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Flashcards in Exam I Questions Deck (40):
1

The CKD-EPI method is superior to the MDRD and Cockcroft-Gault equation in:
A. Pediatric patients
B. Obese patients
C. Patients with mild renal dysfunction
D. All of the above

C. Patients with mild renal dysfunction

2

According to the latest FDA and UK studies, to estimate renal function in an obese patient with a BMI of 35 Kg/m2 you should use the:
A. Cockcroft-Gault equation with the adjusted body weight correction
B. Cockcroft-Gault equation with the lean body weight correction
C. Cockcroft-Gault equation with the body surface area correction factor
D. Cockcroft-Gault equation with the ideal body weight correction

A. Cockcroft-Gault equation with the adjusted body weight correction

3

What is known regarding dosing of drugs in a patient with acute hepatitis with significantly elevated AST and ALT?
A. Doses of drugs that are metabolized by cytochrome P450 (CYPs) will need to be
decreased.
B. Doses of drugs metabolized by both CYPs and UGTs (glucuronide conjugation)
will need to be decreased.
C. There is no need to decrease the dose of drugs metabolized by either CYPs or UGTs.

C. There is no need to decrease the dose of drugs metabolized by either CYPs or UGTs.

4

LT developed acute renal failure this morning after her third dose of an antibiotic. A serum creatinine is obtained and an eGFR is calculated. What do you know about the eGFR?
A. eGFR could be an underestimate of her actual GFR
B. eGFR could be an overestimate of her actual GFR
C. eGFR will accurately estimate her GFR

B. eGFR could be an overestimate of her actual GFR

5

One of the major differences between estimating creatinine clearance using the
Cockcroft-Gault equation compared to estimating GFR by the MDRD or CKD-EPI
equation is that the following patient factor is included in the MDRD and CKD-EPI equations.
A. sex
B. age
C. weight
D. ethnicity

D. ethnicity

6

For which of the following patient population, is it important to directly measure creatinine clearance instead of relying on methods of estimation when determining doses of drug excreted unchanged in the urine.
A. critically ill patients
B. obese patients
C. children
D. All of the above

A. critically ill patients

7

Which of the following liver function tests give you the best information of the patient’s ability to metabolize drugs?
A. Ammonia
B. ALT
C. Alkaline Phosphatase
D. Bilirubin
E. None of the above are helpful in determining the patients ability to metabolize drugs

D. Bilirubin

8

Which of the following are not appropriate for a patient with cirrhosis?
A. Ibuprofen 400 mg po q 6 hours
B. Acetaminophen 500 mg po q 6 hours prn headache
C. Vitamin K 10 mg po q week
D. All of the above are fine in a patient with cirrhosis

A. Ibuprofen 400 mg po q 6 hours

9

Review the lab tests below. What type of liver injury does this patient have?
AST 20
ALT 23
Alkaline Phosphatase 230
Bilirubin 15.2
Albumin 3.0
PT 19.4
INR 1.6

A. Hepatocellular
B. Cholestatic
C. Mixed Hepatocellular and Cholestatic
D. None of the above

B. Cholestatic

10

Dan is 40 year old, 60 kg Caucasian male with a history of chronic alcoholism. He
has moderate hepatic cirrhosis (Child-Pugh B). He arrives in the ER after having an alcohol withdrawal seizure. A decision is made to prevent further withdrawal
seizures using lorazepam for 72 hours and to initiate loading and maintenance doses of phenytoin. His albumin concentration is 3.0 g/dL

Phenytoin: Low ER: Cyp2C9 (major), Cyp2C19 (minor) metabolism.
fu = 0.10 with normal albumin concentrations

Lorazepam: Low ER: Hepatic metabolism by UGT1A4

What is the effect of Dan’s moderate hepatic cirrhosis on the maintenance dose of phenytoin and lorazepam when compared to a healthy adult of the same age and weight? (5 pts)
Phenytoin:
Lorazepam:

Decreased dose of phenytoin due to decreased Cyp2C19 and Cyp2C9. No change in dose of lorazepam due to no change in UGT activity in moderate cirrhosis.

11

Dan is 40 year old, 60 kg Caucasian male with a history of chronic alcoholism. He
has moderate hepatic cirrhosis (Child-Pugh B). He arrives in the ER after having an alcohol withdrawal seizure. A decision is made to prevent further withdrawal
seizures using lorazepam for 72 hours and to initiate loading and maintenance doses of phenytoin. His albumin concentration is 3.0 g/dL

Phenytoin: Low ER: Cyp2C9 (major), Cyp2C19 (minor) metabolism.
fu = 0.10 with normal albumin concentrations

Lorazepam: Low ER: Hepatic metabolism by UGT1A4

At steady state, Dan’s phenytoin total concentration is 10 µg/mL. What do we know about Dan’s unbound phenytoin concentration?
A. Less than 1.0 µg/mL
B. Equal to 1.0 µg/mL
C. Greater than 1.0 µg/mL

C. Greater than 1.0 µg/mL

12

Which of the following disorders can be precipitated by furosemide therapy?
A. Hypernatremia & hypokalemia.
B. Hyperkalemia & hypomagnesemia.
C. Hypokalemia & metabolic alkalosis.
D. Hyponatremia & metabolic acidosis.
E. Metabolic acidosis & metabolic alkalosis

C. Hypokalemia & metabolic alkalosis.

13

In a patient whose serum potassium is 6.3 mEq/L with EKG showing spiking T waves and widened QRS complexes, which of the following strategies should be taken right away?
A. Calcitonin 4 International Units/kg IV Q12H.
B. Calcium gluconate 1 gram IV STAT, then furosemide 20 mg IV x1 dose.
C. Dextrose 50% 25 mL plus NPH insulin 10 Units IV push simultaneously.
D. Lactated ringer’s solution 500 mL bolus over 10 mins.
E. No urgent action is needed at this point.

B. Calcium gluconate 1 gram IV STAT, then furosemide 20 mg IV x1 dose.

14

Which of the following single dose order provides the highest amount of elemental calcium measured in mEq?
A. Calcium carbonate 1 g PO.
B. Calcium chloride 10% 1000 mg IV.
C. Calcium citrate 1000 mg via NG tube.
D. Calcium gluconate 10% 10 mL IV.
E. All of the above orders provide the same amount of elemental calcium

A. Calcium carbonate 1 g PO.

15

Patients receiving chronic lithium therapy are at risk in developing:
A. Hyperkalemia.
B. Hypernatremia.
C. Hypokalemia.
D. Hyponatremia.
E. Metabolic alkalosis.

B. Hypernatremia.

16

Which of the following clinical parameters is not a sign of dehydration?
A. Acute weight loss (e.g., > 3 kg in 2 days).
B. Blood urea nitrogen and serum creatinine ratio > 20.
C. Dry and cracked oral mucosa.
D. Orthostatic hypertension.
E. All of the above are clinical signs of dehydration.

D. Orthostatic hypertension.

17

Intravenous magnesium infusion is a treatment of choice for which of the following
disorders?
A. Constipation.
B. Dehydration.
C. Diabetes insipidus.
D. Pre-eclampsia.
E. Metabolic acidosis.

D. Pre-eclampsia.

18

Which of the following electrolytes functions as a plasma buffer for organic acids in maintaining acid-base balance?
A. Calcium.
B. Chloride.
C. Magnesium.
D. Phosphate.
E. Sodium.

D. Phosphate.

19

A patient with untreated syndrome of inappropriate antidiuretic hormone (SIADH) usually presents with ____________ due to an __________ release of ADH (aka. vasopressin)?
A. Hyponatremia; excess.
B. Hyponatremia; insufficient.
C. Hypernatremia; excess.
D. Hypernatremia; insufficient.
E. Dehydration; excess.

A. Hyponatremia; excess.

20

A patient presents to the Emergency Department (ED) with mental confusion anddisorientation. He appears severely dehydrated. There is no evidence of cardiogenic pulmonary edema based on physical examination and auscultation. All laboratory results are currently pending. His blood pressure is 85/60 mm Hg, and heart rate is 120-130 beats per minutes in sinus tachycardia.

Which of the following is the safety approach that can also quickly stabilize cardiovascular status to improve and maintain blood pressure?
A. Calcium gluconate 1 g IV x1 dose.
B. 0.9% NaCl 0.9% 500 mL IV over 15 minutes.
C. Dextrose 5% 500 mL IV over 30 minutes.
D. Furosemide 20 mg IV x1 dose, followed by NaCl 0.9% 150 mL/hr.
E. Pedialyte 8 oz orally every 10-15 mins for a total of 2 liters in the next 2 hours.

B. 0.9% NaCl 0.9% 500 mL IV over 15 minutes.

21

Which of the following drugs can be used to correct metabolic alkalosis by increasing renal loss of bicarbonate ions?
A. Acetazolamide.
B. Furosemide.
C. Hydrochlorothiazide.
D. Lithium.
E. Vasopressin.

A. Acetazolamide.

22

Jack presents to the ED with severe headache, confusion, and lower extremity weakness. His blood work shows the following abnormal lab results: serum calcium 12.6 mg/dL; serum potassium 3.0 mEq/L. Which of the following IV order(s) is/are safe and will correct his calcium and potassium disorders the fastest? (Jack is 60 kg and has normal renal and hepatic functions)

A. Dextrose 5% at 40 mL/hour only.
B. Dextrose 5%-NaCl 0.9% with KCl 100 mEq/L at 250 mL/hour.
C. Lactated Ringer’s solution at 150 mL/hour; Insulin 10 units slow IV push with 25 g
dextrose.
D. NaCl 0.9% with KCl 20 mEq/L at 200 mL/hour
E. Pamidronate 90 mg IV 1 dose only.

D. NaCl 0.9% with KCl 20 mEq/L at 200 mL/hour

23

A nurse calls down to the pharmacy from the cancer clinic. One of her patients at the clinic requires potassium replacement and she has received a bag of IV fluid with KCl 40 mEq in 250 mL dextrose 5%. The patient is anxious to go home soon.

Can this order be safely infused via a peripheral IV line?

The physician order writes: “infuse the above KCl replacement order at 80 mL/hr”. Is this a safe infusion rate? If you don’t think so, please provide a new rate (in mL/hr) that is optimal.

Yes, peripheral IV line safe.

No, rate is too fast. Max rate = 62.5ml/hr

24

ET, A 65 year old 70 kg male patient with an atrial arrhythmia is prescribed edoxaban. Edoxaban should not be used in patients with CrCl > 95 ml/min due to an increased risk of stroke. What method should be used to estimate CrCl or eGFR to determine whether or not edoxaban should be used in this patient?
A. Cockcroft-Gault
B. MDRD
C. CKD-EPI
D. Any of the above methods will provide an accurate estimation of risk for ET.

C. CKD-EPI

25

According to the latest FDA and UK studies, to estimate renal function in an obese female with BMI of 30 – 39 Kg/m2 you should use which of the following methods?
A. Cockcroft-Gault equation with adjusted body weight correction
B. Cockcroft-Gault equation with lean body weight correction
C. Cockcroft-Gault equation with body surface area correction
D. Cockcroft-Gault equation with the ideal body weight correction

A. Cockcroft-Gault equation with adjusted body weight correction

26

A patient develops acute renal failure due to aminoglycoside toxicity. Her serum creatinine was normal yesterday (1.0 mg/dl) and is 1.2 mg/dl this morning. If you calculate her CrCl or eGFR using the MDRD, Cockcroft-Gault or CKD-EPI methods which of the following is likely to be true?
A. You will be accurately estimating her GFR and her renal function.
B. You will be underestimating her actual GFR and her renal function.
C. You will be overestimating her actual GFR and her renal function.

C. You will be overestimating her actual GFR and her renal function.

27

If a patient is critically ill, which of the following methods are preferred in accessing renal function in order to determine a dose of an antibiotic with a narrow therapeutic range?
A. Obtain a serum creatinine and estimate using the Cockcroft Gault method.
B. Obtain a serum creatinine and estimate using the MDRD method
C. Obtain a serum creatinine and estimate using the CKD-EPI method
D. Obtain a 12 hr serum creatinine and a 24 hr urine creatinine measurement and determine their actual creatinine clearance.

D. Obtain a 12 hr serum creatinine and a 24 hr urine creatinine measurement and determine their actual creatinine clearance.

28

The Schwatz equation is used to estimate the renal function in which patient
population?
A. Obese
B. Elderly
C. Pediatric
D. It can be used in all of the above patients to assess renal function

C. Pediatric

29

Based on the available evidence, which of the following is true regarding estimating renal function in a healthy elderly patient?
A. MDRD equation is better correlated with measured creatinine clearance than the Cockcroft-Gault equation.
B. The Cockcroft-Gault equation is better correlated with measured creatinine clearance than the MDRD equation.
C. If the serum creatinine is < 1.0 mg/dL, the serum creatinine should be normalized to 1.0 mg/dL using the Cockcroft-Gault equation due to the age related lower muscle mass.
D. If the serum creatinine is < 1.0 mg/dL, the serum creatinine should be normalized to 1.0 mg/dL using the MDRD equation due to the age related lower muscle mass.

A. MDRD equation is better correlated with measured creatinine clearance than the
Cockcroft-Gault equation.

30

Loading doses in a patient with chronic kidney disease need to be decreased compared to a patient with normal renal function due to a decrease in the volume of distribution.
A. True
B. False

B. False

31

What is known regarding dosing of drugs in a patient with acute hepatitis with elevated ALT and AST?
A. Doses of drugs that are metabolized by cytochrome P450 (CYPs) need to be decreased.
B. Doses of drugs metabolized by both CYPs and UGTs (glucuronide conjugation) need to be decreased.
C. There is no need to decrease the dose of drugs metabolized by either CYPs or UGTs.

C. There is no need to decrease the dose of drugs metabolized by either CYPs or UGTs.

32

What is known regarding dosing of drugs in a patient with cirrhosis (Child Pugh B)
A. Doses of drugs that are metabolized by cytochrome P450 (CYPs) need to be decreased.
B. Doses of drugs metabolized by both CYPs and UGTs (glucuronide conjugation) need to be decreased.
C. There is no need to decrease the dose of drugs metabolized by either CYPs or UGTs.

A. Doses of drugs that are metabolized by cytochrome P450 (CYPs) need to be decreased.

33

Which of the following liver function tests give you the best information of the patient’s ability to metabolize drugs?
A. Ammonia
B. ALT
C. Alkaline Phosphatase
D. Bilirubin
E. None of the above are helpful in determining the patients ability to metabolize drugs

E. None of the above are helpful in determining the patients ability to metabolize drugs

34

Which of the following drugs will need a decreased dose in mild cirrhosis?
A. Cyclosporine (CYP3A4)
B. Lansoprazole (CYP2C19)
C. Lamotrigine (UGT1A4)
D. Fluoxetine (CYP2D6)

B. Lansoprazole (CYP2C19)

35

The bioavailability of a high extraction ratio drug metabolized by UGT will be significantly decreased in mild to moderate liver cirrhosis.
A. True
B. False

B. False

36

HC is a 53 year old female with cirrhosis due to hepatitis C and mild osteoarthritis in her knees. She is taking spironolactone 100 mg po qd and furosemide 40 mg po qd for her ascites that is only detectable on ultrasound. She has clear mentation and occasional mild headaches. She has small esophageal varices visualized on endoscopy. Her labs include: AST 56, ALT 60, Alk Phos 100, Total bilirubin 1.0, GGT 50, Alb 2.8 and PT 15
seconds. What is her Child-Turcotte Pugh classification?
A. Child-Turcotte Pugh class A
B. Child-Turcotte Pugh class B
C. Child-Turcotte Pugh class C
D. None of the above

B. Child-Turcotte Pugh class B

37

HC is a 53 year old female with cirrhosis due to hepatitis C and mild osteoarthritis in her knees. She is taking spironolactone 100 mg po qd and furosemide 40 mg po qd for her ascites that is only detectable on ultrasound. She has clear mentation and occasional mild headaches. She has small esophageal varices visualized on endoscopy. Her labs include: AST 56, ALT 60, Alk Phos 100, Total bilirubin 1.0, GGT 50, Alb 2.8 and PT 15
seconds.

Based on her laboratory values, what type of liver injury dose HC have?
A. Hepatocellular
B. Cholestatic
C. Mixed hepatocellular and cholestatic
D. None of the above

A. Hepatocellular

38

HC is a 53 year old female with cirrhosis due to hepatitis C and mild osteoarthritis in her knees. She is taking spironolactone 100 mg po qd and furosemide 40 mg po qd for her ascites that is only detectable on ultrasound. She has clear mentation and occasional mild headaches. She has small esophageal varices visualized on endoscopy. Her labs include: AST 56, ALT 60, Alk Phos 100, Total bilirubin 1.0, GGT 50, Alb 2.8 and PT 15
seconds.

Which of the following are true for HC?
A. For her osteoarthritis management, acetaminophen 500 mg po qid is a good choice.
B. For her occasional mild headache, ibuprofen 400 mg po q 6 hours prn pain is a safe and effective treatment.
C. She should limit her ethanol intake to no more than 1 glass of red wine with dinner.
D. All of the above are true

A. For her osteoarthritis management, acetaminophen 500 mg po qid is a good choice.

39

HC is a 53 year old female with cirrhosis due to hepatitis C and mild osteoarthritis in her knees. She is taking spironolactone 100 mg po qd and furosemide 40 mg po qd for her ascites that is only detectable on ultrasound. She has clear mentation and occasional mild headaches. She has small esophageal varices visualized on endoscopy. Her labs include: AST 56, ALT 60, Alk Phos 100, Total bilirubin 1.0, GGT 50, Alb 2.8 and PT 15
seconds.

Over the next few years, HC develops mild muscular back pain, confusion and asterixis. Which of the following would be the best choice for HC’s back pain?
A. morphine 30 mg XL po q 12 hours for back pain
B. diazepam 5 mg po q 8 hours prn back spasms
C. naproxen 220 mg po q 8 hours for back pain
D. back strengthening exercise, massage and hot or cold compresses

D. back strengthening exercise, massage and hot or cold compresses

40

Which of the following is the most common causes(s) of end stage liver disease in the United States?
A. Primary biliary cirrhosis
B. Hepatitis B
C. Hepatitis C and ethanol
D. Acetaminophen overdose
E. Wilson’s disease

C. Hepatitis C and ethanol