Pharmacy Therapeutics 5 — Questions and Answers
Question 1: A patient with gout has a serum uric acid of 9.2 mg/dL and frequent flares. What is the target serum uric acid level with urate-lowering therapy?
- <8 mg/dL
- <7 mg/dL
- <6 mg/dL (Correct answer)
- <5 mg/dL
Correct answer: <6 mg/dL
The ACR recommends a serum uric acid target of <6 mg/dL to prevent urate crystal deposition and reduce gout flare frequency.
Question 2: Which antifungal agent works by inhibiting ergosterol synthesis through binding to lanosterol 14α-demethylase?
- Amphotericin B
- Caspofungin
- Fluconazole (Correct answer)
- Nystatin
Correct answer: Fluconazole
Azoles like fluconazole inhibit fungal CYP51 (lanosterol 14α-demethylase), blocking ergosterol synthesis and disrupting the fungal cell membrane.
Question 3: A patient receiving vancomycin develops flushing, erythema, and pruritis over the neck and upper torso during infusion. What is this reaction called and how is it managed?
- Anaphylaxis — administer epinephrine
- Red man syndrome — slow the infusion rate (Correct answer)
- Stevens-Johnson syndrome — discontinue immediately
- Serum sickness — add corticosteroids
Correct answer: Red man syndrome — slow the infusion rate
Red man syndrome is a rate-dependent infusion reaction caused by histamine release; slowing the infusion rate and premedication with antihistamines prevent recurrence.
Question 4: Which inhaler technique error is most common with dry powder inhalers (DPIs) compared to metered-dose inhalers (MDIs)?
- Inhaling too fast
- Forgetting to shake the device
- Inhaling too slowly (Correct answer)
- Not using a spacer
Correct answer: Inhaling too slowly
DPIs require a fast, forceful inhalation to disaggregate and deliver the powder, so inhaling too slowly results in inadequate drug deposition in the lungs.
Question 5: A patient on methotrexate for rheumatoid arthritis is prescribed trimethoprim-sulfamethoxazole for a UTI. What is the primary concern?
- Increased nephrotoxicity
- Additive myelosuppression and folate depletion (Correct answer)
- QT prolongation
- Disulfiram-like reaction
Correct answer: Additive myelosuppression and folate depletion
Both methotrexate and TMP-SMX inhibit dihydrofolate reductase and folate utilization, leading to additive myelosuppression and risk of severe bone marrow toxicity.
Question 6: Which drug used to treat benign prostatic hyperplasia (BPH) works by blocking 5-alpha reductase and reducing prostate volume over months?
- Tamsulosin
- Finasteride (Correct answer)
- Terazosin
- Sildenafil
Correct answer: Finasteride
Finasteride inhibits 5-alpha reductase, reducing conversion of testosterone to DHT, which causes prostate shrinkage over 3–6 months.
Question 7: Which medication used for smoking cessation carries an FDA black box warning for serious neuropsychiatric adverse effects?
- Nicotine patch
- Bupropion
- Varenicline (Correct answer)
- Nortriptyline
Correct answer: Varenicline
Varenicline (Chantix) previously carried a black box warning for serious neuropsychiatric adverse effects including depression, hostility, and suicidal ideation, though the warning was later revised based on updated evidence.
Pharmacy Therapeutics 5
A patient with gout has a serum uric acid of 9.2 mg/dL and frequent flares.
What is the target serum uric acid level with urate-lowering therapy?