18. Drug References

Question 1

Which resource is most appropriate if you wish to read about regulatory compliance news that affects the pharmaceutical industry, and would like to keep current with issues concerning patents and manufacturing?

A. The Red Book
B. The Orange Book
C.The Pink Sheet
D. The Merck Index
E. Micromedex

Answer 1

C. The Pink Sheet comes out weekly and is specialized information for and about the pharmaceutical industry.

Question 2

A pharmacist has a patient with a rare medical condition. The patient is not doing well, and inquires if there are any clinical trials of new drugs that may be useful for this condition. Where would she look for available trials?
A. guidelines.gov
B. aap.org
C. aafp.org
D. clinicaltrials.gov
E. asco.org

Answer 2

D.

Question 3

Which resource would provide the best background information on the chemical structure and related compounds (the medicine’s class) for a prescription medicinal compound?

A. Goodman and Gilman’s
B. Trissel’s
C. The Handbook of OTC Medications
D. Neofax
E. Sanford Guide

Answer 3

A. Other resources include Remington’s and the Handbook of Pharmaceutical Excipients (for excipients).

Question 4

Winston is an inpatient clinical pharmacist. He is making his rounds when a nurse asks him to identify several medications that she has taken from a man who recently arrived from overseas. Which of the following resources can help Winston identify foreign drugs? (Select ALL that apply.)

A. Martindales
B. Micromedex
C. European Drug Index
D. The Merck Index
E. USP Dictionary of USAN and International Drug Names

Answer 4

A, B, C, E. Diccionario de Especialidades Farmaceuticas is useful for Spanish drug names.

Question 5

Peter has opened his own community pharmacy and wishes to find a formula for compounding a unit dose mixture. He may be able to find guidance from the following sources: (Select ALL that apply.)

A. Handbook on Extemporaneous Formulations
B. International Journal of Pharmaceutical Compounding
C. US Pharmacopoeia National Formulary (chapter on Pharmacy Compounding)
D. Allen’s Compounded Formulations
E. Lexicomp

Answer 5

A, B, C, D. He may also find helpful information in Remington: The Science and Practice of Pharmacy (in the chapter on Extemporaneous Prescription Compounding) or from resources from one of the for-profit compounding organizations.

Question 6

Select the correct section of the US Pharmacopoeia (USP) National Formulary that includes standards for sterile compounding:

A. USP Chapter 790
B. USP Chapter 795
C. USP Chapter 797
D. USP Chapter 875
E. USP Chapter 890

Answer 6

C. USP 797 is standards for sterile compounding.

Question 7

A pharmacist needs to find if a drug has a generic that is AB rated to the brand. Choose the reference source that the pharmacist can use to locate if a generic equivalent is available:

A. Handbook on Extemporaneous Formulations
B. The Orange Book
C. The Pink Sheet
D. Goodman and Gilman’s
E. Micromedex

Answer 7

B. Oral drugs coded as AB are therapeutically equivalent and can be interchanged (brand to generic). The Orange Book is published by the Food and Drug Administration’s (FDA) Center for Drug Evaluation and Research (CDER).

Question 8

Benjamin is hospitalized with trouble breathing, hives, confusion and weakness. He is unable to communicate easily and hands the intake nurse a bag with a pink, oval tablet inside with “M20” imprinted on one side. The nurse calls the pharmacy to locate the name of the medication. The pharmacist can look up the medication using this resource:

A. Briggs
B. The Merck Index
C. Koda-Kimble
D. Goodman and Gilman’s
E. Ident-A-Drug

Answer 8

E.

Question 9

What are the names of the organizations that set treatment standards for the management of diabetes? (Select ALL that apply.)

A. AACE
B. The CHEST guideline
C. NCEP ATP
D. Joint National Commission (JNC)
E. The ADA

Answer 9

A, E. ADA: American Diabetes Association, AACE: American Association of Clinical Endocrinologists

Question 10

Jane is picking up her hypertension medication. She is interested in using something over-the-counter to treat her “low mood.” Jane says she is very weepy, and does not want to discuss this with her doctor who “doesn’t listen anyway.” The pharmacist is unsure what to recommend and recognizes that she needs to have a good resource to find out if a natural product works for different conditions, and to be able to check for dosing and drug interactions. Of the following sources with natural product information, which source is available online, is up-to-date, and would have the information that the pharmacist requires for most natural products?

A. Natural Medicines Comprehensive Database
B. PDR for Herbal Medicines
C. The Complete German Commission E Monographs
D. The Handbook of OTC Medications
E. King’s Guide

Answer 10

A. The Natural Medicines Comprehensive Database is available online, is updated daily as new data becomes available, and is reputable. Other resources may be useful, but will not be as complete a resource.

Question 11

A pharmacist is attempting to find out which ACE inhibitors use starch as an excipient in order to help a patient with celiac disease avoid starch-containing drugs. Which would be the preferred initial resource to look in for the excipient information?

A. Goodman and Gilman’s
B. Trissel’s
C. The product’s package insert (product labeling)
D. Neofax
E. Sanford Guide

Answer 11

C. There are online resources (see Celiac section in the Autoimmune chapter in the RxPrep 2015 course book) and the manufacturer can be contacted. The package insert may, or may not, provide the information required.

Question 12

A pharmacist needs to price a drug in her store. Which drug reference source will list the average wholesale price (AWP) and the suggested retail price?

A. The Red Book
B. The Orange Book
C. The Pink Sheet
D. Goodman and Gilman’s
E. Micromedex

Answer 12

A. The Red Book includes the Average Wholesale Price (AWP) and the suggested retail price. It is also useful to check if a drug is available.

Question 13

A female patient has recently received a diagnosis of multiple sclerosis. She wants to do everything possible to slow down disease progression and to learn how to effectively self-manage the condition. The pharmacist can refer her to this website:

A. FDA’s CDER website
B. MedlinePlus
C. FDA’s MedWatch website
D. MedMARx program
E. Institute for Safe Medication Practices (ISMP)

Answer 13

B. MedlinePlus is a reputable site for comprehensive patient information. The Mayo Clinic and WebMD also have good patient-friendly resources.

Question 14

Which reference name and reference purpose match is not correct?

A. Yellow Book-Travelers Health Information
B. Orange Book-Therapeutic Equivalence
C. Pink Book-Principles of Immunization
D. Red Book-AWP and Retail Pricing
E. Pink Sheet-Medication Safety Principles

Answer 14

E. The Pink Sheet contains pharmaceutical manufacturer company (“Pharma”) news.

Question 15

Jan, a pharmacy intern, is participating in rounds with the thoracic surgical team. A patient has a hospital-acquired pneumonia. Jan wishes to quickly look up the recommended empiric antibiotic treatment, using a resource that she has in her white coat pocket. Select the name of the appropriate resource.

A. Pharmacist’s Letter
B. AHFS Drug Information Handbook
C. MedlinePlus
D. MedMARx
E. The Sanford Guide

Answer 15

E. The Sanford Guide is also available on hand-held devices, including smart phones.

Question 16

A pharmacist is working in a community setting. A patient enters the store and reports that she had swelling around her ankles after beginning pregabalin. The pharmacist wishes to report this reaction to the FDA. The pharmacist will report to this program at the FDA:

A. ISMP’s Medication Safety Reporting System
B. Martindales
C. CDER
D. MedWatch
E. CMS

Answer 16

D. The FDA’s MedWatch program can be used to report adverse reactions to a drug. It is called the FDA’s Adverse Event Reporting System, or FAERS. The pharmacist could also contact the manufacturer.

Question 17

A medical resident stops by the pharmacy satellite with a complaint. He says “I never learned much about women’s health, and I just had to deliver a baby!” Recommend reputable resources to the physician to help bring him up to speed: (Select ALL that apply.)

A. The World Health Organization
B. The FDA’s For women website pages
C. The United Nations website for Women’s Health
D. Centers for Disease Control Women’s Health pages
E. Department of Health and Humans Services at womenshealth.gov

Answer 17

A, B, D, E. Many of the guidelines concerning health conditions specific to females are set by the American College of Obstetricians and Gynecologists, however the patient material may (or may not) be current. If it is current, it is of good quality.

Question 18

A female patient requests information on a sexually transmitted infection. The pharmacist can refer her to this website:

A. FDA’s CDER website
B. CDC website
C. FDA’s MedWatch website
D. MedMARx program
E. nstitute for Safe Medication Practices (ISMP)

Answer 18

B.

Question 19

Select the correct section of the US Pharmacopoeia (USP) National Formulary that includes standards for non-sterile compounding:

A. USP Chapter 790
B. USP Chapter 795
C. USP Chapter 797
D. USP Chapter 875
E. USP Chapter 890

Answer 19

B. USP 795 is standards for non-sterile compounding.

Question 20

A hospital pharmacist is aware that a nurse has given a drug to the wrong patient. The pharmacist will report the medical error to the following authority:

A. The local police
B. The drug manufacturer
C. The FDA
D. CMS
E. To the P&T Committee directly, or designated staff, such as a medical safety officer (as defined by facility)

Answer 20

E. The error should be reported to the P&T Committee, who will be responsible for investigating how the error occurred and implementing procedures to prevent this type of error from repeating. There may be a separate medication safety group that reports to the P&T. The pharmacist may need to report to their supervisor first, as defined by the facility. The facility should report errors to the Institute for Safe Medication Practices\ (ISMP), which collects data on medication errors in order to improve medication safety.

Question 21

What is the guideline called that issues standards for treatment of hypertension?

A. AACE
B. The CHEST guideline
C. NCEP ATP
D. Joint National Commission (JNC)
E. The ADA

Answer 21

D.

Question 22

Which branch of the FDA publishes the Orange Book?

A. The Cosmetics Act
B. CDER
C. Postmarketing Drug Safety Division
D. CDRH
E. Office of Dietary Supplements

Answer 22

B. As part of the U.S. Food and Drug Administration (FDA), the Center for Drug Evaluation and Research (CDER) regulates over-the-counter and prescription drugs, including biological therapeutics and generic drugs.

Question 23

A physician pops his head into the pharmacy satellite. He is flustered and very angrily asks the pharmacist: “I saw a package labeling update for ACE Inhibitors this past week regarding some new contraindication and I think it relates to my patient. Quick. Where can I find the warning?” What is the best place to find this information?

A. Quickly take the package label off a bottle of ACE Inhibitor tablets.
B. Call the company’s drug information hotline.
C. Look on the FDA website.
D. Use LexiComp or Micromedex.
E. Do an internet search using Google search engine.

Answer 23

C. Product labeling changes are posted as alerts on the FDA’s website. Although this information should be readily accessible at the manufacturer, it might not and the physician might be mixing the drugs up. If the change was recent then it would not be expected to be on the label that is with the drug right now. By referring to the FDA, you would be able to quickly help locate the recent update changes for all drug labeling.

Question 24

A patient who is breastfeeding is prescribed an antibiotic. The pharmacist is not sure if the drug is safe to use during lactation. In addition to the package insert (which may have information on drug use in pregnancy and lactation) which resources might be useful to find if the drug is safe to take? (Select ALL that apply.)

A. Natural Standard
B. Micromedex
C. Breastfeeding: A Guide for the Medical Profession
D. The Centers for Disease Control (CDC)
E. Briggs

Answer 24

B, C, D, E. The Micromedex Database that includes pregnancy risk with drugs is called REPRORISK, which is a large database of reproductive risk information.

Question 25

A hospital has not had a pediatric pharmacist on staff for years. They have had several incidents of medication errors in neonates and have convinced one of the trusted staff pharmacists to take on this role. The staff pharmacist has limited experience in pediatric doses. The pharmacist can draw on information from the following sources: (Select ALL that apply.)

A. Harriet Lane Handbook
B. Pediatric Dosage Handbook
C. AHFS Drug Information or Micromedex
D. Trissel’s
E. Professional colleagues

Answer 25

A, B, C, E. The pharmacist will find cases where no published dose or monitoring data exists. Pediatric inpatients are a high source of medication errors. In addition to available resources it is necessary to have a circle of professional colleagues to use as resources when data is scarce. The pharmacist can get on an email “list-serve” to keep up with issues in pediatric pharmacy.

Question 26

A pharmacist did a PGY2 specialty residency in pediatrics. She is an expert in everything about infants, but is lacking in knowledge about medication issues affecting the elderly. Her father passed away this past year, and her Mom has moved in with her and her family. The pharmacist finds out that her Mother is taking many medications, and she is unsure which are safe and which combinations pose risk. What would be reputable resources to locate information on the management of drug use in the elderly? (Select ALL that apply.)

A. The National Institutes of Health Senior pages
B. The American Geriatrics Society at americangeriatrics.org
C. FDA’s guide for older adults
D. seniorlivingmagazine.org
E. elderly.org

Answer 26

A, B, C.

Question 27

A pharmacist on the P&T Committee has become aware of a particular dangerous problem that occurred at their facility. The pharmacist signed off on a prescription for vancomycin four times daily. The pharmacist simply checked the order, which was written for “vancomycin 1 g Q1D” which the prescriber meant as 1 gram daily, but was misread as QID, or four times daily. Due to medication toxicity the patient went into acute renal failure and, in addition, suffered hearing loss. The pharmacist who has reviewed this error can increase awareness about this type of mistake by reporting it to the following organization:

A. The drug manufacturer
B. The state branch of the CDC
C. The FDA’s CDER unit
D. CMS’s Drug Safety Committee (DSC)
E. ISMP’s Medication Errors Reporting Program (MERP)

Answer 27

E. The Institute for Safe Medication Practices collects information on medication errors and helps the profession implement protocols and procedures to reduce error incidence.

Question 28

The following resources represent the two standard “drug therapy” textbooks used for the pharmacological treatment overview, and are organized by disease state. (Select ALL that apply.)

A. Applied Therapeutics, by Koda-Kimble, et al
B. Harrison’s Principles of Internal Medicine
C. Merck Index
D. Pharmacotherapy, by DiPiro, et al
E. The Sanford Guide

Answer 28

A, D.

Question 29

What is the guideline called that issues standards for treatment of dyslipidemia?

A. AACE
B. The CHEST guideline
C. NCEP ATP
D. Joint National Commission (JNC)
E. The ADA

Answer 29

C. NCEP ATP: The National Cholesterol Education Project Adult Treatment Panel, revised in 2013.

Question 30

Jan, a pharmacy intern, is about to graduate. She is looking for a periodic resource that is delivered to home at least monthly that she can use to “keep up” with changes in drug therapy. Select the name of the appropriate resource.

A. Pharmacist’s Letter
B. AHFS Drug Information Handbook
C. MedlinePlus
D. MedMARx
E. The Sanford Guide

Answer 30

A. The Pharmacist’s Letter sends a monthly (hard copy) newsletter and has an online service with “detail documents” that provide further information on the topics discussed.

Question 31

What is the guideline called that issues standards for anticoagulation/antithrombotic therapy?

A. AACE
B. The CHEST guideline
C. NCEP ATP
D. Joint National Commission (JNC)
E. The ADA

Answer 31

B. The CHEST guideline was updated in 2012; recommendations are discussed in the Anticoagulation Chapter.