615-PHARM EXAM 3 MEGA REVIEW Q&A SUMMER COMPLETE SOLUTIONS 1
1. Mr. Holloway presents to your clinic with a significantly swollen, painful big toe and
you diagnose him with gout. Of the following options which would be the best treatment
forMr. Holloway?
a. Acetaminophen with codeine
b. Low-dose colchicine
c. High-dose colchicine
d. High-dose aspirin
Low-dose colchicine. Low-dose colchicine is 1.2 mg followed by 0.6 mg one hour later or
1.8 mg total. High-dose colchicine is 1.2 mg followed by 0.6 mg Q4 to Q6 hours or 4.8
mg total. The difference between the two is low-dose is as effective as high-dose with a
lower side effect profile.
2. Patient education when prescribing colchicine includes?
a. Moderate amounts of alcohol are safe with colchicine
b. Colchicine may be constipating
c. Colchicine always causes some degree of diarrhea
d. Mild muscle weakness is normal
Colchicine always causes some degree of diarrhea
3. You have a patient who is taking allopurinol to prevent gout. What labs will you monitor
for this patient on allopurinol?
a. Blood glucose
b. Complete blood count
c. BUN, creatinine, and creatinine clearance
d. C-reactive protein
BUN, creatinine, and creatinine clearance
4. Mr. Thompson has just started taking febuxostat (Uloric) to treat his gout and he needs to
be educated on what to expect.
a. Feuxostat may cause severe diarrhea
b. He will need frequent CBC monitoring
c. He should consume a high-calcium diet
d. Gout may worsen with therapy
Gout may worsen with therapy
5. Ms. Jensen has been on prednisone for 6 months. Patients who have been on
prednisone for some time should be assessed for what?
a. Iron deficiency anemia
b. Renal dysfunction
c. Osteoporosis
d. Gout
Osteoporosis. Prednisone can also worsen diabetic control and you must educate your
patients to report any tarry black stools or abdominal pain.
6. When you place a patient on prednisone and the total dose exceeds 1 gram, what
additional drug should you prescribe?
a. Naproxen, an NSAID for joint pain
b. Omeprazole, a proton-pump inhibitor to prevent PUD
,615-PHARM EXAM 3 MEGA REVIEW Q&A SUMMER COMPLETE SOLUTIONS 2
c. Metformin, a biguanide to prevent diabetes
d. Furosemide, a diuretic to treat fluid retention
Omeprazole
7. Janet has fractured her ankle and you give her a prescription for Vicodin
(acetaminophen +hydrocodone). What education should you provide before they leave
your clinic?
a. Okay to double dose if the pain is severe
b. Patient should not take any other medications that contain acetaminophen
c. Vicodin is not habit forming
d. Vicodin may cause loose stools and therefore increase fiber intake
Patient should not take any other medications that contain acetaminophen. When you do
have a patient who has pain, always start with NSAIDs if they are not contraindicated in
your patient. That way if their pain is not controlled you can prescribe a medication that
is stronger. My pain is a 3 on the pain scale, can I get a prescription for Dilaudid?
Umm, NO!
8. Margaret has been on 60 mg of prednisone for 10 days for her severe asthma
exacerbation. Since she is breathing much better it is time to discontinue the
medication. What should you know when discontinuing this drug?
a. Prednisone can be abruptly discontinued with no adverse effects
b. Substitute the prednisone with another anti-inflammatory such as ibuprofen
c. Develop a tapering schedule to slowly wean Margaret off the prednisone
d. Transition patient onto an inhaled corticosteroid
Develop a tapering schedule because tapering helps to avoid both recurrent activity of the
underlying disease process and possible cortisol deficiency resulting from the
hypothalamic-pituitary-adrenal axis (HPA) suppression during the period of steroid therapy.
9. Patients who are currently on or will start chronic corticosteroid therapy should be
monitored for what?
a. Stool culture
b. Vitamin B12
c. Serum glucose
d. Folate levels
Serum glucose. FYI: remember steroid therapy will raise glucose levels even in your
nondiabetic patients.
10. Patients with rheumatoid arthritis who are on a chronic low-dose prednisone will need
co-treatment with which medications to prevent further adverse effects?
a. Vitamin D
b. Calcium supplementation
c. A bisphosphonate
d. All of the above
All of the above. FYI: long term steroid therapy can contribute to weakened bones.
11. What is the FDA Black Box Warning for ALL nonsteroidal anti-inflammatory
drugs (NSAIDS)?
a. Increased risk of developing systemic arthritis with prolonged use
, 615-PHARM EXAM 3 MEGA REVIEW Q&A SUMMER COMPLETE SOLUTIONS 3
b. Risk of life-threatening rashes, including Stevens-Johnson
c. Potential for causing life-threatening gastrointestinal bleeds
d. Potential for transient changes in serum glucose levels
Potential for causing life-threatening gastrointestinal bleeds (and ulceration and
perforation of the stomach or intestines). NSAIDs can also increase the risk of
cardiovascular thrombotic events, MI, and stroke, especially with extended use. Elderly
patients are at greater risk and can happen without any warning symptoms. So
EDUCATE, EDUCATE, EDUCATE!
12. If you are getting ready to prescribe an NSAID, a complete drug history should be
conducted as NSAIDs interact with which drug?
a. Diphenhydramine (an antihistamine)
b. Combined oral contraceptives
c. Warfarin (anticoagulant)
d. Omeprazole (proton-pump inhibitor)
Warfarin. NSAIDs work by inhibiting the cox enzymes. Strathman says to get familiar
with the “cox pathway” and how blocking one part of the cox pathway can lead to build
up of other different products. NSAIDs stimulate platelet aggregation by the formation of
thromboxane-A2 leading to the formation of blood clots. See attachment.
13. Gabriella is a 3-year old diagnosed with otitis media and an upper respiratory infection.
You prescribe her an antibiotic (probably amoxicillin) and ibuprofen. What education
should the parents receive?
a. The ibuprofen dose can be doubled if the pain is severe
b. Need to keep Gabriella well hydrated while she is taking ibuprofen
c. Ibuprofen is complete safe in children with no known adverse effects as the
elderly are more prone to GI events
d. The parents can cut the Ibuprofen in half to give to Gabriella
Gabriella needs to stay well hydrated while taking ibuprofen. NSAIDs are excreted by
the kidneys so it is a good idea to keep them flushed.
14. William is a 78-year old who takes two aspirin every morning while he reads his
newspaper to treat arthritis pain in his back. He states the aspirin helps him to “get
moving” each day. Lately he has had some heartburn from the aspirin. After you rule out
an acute GI bleed, what would be an appropriate course of treatment for William?
a. Discontinue the aspirin and switch him to hydrocodone for pain
b. Decrease the aspirin dose to one tablet daily
c. Add an H2 blocker such as ranitidine to his therapy
d. Have William take an antacid 15 minutes before taking the aspirin each day
Add an H2 blocker such as ranitidine.
15. Patients prescribed aspirin therapy require education regarding the signs of aspirin
toxicity. An early sign of aspirin toxicity is?
a. Vomiting
b. Tremors
c. Black tarry stools
d. Tinnitus
1. Mr. Holloway presents to your clinic with a significantly swollen, painful big toe and
you diagnose him with gout. Of the following options which would be the best treatment
forMr. Holloway?
a. Acetaminophen with codeine
b. Low-dose colchicine
c. High-dose colchicine
d. High-dose aspirin
Low-dose colchicine. Low-dose colchicine is 1.2 mg followed by 0.6 mg one hour later or
1.8 mg total. High-dose colchicine is 1.2 mg followed by 0.6 mg Q4 to Q6 hours or 4.8
mg total. The difference between the two is low-dose is as effective as high-dose with a
lower side effect profile.
2. Patient education when prescribing colchicine includes?
a. Moderate amounts of alcohol are safe with colchicine
b. Colchicine may be constipating
c. Colchicine always causes some degree of diarrhea
d. Mild muscle weakness is normal
Colchicine always causes some degree of diarrhea
3. You have a patient who is taking allopurinol to prevent gout. What labs will you monitor
for this patient on allopurinol?
a. Blood glucose
b. Complete blood count
c. BUN, creatinine, and creatinine clearance
d. C-reactive protein
BUN, creatinine, and creatinine clearance
4. Mr. Thompson has just started taking febuxostat (Uloric) to treat his gout and he needs to
be educated on what to expect.
a. Feuxostat may cause severe diarrhea
b. He will need frequent CBC monitoring
c. He should consume a high-calcium diet
d. Gout may worsen with therapy
Gout may worsen with therapy
5. Ms. Jensen has been on prednisone for 6 months. Patients who have been on
prednisone for some time should be assessed for what?
a. Iron deficiency anemia
b. Renal dysfunction
c. Osteoporosis
d. Gout
Osteoporosis. Prednisone can also worsen diabetic control and you must educate your
patients to report any tarry black stools or abdominal pain.
6. When you place a patient on prednisone and the total dose exceeds 1 gram, what
additional drug should you prescribe?
a. Naproxen, an NSAID for joint pain
b. Omeprazole, a proton-pump inhibitor to prevent PUD
,615-PHARM EXAM 3 MEGA REVIEW Q&A SUMMER COMPLETE SOLUTIONS 2
c. Metformin, a biguanide to prevent diabetes
d. Furosemide, a diuretic to treat fluid retention
Omeprazole
7. Janet has fractured her ankle and you give her a prescription for Vicodin
(acetaminophen +hydrocodone). What education should you provide before they leave
your clinic?
a. Okay to double dose if the pain is severe
b. Patient should not take any other medications that contain acetaminophen
c. Vicodin is not habit forming
d. Vicodin may cause loose stools and therefore increase fiber intake
Patient should not take any other medications that contain acetaminophen. When you do
have a patient who has pain, always start with NSAIDs if they are not contraindicated in
your patient. That way if their pain is not controlled you can prescribe a medication that
is stronger. My pain is a 3 on the pain scale, can I get a prescription for Dilaudid?
Umm, NO!
8. Margaret has been on 60 mg of prednisone for 10 days for her severe asthma
exacerbation. Since she is breathing much better it is time to discontinue the
medication. What should you know when discontinuing this drug?
a. Prednisone can be abruptly discontinued with no adverse effects
b. Substitute the prednisone with another anti-inflammatory such as ibuprofen
c. Develop a tapering schedule to slowly wean Margaret off the prednisone
d. Transition patient onto an inhaled corticosteroid
Develop a tapering schedule because tapering helps to avoid both recurrent activity of the
underlying disease process and possible cortisol deficiency resulting from the
hypothalamic-pituitary-adrenal axis (HPA) suppression during the period of steroid therapy.
9. Patients who are currently on or will start chronic corticosteroid therapy should be
monitored for what?
a. Stool culture
b. Vitamin B12
c. Serum glucose
d. Folate levels
Serum glucose. FYI: remember steroid therapy will raise glucose levels even in your
nondiabetic patients.
10. Patients with rheumatoid arthritis who are on a chronic low-dose prednisone will need
co-treatment with which medications to prevent further adverse effects?
a. Vitamin D
b. Calcium supplementation
c. A bisphosphonate
d. All of the above
All of the above. FYI: long term steroid therapy can contribute to weakened bones.
11. What is the FDA Black Box Warning for ALL nonsteroidal anti-inflammatory
drugs (NSAIDS)?
a. Increased risk of developing systemic arthritis with prolonged use
, 615-PHARM EXAM 3 MEGA REVIEW Q&A SUMMER COMPLETE SOLUTIONS 3
b. Risk of life-threatening rashes, including Stevens-Johnson
c. Potential for causing life-threatening gastrointestinal bleeds
d. Potential for transient changes in serum glucose levels
Potential for causing life-threatening gastrointestinal bleeds (and ulceration and
perforation of the stomach or intestines). NSAIDs can also increase the risk of
cardiovascular thrombotic events, MI, and stroke, especially with extended use. Elderly
patients are at greater risk and can happen without any warning symptoms. So
EDUCATE, EDUCATE, EDUCATE!
12. If you are getting ready to prescribe an NSAID, a complete drug history should be
conducted as NSAIDs interact with which drug?
a. Diphenhydramine (an antihistamine)
b. Combined oral contraceptives
c. Warfarin (anticoagulant)
d. Omeprazole (proton-pump inhibitor)
Warfarin. NSAIDs work by inhibiting the cox enzymes. Strathman says to get familiar
with the “cox pathway” and how blocking one part of the cox pathway can lead to build
up of other different products. NSAIDs stimulate platelet aggregation by the formation of
thromboxane-A2 leading to the formation of blood clots. See attachment.
13. Gabriella is a 3-year old diagnosed with otitis media and an upper respiratory infection.
You prescribe her an antibiotic (probably amoxicillin) and ibuprofen. What education
should the parents receive?
a. The ibuprofen dose can be doubled if the pain is severe
b. Need to keep Gabriella well hydrated while she is taking ibuprofen
c. Ibuprofen is complete safe in children with no known adverse effects as the
elderly are more prone to GI events
d. The parents can cut the Ibuprofen in half to give to Gabriella
Gabriella needs to stay well hydrated while taking ibuprofen. NSAIDs are excreted by
the kidneys so it is a good idea to keep them flushed.
14. William is a 78-year old who takes two aspirin every morning while he reads his
newspaper to treat arthritis pain in his back. He states the aspirin helps him to “get
moving” each day. Lately he has had some heartburn from the aspirin. After you rule out
an acute GI bleed, what would be an appropriate course of treatment for William?
a. Discontinue the aspirin and switch him to hydrocodone for pain
b. Decrease the aspirin dose to one tablet daily
c. Add an H2 blocker such as ranitidine to his therapy
d. Have William take an antacid 15 minutes before taking the aspirin each day
Add an H2 blocker such as ranitidine.
15. Patients prescribed aspirin therapy require education regarding the signs of aspirin
toxicity. An early sign of aspirin toxicity is?
a. Vomiting
b. Tremors
c. Black tarry stools
d. Tinnitus
