CCP Drug Therapy Management 2 — Questions and Answers
Question 1: An elderly patient with heart failure is prescribed spironolactone. Which monitoring parameter is most critical?
- Serum potassium (Correct answer)
- Serum sodium
- Blood glucose
- Liver enzymes
Correct answer: Serum potassium
Spironolactone is a potassium-sparing diuretic that can cause hyperkalemia, which is especially dangerous in heart failure patients.
Question 2: A consultant pharmacist identifies that a nursing home resident on warfarin has an INR of 4.8 with no signs of bleeding. What is the most appropriate initial intervention?
- Hold warfarin and recheck INR in 1-2 days (Correct answer)
- Administer vitamin K 10 mg IV immediately
- Continue current dose and recheck in 1 week
- Discontinue warfarin permanently
Correct answer: Hold warfarin and recheck INR in 1-2 days
For supratherapeutic INR without serious bleeding, holding warfarin and rechecking the INR in 1-2 days is the standard approach per CHEST guidelines.
Question 3: Which medication class is considered first-line therapy for reducing cardiovascular events in type 2 diabetes patients with established atherosclerotic cardiovascular disease?
- GLP-1 receptor agonists or SGLT-2 inhibitors (Correct answer)
- Sulfonylureas
- Alpha-glucosidase inhibitors
- Thiazolidinediones
Correct answer: GLP-1 receptor agonists or SGLT-2 inhibitors
ADA guidelines recommend GLP-1 receptor agonists or SGLT-2 inhibitors with proven cardiovascular benefit as preferred add-on therapy in T2DM with ASCVD.
Question 4: A patient taking methotrexate for rheumatoid arthritis should receive supplementation with which vitamin to reduce toxicity?
- Folic acid (Correct answer)
- Vitamin B12
- Vitamin D
- Vitamin C
Correct answer: Folic acid
Folic acid supplementation reduces methotrexate-associated adverse effects such as mucositis, nausea, and hepatotoxicity without reducing efficacy.
Question 5: Which antibiotic class is associated with QT prolongation and should be used cautiously in patients on antipsychotics?
- Fluoroquinolones (Correct answer)
- Penicillins
- Tetracyclines
- Aminoglycosides
Correct answer: Fluoroquinolones
Fluoroquinolones prolong the QT interval and can have an additive effect when combined with antipsychotics, increasing the risk of torsades de pointes.
Question 6: A long-term care resident on bisphosphonate therapy for osteoporosis reports new jaw pain following a dental procedure. What condition should be suspected?
- Osteonecrosis of the jaw (Correct answer)
- Trigeminal neuralgia
- Temporomandibular joint disorder
- Pericoronitis
Correct answer: Osteonecrosis of the jaw
Bisphosphonate-related osteonecrosis of the jaw (BRONJ) is a serious adverse effect characterized by exposed jaw bone after dental procedures.
Question 7: Which pharmacokinetic change associated with aging most significantly affects the dosing of lipid-soluble drugs in elderly patients?
- Increased volume of distribution due to increased body fat (Correct answer)
- Decreased volume of distribution due to decreased body fat
- Increased renal clearance
- Decreased protein binding
Correct answer: Increased volume of distribution due to increased body fat
Aging increases the proportion of body fat relative to lean mass, expanding the volume of distribution for lipid-soluble drugs and prolonging their half-life.
CCP Drug Therapy Management 2
An elderly patient with heart failure is prescribed spironolactone.
Which monitoring parameter is most critical?