Pharmacy Therapeutics 3 — Questions and Answers
Question 1: A patient with COPD and chronic stable angina needs a beta-blocker. Which agent is most appropriate?
- Propranolol
- Metoprolol succinate (Correct answer)
- Carvedilol
- Nadolol
Correct answer: Metoprolol succinate
Metoprolol succinate is a cardioselective beta-1 blocker that minimizes bronchoconstriction risk compared to non-selective agents in patients with COPD.
Question 2: Clindamycin is used to treat infections caused by which of the following organisms?
- Pseudomonas aeruginosa
- Methicillin-resistant Staphylococcus aureus (MRSA) (Correct answer)
- Enterococcus faecalis
- Klebsiella pneumoniae
Correct answer: Methicillin-resistant Staphylococcus aureus (MRSA)
Clindamycin has activity against MRSA in skin and soft tissue infections and also provides anaerobic coverage.
Question 3: Which disease-modifying antirheumatic drug (DMARD) requires baseline and periodic ophthalmology exams due to risk of retinal toxicity?
- Methotrexate
- Leflunomide
- Hydroxychloroquine (Correct answer)
- Sulfasalazine
Correct answer: Hydroxychloroquine
Hydroxychloroquine can deposit in the retina causing irreversible macular toxicity, so annual ophthalmologic exams are mandatory.
Question 4: A patient presents with opioid overdose. Which reversal agent is administered, and what is its mechanism?
- Flumazenil — GABA antagonist
- Naloxone — opioid receptor antagonist (Correct answer)
- Physostigmine — AChE inhibitor
- Neostigmine — nicotinic agonist
Correct answer: Naloxone — opioid receptor antagonist
Naloxone competitively antagonizes mu, kappa, and delta opioid receptors, rapidly reversing respiratory depression caused by opioid overdose.
Question 5: A patient with major depressive disorder fails two adequate SSRI trials. What is the most appropriate next step according to treatment guidelines?
- Add lithium augmentation immediately
- Switch to a different SSRI
- Switch to an SNRI or add augmentation with atypical antipsychotic (Correct answer)
- Start ECT
Correct answer: Switch to an SNRI or add augmentation with atypical antipsychotic
After failure of two SSRIs, switching to an SNRI or augmenting with bupropion, atypical antipsychotics, or lithium is guideline-recommended before escalating to ECT.
Question 6: Which aminoglycoside dosing strategy is preferred to maximize efficacy and minimize nephrotoxicity?
- Multiple daily dosing (MDD)
- Extended-interval (once-daily) dosing (Correct answer)
- Continuous infusion
- Loading dose only
Correct answer: Extended-interval (once-daily) dosing
Extended-interval (once-daily) aminoglycoside dosing exploits concentration-dependent killing and allows a drug-free interval that reduces renal and cochlear toxicity.
Question 7: A patient using long-term oral corticosteroids is at risk for which metabolic complication requiring prophylactic treatment?
- Hypocalcemia from vitamin D toxicity
- Osteoporosis requiring calcium and vitamin D supplementation (Correct answer)
- Hyperkalemia requiring potassium restriction
- Hypothyroidism requiring levothyroxine
Correct answer: Osteoporosis requiring calcium and vitamin D supplementation
Chronic corticosteroid use suppresses bone formation and calcium absorption, necessitating calcium, vitamin D, and often bisphosphonate prophylaxis.
Pharmacy Therapeutics 3
A patient with COPD and chronic stable angina needs a beta-blocker.
Which agent is most appropriate?