kb is a 36-year-old man who presents to a pharmacist

PharmacyPREP.com

Tips Inc Copyright 2000-2013 Prevent Piracy & Report Piracy 1

Therapeutic MOCK TEST 1 - May 2013

1) MP is a 50 year old man. His medical history started hydrochlorothiazide (HCTZ) 25 mg po qd 2 months ago. After 4 months HCTZ increased 25 mg po because his BP was uncontrolled. He is diabetic, has hypercholesterolemia. MP had anaphylactic reaction with amoxicillin in childhood. He smokes half pack a day. Which section of SOAP we have to write this allergy? A) Subjective B) Objective C) Assessment D) Plan E) Follow up Ans: A 2) Which of the following is the next most appropriate step in treating MP ? a. Discontinue HCTZ and re-evaluate blood pressure. b. Adding lisinopril 10 mg po qd to HCTZ 25 mg po qd c. Adding Atenolol 100 mg po qd to HCTZ 25 mg po qd d. Increase HCTZ to 50 mg po qd e. Lifestyle changes require and discontinue HCTZ Ans: B Tips: Atenolol masks hypoglycemia and hydrochlorothiazide is diabetogenic

PharmacyPREP.com


3) Counseling on hydrochlorothiazide 25 mg po qd includes: A. Do not wear contact lenses B. Take it in the morning C. Take with a glass of orange juice or banana (K+

supplement) D. All of the above E. B and C Ans: D

4) NKP is a 47 year old patient has just started raw diet only few days, taken citrus juice daily. Maintain healthy life style such diet and exercise. Patient using atorvastatin 20 mg to treat high cholesterol and recent visit doctor, he increases atorvastatin dose to 40 mg. Patient complains severe dyspepsia and diarrhea. It’ may be due to: a. Because he is on raw food diet b. Changed atorvastatin 20 mg to 40 mg c. Takes citrus juice d. Exercise e. Multivitamins Ans. B Tips: What does statins have GI SEs. However statins common GI SEs. Raw food is high fibre content (insoluble fibre).

PharmacyPREP.com


5) NPK is diagnosed high LDL and TG, what is the best therapy to initiate? A)Rosuvastatin B)Cholestyramine C)Niacin D)Fenofibrate E)Ezetamibe Ans: A TC page 438, 6th ed. Rosuvastatin and atorvastatin have high lowering effect on LDL and TG

6) KP is 53 year old patient who had hypertension came to pharmacy and had prescription of rosuvastatin 10 mg daily as doctor diagnosed him to use hyperlipidemia. Hel told to pharmacist do not want to start medication. Wants to try lifestyle changes. Pharmacist start talking to him about his condition and explained to him benefit of using of medication but also after patient wanted to go lifestyle modification first. What should a good pharmacist do in this situation? A) respect patient autonomy and give him right to decide B) ask patient to see different doctor for second opinion C) ask patient to start after trying lifestyle modifications D) provide patient more evidence base document to show benefit of medication and dangers of hyperlipidemia E) Ask patient what did your doctor tell you. Ans: D

PharmacyPREP.com


7) KM a 60 yo MI patient had bypass surgery past 4 months ago using ASA 325 mg daily, clopidogrel 75 mg daily, rosuvastatin 10 mg daily, nodolol 80 mg daily and salbutamol prn, budesonide daily. Now hospitalized with severe asthma. What is the pharmacist concern in KM? I) drug and drug interactions II) drug and disease interactions III) drug and food interactions a) I only b) III only c) I and II d) II and III e) I, II and III Ans: C

8) A 60 yo patient came to emergency and doctor diagnosed STEMI and ordered Alteplase injection. Currently patient blood pressure is 190/110. What is the drug related problem? A) patient is receiving medication which is NOT indicated for this therapy B) Patient is receiving medication have adverse drug reaction C) Patient is receiving medication that is under dose D) Patient is receiving medication that is overdose E) Patient is Not receiving indicated therapy for indication Ans: A

PharmacyPREP.com


9) A 66 yo male in warfarin treatment for deep vein

thrombosis. A doctor calls and tells you that one of your

mutual patients has taken too many warfarin tablets in error

and has an INR value of 5.2 without any symptoms of

problems. She would like to treat with vitamin K to lower the

INR promptly. Do you have any recommendations?

A) Low dose oral vitamin K therapy promptly reduces elevated

INR

B) Skip dose of warfarin for a day and monitor INR

C) Continue warfarin therapy increase frequency of

monitoring INR

D) Low dose of vitamin K injections promptly reduces elevated

INR

E) It is not a concern, so continue therapy without interruption

Ans: A

Tips; as per CMAJ Feb 2003. It is recommended to low

dose of vitamin K 1 mg or 4 to 5 mg for patient with

INR more than 5 in bleeding or no bleeding symptoms.

10) A 64 yo man weighing 115 kg, and tall 60 inches,

presents to his physician after long international flight

complaining of pain, swelling of his right lower leg. The

patient had knee surgery a month before he travelled.

His medication profile include, CHF (ejection fraction <

15%), remission from lymphoma, MI. His father,

mother, and sister are all diseased from stroke,

pulmonary embolism. Given his profile. Patient most

likely suffering from?

Which of the following is NOT risk factors of DVT?

PharmacyPREP.com


A) Knee surgery B) over weight C) long flight D)

family history E) gender

Ans: E

Tips: RF for above patient, except gender. other RFs

include age > 40 yr, cancer, CHF, MI, and obesity.

11) What is the most important recommendation should

provided to decrease risk of deep vein thrombosis?

A) Avoid taking flights

B) Increase mobility of legs

C) Avoid physical activity

D) Avoid vitamin K intake

E) Avoid dark green vegetables

Ans: B

12) Patient is hospitalized. Drs initiated heparin

infusion. What is incorrect about heparin

A) Heparin dose is based on body weight

B) Loading dose is 80 units/kg and maintenance dose is

15 to 25 units/kg/hr.

C) Heparin is slower onset than LMWH

D) LMWH have longer half life

E) LMWH have predictable response thus not

monitored

Ans: C

13) If doctor initiated dalteparin, which of the following

is NOT required to monitor?

A) Bleeding B) aPTT C) Rash D) INR E) Bruise

PharmacyPREP.com


Ans: B and D

Tips: LMWH act selectively binding with factor Xa,

which is affects on aPTT. However this has NO effect on

prothrombin time, therefore INR is not beneficial.

Dabigatran can be monitored for aPTT. Ref: eCPS

14) A 60 years old patient having systolic CHF. His LVEF is ≤ 40%. He is intolerant to ß-blocker. His doctor should Rx for him: I) CCB II) Only ACEI III) ACEI + ARBs A-I only B-III only C-I and II only D) II and III only E-I, II, III Ans: (B) Reference: Therapeutic Choices 5th edition Page 488 15) In the above scenario if persistent symptoms i.e. if there is no improvement in LVEF, then: I) Discontinue ACEI and ARBs and give Spironolactone II) Discontinue ACEI and ARBs and give Hydralazine/Isosorbide dinitrate III) Add Digoxin to the above regimen A-I only B-III only C-I and II only

PharmacyPREP.com


D-II and III only E-I, II, III Ans: (B) TIPS: Since in case of persistent signs and symptoms, there is a possibility of cardiac lesion, and the patient may develop SVA. 16) Which of the following is NOT used in CHF?

A) Spironolactone B) Verapamil C) amlodipine D) Ethacrinic acid E) carvedilol Ans: B

Josh Holiday is a 26 year old unemployed university

graduate is treatment of major depression. Recently he

purchased several packs of pseudoephedrine from 2 to 3

pharmacies. He has been sent to the hospital by

recommendation of pharmacist after he checked his

blood pressure in pharmacy it was 195/95.

17) What antidepressant he was using?

A) sertraline

B) Amitriptyline

C) Tranylcypromine

D) Selegiline

E) Bupropion

Ans: C

Tips: Desloratidine is recommended as decongestant in

patient using MAO Inh.

PharmacyPREP.com


18) A 66 yo patient arrived to emergency after 6 hours

of symptoms of severe headache, confused and blurred

vision. He had history of transient ischemic attack,

hypertension < 160/85, high cholesterol and diabetes.

Doctors in ER have diagnosed is condition as acute

stroke?

What is the reason doctors have decided not to give

Alteplase

A) he is 66 yr old

B) he has history of high blood pressure

C) He arrived to ER after 6 hours

D) He has history of cholesterol

E) he has history of diabetes

Ans: C

Tips: inclusion criteria are < 3 - 4.5 hr, BP <180/110,

age <75 yr, NO previous surgeries.

19) The above patient having atrial fibrillation. What is will be given secondary prevention of atrial fibrillation of stroke? A) ASA B) Warfarin C) ASA + clopidogrel D) ASA + dypiridamole E) Metoprolol Ans: B

PharmacyPREP.com


20) A 64 year old patient with CHF, has problem with one flight upstairs and from walking 200 yard from car to home. This is characterized, what NYHA levels is? A) NYHA Class 1 b) NYHA Class II C) NYHA Class III D) NYHA Class IV Ans: C 21) Which of the following drugs are not considered in a patient with hypertension and heart failure? A) Ramipril B) Nifedipine C) Metoprolol D) verapamil E) Amlodipine Ans: D Tips: Verapamil is not used in CHF.

22) MK is a 62 year old man. He is on warfarin 2.5 mg

daily for the for the prevention of atrial fibrillation.

Past 3 days ago MK developed sore throat and his

doctor considering to prescribe ampicillin 500 mg QID

A-Effects of warfarin may be increased resulting in

increased risk of bleeding.

B-Effects of warfarin may be decrease resulting in

increased risk of bleeding.

C- Effects of warfarin may be increased resulting in

decreased risk of bleeding.

PharmacyPREP.com


D- Effects of warfarin may be decrease resulting in

decreased risk of bleeding.

E- Effects of warfarin may be decrease resulting do not

effects on bleeding

Ans: A

Tips: INR should be monitored upon addition of

ampicillin and withdrawal of ampicillin. INR should be

periodically reassessed for at least 3 weeks after

ampicillin discontinue, since adjustment in the warfarin

dose may be necessary to maintain an effective level of

anticoagulation.

Cotrimoxazole increase INR. Macrolide (erythromycin,

clarithromycin) increase INR. Fluroquinolone increase

INR.

23) MK is currently stabilized on warfarin 2.5 mg QD

treatment. Which of the following drugs may decrease

warfarin levels

A-Carbamazepine

B-Clarithromycin

C-Cotrimoxazole

D-Ciprofloxacin

E-Digoxin

Ans: A

Tips: Carbamazepine is enzyme CYP 2D6 inducers. It

will decrease warfarin blood levels. Clarithromycin

(and, to a lesser extent, azithromycin) and

cotrimoxazole may increase warfarin blood levels.

Clarithromycin may also increase levels of

carbamazepine, digoxin, statins and theophylline. Other

PharmacyPREP.com


antibiotics that may increase warfarin and digoxin

levels include fluroquinolones

24) A 65 years old patient was admitted to ICU experiencing acute ischemic stroke. His stroke symptoms started 8 hours ago. His was recently discharged from hospital after treatment of mild hemorrhagic stroke symptoms. Why did the doctor decided not to give Alteplase? I) Age II) more than 6 hours III) Hemorrhagic symptoms A) I only B-III only C) I and II only D) II and III only E)I, II, III Ans: D Tips: Age 75 and above, more than 6 hr and bp 185/110 and hemorrhage are the absolute CIs of alteplase.

25) A 41 years old a chronic alcoholic male, no known

allergies, past medical history: Anxiety, difficulty

sleeping. Current medications: triazolam 0.5 mg qhs x 3

years and acetaminophen/caffeine/codeine (Tylenol #1)

ii prn headache. You notice that this patient has been

coming in early for refills for triazolam and has

received extra prescriptions for this medication from

many walk-in clinics. Patient approaches you and states

that he is concerned about his triazolam usage, so he

PharmacyPREP.com


stopped using it 24 hours ago. He asks you what the

most common withdrawal symptoms will be:

A. Diarrhea, shakes and chills

B. Insomnia, muscle spasms and irritability

C. Increased headache, fatigue and nausea

D. Seizures, delirium, and hallucinations

Ans: B

Tips: Autonomic hyperactivity, insomnia, anxiety,

muscle spasm.

26) Which of the following patient assessment is LEAST

important for insomnia?

A) Total sleep time

B) Sleep latency

C) Early and/or frequent awakening

D) Alcohol consumption

E- Daytime impact of sleeping problem

Ans: D

Tips: Sleep diary: TC page 126

27) A physician prescribed alprazolam 0.5 mg SL 3 tab. Repeat 5 times. What is correct? A) Prescription is NOT valid B) Prescriptions is forged C) Prescription should not contain repeats D) prescription is valid E) the prescription is NOT allowed Ans: D

PharmacyPREP.com


Tips: Benzodiazepine can be refilled. Benzodiazepine refills do not require intervals to be specified. Control substance part 1 doctor has to specify intervals of repeats and repeats allowed only for written prescriptions. 28) The pharmacist fills a prescription for sumatriptan 100 mg tablets for a patient with migraine. Appropriate information to provide to the patient includes which of the following?

a. If the sumatriptan does not relieve the headache within four hours, ergotamine may be used. b. If no relief is achieved in two hours, sumatriptan may be repeated. c. If the headache is relieved but another headache occurs eight hours later, sumatriptan may be used for the second headache. d. The maximum dosage in any 24 hour period is six tablets. e. If relief is not achieved, no other medication can be used for 24 hours.

Ans: C

29) A 30-year-old patient, is currently on antidepressant treatment, wants to stop taking fluoxetine because she continues to have trouble sleeping and does not wish to

PharmacyPREP.com


use a sedative. Which is the best option to improve sleep? a) Add lorazepam at bedtime b) Switch to bupropion c) Switch to moclobemide d) Switch to mirtazapine Ans: D

30) MD is a 40-year-old woman who has recently been

diagnosed with panic disorder. She describes to you the

very frightening episodes she has experienced over the

last six months. She was convinced she had a serious

heart problem, but has been assured by her doctor that

she is physically healthy. She is obviously very anxious,

fidgeting with her purse, looking around to see who

may also be in the pharmacy. Upon questioning, you

found out that she has been having trouble

concentrating and sleeping and that she is very worried

about having another attack.

Which of the following medications would be the best

choice, as a single agent, for immediate relief of MD’s

symptoms?

a. Buspirone

b. Desipramine

c. Alprazolam

d. Fluoxetine

Ans: C

PharmacyPREP.com


TIPS: As alprazolam is related to BDZs it’s the best

choice.

FG is a 65-year-old war veteran with a 40-year history

of paranoid schizophrenia. His symptoms include poor

personal hygiene, blunted affect, and delusions,

accompanied by auditory and visual hallucinations. His

delusional symptoms relate to his wartime experiences.

His visual hallucinations involve enemy soldiers from

the war who he believes are stalking him. FG's auditory

hallucinations include the sounds of war, accompanied

by enemy soldiers threatening to end his life if he does

not keep his guard up. FG has been unable to maintain

a job or adequate housing for many years. He currently

lives under a bridge "in case he needs to make a

getaway down the river."

When workers from the free clinic are able to locate

him, they attempt to provide medical care and evaluate

his schizophrenia. If sample medications are available,

they provide him with them. According to their records,

FG was given haloperidol 15 mg 3 times daily and

benztropine 1 mg 3 times daily when they last evaluated

him. He was given enough medication for a few weeks

so that they could evaluate the effectiveness and any

adverse effects. During previous trials with other

neuroleptic agents, extrapyramidal side effects have

limited the dose FG could tolerate.

The physician on the team would like to discontinue the

haloperidol and initiate an agent with fewer

extrapyramidal side effects. He searches the medication

PharmacyPREP.com


supply and finds that he has samples of fluphenazine,

chlorpromazine, thiothixine, and risperidone.

31-Which agent is least likely to cause extrapyramidal

side effects?

A-Fluphenazine

B-Chlorpromazine

C)Thiothixine

D-Risperidone

E-Clozapine

Ans-D

Tips: Risperidone is the agent least likely to cause

extrapyramidal side effects. At doses ≤6 mg per day, the

side effect rate with risperidone is similar to that with

placebo. With increased doses, the risk of

extrapyramidal side effects increases. The most

common side effects with low-dose risperidone are

asthenia and sedation.

32) MJ is a 29 year old has been diagnosed for Crohn's disease. If MJs doctor is considering CDs for remission. What the treatment? A) 5-ASA 4 to 5 wk B) Sulfasalazine 4 to 5 wk C) Prednisone PO 40-60 mg, 12 to16 wks D) Methotrexate E) Infliximab Ans: C TC page 840, 6th.ed.

PharmacyPREP.com


ST, is a 57-year-old male nurse who works for the local

pulmonologist, arrives at work one day complaining of

weakness and fatigue. He explains that these symptoms

have worsened over several days. He reports feeling out

of breath when walking around the office but denies

having had these difficulties in the past.

ST's medical history is significant for hypertension and

benign prostatic hypertrophy. Three months ago he was

hospitalized with a ventricular arrhythmia. His current

medication regimen includes:

Felodipine 5 mg daily

Tamsulosin 0.4 mg daily

Amiodarone 400 mg daily

ST denies the use of herbal products or OTC

medications. He denies tobacco use but admits to social

drinking. His family history is significant for

hypertension.

The pulmonologist for whom ST works is concerned

about ST's symptoms and performs a physical

examination, along with laboratory work. ST's vital

signs are reported as follows: blood pressure, 150/95

mm Hg; heart rate, 90 beats/min, temp 98.6°F, and

respiratory rate, 20 breaths/min. The exam is

unremarkable, with no signs of pulmonary congestion,

lower extremity edema, or signs of infection. The basic

metabolic panel and complete blood count are within

normal limits. The only lab result found to be outside of

normal limits is an elevated erythrocyte sedimentation

rate (ESR).

The pulmonologist is concerned that ST's medications

may be causing pulmonary problems. He performs a

PharmacyPREP.com


bronchoscope to obtain a lung biopsy, which

demonstrates diffuse alveolar damage and fibrosis.

33) What could be pulmonologist concern? A) Felodipine 5 mg daily B-Tamsulosin 0.4 mg daily C) Amiodarone 400 mg daily D-Blood pressure E-Heart rate Ans-C

34) All of the following are side effects of amiodarone EXCEPT: A) Conjunctivitis B) Pulmonary fibrosis C) Aplastic anemia D) Liver dysfunction E) Photophobia Ans: C Tips: The pulmonologist concerns that ST's medications

are causing his symptoms are valid. ST is exhibiting

signs and symptoms of Amiodarone- induced

pulmonary fibrosis. These patients typically present

with an elevated ESR and dyspnea during the first year

of therapy. Treatment involves dosage reduction or

discontinuation of amiodarone or initiation of

corticosteroid therapy. Symptoms resolve quickly once

therapy is altered.

PharmacyPREP.com


35) Which of the following is NOT required to monitor for amiodarone? A) eye exam B) occult blood in stools C) Persistent cough D) Chest x-ray E) Peripheral skin pigmentation Ans: B Tips: Occult blood in stool is traces blood which is NOT detectable

36) A 22-year-old woman, otherwise healthy, presents

with a 6-month history of episodes of unresponsiveness

accompanied by lip smacking lasting 1 to 2 minutes and

occurring 2 to 3 times per month. She takes no

medications She is in a monogamous relationship with a

male sexual partner and only occasionally

uses contraception. A routine EEG shows left temporal

epileptiform activity and MRI of the brain shows left

mesial temporal sclerosis. Which of the following drugs

have decrease the effectiveness of oral contraceptive

pills?

i. Gabapentin

ii. Lamotrigine

iii. Topiramate

a) I only

b) III only

c) I and II

PharmacyPREP.com


d) II and III

e) I, II III

Ans-D

37) Which of the following side effects of phenytoin

therapy is not related to increased serum

concentrations?

I) Ataxia

II) Sedation

III) Hirsutism

a) I only b) III only

c) I and II only

d) II and III only

e) I, II and III

Answer: B: Hirsutism is a common side effect of phenytoin and is not correlated with serum phenytoin concentration. Ataxia and sedation are concentration-dependent side effects. Drugs that cause hirsutism include: phenytoin, androgen, finasteride, OCP, prednisone

38) After her phenytoin therapy has been

optimized, ZM returns to the clinic just before her

wedding and requests an oral contraceptive.

Which of the following statements regarding oral

contraceptives and phenytoin is most correct?

A. There is no potential drug-drug interaction

B. Phenytoin inhibits the metabolism of phenytoin

and may increase their side effects.

C. Oral contraceptives inhibit the metabolism of

phenytoin and may increase its side effects.

PharmacyPREP.com


D. Phenytoin induces the metabolism of oral

contraceptives and may decrease their efficacy.

E. Oral contraceptives induce the metabolism of

phenytoin and may decrease its efficacy.

Answer: D: Phenytoin is an enzyme inducer. It may

increase the metabolism of oral contraceptives and

reduce their efficacy. Patients should be advised to

consider alternative methods of contraception to

avoid unplanned pregnancy.

39) Doctor doubled dose of phenytoin, when to

measure steady state concentration?

A) After 1 day

B) After 1 week

C) After 1 month

D) After 2 week

E) After 3 week

Ans:

Tips: On average at phenytoin dose of:

300 mg/day takes approx. 5 to 7 days to Css



Example. Patient receiving phenytoin 300 mg capsule

daily. The Css is 9.2 mcg/ml. If doctor increased dose

to 400 mg daily. What will be Css.

PharmacyPREP.com


Cnew = (Dnew/Dold) x Cold then increase 15 to 33%

Cnew = (400 mg/300 mg) x 9.2 mcg

= 12.3 mcg/ml

For 15% is 1.15 x 12.5 = 14.1 mcg/ml

For 33% = 16.4 mcg/ml

Then range is 14.1 mcg/mL to 16.4 mcg/mL

40) KM is a 75 yo women, frequently forgets daily activities such housekeeping, names of relative and friends... Doctor diagnosed Alzheimer's. What is goal of therapy? A) Delay the time to transfer nursing home facility B) Decrease mortality C) Decrease cognitive functions damage D) Decrease the time for pharmacotherapy E) Increase medication compliance Ans: C Tips: Decrease cognitive functions damage this delays progression of disease and prevent getting into severe form of dementia. Lab test to confirm cognitive MME, MoCA.

A 55 year-old male, new patient to your pharmacy, overweight suffered a non-ST elevation myocardial

PharmacyPREP.com


infarction 6 days ago had PCI in hospital, bare metal stent to proximal LAD. Currently his medical conditions hypertension, LDL 2.5mmol/L, Tchol/HDL 5. Social history: has smoked 1 ppd x 30 years, family history: brother died of MI 6 years ago. Currently have new prescriptions: EC ASA 325 mg once daily, clopidogrel 75 mg once daily, metoprolol 50 mg bid and ramipril 2.5 mg once daily. Patient using currently vitamin E 800 IU uses for the last one year, hoping that prevent any cardiovascular problems.

41) What is the recommended blood pressure goals for secondary prevention of Acute coronary syndrome patients. A-135/85 B-140/90 C-145/95 D-160/85 E-150/90 Ans: B Tips: TC page 460, 6th ed. shows 140/90

42) Overwhelming data in patients with established CAD supporting the benefits of anticholenesterase drugs in mortality, cardiovascular mortality and stroke. What is

PharmacyPREP.com


the drug of choice recommended above patient to achieve target LDL ? A) Rosuvastatin B-Ramipril C) Niacin D) Fenofibrate E-Beta blockers Ans: A

43) After PCI, and stent doctor has prescribed EC ASA 325 mg once daily, clopidogrel 75 mg once daily Which of the following is NOT the common side effect of clopidogrel? A)Joint pain B)headache C) constipation D)Rash E)Diarrhea Ans: C Tips: Comparison of ASA, clopidogrel and ticlopidine

44) A 53-year-old lady came to the pharmacy with a

prescription for Wellbutrin 150 mg SR. Her profile

shows that she was on Wellbutrin 150mg XL. The

pharmacist asked the patient whether she is aware of

any changes that her doctor made for her therapy, and

she replied that nothing her doctor told her about that.

The best action the pharmacist should do is:

A. Dispense Wellbutrin 150mg SR since there is no

difference between the two

B. Dispense Wellbutrin XL as in her profile

PharmacyPREP.com


C. Call the doctor to see if he has intended to change XL

to SR

D. Give the generic bupropion SR

E. None of the above

Ans: (C)

Tips: Wellbutrin XL is once a day and Wellbutrin SR is

twice a day but could be given once a day, so the best

option is to call the doctor that the

45)A patient was taking fluoxetine for about 4 months. She is bringing a new RX for moclobomide. What should you do about this new RX? a) Call the Dr. and say this new RX will not work because

it has the same effect as fluoxetine b) Fluoxetine should be stopped 2 weeks before starting

moclobomide c) Ask Dr. to prescribe a MAO inh instead of

moclobomide d) Fill the RX and tell pt. to stop fluoxetine Ans: B

46) A patient’s profile 75 year-old female: Weight: 52 kg, has acute ischemic stroke, atrial fibrillation, hypothyroidism, osteoarthritis, and osteoporosis. Medication profile. Digoxin 0.125 mg po qd; Naproxen 375 mg po bid Levothyroxine 0.1 mg po qd; Calcium gluconate 125 mg po qd The physician should: a. Increase the dose of digoxin

PharmacyPREP.com


b. Decrease the dose of digoxin c. Decrease the dose of levothyroxin and monitor digoxin d. Increase dose of levothyroxine to 0.150 mg po qd Ans: C Tips: Levothyroxine might cause arrhythmias.

47). A patient wants to stop taking fluoxetine because she continues to have trouble sleeping and does not wish to use a sedative. Which is the best option to improve sleep?

a) Add lorazepam at bedtime b) Switch to bupropion c) Switch to moclobemide d) Switch to mirtazapine

Ans: D Tips: What is the least nauseating SSRI? sertraline?

48) You were told by the same patient that she once was on antidepressant that caused her limbs to jerk at night. Which antidepressant is most likely to cause this problem?

a) Mirtazapine b) venlafaxine c) bupropion d) moclobemide

Ans: D

PharmacyPREP.com


49) A 36-yo female who presents to your outpatient clinic with a chief complaint of persistent dry cough x3 days. JJ is now on the following medications: Celebrex 100 mg po bid, docusate 100 mg po bid, fluoxetine 20 mg po qd, and captopril 12.5 mg po tid. She comes back to the clinic 6 months later and is complaining of a dry cough persistent for greater than 2 weeks. The cough she presented with at her last visit resolved within days of taking dextromethorphan. What would your assessment of this patient? a) She may have chronic cough that will be unresponsive to any medication. b) Fluoxetine causes cough unresponsive to antitussive. Therefore, you would recommend switching to another antihypertensive. c) Captopril causes cough unresponsive to antitussive. Therefore, you would recommend switching to another antihypertensive. d) You would recommend referring her to an allergist. e) Captopril causes cough unresponsive to antitussives; therefore, you would recommend the patient’s doctor to change to same class of antihypertensive. Ans: C Tips: ACE inhibitors, especially captopril, can induce cough resistant to usual antitussive therapy. The only therapeutic intervention would be to change to a different class agent and see if cough resolves. Depending on when JJ was started on captopril and when

PharmacyPREP.com


she developed the cough, it would be the intervention of choice. Cough for ACEI can occur any time.

50) A patient was scheduled for an endovascular coiling

procedure to treat a brain aneurysm. Several days

before the procedure, the neurosurgeon wrote a

prescription for Plavix 150 mg po daily with

acetylsalicylic acid (ASA) 325 mg po daily. The patient

was to take these medications to prevent platelet

aggregation and clot formation during, and as a result

of, insertion of a foreign substance (the coils) into the

vascular system. The day before the scheduled

procedure, the patient was admitted to the hospital as

planned. Fortunately, the patient had remembered to

bring all current medications to the hospital. During

medication reconciliation, the pharmacist noticed that

the patient was taking Pradax 150 mg daily instead of

the intended Plavix 150 mg daily. The hospital

pharmacist called the community pharmacy to discuss

the situation. It was determined that the order for

Plavix had been misinterpreted and that Pradax had

been dispensed in error.

The hospital pharmacist should inform this incident to?

I) The neurosurgeon should be notified before surgical procedure II) Institute of Safe Medication Practices Canada III) Pharmacy and Therapeutic Committee A-I only B-III only C-I and II only

PharmacyPREP.com


D-II and III only E-I,II, III ANS:C 51) Which of the following measures can prevent these type mix ups! A. Include the generic name throughout the prescription process like clopidogrel for Plavix and dabigatran etexilate for Pradaxa B. Read label with patient at counselling point C. Read label at the time taking drug from shelf and read label at the time of counting and placing bottle back into shelf D. Consider automated alert system in computers E. Academic detailing to enhance prescription practices ANS: A

52) A physician asked for heparin 2,000 units during a

procedure. The nurse retrieved two vials of heparin

from an automated dispensing cabinet that was

supposed to be stocked with 1,000 units/1 mL vials. But a pharmacy technician had accidentally stocked the cabinet with look-alike vials of 10,000 units/1 mL heparin vials. Both concentrations... are in the same size vials with similar orange-brown labels and vial caps... causing the nurse to overlook the stocking error. The patient received heparin 20,000 units, but the nurse quickly noticed the mistake!

PharmacyPREP.com


Which of the following is the management of heparin

overdose?

I) Stop using heparin and test aPTT and INR II) Protamine sulphate antidote administration III)Treatment included administration of intravenous fluids, plasma volume expander, fresh frozen plasma, packed red blood cells, and platelets. A) I only B-III only C-I and II only D-II and III only E-I,II, III ANS:E

53) Multiple issues often underlie the inadvertent

administration of high-concentration heparin. What are

the examples of contributing factors to such incidents

include:

A. The storage of high-concentration heparin vials close

to low-concentration heparin flush products.

B. Confirmation bias that can cause a health care professional to read a label or select a drug product and “see” what they expect to see, rather than what is actually selected. C. Often, more concentrations than necessary are present in both the pharmacy and patient care area stock. D. Incomplete communication between physicians and nurses at the time of gathering drugs and supplies for central vascular line (CVL) insertion and during procedure E. All of the above ANS:E

PharmacyPREP.com


54) GS is a 49 year women. Her physician had prescribed morphine ‘.5 mg’ IV for the management of post-operative pain. However, a unit secretary did not see the decimal point and transcribed the order by hand onto a medication administration record (MAR) as ‘5 mg.’ An experienced nurse followed the directions on the MAR without question and gave the baby 5 mg of IV. Morphine initially and another 5 mg dose two hours later. Which of the following serious symptoms could be associated with fatal error? A) Mydriasis B)Severe constipation C) Respiratory depression D) Bleeding E)All of the above Ans: C

55) Venlafaxine was omitted for 10 days for a 78 year old patient. The order was inadvertently crossed off from medication administration records and subsequently not transcribed on transfer to chronic care. Patient experienced all of the following, except? A) nausea and vomiting B)Delirium C) Flu like symptoms D)Insomnia E)Tremors Ans: E Tips: SSRI or SNRI withdrawal or discontinued symptoms: flu like symptoms. However no tremors and cognitive symptoms.

PharmacyPREP.com


56) A nurse had an order to administer a 200 mg depot injection of zuclopenthixol decanoate. She had no previous experience with the drug and misunderstood the vial’s label. Instead of giving the patient his usual dose of 1ml of a 200mg/ml solution, she interpreted the entire vial to contain 200mg. Five times the normal dose was given (the vial was only half full). The patient may experienced the following? A) unpleasant extra pyramidal symptoms B) suicidal symptoms C) disorientation D) Insomnia E)none of the above ANS: A

57) Which of the following can be crushed and chewed?

A) Dutasteride

B) Ibandronate

C)Duloxetine

D) Divalproex

E) ASA 80 mg

ANS:E

58. BN is a 91kg, 52-year old female who was recently diagnosed with type 2 diabetes. On physical exam her BP was 190/94, serum creatinine was 150umol/L, K is 4.5mmol/L. 11) The recommended BP target for BN is? A) <130/80 B)>130/80

PharmacyPREP.com


C) 140/90 D)<140/90 E)>140/90 Ans: A 59) What is the target waist line circumference? A)<99 cm B)<102 C)<88 cm d)>88 cm e)>102 cm Ans:C

60. What is the initial therapy? A) Ramipril 5 mg B) verapamil/losartan C) Atenolol D) metoprolol E) Hydrochlorothiazide 50 mg Ans: B 61) After 6 months, she has still high blood pressure 155/90, what to do? A. Increase dose to Ramipril 5 mg B. Check the compliance of medication C. Change Ramipril 2.5 mg to Losaartan D. Change Ramipril 2.5 mg to Hydrochlorothiazide 25 mg E. Change Ramipril 2.5 mg to Metoprolol 50 mg ANS: B

PharmacyPREP.com


62. JM is 75 year old diagnosed with Alzheimer’s disease and diastolic dysfunction, his current medication include donepezil 10mg QD, furosemide 40mg QD, verapamil SR 180mg QD. Jims father and mother both have had suffered Alzheimer in their old age. Symptoms of Alzheimer’s disease, all EXCEPT: a) Slurred speech

B)Delay cognitive functions detritions C)Fatigue D)Dementia E) Loss of memory

Ans: C Tips: Fatigue and reversing cognitive functions are NOT a goal of therapy for dementia.

63) All of the following are the risk factor of Alzheimer’s disease, EXCEPT a) Female gender

B)Family history C)Age D)Emotional stress E)None of the above

Ans: D

64. A 10 years old patient experiencing Otitis media. His doctor prescribed for him Suprax 100 mg/5ml, 10 ml TID. Parents have a concern that their child is old enough

PharmacyPREP.com


now, and they would prefer tablet. The pharmacist should do the following: (A) Call the doctor to switch change dosage form (B) Tell the parents that there is no difference between the tablet and the susp. in treating the ear infection (C) Tell the parents that the tablet is given for patients that have an age of 18 and more (D) Otitis media should be treated with suspension and not tablet in order to have a better effect (E) Tell the parents that the taste of tablet is bitter

Ans: D

65) Mr BB is a 55year old obese man who has been a patient at your pharmacy for many years. He is receiving atenolol 50 mg OD for hypertension, atorvastatin 20 mg OD and glyburide 5 mg BID for blood glucose control. He smoked a pack of cigarettes a day for the last 38 years. His lipid profile is under controlled. By some reason he started to take herbal product containing niacin and find problem of muscular pain. This pain was not continuous. What should patient do? A. Take Tylenol on prn base B. Refer to his physician C. Ask for creatinin kinase test D. Patient need not to worry as this pain subsides after

discontinuation of herbal products. E. Use antidote of niacin Ans-B

PharmacyPREP.com


66) A 65-year-old man with a history of hypertension,

atrial fibrillation, hypercholesterolemia, and a right

middle cerebral artery stroke 6 months previous

reports 3 separate episodes of head deviation to the left

with rhythmic jerking of the left arm and left side of his

face lasting approximately 1 minute. He is taking

warfarin, atenolol, and atorvastatin. What is drug of

choice for epilepsy.

A-Lamotrigine (monotherapy)

B-Gabapentin,

C-Valproic acid

D-Phenytoin

E-Carbamazepine

Ans: A

67)If patient peptic ulcer symptoms do not respond to the initial trial of esomeprazole 20 mg daily for 4 wks, which would be the most appropriate recommendation? A-decrease alcohol intake B-Take small meals C-Add domperidone D-Switch treatment to H2RA E- Double dose of esmoprazole Ans: E TC page 727, Management

68) A pharmacist is working as a relief in another

pharmacy. A patient came with a prescription of Ativan

1 mg. The pharmacist remembered that the same

patient came with another prescription of same drug

PharmacyPREP.com


two days ago in the other pharmacy where he worked.

What should the pharmacy do?

A. Call the police

B. Refuse to fill the new prescription

C. Discuss the matter with the patient

D. Call the doctor and tell him that the patient is

addictive

Ans: C

Tips: tell patient that, want to discuss with your new

doctor.

69) A 58-year-old female patient with weight of 52 kg.

Her creatinine clearance 40mL/min has M.I., Angina,

atrial fibrillation, CHF and hypercholesterolemia.

KCl = 4 meq/L (normal value 3.5 to 5 meq/L)

Current medication: Digoxin 0.125 mg po QD,

Furosemide 40 mg po QD, Warfarin 5 mg po QD,

Lovastatin 20mg po initiated 1 month ago, Captopril

12.5 mg po tid, Kcl, 20 meq po BID, Nitroglycerin

0.4mg SL prn, Nitroglycerin patch 0.4mg/hr q 24h

Which of the following is appropriate recommendation

with Janna’s physician:

I. Fill the prescription the way it is

II. Decrease digoxin dose

III. Increase furosemide dose

A-I only

B-III only

C-I and II only

D-II and III only

E-All of the above

Ans: B (III only)

PharmacyPREP.com


Tips: Digoxin dose is suitable for this creatinin

clearance because it is a low level. Furosemide should be

increased due to renal creatinin clearance is low. TC 4th

ed. page 1202.

70) MJ is 70 year old man. Has been on anti-parkinson's medications levodopa/carbidopa tid. and Furosemide for the treatment of hypertension. He also uses arthritis medications Acetaminophen 650 mg q6h and vitamin B12

injections. Recently he has been diagnosed for urinary incontinence. What is the cause of urinary incontinence? A) Levodopa/carbidopa B) Furosemide C) Acetaminophen D) Vitamin B12 injection Ans: A TC page 879 6th ed. Drugs that may cause or aggravate urinary retention should be avoided in urinary incontinence.

71) The doctor prescribes a combination treatment of SSRI + benzodiazepines for which there is a risk for a pharmacokinetic interaction. Which of the following is the best course of action? A) Recommend avoiding the combination due to the narrow safety margin of SSRI

PharmacyPREP.com


B) Recommend avoiding the combination due to narrow safety of margin of benzodiazepines C) Dispense the combination and monitor for increased side effects of SSRI D) Dispense the combination and monitor for increased side effects of benzodiazepines Ans: D

72) A 30 yo maniac patient on lithium 600 mg q8h admitted to hospital with hallucination and disorientation. What is the better explanation or drug related problem? A) non adherence B) taking too much medication C) Taking too little dose D) toxicity of lithium E) Need additional drug therapy Ans: E Tips: Lithium min dose 900 mg to 2100 mg daily. Over dose symptoms can occur if lithium serum levels are over 2 mEq/L. Hallucination, and disorientation need additional therapies like mood stabilizers. 73) A 25 year old student is taking paroxetine daily for the treatment of depression for the past 3 months. Currently doctor diagnosed patient as maniac. What is appropriate to do? A) Continue paroxetine and start lithium B) Discontinue paroxetine and start lithium

PharmacyPREP.com


C) Continue paroxetine and add haloperidol and lithium D) Discontinue paroxetine and add haloperidol E) Increase dose of lithium Ans: B

74) A patient with neuropathic pain was prescribed carbamazepine by his doctor, with some relief of his signs and symptoms but with more side effects that are bothering the patient. Which of the following symptoms are not dose dependent? A-Rash B-Dizziness C-visual disturbances D-GI upset Ans-A Tips: Carbamazepine idiosyncratic ADR is rash, require to discontinue and talk to doctor. A patient with allergic amitriptyline should not take carbamazepine because these two drugs are structurally same class.

75) A patient was on lovastatin since last six months. His lipid profile is under controlled. By some reason he started to take herbal product containing niacin and find problem of muscular pain. This pain was not continuous. What should patient do? A. Take Tylenol on PRN base B. Contact to doctor C. Contact to doctor and ask for CK-MM tests D. Patient need not to worry

PharmacyPREP.com


ANS: C Tips: TC 6th ed. page 440

76) What laboratory test monitored regularly, patient using statins? A-LFT (AST +ALT) B) CK-MB C) BP D) RFT E) CK-MM ANS: A

77)What statin should take with food?

A) Atorvastatin

B) Lovastatin

C-Fluvastatin

D-Simvastatin

E-Rosuvastatin

ANS: B

Tips: FL are taken with food. Lovastatin have very high

effect on bioavailable.

78) A 10 years child with ADHD. His doctor diagnosed

his condition and prescribed methylphenidate CR

capsule 10 mg twice daily. Best thing the pharmacist

should do is

A-Call the doctor to switch the patient to

methylphenidate CR tab 20 mg/dose since the later is

given in divided doses.

PharmacyPREP.com


B-Call the doctor to ensure him that methylphenidate

CR is given once daily and not twice daily

C-Dispense the prescription as it is

D-Call the doctor to prescribe him methylphenidate

since the capsule can be opened and sprinkled on soft

foods

E-None of the above

Ans:B: methylphenidate CR is given as 20 mg/dose 8

hours apart and controlled release as a single dose

79) What is monitored in 10-year-old using methylphenidate, except? A-Weight loss B-Insomnia C-Constipation D-Reduce hyperactivity E-Attention in his studies F-Suicidal plans Ans-C

80)The child mother is concerned about addiction of ADHD medications, What to tell her? except A) Giving ADHD therapy now will reduce the abuse further in life B) Drug has addiction. However it is safe to use as

prescribed by doctor. C) Improve in social interactions D) Improve in athletic performance E-Improve academic performance Ans: D

PharmacyPREP.com


81) Which of the following antidepressants is most effective in the treatment of post herpetic neuralgia, and diabetic neuropathic pain? a. Amitriptyline b. Fluoxetine c. Paroxetine d. Citalopram Ans: A TC page 143 Tips: Amitriptyline is used in post herpetic, diabetic neuropathic pains, however it not used in trigeminal neuralgia pain Amitriptyline dose 10 to 25 mg QHS daily at weekly intervals until pain relief or side effects.

82)Which of the following DOES NOT have any value in the treatment of symptoms of trigeminal neuralgia I) Carbamazepine II) Baclofen III) Meloxicam A-I only B-III only C-I and II only D-II and III only E-I, II, III Ans: B TC page 139 NSAIDs, and acetaminophen are NOT effective for the treatment of neuralgia.

PharmacyPREP.com


83) KP is a 27 year old man using salbutamol and fluticasone inhalers for asthma. Having dry cough. He asks pharmacist, why all OTC cough suppressants like dextromethorphan (DM) should be avoided? A) DM may hide early symptoms of asthma attack B) DM interact with corticosteroids making both ineffective C)all people asthma should consult with physician as soon as respiratory symptoms develops D) codeine is more safe and effective for people with asthma Ans: A

84. What is the target of total cholesterol in the patient have coronary artery disease (MI, post MI, STEMI, NSTEMI, Unstable angina) A) < 2.2 mmol/L B) <4.0 mmol/L C) <1.8 mmol/L D) 4.5 mmol/L ANS: B TC page 436, 6th ed.

85) What is the target of LDL in the patient have diabetes mellitus

PharmacyPREP.com


A) < 2.2 mmol/L B) <2.0 mmol/L C) <1.8 mmol/L D) 2.5 mmol/L ANS: B 86) Which of the following patient have high risk of Acute Coronary syndrome. A) + ve cardiac enzyme like Troponin I B) ST segment changes C) TIMI risk score > 3 D) Heart failure E) All of the above ANS: E

87) A pharmacist during in putting a prescription into the computer forgot to enter the number of refills that were indicated in the prescriptions, and the patient pick up his medication from the pharmacy and went home. The best action the pharmacist should do: A-Call the patient to tell him that you forgot to put the number of refills B-No problem, next time when he comes you can tell him to go to his doctor to write other refills C-Don’t tell the patient that you forgot to put the refills

PharmacyPREP.com


D-Call the patient inform him that you forgot to put the refills and tell him that you are going to enter the refills into the computer E-None of the above Ans-D Tips: We have to call the patient inform him about the error, and input the number of refills into the computer, and issue a drug incident error for that and inform the manager or district manager about that, and take the steps of not repeating this error again

88) KK, is a 43-year-old male, presents to your pharmacy requesting something for his “ulcer.” On questioning him, you learn that: 1) he has had “stomach pains: that have been getting progressively worse over the month; 2) he does not take any NSAIDs/ASA; 3) his pain does not rise towards the neck (heartburn); 4) he has not alarm features; and 5) he never has been diagnosed with an ulcer. He smokes 3 to 4 cigarettes a day and usually has 2 glasses of wine with dinner. Based on the evidence, what would be an appropriate next step to manage KK? a) Stop the cigarettes and the wine b) Try an alginate-containing product c) Suggest he see his family doctor for possible H. pylori testing. d) Go to the Emergency room to be assessed for a possible peptic ulcer Ans: C

PharmacyPREP.com


A 80 yo male with NYHA II CHF (EF 33%), purchasing

Gravol for nausea, dizziness, ↓appetite x 2wks. He

thinks it is related to recent ramipril dose increased.

Patient medical history include MI (past 3 yr ago),

HTN(past 20 yrs), ↑lipids(x 2yrs), CHF(x 1yr), atrial

fibrillation ( for 10 wks). His current meds include:

Pravastatin 40mg QD (x2yrs), amiodarone 200mg QD

(x6wks), digoxin 0.25mg QD (x1yr), warfarin 5mg QD

(for a 6wks), carvedilol 25mg BID (x 1yr), HCTZ 25mg

QD (x 25yrs), Ramipril 10mg QD (↑from 5mg 2wks

ago).

89) A patient has symptoms of heart failure at less than ordinary activity, which is defined as? A-symptoms may appear at climbing one flight upstairs. Or walking 200 yards b-symptoms may appear 30 minutes jogging C-symptoms may appear after 3 to 5 times of exercise for 30 min in a week D-None of the above Ans-A 90) What is initial therapy for patient has heart failure symptoms from NYHA classification 1 to IV. A) ACE I and beta blockers B-ARBs and beta blockers C-Digoxin and beta blockers D-Diuretics and beta blockers E-Spironolactone and beta blockers

PharmacyPREP.com


Ans: A

91) If hypothetically doctor choose to use metoprolol and enalapril to assess the tolerability. Which of the following need to be watched? A) Shortness of breath B)Ankle edema C) Weakness D) Dry or productive cough E)Fatigue Ans: D

92) A regular customer of your pharmacy, complaining about having to get up in the nights, as he woke up two times due to asthma symptoms. Currently he is on salbutamol and ICS puffers. What is the first step a pharmacist should do? A) refer to doctor B) recommend sleep hygiene C) increase dose of ICS D) Add to LABA or LTRA E) Check use of salbutamol and ICS puffers devices Ans: E

PharmacyPREP.com


93) The above patient comes to pharmacy. Asking why he got oral fungal infections. He is currently using inhaled corticosteroid like fluticasone 500 mcg bid. What is the cause of his oral fungal infection? A) Due to high dose if ICS B) Due to incorrect technique of ICS C) Due to NOT using spacer D) It is usual side effect of ICS Ans: D

94) A patient has COPD and renal failure, developed pneumonia, which of the following fluroquinolones can be used? A) Ciprofloxacin B) Moxifloxacin C) Levofloxacin D)Norfloxacin E) Gemifloxacin Ans-B Tips: Hepatic elimination antibiotics: doxycycline, azithromycin, and clarithromycin (major), moxifloxacin, clindamycin, Pen V, ceftriaxone, spectinomycin. 95) Ted is a 55 year-old male, and a new patient to your pharmacy. 163 cm, 86 kg

PharmacyPREP.com


He suffered a non-ST elevation myocardial infarction 1 week ago. He tells you that he had PCI in hospital, with a bare metal stent to his proximal LAD. What are the clinical features used to calculate TIMI risk score? A)Age >65 y B)hypertension C)high cholesterol D)any ASA use within 7 d E) all of the above Ans: E

96. Ms AB is 72 kg. 50 y/o woman who was recently diagnosed with type 2 diabetes. On physical exam her BP is 120/80. Her family doctor told her the results of her 24hour urine collection showed a normal amount of protein in the urine. Which of the following interventions should be implemented to decrease Ms AB’s chance of developing renal disease? A)Initiation of an ACE inhibitor B)Initiation of an ARB C)Optimal blood glucose control D)Reduction of protein intake to 0.6 g/kg/day ANS: C

97) A patient was taking Dimicron 180 mg (glicalizide)

dose recently decreased to 80 mg BID. also the patient.

The patient suppose to be given 1 box of Diovan (valsartan) 80 mg and boxes of Dimicron the label of Diovan was wrongly placed on Dimicron and the vice

PharmacyPREP.com


versa. The patient is advised to take 1 pill of Diovan and 2 pill of Dimicron. Because of wrong labeling, which symptoms patient experience initially? A) Increased pulse rate B) decrease pulse rate C) Decrease systolic pressure D) decrease diastolic pressure E) Hypoglycemia ANS: C

98) A 65 years old patient presents with psychomotor agitation. Patient is on Fluoxetine for 6 weeks for the treatment of depression. There was an improvement in his appetite and in his sleep disturbance. Doctor should now: (A) Taper and discontinue the medication (B) Continue the medication for 6 months (C) Add Lithium (D) Add Olanzapine (E) “C” or “D” Ans: (D) Reference: Therapeutic Choices 6th edition...Antidepressant management If partial response augmentation with lithium or SGA. or CBT/IPT

99) A parent of ADHD child call your pharmacy to ask her concern on her child medication. After initiated methylphenidate bid 10 mg takes 7 am SR tabs and 3 pm

PharmacyPREP.com


IR tabs. She is concerned about her child loosed his appetite and going to bed late in nights wakes up late in the morning. What is the appropriate to do? A) ask her to contact doctor B) ask her to check weight C) ask her to give medication 7 am SR tab and 12 noon IR tabs D) ask her increase diet E) ask her to check his school performance Ans: C Tips: Give medication with meals, high calories meals, when stimulants effects are low specially breakfast and bedtime and supplemental boost ensure and also engage child in meal prep and shopping for favourite food.Ref: Rx files. To increase appetite cyproheptadine can be used.

100. A 41 years old a chronic alcoholic male, no known

allergies, past medical history: Anxiety, difficulty

sleeping. Current medications: triazolam 0.5 mg qhs x 3

years and acetaminophen/caffeine/codeine (Tylenol #1)

ii prn headache

You notice that this patient has been coming in early for

refills for triazolam and has received extra

prescriptions for this medication from many walk-in

clinics.

Patient approaches you and states that he is concerned

about his triazolam usage, so he stopped using it 24

PharmacyPREP.com


hours ago. He asks you what the most common

withdrawal symptoms will be:

A. Diarrhea, shakes and chills

B. Insomnia, muscle spasms and irritability

C. Increased headache, fatigue and nausea

D. Seizures, delirium, and hallucinations

Ans: B

kb is a 36-year-old man who presents to a pharmacist

Documents