ACCP PHARMACOTHERAPY (TO STUDY FOR
THE BCPS EXAM) 302 QUESTIONS &
ANSWERS GRADED A+
1 of 302
Definition
Answer D: Evaluate tolterodine use.
(Confusion in the elderly can be a symptom of many different
medical conditions. Because the urinalysis is negative for leukocyte
esterase and nitrite, urinary tract infection is not likely the cause, and
empiric therapy is not warranted (Answer A is incorrect). Increasing
the donepezil dose to 20 mg exceeds the recommended dosage for
mild to moderate AD (Answer B is incorrect). Disease- and drug-
related causes for changes in mental status should be ruled out
before initiating any additional therapy (Answer C is incorrect).
,Confusion may be related to the use of anticholinergic drugs;
therefore, the patient's use of tolterodine should be evaluated
(Answer D is correct).)
Give this one a try later!
A 32-year-old woman has a new diagnosis of relapsing-remitting multiple
sclerosis (MS). She has not taken any previous MS therapy and presents to the
clinic today to discuss her therapy options. The medical resident would like to
consider a trial of glatiramer acetate.
Which one of the following statements best describes the use of glatiramer
acetate as a first-line agent in this patient?
A. It is not a first-line therapy for relapsing-remitting MS.
B. It is an appropriate first-line therapy option for this patient.
C. It is an appropriate first-line therapy option, but it should be given
concurrently with interferon beta-1b.
D. It may be used in this patient only after a trial of dalfampridine.
A 45-year-old woman (height 64 inches, weight 88.6 kg) who has had T2DM for 5
years presents for her annual physical examination. Her vital signs and laboratory
show the following: blood pressure 134/79 mm Hg, heart rate 84 beats/minute,
and microalbumin/creatinine ratio 11.1. Fasting laboratory results reveal TC 184
mg/dL, TG 210 mg/dL, HDL-C 45 mg/dL, LDL-C 97 mg/dL, non-HDL-C 139 mg/dL,
AIC 9.8%, scr 1.2 mg/dL, and K 4.5 mEq/L. She has not smoked for 8 years. She
currently takes metformin 1000 mg twice daily, atorvastatin 80 mg/day, and
lisinopril 40 mg/day.
Which one of the following would best improve this patient's AIC and
cardiovascular (C V) risk factors?
A. Lose 5-9 kg with lifestyle modification.
B. Start a fish oil supplement.
C. Change atorvastatin to pravastatin 40 mg/day.
D. Start aspirin 325 mg/day.
, A 78-year-old woman residing in a long-term care facility was stable until 2
weeks ago, when she experienced an increase in confusion that
necessitated a psychiatric evaluation. The patient has a history of HTN,
T2DM, mild cognitive impairment associated with AD, and recent-onset
urge urinary incontinence. Her current drugs include glipizide 10 mg/day,
metformin 500 mg three times/day, lisinopril 10 mg/day, aspirin 81 mg/day,
donepezil 10 mg/day, and tolterodine 2 mg twice daily. A urinalysis was
negative for leukocyte esterase and nitrite.
Which one of the following is best to recommend for this patient?
A. Start empiric therapy with sulfamethoxazole/trimethoprim.
B. Increase the dose of donepezil to 20 mg/day.
C. Add memantine 5 mg/day.
D. Evaluate tolterodine use.
A 39-year-old Woman (weight 110 kg, height 163 cm) presents to her primary care
physician with substernal chest pain. The pain has occurred at around 7:00 a.m.
for the past 2 weeks. She ranks the pain as 5/10. The pain does not appear to be
associated with an activity and lasts less than 10 minutes. Social history reveals no
tobacco or alcohol abuse. Her home drugs include norethindrone 1 mg/Ethinyl
estradiol 0.035 mg daily. Vital signs include BP 134/74 mm Hg and HR 86
beats/minute. Laboratory results include TC 160 mg/dL, TG 120 mg/dL, and HDL-
C 45 mg/dL; a chemistry panel is within normal limits. A treadmill stress test is
performed; however, the patient is unable to complete the examination because
of leg cramping. Subsequent coronary angiography reveals no coronary lesions;
however, vasospasms are noted in the circumflex artery.
Which one of the following is best to recommend for this patient?
A. Atenolol 50 m
Don't know?
2 of 302
Term
A 62-year-old man who received a liver transplant years ago
secondary to hepatitis C virus and hepatocellular cancer has had an
, elevated SCr during the past few months at follow-up. The
hepatologist wants to change him to a less nephrotoxic
immunosuppressive regimen. The patient's current drugs are
tacrolimus 2 mg twice daily, famotidine 20 mg twice daily,
metoprolol 50 mg twice daily, amlodipine 10 mg once daily,
zolpidem 10 mg as needed, multivitamin once daily, and
supplemental calcium, which he takes when he remembers. The
decision is made to initiate sirolimus to decrease calcineurin inhibitor
(CNI) exposure.
Which one of the following test panels would be best to obtain
before initiating sirolimus therapy in this patient?
A. Urine protein, thyroid-stimulating factor (TSH), and lipid panel.
B. Urine protein, WBC, and lipid panel.
C. WBC and TSH.
D. TSH and lipid panel.
Give this one a try later!
Answer B: Urine protein, WBC, and lipid panel.
(Assessing patients before initiating a new immunosuppressive drug
therapy is necessary not only to ensure that the new therapy is appropriate,
but also to evaluate tolerability and adherence. Sirolimus is associated with
several adverse effects that tend to limit its use, are dose limiting, and lead
to a decreased quality of life. Commonly observed toxicities include
cytopenia, edema, hyperlipidemia, diarrhea, impaired wound healing, and
proteinuria; rarely observed toxicities include bronchial anastomotic
dehiscence, venous thromboembolism, and pneumonitis. Screening for
potential complications before initiating therapy may help lead to positive
outcomes. Checking a lipid panel, urine protein, and WBC before initiating
sirolimus therapy is necessary (Answer B is correct). Thyroid function is not
known to be affected by the use of sirolimus (Answer A, Answer C, and
Answer D are incorrect).)
THE BCPS EXAM) 302 QUESTIONS &
ANSWERS GRADED A+
1 of 302
Definition
Answer D: Evaluate tolterodine use.
(Confusion in the elderly can be a symptom of many different
medical conditions. Because the urinalysis is negative for leukocyte
esterase and nitrite, urinary tract infection is not likely the cause, and
empiric therapy is not warranted (Answer A is incorrect). Increasing
the donepezil dose to 20 mg exceeds the recommended dosage for
mild to moderate AD (Answer B is incorrect). Disease- and drug-
related causes for changes in mental status should be ruled out
before initiating any additional therapy (Answer C is incorrect).
,Confusion may be related to the use of anticholinergic drugs;
therefore, the patient's use of tolterodine should be evaluated
(Answer D is correct).)
Give this one a try later!
A 32-year-old woman has a new diagnosis of relapsing-remitting multiple
sclerosis (MS). She has not taken any previous MS therapy and presents to the
clinic today to discuss her therapy options. The medical resident would like to
consider a trial of glatiramer acetate.
Which one of the following statements best describes the use of glatiramer
acetate as a first-line agent in this patient?
A. It is not a first-line therapy for relapsing-remitting MS.
B. It is an appropriate first-line therapy option for this patient.
C. It is an appropriate first-line therapy option, but it should be given
concurrently with interferon beta-1b.
D. It may be used in this patient only after a trial of dalfampridine.
A 45-year-old woman (height 64 inches, weight 88.6 kg) who has had T2DM for 5
years presents for her annual physical examination. Her vital signs and laboratory
show the following: blood pressure 134/79 mm Hg, heart rate 84 beats/minute,
and microalbumin/creatinine ratio 11.1. Fasting laboratory results reveal TC 184
mg/dL, TG 210 mg/dL, HDL-C 45 mg/dL, LDL-C 97 mg/dL, non-HDL-C 139 mg/dL,
AIC 9.8%, scr 1.2 mg/dL, and K 4.5 mEq/L. She has not smoked for 8 years. She
currently takes metformin 1000 mg twice daily, atorvastatin 80 mg/day, and
lisinopril 40 mg/day.
Which one of the following would best improve this patient's AIC and
cardiovascular (C V) risk factors?
A. Lose 5-9 kg with lifestyle modification.
B. Start a fish oil supplement.
C. Change atorvastatin to pravastatin 40 mg/day.
D. Start aspirin 325 mg/day.
, A 78-year-old woman residing in a long-term care facility was stable until 2
weeks ago, when she experienced an increase in confusion that
necessitated a psychiatric evaluation. The patient has a history of HTN,
T2DM, mild cognitive impairment associated with AD, and recent-onset
urge urinary incontinence. Her current drugs include glipizide 10 mg/day,
metformin 500 mg three times/day, lisinopril 10 mg/day, aspirin 81 mg/day,
donepezil 10 mg/day, and tolterodine 2 mg twice daily. A urinalysis was
negative for leukocyte esterase and nitrite.
Which one of the following is best to recommend for this patient?
A. Start empiric therapy with sulfamethoxazole/trimethoprim.
B. Increase the dose of donepezil to 20 mg/day.
C. Add memantine 5 mg/day.
D. Evaluate tolterodine use.
A 39-year-old Woman (weight 110 kg, height 163 cm) presents to her primary care
physician with substernal chest pain. The pain has occurred at around 7:00 a.m.
for the past 2 weeks. She ranks the pain as 5/10. The pain does not appear to be
associated with an activity and lasts less than 10 minutes. Social history reveals no
tobacco or alcohol abuse. Her home drugs include norethindrone 1 mg/Ethinyl
estradiol 0.035 mg daily. Vital signs include BP 134/74 mm Hg and HR 86
beats/minute. Laboratory results include TC 160 mg/dL, TG 120 mg/dL, and HDL-
C 45 mg/dL; a chemistry panel is within normal limits. A treadmill stress test is
performed; however, the patient is unable to complete the examination because
of leg cramping. Subsequent coronary angiography reveals no coronary lesions;
however, vasospasms are noted in the circumflex artery.
Which one of the following is best to recommend for this patient?
A. Atenolol 50 m
Don't know?
2 of 302
Term
A 62-year-old man who received a liver transplant years ago
secondary to hepatitis C virus and hepatocellular cancer has had an
, elevated SCr during the past few months at follow-up. The
hepatologist wants to change him to a less nephrotoxic
immunosuppressive regimen. The patient's current drugs are
tacrolimus 2 mg twice daily, famotidine 20 mg twice daily,
metoprolol 50 mg twice daily, amlodipine 10 mg once daily,
zolpidem 10 mg as needed, multivitamin once daily, and
supplemental calcium, which he takes when he remembers. The
decision is made to initiate sirolimus to decrease calcineurin inhibitor
(CNI) exposure.
Which one of the following test panels would be best to obtain
before initiating sirolimus therapy in this patient?
A. Urine protein, thyroid-stimulating factor (TSH), and lipid panel.
B. Urine protein, WBC, and lipid panel.
C. WBC and TSH.
D. TSH and lipid panel.
Give this one a try later!
Answer B: Urine protein, WBC, and lipid panel.
(Assessing patients before initiating a new immunosuppressive drug
therapy is necessary not only to ensure that the new therapy is appropriate,
but also to evaluate tolerability and adherence. Sirolimus is associated with
several adverse effects that tend to limit its use, are dose limiting, and lead
to a decreased quality of life. Commonly observed toxicities include
cytopenia, edema, hyperlipidemia, diarrhea, impaired wound healing, and
proteinuria; rarely observed toxicities include bronchial anastomotic
dehiscence, venous thromboembolism, and pneumonitis. Screening for
potential complications before initiating therapy may help lead to positive
outcomes. Checking a lipid panel, urine protein, and WBC before initiating
sirolimus therapy is necessary (Answer B is correct). Thyroid function is not
known to be affected by the use of sirolimus (Answer A, Answer C, and
Answer D are incorrect).)
