concentration for the patient's indication. |
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Carmen is a 42 year-old female with a heart condition. She is presenting to the hospital with a DVT. The medical resident wishes to give her a low molecular weight heparin (LMWH), but the older physician insists on using heparin. What are advantages to the use of LMWHs over heparin? (Select ALL that apply.) Answer ALMWHs are more efficacious than heparin in treating DVTs. BLMWHs are more cost effective than heparin. CLMWHs are easier to reverse in patients that experience significant bleeding. DLMWHs do not require aPTT monitoring. ELMWHs have a more consistent anticoagulation response. |
BLMWHs are more cost effective than heparin.
DLMWHs do not require aPTT monitoring. ELMWHs have a more consistent anticoagulation response. |
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Which of the following parameters need to be monitored during heparin therapy? Answer AHematocrit, hemogloblin, platelets, and PT BHematocrit, hemoglobin, platelets, AST, and ALT CSCr, platelets, and aPTT DHematocrit, hemoglobin, platelets, and aPTT ECBC and Chem 7 panel |
DHematocrit, hemoglobin, platelets, and aPTT |
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Camden has developed a DVT and will be placed on dalteparin. Choose the correct statements concerning dalteparin: (Select ALL that apply.) Answer ADalteparin is safe to use if a person had a history of heparin-induced thrombocytopenia. BDalteparin is safe to use in a patient receiving concurrent neuraxial anesthesia. CEfficacy can be monitored with anti-Xa levels, but monitoring is not routinely required. DDalteparin can cause bleeding, hyperkalemia, and thrombocytopenia. EDalteparin is administered by intramuscular injection. |
CEfficacy can be monitored with anti-Xa levels, but monitoring is not routinely required. DDalteparin can cause bleeding, hyperkalemia, and thrombocytopenia. |
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Gene is receiving dabigatran. What is the name of the test used to monitor the dabigatran efficacy and toxicity? Answer AThe activated partial thromboplastin time BThe international normalized ratio CFactor Xa DActivated clotting time ENone of the above
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ENone of the above |
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What would be expected to occur if a patient on warfarin with a stable INR is started on phenobarbital? (Select ALLthat apply.) Answer AThe INR would increase. BThe INR would decrease. CThe patient may clot. DThe patient may experience bleeding. EThe INR would not change. |
BThe INR would decrease. CThe patient may clot. |
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What would be expected to occur if a patient on warfarin with a stable INR is started on amiodarone? (Select ALL that apply.) Answer AThe INR would increase. BThe INR would decrease. CThe patient may clot. DThe patient may experience bleeding. EThe INR would not change. |
AThe INR would increase.
DThe patient may experience bleeding. |
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Rivaroxaban works by the following mechanism of action: Answer AVitamin K antagonist BFactor Xa inhibitor CDirect thrombin inhibitor DFactor IIa inhibitor EInhibits antithombin |
BFactor Xa inhibitor |
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Henry is a 58 year-old male with atrial fibrillation. He has been using warfarin for over two years and is normally well-controlled. His cardiologist began amiodarone therapy without lowering the warfarin dose. In addition, he was started on citalopram. He is admitted to the emergency room with weakness and bleeding gums. The INR is taken and is 9.5. The hemoglobin is 8.4 g/dL. His pants are stained with blood which is coming from his rectum. Choose the correct course of action: Answer AHold warfarin x 1 dose and administer phytonadione 1 to 2.5 mg orally. BOmit the next 1-2 doses, monitor frequently, and resume therapy when the INR is in the therapeutic range. CHold warfarin and administer phytonadione 2 mg by SC injection. DHold warfarin therapy and give vitamin K 10 mg by slow IV injection along with four-factor prothrombin complex concentrate. EHold warfarin therapy and give vitamin K 10 mg by IM injection and fresh frozen plasma. |
DHold warfarin therapy and give vitamin K 10 mg by slow IV injection along with four-factor prothrombin complex concentrate. |
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Camden has developed a DVT and will be placed on dalteparin. What is the correct brand name for dalteparin? Answer ALovenox BFragmin CArixtra DPradaxa EAngiomax |
BFragmin |
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Cassandra is a 25 year-old female who is receiving warfarin for a DVT. Counseling to Cassandra should include the following: Answer AWarfarin is safe in pregnancy (Pregnancy Category A) BWarfarin may be safe in pregnancy (Pregnancy Category B) CWarfarin may be unsafe in pregnancy (Pregnancy Category C) DWarfarin is unsafe in pregnancy but can be used if the benefits outweigh the risks (Pregnancy Category D) EWarfarin is unsafe in pregnancy and cannot be used (Pregnancy Category X) |
EWarfarin is unsafe in pregnancy and cannot be used (Pregnancy Category X) |
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Which of the following statements regarding warfarin are correct? (Select ALL that apply.) Answer AThe antidote is protamine. BWarfarin blocks the activation of clotting factors II, VII, IX, and X. CPatients on warfarin should not eat any vitamin K containing foods. DWarfarin is a vitamin K antagonist. EWarfarin generally takes 2 days to become therapeutic. |
BWarfarin blocks the activation of clotting factors II, VII, IX, and X.
DWarfarin is a vitamin K antagonist. |
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A hospitalized patient developed a pulmonary embolism and was started on enoxaparin therapy. The physician began warfarin therapy on Monday and wrote an order to discontinue the enoxaparin therapy the following day. The pharmacist contacted the prescriber to recommend the following action: Answer AContinue the enoxaparin until the INR reaches the therapeutic range for one value. BContinue the enoxaparin until the INR has been therapeutic for at least 24 hours. CContinue the enoxaparin until the INR has been therapeutic for at least 48 hours. DContinue the enoxaparin for a full 7 days and the patient has been therapeutic for at least 2 of those days. EPulmonary emboli cannot be treated with warfarin; the warfarin should be discontinued. |
BContinue the enoxaparin until the INR has been therapeutic for at least 24 hours. |
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Annabelle is beginning warfarin therapy. She asks the pharmacist which foods are high in vitamin K. Which of the following foods are high in vitamin K? (Select ALL that apply.) Answer ACauliflower BCanola and soybean oils CBroccoli and brussels sprouts DFish and fish oils EGreen and black tea |
ACauliflower BCanola and soybean oils CBroccoli and brussels sprouts
EGreen and black tea |
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Shanice is a 70 year-old patient that has been using warfarin therapy in the hospital. She had a deep vein thrombosis (DVT) in her right lower leg. She is being discharged, and the outpatient pharmacist who is going to dispense her warfarin is checking her medication profile for drug interactions. She notices that the patient is using medications which increase the risk of bleeding. She will counsel the patient on increased bleeding risk. Which of the following medications can increase her bleeding risk? (Select ALL that apply.) Answer ACo-enzyme Q10 BClopidogrel CAmiodarone DGinkgo biloba ELithium |
BClopidogrel CAmiodarone DGinkgo biloba |
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Select the correct mechanism of action for Lovenox: Answer AOral direct thrombin inhibitor BInjectable direct thrombin inhibitor CVitamin K antagonist DInhibits Factor Xa and Factor IIa via antithrombin ESelectively inhibits Factor Xa |
DInhibits Factor Xa and Factor IIa via antithrombin |
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Select the correct dosing recommendation for dabigatran for a patient with a creatinine clearance of 54 mL/min: Answer ATake a 150 mg capsule twice daily, with food. BTake a 150 mg capsule twice daily, without food. CTake a 150 mg capsule twice daily, with or without food. DTake a 75 mg capsule twice daily, with or without food. ETake 150 mg capsule once daily, with food. |
CTake a 150 mg capsule twice daily, with or without food. |
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What is the purpose of using a heparin "lock-flush," such as HepFlush? Answer ATo provide systemic anticoagulation prophylaxis BTo provide systemic anticoagulation treatment CTo keep IV lines open DTo prevent HIT ETo dilute other medications going through the same IV line
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CTo keep IV lines open |
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A female patient is hospitalized with a DVT. She is pregnant. The physician will begin heparin therapy. What is the mechanism of action of heparin? Answer AHeparin potentiates factor V BHeparin potentiates factor IXa CHeparin potentiates factor Xa DHeparin potentiates antithrombin EHeparin inhibits clotting factors II, VII, IX, & X |
DHeparin potentiates antithrombin |
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Select the correct indication for dabigatran: Answer ATo provide anticoagulation in patients with acute coronary syndrome. BTo reduce the risk of stroke and blood clots in patients with non-valvular atrial fibrillation. CTo reduce the risk of stroke and blood clots in patients with ventricular tachycardia. DTo provide anticoagulation in patients who had bleeding on heparin. ETo reduce the risk of stroke and blood clots in patients with acute coronary syndome.
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BTo reduce the risk of stroke and blood clots in patients with non-valvular atrial fibrillation. |
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Roxanna is a pharmacist working in an inpatient medical ward of the local hospital. She is responsible for monitoring anticoagulation therapy. Roxanna routinely obtains laboratory parameters and adjusts the doses of low molecular weight heparins (LMWHs), as needed. Which of the following clinical situations is it appropriate to monitor the level of anticoagulation with LMWH therapy? (Select ALL that apply.) Answer APatients with a myocardial infarction BSignificant renal impairment CPregnancy DMechanical heart valves EExtremes of body weight |
BSignificant renal impairment CPregnancy DMechanical heart valves EExtremes of body weight |
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The pharmacist is counseling Annabelle, a patient beginning warfarin therapy, on how to recognize if she may be bleeding internally or externally. Signs that she may be bleeding include the following: (Select ALL that apply.) Answer AXerostomia BRed or black stools CEpistaxis DMetallic taste in mouth when she brushes her teeth EHeadaches, dizziness or weakness |
BRed or black stools CEpistaxis DMetallic taste in mouth when she brushes her teeth EHeadaches, dizziness or weakness |
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Jessica is a 62 year-old female with chronic urinary tract infections. Several times a year, she receives a prescription forBactrim. The physician suggested she use the antibiotic daily, but she prefers not to because she feels that she is already using too many medications. Jessica comes to the pharmacy today with a prescription for warfarin. She tells the pharmacist that the heart doctor found her heart was "beating funny." The pharmacist should emphasize the following counseling to Jessica: (Select ALL that apply.) Answer AIf you get a UTI, the antibiotic Bactrim could make your warfarin level increase. BWhen taking the warfarin and Bactrim, separate the doses by 4 hours to decrease the risk of the drug interaction. CThe drug interaction between warfarin and Bactrim for a UTI may lead to significant bleeding. DWarfarin can cause the Bactrim to be ineffective in treating the UTI. EMake sure to inform your health care providers that you are using warfarin so they can choose alternative medications that do not cause drug-drug interactions. |
AIf you get a UTI, the antibiotic Bactrim could make your warfarin level increase.
CThe drug interaction between warfarin and Bactrim for a UTI may lead to significant bleeding.
EMake sure to inform your health care providers that you are using warfarin so they can choose alternative medications that do not cause drug-drug interactions. |
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Emilio is receiving warfarin. What is the name of the test used to monitor warfarin efficacy and toxicity? Answer APotentiation factor BFactors II, VII, IX and X CAnti-Xa level DThe international normalized ratio EThe activated partial thromboplastin time |
DThe international normalized ratio |
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Select the correct mechanism of action for Pradaxa: Answer AOral direct thrombin inhibitor BInjectable direct thrombin inhibitor CVitamin K antagonist DOral Factor Xa inhibitor EInhibits Factor Xa and Factor IIa via antithrombin |
AOral direct thrombin inhibitor |
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Melik is a 43 year-old male who is usually well-controlled on a warfarin regimen of 7.5 mg five days weekly, and 5 mg two days weekly. He presents to the anticoagulation clinic to have his INR checked. He reports that he had an upper respiratory infection and the physician had given him a 10-day course of levofloxacin. He just took his last levofloxacin tablet this morning. His INR is elevated today at 3.5; the target therapeutic INR is 2-3. Choose the preferred course of action: Answer AHold the warfarin dose today; resume usual dosing regimen when INR is therapeutic and have the patient monitor for symptoms of bleeding. BHold warfarin and administer phytonadione 5 mg PO x 1 now. Resume warfarin when the INR is therapeutic. CHold warfarin and administer phytonadione 2 mg by SC injection. Resume warfarin when the INR is therapeutic. DHold warfarin and administer phytonadione 2 mg by IM injection. Resume warfarin when the INR is therapeutic. EHold warfarin and administer phytonadione 2 mg by IV injection. Resume warfarin when the INR is therapeutic. |
AHold the warfarin dose today; resume usual dosing regimen when INR is therapeutic and have the patient monitor for symptoms of bleeding. |
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A patient has developed heparin-induced thrombocytopenia (HIT). He requires anticoagulation therapy for a pulmonary embolism. Which of the following agents would not pose a risk for HIT in this patient? Answer AEnoxaparin BArgatroban CDalteparin DHeparin ENone of the above |
BArgatroban |
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Thomas was admitted to the local hospital for a knee replacement. Orthopedic surgery is considered high risk for venous thromboembolism (VTE) but Thomas did not receive any VTE prophylaxis. He developed a deep vein thrombosis and was discharged on warfarin. This was his first incidence of VTE. Normally, Thomas is thin and active. How long should Thomas receive warfarin? Answer AOne month BTwo months CThree months DSix months ETwelve months |
CThree months |
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Which of the following is a possible side effect from the long-term use of heparin therapy? Answer AGingival hyperplasia BOsteoporosis CGERD DHirsutism EHypokalemia
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BOsteoporosis |
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Casey is a 66 year-old male with hypertension, renal disease and degenerative joint disease. In his younger years, Casey was a football player and has lived with the pain of a hip injury for many years. He enters the hospital for elective hip replacement surgery. His creatinine clearance is 25 mL/min. The physician orders enoxaparin 30 mg SC BID for DVT prophylaxis. Choose the correct statement: Answer AThe dose is correct as ordered. BThe dose should be 60 mg SC daily. CThe dose should be 45 mg SC daily. DThe dose should be 30 mg SC daily. EThe patient should receive heparin for DVT prophylaxis.
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DThe dose should be 30 mg SC daily. |
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Which of the following scenarios are the injectable direct thrombin inhibitors considered the drugs of choice? Answer ATo provide anticoagulation in patients who have heparin-induced thrombocytopenia (HIT). BTo provide anticoagulation in patients who had a recent intracranial hemorrhage. CTo provide anticoagulation in patients who had heparin-induced hyperkalemia. DTo provide better anticoagulation in ACS patients. EFor patients who are allergic to latex. |
ATo provide anticoagulation in patients who have heparin-induced thrombocytopenia (HIT). |
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Helen is receiving a heparin drip. What is the name of the test used to monitor for heparin efficacy? Answer APotentiation factor BFactors IIa, VIIa, IXa and Xa test CActivated clotting time DInternational normalized ratio EThe activated partial thromboplastin time |
EThe activated partial thromboplastin time |
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Jeremiah is being started on apixaban. He is 6'1" and weighs 214 lbs. His recent laboratory parameters include a Na+ 139 mEq/L and SCr of 1.1 mg/dL. Which of the following statements are correct regarding apixaban for this patient? Answer AHe should be started on apixaban 5 mg daily. BApixaban must be taken with food. CApixaban is indicated for treatment of VTE. DApixaban is indicated for stroke prevention in patients with prosthetic heart valves. EApixaban carries a black box warning regarding the risk of stroke in patients who discontinue therapy prematurely.
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EApixaban carries a black box warning regarding the risk of stroke in patients who discontinue therapy prematurely. |
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Which of the following is the most likely adverse effect from the use of heparin? Answer ALeukopenia BHypercalcemia CBleeding DDecreased cognitive function ELupus like syndrome |
CBleeding |
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Select the correct statement concerning Pradaxa: (Select ALL that apply.) Answer AIt is indicated for patients with valvular atrial fibrillation to reduce the risk of stroke. BIt has more drug and food interactions than warfarin. CIt causes the same amount of GI bleeding as warfarin. DIt does not require blood tests to monitor for effectiveness. EIt does not have an antidote.
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DIt does not require blood tests to monitor for effectiveness. EIt does not have an antidote. |
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A hospitalized patient is post-op day #1 after a right hip arthroplasty. The patient has a history of a previous VTE. The doctor has recommended that the patient begin warfarin with Lovenox bridge therapy but the patient responds that he does not wish to take "rat poison". The pharmacy intern wants to explain to the patient the risks associated with not taking an anticoagulant, when indicated. The intern should explain to the patient that he is at higher risk for the following complications if he chooses not to use the warfarin: (Select ALL that apply.) Answer ADeep vein thrombosis BPulmonary embolism CBleeding DPleural Effusion ECardiac Tamponade
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ADeep vein thrombosis BPulmonary embolism |
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How long should peri-operative antibiotic prophylaxis be continued for most surgeries? Answer A5 days B7 days C10 days D1 day or less E2 days |
D1 day or less |
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Which antimicrobial is not considered to be part of the standard therapeutic regimens for treating Helicobacter pyloriinfections? Answer AAmoxicillin BClarithromycin CTelithromycin DTetracycline EMetronidazole |
CTelithromycin |
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Which of the following statements regarding fidaxomicin is correct? Answer AClinical evidence supports that fidaxomicin is more efficacious than metronidazole BClinical evidence supports that fidaxomicin is less efficacious than metronidazole CClinical evidence supports that fidaxomicin is more efficacious than vancomycin DClinical evidence supports that fidaxomicin is equally as efficacious as vancomycin EClinical evidence supports that fidaxomicin is less efficacious than vancomycin
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DClinical evidence supports that fidaxomicin is equally as efficacious as vancomycin |
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Eleanor, a 62 year-old female, is receiving metronidazole intravenously for a Bacteroides fragilis infection. Choose the correct statement for metronidazole when given intravenously: Answer AThis medication should be stored at room temperature; refrigeration may cause crystallization. BThis medication should be infused no faster than 2.5 mg/min. CUse a slow infusion rate or severe hypotension could result. DDo not use this medication if gout is present. EThere is no interaction with warfarin or other anticoagulants. |
AThis medication should be stored at room temperature; refrigeration may cause crystallization. |
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JM is a 50 year old man recently diagnosed with a mild case of Clostridium difficile-associated diarrhea. He has a serum white blood cell count of 14,000 cells/mm3 and a SCr of 1.0 mg/dL with 6-8 loose bowel movements per day. What would be the most appropriate therapy for JM? Answer AMetronidazole 500 mg IV Q6H BMetronidazole 500 mg PO TID CVancomycin 125 mg PO QID DVancomycin 500 mg PO QID EVancomycin 125 mg PO QID and metronidazole 500 mg IV Q8H |
BMetronidazole 500 mg PO TID |
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Which of the following classes of antibiotics work by concentration-dependent killing? Answer ATetracyclines BCarbapenems CFluoroquinolones DMacrolides EStreptogramins |
CFluoroquinolones |
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Becky is a 34 year old female who was recently diagnosed with an uncomplicated urinary tract infection (UTI). She has a history of VRE in the past. She has an allergy history of hives to several antibiotic drug classes including penicillin, sulfa, nitrofurantoin and fluoroquinolones. Which of the following medications would be the best choice to treat Becky's UTI? Answer ANorfloxacin BAmpicillin-sulbactam CFosfomycin DBactrim EFidaxomicin |
CFosfomycin |
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Itraconazole is used for a variety of fungal infections including blastomycosis, histoplasmosis, aspergillosis and onychomycosis. Itraconazole cannot be used with certain drugs. Which of the following drugs is contraindicated with the use of itraconazole? Answer ACetirizine BQuinidine CZafirlukast DAzithromycin EAmphotericin B |
BQuinidine |
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Stephanie, a 49 year-old female, is picking up a prescription for moxifloxacin. Her medical history is significant for dyslipidemia, diabetes, atrial fibrillation and osteoporosis. She is currently taking atorvastatin, amiodarone, sitagliptin, exenatide, metformin, calcium citrate, and vitamin D. Which of the following can be caused by potential drug interactions of all these medications? (Select ALL that apply.) Answer AQT prolongation BImpaired absorption of moxifloxacin CHypoglycemia or hyperglycemia DPeripheral edema, fluid retention due to quinolone addition EAdditive nephrotoxicity
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AQT prolongation BImpaired absorption of moxifloxacin CHypoglycemia or hyperglycemia |
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Which cephalosporin can be dosed once daily in patients with normal renal function? Answer ACeftaroline BCefuroxime CCeftazidime DCefepime ECeftriaxone |
ECeftriaxone |
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Based on national resistance rates, which of the following antibiotics is considered to be least effective in treating MRSA skin and soft tissue infections empirically? Answer AClindamycin BVancomycin CLinezolid DDaptomycin ETelavancin |
AClindamycin |
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A 42 year-old female patient is choosing an OTC product for a vaginal fungal infection. She has had three vaginal fungal infections in three months. She is overweight and is eating a candy bar. She should be recommended to have the following conditions tested: Answer ADiabetes and HIV BCancer and neoplasm CHypothyroidism and hepatitis DSinusitis and otitis media EBipolar and schizophrenia
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ADiabetes and HIV |
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When should peri-operative antibiotic prophylaxis with cefazolin be initiated in patients undergoing elective surgeries such as hip arthroplasty? Answer AWithin 1 hour of incision BWithin 2 hours of incision CWithin 3 hours of incision DWithin 2 hours after the surgery is over EImmediately after the surgery is over |
AWithin 1 hour of incision |
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Charles comes to the clinic and is diagnosed with syphilis. Choose the correct statement: Answer ASyphilis is due to an infection caused by the organism Syphilis pallidum. BThe treatment for early syphilis is Bicillin CR. CPrimary syphilis presents as a painful, oozing lesion several days after infection. DThe treatment for neurosyphilis is doxycycline. EDoxycycline is an alternative for primary syphilis if the patient was allergic to penicillin. |
EDoxycycline is an alternative for primary syphilis if the patient was allergic to penicillin |
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Which of the following statements is correct regarding intravenous ampicillin? Answer AAmpicillin is compatible with D5W for 24 hours under refrigeration. BAmpicillin is compatible with D5W for 8 hours at room temperature CAmpicillin is compatible with NS for 8 hours at room temperature. DAmpicillin is compatible with NS for 4 days under refrigeration EAmpicillin does not come in an intravenous formulation. |
CAmpicillin is compatible with NS for 8 hours at room temperature. |
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YS is an 8 year old male who was found to be colonized with methicillin-resistant Staphylococcus aureus. He was seen at an outpatient clinic for his first ever skin infection, a pustule and probable cellulitis. What is the most appropriate oral antibiotic therapy for YS? Answer ACetriaxone BCiprofloxacin CClindamycin DVancomycin EMinocycline
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CClindamycin |
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Tessa is a 22 year-old female who has a serious intra-abdominal gram-negative infection. She has been in the hospital for 12 days and is suffering from moderate renal impairment. The medical team wants to treat her infection but not put her kidneys at risk for further toxicity. Which of the following antibiotics do not require dose adjustment in moderate renal impairment? Answer APiperacillin/tazobactam BCiprofloxacin CVancomycin DCefepime ETigecycline |
ETigecycline |
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A patient presents with a mild-moderate Clostridium difficile infection. What is the best treatment option for this patient? Answer AVancomycin 125 mg PO QID 10-14 days. BVancomycin 250 mg PO QID x 7-10 days. CMetronidazole 500 mg PO three times daily x 10-14 days. DMetronidazole 500 mg PO three times daily x 7-10 days. EMetronidazole 250 mg PO BID x 14 days. |
CMetronidazole 500 mg PO three times daily x 10-14 days. |
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DT is a 29-year-old, 45 kg female who was hospitalized for observation due to a minor motor vehicle accident (MVA). She is ready to be discharged home, but the following organisms grew out of her urine culture. Her urinalysis confirms a lower urinary tract infection and she has normal kidney function. Culture and Sensitivity Report for Pseudomonas aeruginosaAmikacin - S Ciprofloxacin - S Gentamicin - R Tobramycin - S Levofloxacin - S Piperacillin/tazobactam - S Cefepime - R Imipenem - S TMP/SMX - R Culture and Sensitivity Report for Klebsiella pneumoniae Amikacin - S Ciprofloxacin - R Gentamicin - R Tobramycin - R Levofloxacin - R Piperacillin/tazobactam - S Cefepime - S Imipenem - S TMP/SMX - S Based on the culture and sensitivity reports (shown above), select the most appropriate outpatient treatment regimen for DT's urinary tract infection. Answer APiperacillin-tazobactam 4.5 gm IV Q6H BAmikacin 5 mg/kg IV Q8H CCiprofloxacin 750 mg PO daily and sulfamethoxazole-trimethoprim 1 DS PO BID DCiprofloxacin 750 mg PO BID ELevofloxacin 750 mg PO daily and Cefazolin 1 gm IV Q8H |
CCiprofloxacin 750 mg PO daily and sulfamethoxazole-trimethoprim 1 DS PO BID |
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Ryan is a 70-year-old male who lives in a skilled nursing facility. He has been complaining about urinary urgency and painful urination. His laboratory tests are negative for all sexually transmitted diseases, but positive for an Extended Spectrum Beta-Lactamase (ESBL) producing Klebsiella pneumoniae. What empiric antimicrobial regimen would you recommend for Ryan? Answer APiperacillin-tazobactam BErtapenem CTicarcillin-clavulanic acid DCefepime ECeftaroline |
BErtapenem |
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A patient has an MRSA wound infection. She has heart failure and impaired renal function with an estimated creatinine clearance of 40 mL/min. Her current medications include metoprolol extended-release, lisinopril and furosemide. She is going to receive intravenous vancomycin while in the hospital. Choose the correct statement: Answer AVancomycin should not be used in patients with heart failure. BShe should receive the vancomycin orally due to the risk of further renal insufficiency. CShe is at an elevated risk of ototoxicity due to the concurrent use of furosemide. DThe trough is not important; only vancomycin peaks should be monitored. EShe should receive ceftazidime instead of vancomycin. |
CShe is at an elevated risk of ototoxicity due to the concurrent use of furosemide. |
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Linezolid will most likely have a drug-drug interaction with which of the following medications? Answer AVenlafaxine BMetoprolol CEnalapril DCalcium carbonate EAmpicillin |
AVenlafaxine |
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Choose an acceptable treatment option for daily suppressive therapy for a herpes simplex genital infection: Answer AAcyclovir 400 mg PO BID BGanciclovir 250 mg PO BID CValganciclovir 500 mg PO daily DFamciclovir 2,000 mg PO daily EFoscarnet 50 mg IV daily
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AAcyclovir 400 mg PO BID |
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A patient presents to the physician with the following symptoms: productive cough with blood, fatigue, night sweats and poor appetite. He has lost 16 pounds unintentionally over the past few months. He is likely to be tested positive for the following infection: Answer ALung cancer BCrohn's disease CHIV disease DTuberculosis EInfluenza
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DTuberculosis |
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What are acceptable treatment options for latent tuberculosis? (Select ALL that apply.) Answer AIsoniazid BAzithromycin CRifampin + pyrazinamide DPyrazinamide ERifampin |
AIsoniazid
ERifampin |
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A nine year-old girl has an acute otitis media infection. Her mother has received a prescription for antibiotics and was told to watch the girl first to see if she improves, prior to filling the prescription. The mother is fine with this plan, but wants something now to treat the child's ear pain. Which of the following are acceptable options for her daughter's ear pain? (Select ALL that apply.) Answer AAcetaminophen BAspirin CIbuprofen DTopical benzocaine otic drops EDebrox
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AAcetaminophen
CIbuprofen DTopical benzocaine otic drops
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When a patient is diagnosed with community acquired Clostridium difficile-associated diarrhea (CDAD) for the first time, what measures should be taken to minimize therapeutic failure? Answer ADiscontinue the offending antimicrobial agent(s) as soon as possible BInitiate antiperistaltic drugs such as loperamide immediately CInitiate monotherapy treatment and continue for 30 days to ensure eradication of CDAD DInitiate combination therapy immediately EStart on probiotics immediately |
ADiscontinue the offending antimicrobial agent(s) as soon as possible |
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Regimens for treating TB have an initial phase of 2 months, followed by a choice of several options for the continuation phase of either 4 or 7 months (or longer). Which medications are included in the preferred treatment regimen for the initial phase of TB? Answer AIsoniazid, rifampin, ethambutol, pyridoxine BIsoniazid, rifampin, streptomycin, pyrazinamide CIsoniazid, rifampin, ethambutol, pyrazinamide DIsoniazid, ethambutol, pyrazinamide, pyridoxine EIsoniazid, rifampin, ethambutol, kanamycin
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CIsoniazid, rifampin, ethambutol, pyrazinamide |
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A patient is taking Moxatag for treatment of strep throat. Which of the following statements is correct regarding Moxatag? Answer AThis medication can be used in patients with a creatinine clearance less than 30 mL/min. BAdminister within 1 hour of finishing a meal. CMoxatag should be stored in the refrigerator. Main side effects are rash, gastrointestinal upset, and diarrhea. DMoxatag is an extended release product delivered by the osmotic-controlled release oral delivery system (OROS). EMoxatag is safe to use in a patient who has a penicillin allergy. |
BAdminister within 1 hour of finishing a meal. |
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Which of the following antibiotics require dose adjustment for severe renal dysfunction (CrCl < 30 mL/min)? (Select ALLthat apply.) Answer ADoxycycline BPiperacillin/Tazobactam CDaptomycin DNafcillin ECiprofloxacin |
BPiperacillin/Tazobactam CDaptomycin
ECiprofloxacin |
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Which of the following statements concerning Nizoral A-D is correct? Answer AIt contains clotrimazole 1%. BIt contains clotrimazole 2%. CIt contains ketoconazole 2%. DIt contains itraconazole 1.5%. EIt contains ketoconazole 1%. |
EIt contains ketoconazole 1%. |
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In patients with infective endocarditis who are receiving traditional dosing of gentamicin in combination with vancomycin, what is the peak goal for gentamicin? Answer A1 mcg/mL B2 mcg/mL C4 mcg/mL D5 mcg/mL E10 mcg/mL |
C4 mcg/mL |
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A patient is picking up a prescription for erythromycin ethylsuccinate (E.E.S.) oral suspension. Choose the correct statement: Answer AThis medication cannot be used if the patient has a penicillin allergy. BThis medication should not be administered with food. CThis medication is a major inhibitor of cytochrome P450 2C9. DThis medication is effective for treating the flu. EThis medication should be refrigerated.
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EThis medication should be refrigerated. |
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A man with chills and a fever sneezes and coughs inside a crowded bus. The other passengers in the bus may have been put at risk of contracting the following conditions which are transmitted by aerosolized droplets, via sneezing or coughing: (Select ALL that apply.) Answer ATuberculosis BVaricella CClostridium difficile DTrichomoniasis EInfluenza |
ATuberculosis BVaricella
EInfluenza |
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Zosyn is a commonly used medication in hospitals since it has broad spectrum coverage. Zosyn contains: Answer AImipenem and cilastatin BTicarcillin and tazobactam CTicarcillin and clavulanic acid DPiperacillin and tazobactam EPiperacillin and clavulanic acid |
DPiperacillin and tazobactam |
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Patricia works as a home health nurse. She visits patients with tuberculosis (TB) and watches them take their medication. Choose the correct statements: (Select ALL that apply.) Answer AThe primary purpose is to increase adherence and reduce the risk to the public health. BThe TB medications, if used in this type of program, can be dosed twice or three times weekly instead of daily. CRifampin cannot be used in a DOT program DDOT is not necessary for TB as this infection is not fatal. EThis is called directly observed therapy (DOT). |
AThe primary purpose is to increase adherence and reduce the risk to the public health. BThe TB medications, if used in this type of program, can be dosed twice or three times weekly instead of daily.
EThis is called directly observed therapy (DOT). |
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Which of the following patients is a good candidate for antimicrobial prophylaxis prior to a dental procedure? Answer AA patient with heart failure BA patient with atrial fibrillation CA patient with GERD DA patient with a prosthetic heart valve EA patient with a history of bacteremia
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DA patient with a prosthetic heart valve |
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Which of the following is a common goal associated with Antimicrobial Stewardship Programs? Answer APromoting carbapenem utilization BReducing the emergence of resistance and toxicity associated with antimicrobial agents. CMinimizing the bulk of the pharmacy budget being spent on antimicrobials DReducing physician autonomy EMinimizing inter-disciplinary relationships |
BReducing the emergence of resistance and toxicity associated with antimicrobial agents |
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Choose the correct statement concerning vancomycin pharmacodynamics/pharmacokinetics and therapeutic drug monitoring. (Select ALL that apply). Answer AVancomycin exhibits concentration-dependent kill. BTreating pneumonia requires higher troughs (15-20 mcg/mL) as vancomycin has relatively poor lung penetration. CAlternative agents should be considered if the MIC of an organism is ≥ 2 mcg/mL. DTreating meningitis requires a higher trough (15-20 mcg/mL) as vancomycin has poor CNS penetration. EVancomycin troughs should be drawn before the fourth dose. |
BTreating pneumonia requires higher troughs (15-20 mcg/mL) as vancomycin has relatively poor lung penetration. CAlternative agents should be considered if the MIC of an organism is ≥ 2 mcg/mL. DTreating meningitis requires a higher trough (15-20 mcg/mL) as vancomycin has poor CNS penetration. EVancomycin troughs should be drawn before the fourth dose. |
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Roger is a 58 year-old male who is in the medical intensive care unit with a severe Pseudomonas aeruginosa infection. He is on ciprofloxacin and cefepime and his infection does not seem to be clearing. Which of the following medications should be used to replace the current therapy? Answer ADoripenem BErtapenem CLinezolid DMinocycline ETigecycline |
ADoripenem |
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Mr. Smith comes to the pharmacy with a prescription for azithromycin for treatment of his community-acquired pneumonia. Choose the common etiologies of community-acquired pneumonia: (Select ALL that apply.) Answer APseudomonas BEnterococcus CStreptococcus pneumoniae DMycoplasma pneumoniae EHaemophilus influenza |
CStreptococcus pneumoniae DMycoplasma pneumoniae EHaemophilus influenza |
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Gerri is receiving amphotericin B deoxycholate for treatment of aspergillosis. Which of the following side effects are most likely to occur with treatment? Answer AHyponatremia, hypocalcemia, hypokalemia BHyponatremia, hypokalemia, chest tightness CHypocalcemia, hyperkalemia, leucopenia DHypomagnesemia, hypokalemia, rigors EHyperkalemia, hypermagnesemia, hypotension
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DHypomagnesemia, hypokalemia, rigors |
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Which of the following are common components of Antimicrobial Stewardship Programs? (Select ALL that apply.) Answer AAntimicrobial pre-authorization policy BOpen formulary policy CIntravenous to oral switching protocol DDe-escalation of therapy EDisease care pathways or protocols |
AAntimicrobial pre-authorization policy
CIntravenous to oral switching protocol DDe-escalation of therapy EDisease care pathways or protocols |
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Don comes to the hospital from a skilled nursing facility with signs and symptoms of a severe infection. His cultures are positive for MRSA. Upon further work up, the MRSA is found to have a vancomycin minimum inhibitory concentration (MIC) of 4 mcg/mL. The medical team is asking you about whether vancomycin should be used in this patient. Which of the following statements regarding vancomycin use in this patient is correct? Answer AVancomycin should be diluted in normal saline only. BVancomycin should be stored at room temperature. Refrigeration causes crystallization. CVancomycin should not be used in this patient due to the high MIC. DVancomycin can be used in this patient as long as the trough level is between 15-20 mcg/mL. EVancomycin should be used in this patient as long as higher doses are used. |
CVancomycin should not be used in this patient due to the high MIC. |
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PM is a 70 year old man who was recently diagnosed as having a severe case of Clostridium difficile-associated diarrhea. He has a serum white blood cell count of 24,000 cells/mm3 and a SCr of 2.2 mg/dL with 6-7 loose bowel movements per day. What would be the most appropriate therapy for PM? Answer AMetronidazole 500 mg IV QID BVancomycin 125 mg PO QID and metronidazole 500 mg IV Q8H CMetronidazole 500 mg PO TID DVancomycin 500 mg IV QID EVancomycin 125 mg PO QID
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EVancomycin 125 mg PO QID |
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A patient is starting quadruple therapy for treatment of active tuberculosis. Rifampin is part of the regimen. Which of the following is correct regarding rifampin therapy? Answer AThis medication should be taken with meals. BThis medication is a potent inhibitor of many hepatic enzymes leading to many drug interactions. CThis medication can cause orange-red discoloration of body secretions and stain contact lenses. DThis medication can cause optic neuritis. EThis medication is taken three times daily. |
CThis medication can cause orange-red discoloration of body secretions and stain contact lenses. |
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Which of the following statements concerning bronchitis are correct? (Select ALL that apply.) Answer AMost cases of acute bronchitis are viral; antibiotics will not help BIn mild-moderate cases of acute bronchitis, treatment is generally supportive. CIt is best to suppress a cough that brings up mucus. DAntibiotics may be considered for patients who meet the definition of acute exacerbation of chronic bronchitis. EAntibiotics are utilized when fever is present. |
AMost cases of acute bronchitis are viral; antibiotics will not help BIn mild-moderate cases of acute bronchitis, treatment is generally supportive.
DAntibiotics may be considered for patients who meet the definition of acute exacerbation of chronic bronchitis. |
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Tommy is picking up a prescription for Keflex. Tommy should be counseled on the following points: (Select ALL that apply.) Answer AIt is important to finish the entire course of therapy even if you start feeling better. BThis medication can increase your risk of sunburn. CThe medication can cause a rash, GI upset, and diarrhea. DThis medication may darken your urine. EIf your symptoms worsen, contact your doctor. |
AIt is important to finish the entire course of therapy even if you start feeling better.
CThe medication can cause a rash, GI upset, and diarrhea.
EIf your symptoms worsen, contact your doctor. |
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HM is a 45 year old female who was recently diagnosed with mild-moderate Clostridium difficile-associated diarrhea (CDAD) and was treated with metronidazole 2 weeks ago. HM now has his first recurrent episode of CDAD of the same severity. What treatment should HM receive now? Answer AMetronidazole 500 mg IV Q6H BMetronidazole 500 mg PO TID CVancomycin 125 mg PO QID DVancomycin 500 mg PO QID EFidaxomicin 200 mg PO BID |
BMetronidazole 500 mg PO TID |
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Jeannie is being transitioned from ciprofloxacin intravenous to ciprofloxacin oral suspension. Which of the following statements regarding ciprofloxacin oral suspension are true? (Select ALL that apply.) Answer AThis agent may prolong the QT interval. BThe patient's blood sugar may be affected. CThis medication should not be given through feeding tubes. DThis agent can cause peripheral neuropathies. EThis medication should be shaken prior to use. |
AThis agent may prolong the QT interval. BThe patient's blood sugar may be affected. CThis medication should not be given through feeding tubes. DThis agent can cause peripheral neuropathies. EThis medication should be shaken prior to use. |
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A physician calls and asks the pharmacist to provide information on the drug telithromycin. Choose the correct statement: Answer AThis drug can cause acute hepatic failure. BThis drug covers gram negative organisms only. CThe brand name is Vibativ. DThis drug is not associated with visual disturbances. EThe brand name is Tygacil. |
AThis drug can cause acute hepatic failure |
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Many patients test positive for tuberculosis (TB). Which of the following patients should be given treatment for latent tuberculosis if the Mantoux tuberculin skin test has an induration of 8 mm? (Select ALL that apply.) Answer APersons with a close contact of a known TB case. BHIV-infected persons. CHealthcare worker. DPatients without any known risk factors who are over 35 years of age. EPersons who are immunocompromised. |
APersons with a close contact of a known TB case. BHIV-infected persons.
EPersons who are immunocompromised. |
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Many hospitalized patients with MRSA skin and soft tissue infections are typically treated with IV therapy and transitioned to an oral agent to allow ease of use and discharge from the hospital. Prior to sending patients home on clindamycin, what test should be performed to ensure clindamycin's effectiveness? Answer AHodge test BD-test CE-test DSynergy test EMBC test |
BD-test |
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A 43 year-old woman went to the doctor complaining of urinary frequency and urgency. She has a history of hypertension and migraine headaches. Her medications include atenolol 50 mg daily and sumatriptan 50 mg as-needed. Her listed allergies are trimethoprim-sulfamethoxazole (rash) and ciprofloxacin (headache, joint pain). She has been diagnosed with a urinary tract infection (UTI). Choose the correct statement: Answer AThe patient should be treated with Bactrim, the drug of choice for community-acquired UTIs. BMost cases of community-acquired UTI are caused by S. pneumonia. CThe patient should be treated with nitrofurantoin for an uncomplicated UTI. DThe patient should be treated with clindamycin. EThe patient should be treated with moxifloxacin for 3 days. |
CThe patient should be treated with nitrofurantoin for an uncomplicated UTI. |
