Pharmacy Therapeutics 2 — Questions and Answers
Question 1: A patient with atrial fibrillation and CrCl of 35 mL/min is started on a DOAC. Which agent requires the most significant dose reduction at this renal function level?
- Apixaban
- Rivaroxaban
- Dabigatran (Correct answer)
- Edoxaban
Correct answer: Dabigatran
Dabigatran is primarily renally eliminated and is contraindicated or requires substantial dose reduction at CrCl <30 mL/min, with caution at 30–50 mL/min.
Question 2: Which of the following is the preferred first-line pharmacological treatment for generalized anxiety disorder (GAD) in adults?
- Lorazepam
- Buspirone
- Sertraline (Correct answer)
- Alprazolam
Correct answer: Sertraline
SSRIs such as sertraline are first-line for GAD because of their favorable safety profile and efficacy with long-term use.
Question 3: A patient on warfarin has an INR of 9 with no active bleeding. What is the most appropriate management?
- Hold warfarin and give IV vitamin K 10 mg
- Hold warfarin and give oral vitamin K 2.5 mg (Correct answer)
- Continue warfarin at reduced dose
- Administer 4-factor PCC immediately
Correct answer: Hold warfarin and give oral vitamin K 2.5 mg
For supratherapeutic INR (>8) without bleeding, holding warfarin and giving low-dose oral vitamin K (2–2.5 mg) is recommended to lower INR without over-correction.
Question 4: Which antiepileptic drug is considered safest for use during pregnancy in women with epilepsy?
- Valproate
- Phenytoin
- Lamotrigine (Correct answer)
- Carbamazepine
Correct answer: Lamotrigine
Lamotrigine has the most favorable fetal safety profile among antiepileptics and is preferred when epilepsy must be treated during pregnancy.
Question 5: In a patient with Stage 3 chronic kidney disease and type 2 diabetes, which glucose-lowering agent offers the most evidence for renal protection?
- Glipizide
- Pioglitazone
- Empagliflozin (Correct answer)
- Acarbose
Correct answer: Empagliflozin
SGLT2 inhibitors like empagliflozin reduce intraglomerular pressure and have demonstrated cardiorenal protective effects in CKD with diabetes.
Question 6: A patient taking lithium develops polyuria and polydipsia. Which medication can reduce these symptoms by decreasing lithium-induced nephrogenic diabetes insipidus?
- Furosemide
- Amiloride (Correct answer)
- Hydrochlorothiazide
- Spironolactone
Correct answer: Amiloride
Amiloride blocks sodium channels in the collecting duct, reducing lithium uptake into cells and attenuating lithium-induced nephrogenic diabetes insipidus.
Question 7: Which class of antihypertensives is contraindicated in bilateral renal artery stenosis?
- Calcium channel blockers
- Beta-blockers
- ACE inhibitors (Correct answer)
- Alpha-blockers
Correct answer: ACE inhibitors
ACE inhibitors reduce efferent arteriolar tone, which is the compensatory mechanism maintaining GFR in bilateral renal artery stenosis, and can precipitate acute renal failure.
Pharmacy Therapeutics 2
A patient with atrial fibrillation and CrCl of 35 mL/min is started on a DOAC.
Which agent requires the most significant dose reduction at this renal function level?