Exam Quick Facts (2026)
:Questions And Answers With
Rationals/Graded A+ Update
100% Correct
SECTION 1: CARDIOVASCULAR & ANTICOAGULATION
Question 1
A 72-year-old male patient with a history of atrial fibrillation presents with an INR
of 3.8 during a routine check. He is completely asymptomatic. According to the
latest CPJE clinical guidelines, what is the most appropriate action?
A. Continue warfarin at the same dose and schedule
B. Hold warfarin for 2 days and recheck INR in 2–3 days
C. Administer oral vitamin K 10 mg immediately
D. Administer fresh frozen plasma intravenously
Correct Answer: B
🔍 Rationale: For an asymptomatic patient with an INR between 3.0 and 4.5, the
recommended action is to hold 1–2 doses of warfarin and recheck the INR. Vitamin
K is generally reserved for elevations >5.0 (without bleeding) or for any INR when
bleeding is present. Fresh frozen plasma is only used in cases of life-threatening
bleeding.
Question 2
,A patient who has been stable on apixaban (Eliquis) for three years presents to the
ER with an acute hip fracture that requires emergency surgery. Which reversal agent
is most appropriate?
A. Protamine sulfate
B. Vitamin K
C. Andexanet alfa
D. Phytonadione
Correct Answer: C
🔍 Rationale: Andexanet alfa (Andexxa) is the specific reversal agent approved
for direct Factor Xa inhibitors, including apixaban and
rivaroxaban. Protamine reverses heparin (not DOACs). Vitamin
K reverses warfarin only. Phytonadione is just another name for vitamin K.
Question 3
A 58-year-old female is started on lisinopril for hypertension. Three weeks later, she
returns to the pharmacy with a persistent, dry, hacking cough. What is the most
appropriate alternative therapy?
A. Hydrochlorothiazide (HCTZ)
B. Losartan (Cozaar)
C. Amlodipine (Norvasc)
D. Metoprolol (Lopressor)
Correct Answer: B
🔍 Rationale: A persistent dry cough is a classic, well-documented adverse effect
of ACE inhibitors (lisinopril, enalapril, etc.). The preferred alternative in this scenario
is an ARB (Angiotensin II Receptor Blocker) such as losartan, because ARBs have a
very similar efficacy profile with a near-absence of the dry cough. HCTZ, amlodipine,
or metoprolol are alternative antihypertensive classes but do not directly replace the
RAS blockade.
Question 4
A 45-year-old male with chronic stable angina is currently prescribed metoprolol and
sublingual nitroglycerin. He is starting a new medication for erectile dysfunction.
Which agent would present a severe drug interaction risk?
,A. Sildenafil (Viagra)
B. Tadalafil (Cialis)
C. Vardenafil (Levitra)
D. All of the above
Correct Answer: D
🔍 Rationale: All PDE-5 inhibitors (sildenafil, tadalafil, vardenafil, avanafil)
are strictly contraindicated with nitrates of any form (e.g., nitroglycerin, isosorbide
mononitrate/dinitrate). Concurrent use can cause a severe, life-threatening
hypotension. Patients must be counseled to avoid PDE-5 inhibitors while taking any
nitrate medication.
Question 5
Which of the following medication combinations is appropriate for the management
of acute decompensated heart failure in a hospitalized patient presenting with
significant fluid overload?
A. Metoprolol + Lisinopril
B. Furosemide (IV) + Nitroglycerin (IV)
C. Spironolactone + Eplerenone
D. Digoxin + Amiodarone
Correct Answer: B
🔍 Rationale: In acute decompensated heart failure, the primary goals
are decongestion and afterload reduction. IV furosemide is the standard loop
diuretic for rapid fluid removal, and IV nitroglycerin provides venodilation and mild
arterial dilation to reduce preload and afterload. Metoprolol would not be
appropriate in the acute decompensated phase (used for chronic stable
management).
Question 6
A 32-year-old female with migraine headaches is prescribed sumatriptan and a new
CGRP antagonist. Which statement regarding dispensing sumatriptan is correct
regarding its DEA schedule?
A. It is a Schedule C-III controlled substance; a physician’s DEA number is required.
B. It is not a controlled substance; no DEA number is needed.
C. It is a Schedule C-II controlled substance; a hard copy prescription is required.
D. It is classified as an OTC medication in California.
, Correct Answer: B
🔍 Rationale: Sumatriptan and other triptans are not controlled substances by DEA
definition. No DEA number is required on the prescription. However, for CGRP
antagonists (e.g., erenumab, galcanezumab), they are also not scheduled, though
some require pharmacy coordination due to specialty pharmacy distribution.
Question 7
A 50-year-old male presents with a new prescription for simvastatin 40 mg daily.
The patient’s profile also shows amiodarone 200 mg daily for arrhythmia. What is
the pharmacist’s primary concern?
A. Increased risk of hyperglycemia
B. Increased risk of myopathy and rhabdomyolysis
C. Increased risk of dyspepsia
D. Reduced efficacy of simvastatin
Correct Answer: B
🔍 Rationale: Amiodarone is a strong inhibitor of CYP3A4, the primary enzyme
responsible for simvastatin metabolism. This interaction results in significantly
elevated simvastatin plasma concentrations, leading to a substantially increased risk
of myopathy and rhabdomyolysis. The FDA recommends limiting simvastatin to
20 mg/day when co-administered with amiodarone.
SECTION 2: INFECTIOUS DISEASES & ANTIBIOTIC
STEWARDSHIP
Question 8
A 24-year-old female presents with acute uncomplicated cystitis. According to
current IDSA and CPJE guidelines, which of the following is the first-line empiric
therapy?
A. Ciprofloxacin (Cipro) 250 mg BID
B. Nitrofurantoin (Macrobid) 100 mg BID for 5 days
C. Amoxicillin 500 mg TID
D. Doxycycline 100 mg BID
:Questions And Answers With
Rationals/Graded A+ Update
100% Correct
SECTION 1: CARDIOVASCULAR & ANTICOAGULATION
Question 1
A 72-year-old male patient with a history of atrial fibrillation presents with an INR
of 3.8 during a routine check. He is completely asymptomatic. According to the
latest CPJE clinical guidelines, what is the most appropriate action?
A. Continue warfarin at the same dose and schedule
B. Hold warfarin for 2 days and recheck INR in 2–3 days
C. Administer oral vitamin K 10 mg immediately
D. Administer fresh frozen plasma intravenously
Correct Answer: B
🔍 Rationale: For an asymptomatic patient with an INR between 3.0 and 4.5, the
recommended action is to hold 1–2 doses of warfarin and recheck the INR. Vitamin
K is generally reserved for elevations >5.0 (without bleeding) or for any INR when
bleeding is present. Fresh frozen plasma is only used in cases of life-threatening
bleeding.
Question 2
,A patient who has been stable on apixaban (Eliquis) for three years presents to the
ER with an acute hip fracture that requires emergency surgery. Which reversal agent
is most appropriate?
A. Protamine sulfate
B. Vitamin K
C. Andexanet alfa
D. Phytonadione
Correct Answer: C
🔍 Rationale: Andexanet alfa (Andexxa) is the specific reversal agent approved
for direct Factor Xa inhibitors, including apixaban and
rivaroxaban. Protamine reverses heparin (not DOACs). Vitamin
K reverses warfarin only. Phytonadione is just another name for vitamin K.
Question 3
A 58-year-old female is started on lisinopril for hypertension. Three weeks later, she
returns to the pharmacy with a persistent, dry, hacking cough. What is the most
appropriate alternative therapy?
A. Hydrochlorothiazide (HCTZ)
B. Losartan (Cozaar)
C. Amlodipine (Norvasc)
D. Metoprolol (Lopressor)
Correct Answer: B
🔍 Rationale: A persistent dry cough is a classic, well-documented adverse effect
of ACE inhibitors (lisinopril, enalapril, etc.). The preferred alternative in this scenario
is an ARB (Angiotensin II Receptor Blocker) such as losartan, because ARBs have a
very similar efficacy profile with a near-absence of the dry cough. HCTZ, amlodipine,
or metoprolol are alternative antihypertensive classes but do not directly replace the
RAS blockade.
Question 4
A 45-year-old male with chronic stable angina is currently prescribed metoprolol and
sublingual nitroglycerin. He is starting a new medication for erectile dysfunction.
Which agent would present a severe drug interaction risk?
,A. Sildenafil (Viagra)
B. Tadalafil (Cialis)
C. Vardenafil (Levitra)
D. All of the above
Correct Answer: D
🔍 Rationale: All PDE-5 inhibitors (sildenafil, tadalafil, vardenafil, avanafil)
are strictly contraindicated with nitrates of any form (e.g., nitroglycerin, isosorbide
mononitrate/dinitrate). Concurrent use can cause a severe, life-threatening
hypotension. Patients must be counseled to avoid PDE-5 inhibitors while taking any
nitrate medication.
Question 5
Which of the following medication combinations is appropriate for the management
of acute decompensated heart failure in a hospitalized patient presenting with
significant fluid overload?
A. Metoprolol + Lisinopril
B. Furosemide (IV) + Nitroglycerin (IV)
C. Spironolactone + Eplerenone
D. Digoxin + Amiodarone
Correct Answer: B
🔍 Rationale: In acute decompensated heart failure, the primary goals
are decongestion and afterload reduction. IV furosemide is the standard loop
diuretic for rapid fluid removal, and IV nitroglycerin provides venodilation and mild
arterial dilation to reduce preload and afterload. Metoprolol would not be
appropriate in the acute decompensated phase (used for chronic stable
management).
Question 6
A 32-year-old female with migraine headaches is prescribed sumatriptan and a new
CGRP antagonist. Which statement regarding dispensing sumatriptan is correct
regarding its DEA schedule?
A. It is a Schedule C-III controlled substance; a physician’s DEA number is required.
B. It is not a controlled substance; no DEA number is needed.
C. It is a Schedule C-II controlled substance; a hard copy prescription is required.
D. It is classified as an OTC medication in California.
, Correct Answer: B
🔍 Rationale: Sumatriptan and other triptans are not controlled substances by DEA
definition. No DEA number is required on the prescription. However, for CGRP
antagonists (e.g., erenumab, galcanezumab), they are also not scheduled, though
some require pharmacy coordination due to specialty pharmacy distribution.
Question 7
A 50-year-old male presents with a new prescription for simvastatin 40 mg daily.
The patient’s profile also shows amiodarone 200 mg daily for arrhythmia. What is
the pharmacist’s primary concern?
A. Increased risk of hyperglycemia
B. Increased risk of myopathy and rhabdomyolysis
C. Increased risk of dyspepsia
D. Reduced efficacy of simvastatin
Correct Answer: B
🔍 Rationale: Amiodarone is a strong inhibitor of CYP3A4, the primary enzyme
responsible for simvastatin metabolism. This interaction results in significantly
elevated simvastatin plasma concentrations, leading to a substantially increased risk
of myopathy and rhabdomyolysis. The FDA recommends limiting simvastatin to
20 mg/day when co-administered with amiodarone.
SECTION 2: INFECTIOUS DISEASES & ANTIBIOTIC
STEWARDSHIP
Question 8
A 24-year-old female presents with acute uncomplicated cystitis. According to
current IDSA and CPJE guidelines, which of the following is the first-line empiric
therapy?
A. Ciprofloxacin (Cipro) 250 mg BID
B. Nitrofurantoin (Macrobid) 100 mg BID for 5 days
C. Amoxicillin 500 mg TID
D. Doxycycline 100 mg BID
