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NEW QUESTION 56
A 65-year-old man presents to the internal medicine clinic with decreased exercise tolerance, lower extremity edema, and shortness of breath.
He has a history of diastolic dysfunction (ejection fraction of 60%) and hypertension; BP =
150/90 mm Hg, HR = 86 bpm.
Current medications include digoxin 125 mcg daily, furosemide 40 mg daily, enalapril 10 mg twice daily, aspirin 325 mg daily, and potassium 10 mEq twice daily. The digoxin concentration is 0.4 ng/mL.
After resolution of this exacerbation, which of the following should the pharmacotherapy specialist recommend to the internist regarding this patient's maintenance drug therapy?
- A. Discontinue digoxin and add amlodipine.
- B. Increase furosemide.
- C. Discontinue digoxin and add metoprolol.
- D. Increase digoxin.
Answer: C
NEW QUESTION 57
Post myocardial infarction, a patient's cardiac profile and serum chemistry results show the following values:
Heart rate: 120 bpm
Blood pressure: 80/40 mm Hg
Pulmonary capillary Wedge pressure: 6 mm Hg
Right atrial pressure: 2 mm Hg
Cardiac index: 2.3 L/min/m2
Sodium: 136 mEq/L
Potassium: 4.2 mEq/L
Chloride: 98 mEq/L
Bicarbonate: 22 mEq/L
Blood urea nitrogen: 25 mg/dL
Creatinine: 1.0 mg/dL
Glucose: 110 mg/dL
Which one of the following therapeutic regimens is most appropriate for the initial treatment of this patient?
- A. Normal saline 500 mL/h
- B. Furosemide 40 mg intravenous push
- C. Nitroprusside 2 mcg/kg/min
- D. Dopamine 15 mcg/kg/min
Answer: A
NEW QUESTION 58
A 53-year-old man has been diagnosed with a deep vein thrombosis. Weight = 94kg and height
= 170 cm. Creatinine clearance F 60 mL/min, CBC results are within normal limits, and baseline INR = 0.9.
The pharmacotherapy specialist receives orders for warfarin 5 mg orally every evening and enoxaparin 80 mg subcutaneously every 12 hours. Which of the following is the best course of treatment?
- A. Continue enoxaparin 80 mg every 12 hours.
- B. Change enoxaparin to 140 mg every 24 hours.
- C. Change enoxaparin to 80 mg every 24 hours.
- D. Change enoxaparin to 100 mg every 24 hours.
Answer: C
NEW QUESTION 59
A 35-year-old patient presents with symptoms consistent with acute pharyngitis. The patient reports no other illnesses, no known drug allergies, and a medical history significant for generalized anxiety disorder. The appropriate therapy should be determined by testing for which of the following?
- A. Haemophilus influenzae
- B. Streptococcus pneumoniae
- C. Group A Streptococcus
- D. Staphylococcus aureus
Answer: C
NEW QUESTION 60
A 72-year-old patient, weighing 72 kg and measuring 173 cm tall, presents to the emergency department with an acute ischemic stroke. The symptoms have been present for just over an hour. The patient has a history of hypertension and is currently taking lisinopril 10 mg daily.
The patient's evaluation reveals no intracerebral hemorrhaging. The current BP is 178/100 mm Hg. It is now 150 minutes from stroke symptom onset.
Which of the following should now be administered?
- A. An antihypertensive; reconsider intra-arterial thrombolytics once BP decreases
- B. Intravenous glycoprotein IIb/IIIa inhibitor
- C. Intravenous-PA
- D. An antihypertensive; reconsider intravenous t-PA once BP decreases
Answer: C
NEW QUESTION 61
A pharmacotherapy specialist wishes to investigate the impact of thiazolidinedione therapy on Weight gain. The specialist will determine average body weight immediately before participants begin therapy with pioglitazone and again after they complete 12 weeks of treatment. Which of the following statistical methods is most appropriate for analyzing these data?
- A. Paired t test
- B. Fisher's exact test
- C. Chi-square test
- D. Unpaired t test
Answer: D
NEW QUESTION 62
A 66-year-old man with a history of chronic bronchitis is seen in October for treatment of an acute exacerbation. He received the pneumococcal vaccine 3 years ago and an influenza vaccine this past March. Which of the following should the pharmacotherapy specialist recommend?
- A. Influenza Vaccine
- B. Both Vaccines
- C. Oseltamivir With influenza Vaccine
- D. Neither Vaccine
Answer: D
NEW QUESTION 63
A 55 year old woman being treated for hypothyroidism with levothyroxine 125 mcg daily is currently euthyroid. She now has menopausal symptoms and is receiving conjugated estrogens.
What effect is this most likely to have on her thyroid function tests?
- A. Decreased free T4
- B. Decreased total T4
- C. No changes in TSH
- D. No changes in reverse triiodothyronine uptake
Answer: B
NEW QUESTION 64
A 47-year-old patient with type 2 diabetes mellitus and no known coronary heart disease has the following fasting lipid profile. HDL cholesterol = 40 mg/dL, LDL cholesterol = 164 mg/dL, and triglycerides = 150 mg/dL. The patient has an ASCVD 10-year risk score of 6%. According to the ACC/AHA, which of the following is the most appropriate intervention for this patient's LDL?
- A. LDL lowering only warranted if the LDL was > 190 mg/dL
- B. Reduce LDL by >50% (high intensity statin)
- C. Reduce LDL by 30-50% (moderate intensity statin)
- D. No indication to lower LDL
Answer: B
NEW QUESTION 65
A 69-year-old Woman with chronic liver disease treated with furosemide and potassium chloride for ascites and peripheral edema presents with weakness and fatigue. Her serum laboratory Values are:
* Sodium: 138 mEq/L
* Potassium: 2.6 mEq/L
* Glucose: 88 mg/dL
* BUN: 33 mg/dL
* Chloride: 101 mEq/L
* HCO3- 26 mEq/L
* Creatinine: 1.1 mg/dL
Attempts to increase her serum potassium over the next 48 hours include intravenous replacement (240 mEq over this period), without success. The current serum potassium concentration is 2.8 mEq/L. Which of the following is the most appropriate test to obtain for this patient?
- A. Urinary sodium
- B. Serum magnesium
- C. Urinary potassium
- D. Serum antidiuretic hormone
Answer: D
NEW QUESTION 66
Administration of a marketed drug to a patient for an off-label indication without approval from a local IRB is permissible in which of the following situations?
- A. The patient's physician considers that the risk/benefit ratio favors the use of the drug.
- B. The patient's physician has filed a Notice of Claimed Investigational Exemption for a New Drug with the FDA.
- C. The drug is administered under a protocol sponsored by an NIH grant.
- D. The drug is administered on the request of the patient or the patient's representative.
Answer: A
NEW QUESTION 67
Many clinically important adverse drug reactions (ADRs) are detected after the marketing of a drug, rather than during premarketing clinical trials. Of the following, which is the primary reason for this phenomenon?
- A. Too few patients are studied for too short a period of time during premarketing clinical trials.
- B. Pharmaceutical companies prefer to market agents with favorable side-effect profiles, so they focus premarketing studies on efficacy rather than on ADRs.
- C. Premarketing studies focus on efficacy rather than on safety; therefore, the study design accounts for the failure to detect ADRs.
- D. Adverse reactions that are due to drug interactions or drug accumulation in renal insufficiency cannot be studied prospectively during the premarketing phase of clinical evaluation.
Answer: A
NEW QUESTION 68
Which of the following is an example of a sentinel event, as defined by the Joint Commission?
- A. Administration of digoxin to the Wrong patient without adverse events
- B. Death due to heart failure following discharge against medical advice
- C. Death due to overdose of methylphenidate obtained from a brother's prescription
- D. Removal of the Wrong breast during surgery
Answer: A
NEW QUESTION 69
A pharmacy resident calculates the appropriate gentamicin dose and frequency for an elderly patient on hemodialysis. This skill reflects what type of residency learning?
- A. Comprehension
- B. Analysis
- C. Evaluation
- D. Application
Answer: D
NEW QUESTION 70
A 65-year-old woman on chronic hemodialysis presents with difficulty breathing and inability to sleep. The patient has had shortness of breath, diaphoresis, and nausea, but has not vomited.
She denies having abdominal pain, diarrhea, or chest pain. She has tachycardia and tachypnea, and exhibits peaked T waves with occasional PVCs on the ECG. Serum chemistry values are:
* Sodium: 137 mEq/L
* BUN: 125 mg/dL
* Potassium: 7.2 mEq/L
* Creatinine: 12.8 mg/dL
* Chloride: 97 mEq/L
* Glucose: 95 mg/dL
* HCO3- : 11 mEq/L
* Calcium: 8.5 mg/dL
* Albumin: 3.1 g/dL
* Phosphorus: 1.7 mg/dL
Which of the following should the pharmacotherapy specialist recommend for immediate therapy?
- A. Sodium polystyrene sulfonate with sorbitol orally
- B. Sodium bicarbonate intravenously
- C. Hemodialysis
- D. Calcium gluconate intravenously
Answer: D
NEW QUESTION 71
A 35-year-old Woman is diagnosed with pustular psoriasis, which covers 35% of her body. She has tried high-potency topical steroid creams and topical coal tar with ultraviolet B treatments in the past, with no effect. Which of the following is the best therapeutic option for this patient?
- A. Calcipotriene
- B. Anthralin
- C. Methotrexate
- D. Halobetasol
Answer: C
NEW QUESTION 72
A patient with a nasogastric output of 8 L daily and respirations of 10 bpm has the following - laboratory values:
This clinical information is most consistent with which of the following?
- A. Compensated respiratory alkalosis
- B. Uncompensated respiratory alkalosis
- C. Uncompensated metabolic alkalosis
- D. Compensated metabolic alkalosis
Answer: A
NEW QUESTION 73
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