Drug Therapy Monitoring & Clinical Decision-Making Flashcards
7 cards from real MTM practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.
Read the first 7 Drug Therapy Monitoring & Clinical Decision-Making flashcards as text
A patient on warfarin has an INR of 4.8 with no signs of bleeding. What is the most appropriate clinical action?
Answer: Hold 1-2 doses and recheck INR in 1-2 days
For supratherapeutic INR (4.5-10) without bleeding, holding 1-2 doses and rechecking INR in 24-48 hours is the standard approach.
Which serum creatinine-based equation is preferred for adjusting medication doses in patients with chronic kidney disease?
Answer: CKD-EPI creatinine equation
The CKD-EPI creatinine equation provides the most accurate GFR estimate for CKD staging and is preferred by major nephrology guidelines.
A patient with type 2 diabetes has an A1C of 9.2% on metformin monotherapy. Which add-on agent provides the greatest A1C reduction while minimizing hypoglycemia risk?
Answer: Semaglutide
GLP-1 receptor agonists like semaglutide provide 1.5-2% A1C reduction with low hypoglycemia risk and additional cardiovascular benefits.
Which laboratory finding most urgently warrants discontinuation of an ACE inhibitor?
Answer: Serum potassium of 6.5 mEq/L with ECG changes
Severe hyperkalemia (≥6.0 mEq/L) with ECG changes represents a life-threatening emergency requiring immediate ACE inhibitor discontinuation.
When monitoring a patient on amiodarone long-term, which organ system requires the MOST frequent surveillance due to potentially irreversible toxicity?
Answer: Thyroid (TFTs every 6 months)
Amiodarone contains 37% iodine by weight and causes thyroid dysfunction in up to 14% of patients, requiring TFT monitoring every 6 months.
A patient on lithium presents with coarse tremor, confusion, and nausea. Serum lithium level is 1.9 mEq/L. What is the priority intervention?
Answer: Hold lithium and provide aggressive IV hydration
Lithium toxicity (therapeutic range 0.6-1.2 mEq/L) requires immediate drug discontinuation and IV saline to promote renal lithium excretion.
Which clinical parameter is the BEST surrogate marker for monitoring response to statin therapy in a high-risk cardiovascular patient?
Answer: Percent reduction in LDL-C from baseline
Current ACC/AHA guidelines emphasize percent reduction in LDL-C (≥50% for high-intensity statins) as the primary monitoring parameter rather than absolute targets.