Idea Transcript
NAPLEX® Sample Questions
1. Which of the following is an orally disintegrating tablet formulation of prednisolone, used to treat exacerbations of asthma and other inflammatory diseases and conditions in children? a. Celestone Soluspan b. PediaPred c. Orapred d. Vasocidin e. Juvéderm View Answer
1(c). Orapred ODT (Prednisolone sodium phosphate disintegrating tablets) is a sodium salt of the phosphoester of the glucocorticoid prednisolone. It is indicated in the treatment of the atopic dermatitis, Crohn's disease, ulcerative colitis and acute exacerbations of chronic obstructive pulmonary disease (COPD). Dosage of Orapred ODT should be individualized according to the severity of the disease and the response of the patient. The initial dose of Orapred ODT may vary from 10 to 60 mg (prednisolone base) per day, depending on the specific disease entity being treated. Fluid retention, alteration in glucose tolerance, elevation in blood pressure, behavioral and mood changes, increased appetite and weight gain are commonly reported side effects of Orapred.
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2. An active ingredient of Ablecet is: a. Rifampicin b. Ketoconazole c. Amphotericin B d. Lisinopril e. Isradipine View Answer
2(c). The active ingredient of Abelcet is Amphotericin B. It is also available under the following trade names: Amphotec (a powder for injection), and Ambisome (a liposomal form). It should be given parenterally via an I.V. infusion. It is an antifungal agent. It is indicated for the treatment of invasive fungal infections caused by invasive aspergillosis. The recommended daily dosage for adults and children is 5 mg/kg given as a single infusion. Abelcet should be administered by intravenous infusion at a rate of 2.5 mg/kg/h. If the infusion time exceeds 2 hours, mix the contents by shaking the infusion bag every 2 hours. Patients should be pretreated with antipyretics, antihistamines, antiemetics and with Meperidine to reduce the signs and symptoms of shaking chills and fever. Abdominal pain, anorexia, anxiety, hypokalemia, anemia, nephrotoxicity and diarrhea are reported side effects of the drug.
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3. Gardasil is a vaccine indicated for the prevention of which of the following diseases caused by Human Papillomavirus (HPV)? a. Vaginal cancer b. Hepatitis B c. Yellow fever d. Tetanus e. Tuberculosis View Answer
3(a). Gardasil is a vaccine indicated in girls and women 9 through 26 years of age for the prevention of the following diseases caused by Human Papillomavirus (HPV) types included in the vaccine: 1. Cervical, vulvar, and vaginal cancer caused by HPV types 16 and 18. 2. Genital warts (condyloma acuminata) caused by HPV types 6 and 11. It is also indicated in boys and men 9 through 26 years of age for the prevention of genital warts (condyloma acuminata) caused by HPV types 6 and 11.
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4. A physician writes the following prescription: Zelapar 1.25 mg tablets qty. 30 1 tab p.o. daily for hypertension. Which of the following would be the MOST APPROPRIATE action of the pharmacist? a. Fill as written. b. Call the physician regarding dosage strength. c. Call the physician regarding dosage frequency. d. Call the physician regarding route of administration. e. Call the physician regarding drug indication. View Answer
4(e). Zelapar orally disintegrating tablets contain Selegiline hydrochloride as an active ingredient. Selegiline is best known as an irreversible inhibitor of monoamine oxidase (MAO). It is available for oral administration (not to be swallowed) in a strength of 1.25 mg. It is indicated as an adjunct in the management of patients with Parkinson's disease (not the hypertension) being treated with levodopa/carbidopa who exhibit deterioration in the quality of their response to the therapy. Treatment should be initiated with 1.25 mg given once a day for at least 6 weeks. After 6 weeks, the dose may be escalated to 2.5 mg given once a day if a desired benefit has not been achieved and the patient is tolerating Zelapar. It should be taken in the morning before breakfast and without liquid. A severe hypertensive crisis, orthostatic/postural hypotension, dizziness, somnolence, ECG abnormality, nausea, dyspepsia, abnormal dreams, and infection are reported side effects of Zelapar.
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5. What is the name of the active ingredient in Xolegel? a. Fluconazole b. Metronidazole c. Ketoconazole d. Itraconazole e. Clotrimazole View Answer
5(c). Xolegel contains the antifungal agent Ketoconazole 2% in a topical anhydrous gel vehicle for topical administration. It is indicated for the topical treatment of seborrheic dermatitis in immuno competent adults and children 12 years of age and older. The gel should be applied once daily to the affected area for 2 weeks. Xolegel is for topical use only, and not for oral, ophthalmic, or intra vaginal use.
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6. Abilify is indicated for the treatment of: a. Hypertension b. Depression c. Rheumatoid arthritis d. Schizophrenia e. Glaucoma View Answer
6(d). Abilify (Aripiprazole) is classified as an antipsychotic agent. It is indicated for the treatment of schizophrenia. The recommended therapeutic dose of the drug is 10 to 30 mg once a day without regard to meals. NMS, tardive dyskinesia, extrapyramidal symptoms and agitation are reported side effects of Abilify. It is available as a tablet for an oral administration.
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7. Humira is NOT indicated for which of the following? a. Rheumatoid arthritis b. Psoriatic arthritis c. Ankylosing spondylitis d. Crohn's disease e. Irritable Bowel Syndrome View Answer
7(e). Humira (Adalimumab) is a recombinant human IgG1 monoclonal antibody specific for human tumor necrosis factor (TNF). It is supplied as a sterile, preservative-free solution of Adalimumab for subcutaneous administration. It is indicated for reducing signs and symptoms, inducing major clinical response, inhibiting the progression of structural damage, and improving physical function in adult patients with moderately to severely active rheumatoid arthritis, juvenile idiopathic arthritis, psoriatic arthritis, ankylosing spondylitis, plaque psoriasis and Crohn's disease. The recommended dose of Humira for adult patients with rheumatoid arthritis, psoriatic arthritis, or ankylosing spondylitis is 40 mg administered every other week. The recommended dose of Humira for patients 4 to 17 years of age with polyarticular juvenile idiopathic arthritis is based on weight of patients. The recommended dose of Humira for adult patients with plaque psoriasis is an initial dose of 80 mg, followed by 40 mg given every other week starting one week after the initial dose. Patients treated with Humira are at increased risk for developing serious infections that may lead to hospitalization or death. Most patients who developed these infections were taking concomitant immunosuppressants such as methotrexate or corticosteroids. Humira should be discontinued if a patient develops a serious infection or sepsis. Reported infections include: 1. Active tuberculosis, including reactivation of latent tuberculosis. 2. Invasive fungal infections, including histoplasmosis, coccidioidomycosis, candidiasis, aspergillosis, blastomycosis, and pneumocystosis. 3. Bacterial, viral and other infections due to opportunistic pathogens.
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8. Which of the following auxiliary labels requires before dispensing Noxafil? a. Take on an empty stomach. b. May cause drowsiness. c. For ear use only. d. Shake well before use. e. Refrigerate. View Answer
8(d). Noxafil (Posaconazole) is a triazole antifungal agent available in a suspension for an oral administration. It is a white, cherry flavored immediate-release suspension containing 40 mg of Posaconazole per ml. It is indicated for prophylaxis of invasive Aspergillus and Candida infections in patients, 13 years of age and older, who are at high risk of developing these infections due to being severely immunocompromised, such as hematopoietic stem cell transplant (HSCT)recipients with graft-versus-host disease (GVHD) or those with hematologic malignancies with prolonged neutropenia from chemotherapy. It is also indicated for the treatment of oropharyngeal candidiasis, including oropharyngeal candidiasis refractory to itraconazole and/or fluconazole. Each dose of Noxafil should be administered during or immediately (i.e. within 20 minutes) following a full meal. In patients who cannot eat a full meal, each dose of Noxafil should be administered with a liquid nutritional supplement or an acidic carbonated beverage. For patients who cannot eat a full meal or tolerate an oral nutritional supplement or an acidic carbonated beverage, alternative antifungal therapy should be considered or patients should be monitored closely for breakthrough fungal infections. A pharmacist should instruct a patient to shake Noxafil oral suspension well before use. Arrhythmias, QT prolongation and liver toxicity are reported side effects of the drug.
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9. What is the major difference between Travatan and Travatan Z? a. different active ingredient b. different potency c. different manufacturer d. different preservative e. different drug indication View Answer
9(d). Travatan Z (Travoprost) is a new formulation of Travatan solution in which benzalkonium chloride is replaced with SofZia, a robust ionic buffered preservative system that is gentle to the ocular surface. Travoprost is a synthetic prostaglandin F analogue. It is indicated for the reduction of elevated intraocular pressure in patients with open-angle glaucoma or ocular hypertension, who are intolerant of or insufficiently responsive to other intraocular pressure lowering medications. The recommended dosage is one drop in the affected eye(s) once daily in the evening. It should not be administered more than once daily since it has been shown that more frequent administration of prostaglandin analogs may decrease the intraocular pressure lowering effect.
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10. Which of the following sedative hypnotic agents is useful as an antiemetic agent for treatment of cancer chemotherapy-induced nausea and vomiting? a. Doral b. Klonopin c. Centrax d. Librium e. Ativan View Answer
10(e). Ativan (Lorazepam) is classified as the benzodiazepine class of drugs. It is indicated for the treatment of anxiety and insomnia. The parenteral form of Lorazepam reduces the severity and duration of nausea and vomiting associated with emetogenic cancer therapy. It is available in tablet, concentrated oral solution and injection form. Sedation, depression, constipation, lethargy, fatigue, diplopia and nystagmus are reported side effects of the drug. Librium (Chlordiazepoxide), Tranxene (Clorazepate), Valium (Diazepam) and Serax (Oxazepam) are indicated for the relief of acute alcohol withdrawal symptoms like agitation, tremor, impending and acute delirium.
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11. Fentora is an effervescent buccal formulation of the potent opioid analgesic: a. Oxycodone b. Morphine c. Fentanyl d. Oxymorphone e. Codeine View Answer
11(c). Fentora (Fentanyl buccal tablet) is a potent opioid analgesic, intended for buccal mucosal administration. Fentora is formulated as a flat-faced, round, beveled-edge white tablet. Fentora is designed to be placed and retained within the buccal cavity for a period sufficient to allow disintegration of the tablet and absorption of Fentanyl across the oral mucosa. Fentora employs the OraVescent drug delivery technology, which generates a reaction that releases carbon dioxide when the tablet comes in contact with saliva. It is believed that transient pH changes accompanying the reaction may optimize dissolution (at a lower pH) and membrane permeation (at a higher pH) of Fentanyl through the buccal mucosa. Each tablet contains Fentanyl citrate equivalent to Fentanyl base: 100, 200, 300, 400, 600 and 800 micrograms. It is indicated only for the management of breakthrough pain in patients with cancer who are already receiving and who are tolerant to around-the-clock opioid therapy for their underlying persistent cancer pain. Patients considered opioid tolerant are those who are taking around-the-clock medicine consisting of at least 60 mg of oral morphine daily, at least 25 mcg of transdermal Fentanyl/hour, at least 30 mg of oxycodone daily, at least 8 mg of oral hydromorphone daily or an equianalgesic dose of another opioid daily for a week or longer. This product must not be used in opioid non-tolerant patients because life-threatening hypoventilation and death could occur at any dose in patients not on a chronic regimen of opioids. For this reason, Fentora is contraindicated in the management of acute or postoperative pain. Physicians should individualize treatment using a progressive plan of pain management. For opioid-tolerant patients not being converted from Actiq, the initial dose of Fentora is always 100 mcg.
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12. Pylera is indicated for the treatment of: a. Hepatitis B infection b. Helicobacter pylori infection c. P.Carinii.Pneumonia infection d. H. influenza infection e. S. pneumoniae infection View Answer
12(b). Pylera capsules are a combination antimicrobial product containing Bismuth subcitrate potassium, Metronidazole, and Tetracycline hydrochloride for oral administration. Each hard gelatin capsule contains: 1. Bismuth subcitrate potassium, 140 mg 2. Metronidazole, 125 mg 3. Tetracycline hydrochloride, 125 mg Pylera capsules, in combination with Omeprazole are indicated for the treatment of patients with Helicobacter pylori infection and duodenal ulcer disease (active or history of within the past 5 years) to eradicate H. pylori. The eradication of Helicobacter pylori has been shown to reduce the risk of duodenal ulcer recurrence. Each dose of Pylera includes 3 capsules. Each dose of all 3 capsules should be taken 4 times a day, after meals and at bedtime for 10 days. Patients should be instructed to swallow the Pylera capsules whole with a full glass of water (8 ounces). One Omeprazole 20 mg capsule should be taken twice a day with Pylera after the morning and evening meal for 10 days.
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13. The FDA has recently approved Risperdal-M Tab for which of the following indications? a. Obsessive Compulsive Disorder b. Schizophrenia c. Irritability associated with Autism d. Bipolar mania e. Parkinsonism View Answer
13(c). Risperdal (Risperidone) is classified as an antipsychotic agent. It is available in tablet, oral solution and orally disintegrating tablet form. Each tablet for an oral administration contains 0.25 mg, 0.5 mg, 1 mg, 2 mg, 3 mg, or 4 mg Risperidone. It is also available as a 1 mg/mL oral solution. Risperdal M-Tab (orally disintegrating tablets) are available in 0.5 mg, 1 mg, 2 mg, 3 mg, and 4 mg strengths. It is indicated for the acute and maintenance treatment of schizophrenia. On October 6, 2006 - The U.S. Food and Drug Administration (FDA) approved Risperdal (Risperidone) orally disintegrating tablets, an adult antipsychotic drug, for the symptomatic treatment of irritability in autistic children and adolescents. The approval is the first for the use of a drug to treat behaviors associated with autism in children. These behaviors are included under the general heading of irritability, and include aggression, deliberate self-injury, and temper tantrums. The dosage of Risperdal should be individualized according to the response and tolerability of the patient. The total daily dose of Risperdal can be administered once daily or half the total daily dose can be administered twice daily. Caution should be exercised with dosage for smaller children who weigh less than 15 kg. NMS, tardive dyskinesia, extrapyramidal symptoms and agitation are reported side effects of the drug.
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14. Which of the following would indicate that a patient understands why he is taking Brovana? a. "I have bipolar disorder." b. "I have obsessive compulsive disorder." c. "I have post-herpetic neuralgia." d. "I have severe diabetic peripheral neuropathy." e. "I have chronic bronchitis." View Answer
14(e). Brovana (Arformoterol tartrate) is a selective beta2-adrenergic bronchodilator. It is indicated for the long term, twice daily (morning and evening) maintenance treatment of bronchoconstriction in patients with chronic obstructive pulmonary disease (COPD), including chronic bronchitis and emphysema. It is for use by nebulization only. The recommended dose of Brovana (Arformoterol tartrate) inhalation solution for COPD patients is 15 mcg administered twice a day (morning and evening) by nebulization. A total daily dose greater than 30 mcg (15 mcg twice daily) is not recommended. Brovana should be stored refrigerated in foil pouches. Asthenia, fever, headache, vomiting, hyperkalemia, leukocytosis, nervousness, and tremor are reported side effects of Brovana.
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15. The final dosage form of which of the following drug(s) could not be an elixir ? I. Cefobid II. Moxalactam III. Flagyl a. I only b. III only c. I and II only d. II and III only e. All View Answer
15(e). Elixir contains 5 to 40% alcohol. All of the mentioned drugs have been found to interact with alcohol and may produce disulfiramlike reactions. Ethanol is generally converted to acetaldehyde by an alcohol dehydrogenase enzyme, which is then subsequently converted to acetic acid by action of aldehyde dehydrogenase enzyme. Accumulation of acetaldehyde may be responsible for producing hot flashing, throbbing headaches and disulfiram-like reactions. All of the above drugs inhibit the aldehyde dehydrogenase enzyme and produce disulfiram-like reactions. Therefore, the final dosage form of these all mentioned drugs could not be an elixir.
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16. Which of the following is/are reported side effects of Tyzeka? I. Lactic acidosis II. Severe hepatomegaly with steatosis III. Acute exacerbations of hepatitis B a. I only b. III only c. I and II only d. II and III only e. All View Answer
16(e). Lactic acidosis and severe hepatomegaly with steatosis, including fatal cases, have been reported with the use of Tyzeka (Telbivudine) alone or in combination with antiretrovirals. Severe acute exacerbations of hepatitis B have been reported in patients who have discontinued anti-hepatitis B therapy, including Tyzeka. Hepatic function should be monitored closely with both clinical and laboratory follow-up for at least several months in patients who discontinue antihepatitis B therapy. If appropriate, resumption of anti-hepatitis B therapy may be warranted.
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17. A pharmacist receives a new prescription for Augmentin 500 mg. The prescription reads 1 tab po bid x 10 days. A technician in the pharmacy fills and processes the prescription using 250 mg of Augmentin instead, since the pharmacy is out of stock of 500 mg Augmentin tablets. The pharmacist who is doing the final check of the prescription should: a. Fill the prescription as it is. b. Call the physician and get approval regarding this switch. c. Not fill the prescription. d. Fill the prescription but counsel and inform the patient about this switch. View Answer
17(c). Since both the 250 mg and 500 mg tablets of amoxicillin/clavulanate potassium contain the same amount of clavulanic acid (125 mg, as the potassium salt), two amoxicillin/clavulanate potassium 250 mg tablets are not equivalentto one 500 mg amoxicillin/clavulanate potassium tablet. Therefore two 250 mg amoxicillin/clavulanate potassium tablets should not be substituted for one 500 mg amoxicillin/clavulanate potassium tablet.
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18. Which of the following statements is NOT TRUE about vaccines or immunizations? a. Two live vaccines may be given at the same time. b. parenteral or intranasal administration of a live vaccine is not thought to affect the immune response of a subsequently administered oral live vaccine. c. A live vaccine and an inactivated vaccine can be administered without regard to the timing of the other. d. Antipyretics/analgesics such as acetaminophen or ibuprofen should routinely be given prior to immunization to reduce the discomfort. View Answer
18(d). If more than one non-oral live vaccine (e.g., live attenuated influenza vaccine [LAIV], varicella, mumps) needs to be administered, it is recommended that thevaccines be given on the same day. However, if this is not possible, doses of the live vaccines should be separated by at least four weeks. The four-week interval reduces the interference of immune response to the firstvaccine by the second vaccine. This rule for separation does not apply to the administration of oral live vaccines not given on the same day: typhoid and rotavirus. These vaccines can be given less than four weeks apart. However, this scenario isn’t likely to occur because the age groups for which these vaccines are recommended do not overlap. In addition, parenteral or intranasal administration of a live vaccine is not thought to affect the immune response of a subsequently administered oral live vaccine. A live vaccine and an inactivated vaccine can be administered without regard to the timing of the other. Antipyretics/analgesics such as acetaminophen or ibuprofen should not routinely be given prior to immunization. They might reduce a patient’s immune response. However, if needed, these meds can be used for treatment of fever and pain as needed following vaccination.
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19. Which of the following information regarding Pneumovax 23 is TRUE? a. Pneumococcal vaccine is administered intradermally as one 0.5-mL dose. b. Pneumococcal vaccine MUST NOT be administered at the same time as influenza vaccine. c. For any person who has received a dose of pneumococcal vaccine at age greater than 65 years,revaccination is not indicated. d. PNEUMOVAX 23 is approved for use in children older than 1 year of age. View Answer
19(c). PNEUMOVAX 23 is a vaccine indicated for active immunization for the prevention of pneumococcal disease caused by the 23 serotypes contained in the vaccine. PNEUMOVAX 23 is NOT approved for use in children younger than 2 years of age because children in this age group do not develop an effective immune response to capsular types contained in the polysaccharide vaccine. The Advisory Committee on Immunization Practices (ACIP) has recommendations for revaccination against pneumococcal disease for persons at high risk who were previously vaccinated with PNEUMOVAX 23. Routine revaccination of immunocompetent persons previously vaccinated with a23-valent vaccine, is not recommended. All persons in this category should receive the pneumococcal vaccine, including previously unvaccinated persons and persons who have not received vaccine within 5 years (and were 9 lb or were diagnosed with GDM. 4. High-risk race/ethnicity. 5. A1C ≥5.7%, Impaired Glucose Tolerance (IGT), or Impaired Fasting Glucose (IFG) on previous testing. 6. Hypertension (≥140/90 mm Hg or on therapy). 7. HDL-C 250 mg/dL.
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55. The terms "prescription" and "drug order" do not include an order for medication requiring a prescription to be dispensed, which is provided for the immediate administration to the ultimate user or recipient. True or False
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55. Answer: True. The terms "prescription" and "drug order" do not include an order for medication requiring a prescription to be dispensed, which is provided for the immediate administration to the ultimate user or recipient.
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56. Which of the following information is/are TRUE about Mifepristone? I. It is commonly known as RU-486. II. It is indicated for the medical termination of intrauterine pregnancy through 49 days' pregnancy. III. The recommended dose is one (200 mg Mifepristone) as a single oral dose. a. I only b. I and II only c. II and III only d. II and III only e. All
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Answer 56: I and II are true. Mifepristone (Mifeprex) is a synthetic steroid with antiprogestational effects. Mifepristone (Mifeprex) is indicated for the medical termination of intrauterine pregnancy through 49 days' pregnancy. For purposes of this treatment, pregnancy is dated from the first day of the last menstrual period in a presumed 28 day cycle with ovulation occurring at mid-cycle. The duration of pregnancy may be determined from menstrual history and by clinical examination. Ultrasonographic scan should be used if the duration of pregnancy is uncertain, or if ectopic pregnancy is suspected. Any intrauterine device (“IUD”) should be removed before treatment with Mifepristone (Mifeprex) begins. Patients taking Mifepristone (Mifeprex) must take 400 µg of Misoprostol two days after taking Mifepristone (Mifeprex) unless a complete abortion has already been confirmed before that time. Day One: Mifeprex Administration Patients must read the MEDICATION GUIDE and read and sign the PATIENT AGREEMENT before Mifeprex is administered. Three 200 mg tablets (600 mg) of Mifeprex are taken in a single oral dose. Day Three: Misoprostol Administration The patient returns to the health care provider two days after ingesting Mifeprex. Unless abortion has occurred and has been confirmed by clinical examination or ultrasonographic scan, the patient takes two 200 µg tablets (400 µg) of misoprostol orally. During the period immediately following the administration of Misoprostol, the patient may need medication for cramps or gastrointestinal symptoms. The patient should be given instructions on what to do if significant discomfort, excessive vaginal bleeding or other adverse reactions occur and should be given a phone number to call if she has questions following the administration of the Misoprostol. In addition, the name and phone number of the physician who will be handling emergencies should be provided to the patient. Day 14: Post-Treatment Examination Patients will return for a follow-up visit approximately 14 days after the administration of Mifeprex. This visit is very important to confirm by clinical examination or ultrasonographic scan that a complete termination of pregnancy has occurred. Pregnancy termination by surgery is recommended in cases when Mifepristone (Mifeprex) and misoprostol fail to cause termination of intrauterine pregnancy Serious and sometimes fatal infections and bleeding occur very rarely following spontaneous, surgical, and medical abortions, including following Mifepristone (Mifeprex) use. Ensure that the patient knows whom to call and what to do, including going to an Emergency Room if none of the provided contacts are reachable, if she experiences sustained fever, severe abdominal pain, prolonged heavy bleeding, or syncope, or if she experiences abdominal pain or discomfort or general malaise (including weakness, nausea, vomiting or diarrhea) more than 24 hours after taking Misoprostol.
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57. The cryogenic vessel shall be properly labeled and color coded according to the medical gas contained in the vessel. Which of the following color-code is used for medical oxygen? a. Yellow b. Green c. Gray d. Brown View Answer
57. Answer: Green. As used in this section, "cryogenic vessel" means an insulated metal container in the form of a cylinder or other design used to hold gases that have been liquefied by extreme reductions in temperature. (C). Each cryogenic vessel subject to this section shall meet the following requirements: (1). The vessel shall be properly labeled according to the medical gas contained in the vessel. (2). The vessel shall be color coded as follows: (a). Air - yellow; (b). Carbon dioxide - gray; (c). Cyclopropane - orange; (d). Helium - brown; (e). Nitrogen - black; (f). Nitrous oxide - blue; (g). Oxygen - green. The colors specified in this division shall not be used for any medical gas other than those specified in this division.
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58. Using the NARxCHECK, a pharmacist is receiving a scaled score of 650 for a particular patient. Which of the following statements based on this scaled score is TRUE? a. Very low risk for misuse b. low risk for misuse c. moderate risk for misuse d. High risk for misuse View Answer
58. Answer: High risk for misuse, [https://www.nabp.net]. NARXCHECK is an automatic prescription drug abuse assessment and management tool for health care providers. Once integrated into the facility's system, NARxCHECK automatically queries the state PMP database to generate a report that includes a score for three different drug classes: narcotics, sedatives, and stimulants. These three-digit scores (000-999) help practitioners to decide whether or not they need to review a patient history before prescribing additional medications. The score is easy to read using the following guidelines: 1. Less than 200 = Be confident - low risk for misuse. 2. 200 - 500 = Be curious - moderate risk for misuse. 3. Greater than 500 = Be cautious - higher risk for misuse.
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59. Which of the following information about Spritam is/are TRUE? I. The active ingredient is Levetiracetam (Spritam). II. It is the first FDA approved drug that uses ZipDose technology. III. It is indicated for the treatment of depression. a. I only b. III only c. I and II only d. II and III only e. All
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59(b): I and II only. Levetiracetam (Spritam) is indicated for the treatment of partial onset seizures, myoclonic seizures and primary generalized tonic-clonic seizures in adults and children with epilepsy. Spritam utilizes Aprecia's proprietary ZipDose® Technology platform, a groundbreaking advance that uses three-dimensional printing (3DP) to produce a porous formulation that rapidly disintegrates with a sip of liquid.1 While 3DP has been used previously to manufacture medical devices, this approval marks the first time a drug product manufactured with this technology has been approved by the FDA. ZipDose Technology enables the delivery of a high drug load, up to 1,000 mg in a single dose. As a result, Spritam enhances the patient experience - administration of even the largest strengths of Levetiracetam (Spritam) with just a sip of liquid. In addition, with Spritam there is no measuring required as each dose is individually packaged, making it easy to carry this treatment on the go. The recommended daily dose is 1000 to 3000 mg per day. Sleepiness, weakness, dizziness, infection, tiredness, acting aggressive, nasal congestion, decreased appetite, and irritability are commonly reported side effects of Levetiracetam (Spritam). Levetiracetam is also available under the trade names Keppra and Elepsia.
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60. FDA has recently approved Addyi (Flibanserin). It is indicated for the treatment of: a. PTSD b. STD c. HSDD d. PTD View Answer
60. Answer: HSDD. The U.S. Food and Drug Administration has recently approved Addyi (Flibanserin) to treat acquired, generalized hypoactive sexual desire disorder (HSDD) in premenopausal women. Prior to Addyi’s approval, there were no FDA-approved treatments for sexual desire disorders in men or women. HSDD is characterized by low sexual desire that causes marked distress or interpersonal difficulty and is not due to a co-existing medical or psychiatric condition, problems within the relationship, or the effects of a medication or other drug substance. HSDD is acquired when it develops in a patient who previously had no problems with sexual desire. HSDD is generalized when it occurs regardless of the type of sexual activity, the situation or the sexual partner. Because of a potentially serious interaction with alcohol, treatment with Addyi will only be available through certified health care professionals and certified pharmacies. Addyi can cause severely low blood pressure (hypotension) and loss of consciousness (syncope). These risks are increased and more severe when patients drink alcohol or take Addyi with certain medicines (known as moderate or strong CYP3A4 inhibitors) that interfere with the breakdown of Addyi in the body. Because of the alcohol interaction, the use of alcohol is contraindicated while taking Addyi. Addyi is being approved with a risk evaluation and mitigation strategy (REMS), which includes elements to assure safe use (ETASU). The FDA is requiring this REMS because of the increased risk of severe hypotension and syncope due to the interaction between Addyi and alcohol. The REMS requires that prescribers be certified with the REMS program by enrolling and completing training. Certified prescribers must counsel patients using a Patient-Provider Agreement Form about the increased risk of severe hypotension and syncope and about the importance of not drinking alcohol during treatment with Addyi. Additionally, pharmacies must be certified with the REMS program by enrolling and completing training. Certified pharmacies must only dispense Addyi to patients with a prescription from a certified prescriber. Additionally, pharmacists must counsel patients prior to dispensing not to drink alcohol during treatment with Addyi.
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61. Onfi is available in which of the following dosage forms? I. Tablet II. Oral Suspension III. Capsule a. I only b. III only c. I and II only d. II and III only e. All View Answer
61.Answer: (c). The active ingredient found in Onfi is Clobazam. It is classified as schedule IV controlled substance. Each Onfi (Clobazam) tablet contains 10 mg or 20 mg of clobazam. It is also available for oral administration as an off-white suspension containing clobazam at a concentration of 2.5 mg/mL. Onfi (Clobazam) is classified as benzodiazepine. Clobazam potentiates the GABAergic neurotransmission by binding at the benzodiazepine site of the GABAa receptor. Onfi (Clobazam) is indicated for the adjunctive treatment of seizures associated with Lennox-Gastaut syndrome (LGS) in patients 2 years of age or older. A daily dose of Onfi (Clobazam) greater than 5 mg should be administered in divided doses twice daily; a 5 mg daily dose can be administered as a single dose. As with all antiepileptic drugs and benzodiazepines, withdraw Onfi (Clobazam) gradually. The patient should taper by decreasing the total daily dose by 5-10 mg/day on a weekly basis until discontinued. Somnolence, depression, sedation, withdrawal symptoms, serious dermatological reactions and suicidal behavior and ideation are commonly reported side effects of Onfi (Clobazam).
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62. Which of the following information is/are TRUE about Homocysteine? I. It is not possible to get homocysteine from the diet. II. Homocysteine can be recycled back into methionine using vitamin B12-related enzymes. III. Elevated homocysteine levels have been associated with severe bleeding. a. I only b. III only c. I and II only d. II and III only e. All View Answer
62. Answer: I and II only. Homocysteine is an amino acid. Amino acids are the building blocks of proteins. It is not possible to get homocysteine from the diet. It must be made from methionine, another amino acid that is found in meat, fish, and dairy products. Vitamins B6 (pyridoxine), B12 and folic acid are needed to make this reaction occur. Foods containing methionine are transformed into homocysteine in the bloodstream. Homocysteine is converted in the body to cysteine, with vitamin B6 facilitating this reaction. Homocysteine can also be recycled back into methionine using vitamin B12-related enzymes. Cysteine is an important protein in the body that has many roles. It is involved in the way proteins within cells are folded, maintain their shape, and link to each other. Cysteine is a source of sulfide and is part of the metabolism of different metals in the body including iron, zinc and copper. Cysteine also acts as an anti-oxidant. If homocysteine cannot be converted into cysteine or returned to the methionine form, levels of homocysteine in the body increase. Elevated homocysteine levels have been associated with heart attack, stroke, blood clot formation, and perhaps the development of Alzheimer's disease.
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63. Rolapitant is indicated for the treatment of: a. Hypertension b. Diabetes c. Nausea and vomiting d. Schizophrenia e. Rheumatoid arthritis View Answer
63. Answer: (c). The U.S. Food and Drug Administration approved Rolapitant (Varubi) to prevent delayed phase chemotherapy-induced nausea and vomiting (emesis). Rolapitant (Varubi) is approved in adults in combination with other drugs (antiemetic agents) that prevent nausea and vomiting associated with initial and repeat courses of vomit-inducing (emetogenic and highly emetogenic) cancer chemotherapy. Rolapitant (Varubi) is a substance P/neurokinin-1 (NK-1) receptor antagonist. Activation of NK-1 receptors plays a central role in nausea and vomiting induced by certain cancer chemotherapies, particularly in the delayed phase. It is available in tablet form. Rolapitant (Varubi) inhibits the CYP2D6 enzyme, which is responsible for metabolizing certain drugs. Varubi is contraindicated with the use of thioridazine, a drug metabolized by the CYP2D6 enzyme, because use of the two drugs together may increase the amount of thioridazine in the blood and cause an abnormal heart rhythm that can be serious. The most common side effects in patients treated with Rolapitant (Varubi) include a low white blood cell count (neutropenia), hiccups, decreased appetite and dizziness. Source: www.pharmacyexam.com
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64. Which of the following information is/are TRUE about Durlaza? I. Clopidogrel is an active ingredient. II. Indicated for the secondary prevention of stroke and acute cardiac events, including myocardial infarction (heart attack). III. Available as 24-hour, extended release capsules formulation containing 162.5mg active ingredient. a. I only b. III only c. I and II only d. II and III only e. All View Answer
64. Answer: (d) II and III are true. Durlaza is an aspirin formulation for secondary prevention in high-risk CVD patients. The aspirin delivery technology in Durlaza extends the release of aspirin in a manner designed to provide a stable antiplatelet effect over the course of the day. Low-dose aspirin has been proven to reduce the risk of secondary cardiovascular events and mortality in high-risk patients with stable cardiovascular disease. This is primarily due to aspirin’s ability to inhibit platelet aggregation (blood clotting). While the body is making platelets 24-hours a day, current immediate-release traditional aspirin only stays in the blood for about a mean duration of four to six hours, with peak plasma concentrations peaking after just 30 minutes. Durlaza utilizes extended-release, microcapsule technology to prolong aspirin release. Durlaza offers the only once-daily, 24-hour antiplatelet therapy through the extended release of its 162.5mg dose, resulting in prolonged absorption, and sustained platelet exposure to aspirin. Durlaza, like immediate-release aspirin, increases the risk of bleeding and gastric ulceration, and may cause fetal harm when administered to a pregnant woman.
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65. Which of the following vaccines is required to be stored in a freezer? a. Hepatitis A b. Human papilloma virus c. Influenza d. Herpes Zoster
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65. Answer: Herpes zoster. The following vaccines are required to be stored in refrigerator (2 to 8 degree C): 1. HepA (Hepatitis A) 2. HepB (Hepatitis B) 3. Hib (Haemophilus influenzae type b) 4. HPV (Human papilloma virus) 5. Influenza 6. Meningococcal-combinations 7. Pneumococcal 8. Rotavirus 9. Any diphtheria/tetanus toxoid, pertussis combination The following vaccines are required to be stored in freezer (-50 to -15 degrees C): 1. VAR (Varicella) 2. HZV (Herpes Zoster Vaccine) 3. MMRV = Measles, mumps, rubella, varicella The following vaccines can be stored in refrigerator (2 to 8 degree C) or freezer (-50 to -15 degrees C): 1. MMR (Measles, mumps, rubella)
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66. With the ICD-10-PCS, the length of inpatient procedure codes will increase to: a. 7 alphanumeric characters b. 3 alphanumeric characters c. 13 alphanumeric characters d. 10 alphanumeric characters View Answer
66. Answer: 7 alphanumeric characters. The U.S. Department of Health and Human Services (HHS) announced a final rule that will facilitate the United States’ ongoing transition to an electronic health care environment through adoption of new healthcare code sets for use in electronic health care transactions. This rule adopts updated versions of the code sets, under the authority of HIPAA (ICD-10 final rule). The ICD-10 code sets replace the current ICD-9-CM code set. The industry currently uses about 4,000 unique ICD-9-CM volume 3 codes to describe inpatient procedures. ICD-9 procedure codes are 3-4 digits in length (e.g., 47.01 – Laparoscopic appendectomy). With the ICD-10-PCS mandate, the length of inpatient procedure codes will increase to 7 alphanumeric characters (e.g., ODTJ4ZZ – Laparoscopic appendectomy).
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67. Which of the following is strong CYP1A2 inhibitor? (Select All that apply). a. Fluvoxamine b. Ciprofloxacin c. Caffeine d. Fluoxetine e. Cimetidine View Answer
67. Answer: (a,b). Dose adjustments may be necessary in patients with concomitant use of: Strong CYP1A2 inhibitors (e.g., fluvoxamine, ciprofloxacin, or enoxacin); Moderate or weak CYP1A2 inhibitors (e.g., oral contraceptives, or caffeine); CYP2D6 or CYP3A4 inhibitors (e.g., cimetidine, escitalopram, erythromycin, paroxetine, bupropion, fluoxetine, quinidine, duloxetine, terbinafine, or sertraline); CYP3A4 inducers (e.g., phenytoin, carbamazepine, St. John’s wort, and rifampin); or CYP1A2 inducers (e.g., tobacco smoking).
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68. Which of the following information is/are TRUE about preparing TPN formulation? (Select All that apply). a. A lipid emulsion in a three-in-one admixture obscures the presence of calcium phosphate precipitates. b. The solubility of the added calcium should be calculated from the volume at the time the calcium is added and should NOT be based upon the final volume. c. If the amount of calcium or phosphate which must be added is likely to cause a precipitate, some or all of the calcium should be administered separately. d. If a three-in-one admixture is medically necessary, then add the calcium before the lipid emulsion. e. When adding calcium and phosphate to an admixture, the calcium should be added first. View Answer
68. Answer: (a,b,c,d). TPN solutions are made according to a variety of formulations and compounding protocols. Thus, there are possibilities of calcium phosphate precipitates and many other chemical incompatibilities. Precipitates could develop because of a number of factors such as: the concentration, pH, and phosphate content of the amino acid solutions; the calcium and phosphorous additives; the order of mixing; the mixing process; or the compounder. The presence of a lipid emulsion in the TPN admixture would obscure the presence of any precipitate. Because of the potential for life threatening events, caution should be taken to ensure that precipitates have not formed in any parenteral nutrition admixtures. 1. The amounts of phosphorous and of calcium added to the admixture are critical. The solubility of the added calcium should be calculated from the volume at the time the calcium is added. It should not be based upon the final volume. Some amino acid injections for TPN admixtures contain phosphate ions (as a phosphoric acid buffer). These phosphate ions and the volume at the time the phosphate is added should be considered when calculating the concentration of phosphate additives. Also, when adding calcium and phosphate to an admixture, the phosphate should be added first. 2. The line should be flushed between the addition of any potentially incompatible components. 3. A lipid emulsion in a three-in-one admixture obscures the presence of a precipitate. Therefore, if a lipid emulsion is needed, either: (1). use a two-in-one admixture with the lipid infused separately, or (2). if a three-in-one admixture is medically necessary, then add the calcium before the lipid emulsion and according to the recommendations in number 1 above. If the amount of calcium or phosphate which must be added is likely to cause a precipitate, some or all of the calcium should be administered separately. Such separate infusions must be properly diluted and slowly infused to avoid serious adverse events related to the calcium. 4. A filter should be used when infusing either central or peripheral parenteral nutrition admixtures. Standards of practice vary, but the following is suggested: a 1.2 micron air eliminating filter for lipid containing admixtures, and a 0.22 micron air eliminating filter for nonlipid containing admixtures.
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69. Which of the following HMG-CoA inhibitors can be taken during any time of the day with or without food? (Select All that apply) a. Atorvastatin b. Pravastatin c. Simvastatin d. Pitavastatin e. Rosuvastatin View Answer
69. Answer: (a,b,d,e). Name
Dose Timing
Food
Pitavastatin
Any time of the day
With or without food
Simvastatin
Evening
N/A
Atorvastatin
Any time of the day
With or without food
Fluvastatin
Evening
With or without food
Pravastatin
Any time of the day
With or without food
Lovastatin
Evening
With food
Rosuvastatin
Any time of the day
With or without food
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Which of the following information about Zurampic is/are TRUE? (Select All that apply). a. Acute liver failure has reported with Zurampic. b. Zurampic should be used in combination with a xanthine oxidase inhibitor. c. An active ingredient found in Zurampic is Lesinurad. d. Zurampic is a xanthine oxidase inhibitor. e. Zurampic is indicated for the treatment of hyperuricemia associated with gout. View Answer
Answer: (b,c,e). Zurampic (Lesinurad) is a URAT1 inhibitor. It is available as blue film-coated tablets for oral administration containing 200 mg Lesinurad. It should be used in combination with a xanthine oxidase inhibitor. Lesinurad reduces serum uric acid levels by inhibiting the function of transporter proteins involved in uric acid reabsorption in the kidney. It is indicated in combination with a xanthine oxidase inhibitor for the treatment of hyperuricemia associated with gout in patients who have not achieved target serum uric acid levels with a xanthine oxidase inhibitor alone. Zurampic (Lesinurad) is not recommended for the treatment of asymptomatic hyperuricemia. Zurampic (Lesinurad) should not be used as monotherapy. Zurampic (Lesinurad) tablets are for oral use and should be co-administered with a xanthine oxidase inhibitor, including allopurinol or febuxostat. Zurampic (Lesinurad) is recommended at 200 mg once daily. This is also the maximum daily dose. Zurampic (Lesinurad) should be taken by mouth, in the morning with food and water. Zurampic (Lesinurad) causes an increase in renal uric acid excretion, which may lead to renal events including transient increases in serum creatinine, renal-related adverse reactions, and kidney stones. These renal events occurred more frequently in patients receiving Zurampic (Lesinurad) 400 mg, when used as monotherapy or in combination with a xanthine oxidase inhibitor. Kidney function is required to monitor.
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71. Poison Ivy rash is an example of: a. Type I Hypersensitivity b. Type II Hypersensitivity c. Type III Hypersensitivity d. Type IV Hypersensitivity e. Type V Hypersensitivity View Answer
71. Answer: (d), Type 4 hypersensitivity is often called delayed type. Delayed hypersensitivity does not start to be noticeable until several hours to a full day after exposure to the antigen. It may last for over a week. Poison ivy rash is caused by an allergic reaction to an oily resin called urushiol (u-ROO-she-ol). This oil is in the leaves, stems and roots of poison ivy, poison oak and poison sumac. Urushiol, which is a hapten, when absorbed through the skin from a poison ivy plant, it (urushiol) undergoes oxidation in the skin cells to generate the actual hapten, a reactive molecule called a quinone, which then reacts with skin proteins to form hapten adducts. T lymphocytes recognize the foreign substances, usually after the antigen is eaten, degraded, and presented (in pieces) by so-called antigen-presenting cells such as Langerhans cells in the skin, or macrophages. Urushiol metabolites (metabolite of Poison Ivy) are presented by this and other mechanisms. The T lymphocytes pour out inflammatory signal substances called cytokines. These call in armies of white blood cells called monocytes, which become macrophages. The macrophages become activated by the cytokines and attack everything in the vicinity, and can cause severe tissue damage. Usually, the first exposure causes only sensitization, in which there is a proliferation of effector T-cells. After a subsequent, second exposure, the proliferated T-cells can become activated, generating an immune reaction that produces typical blisters of a poison ivy exposure. In addition to poison ivy, a good example is the skin reaction to injected tuberculosis antigen. In fact, when tuberculosis bacteria infect the lung, it is the delayed hypersensitivity against them which destroys the lung. Unlike the other types, it is not antibody mediated but rather is a type of cell-mediated response.
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72. Which of the following rating scales is commonly used to evaluate the severity of extrapyramidal symptoms (EPS)? (Select ALL that apply) a. SAS b. BARS c. AIMS d. ESRS e. PDS View Answer
72. Answer: (a,b,c,d). Extrapyramidal symptoms (EPS) are drug-induced movement disorders that include acute and tardive symptoms. These symptoms include dystonia (continuous spasms and muscle contractions), akathisia (motor restlessness), Parkinsonism (characteristic symptoms such as rigidity, bradykinesia, and tremor), and tardive dyskinesia (irregular, jerky movements). Since it is difficult to measure extrapyramidal symptoms, rating scales are commonly used to assess the severity of movement disorders. The Simpson-Angus Scale (SAS), Barnes Akathisia Rating Scale (BARS), Abnormal Involuntary Movement Scale (AIMS), and Extrapyramidal Symptom Rating Scale (ESRS) are rating scales frequently used for such assessment and are not weighted for diagnostic purposes.
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73. Home ovulation tests usually detect a preovulatory surge in which of the following in the urine? a. Prolactin b. Oestrogen c. Oxytocin d. Progesterone e. Luteinizing hormone View Answer
73. Home ovulation tests usually detect a preovulatory surge in which of the following in the urine? a. Prolactin b. Oestrogen c. Oxytocin d. Progesterone e. Luteinizing hormone Answer: (e). An ovulation home test is used by women to help determine the time in the menstrual cycle when getting pregnant is most likely. The test detects a rise in luteinizing hormone (LH) in the urine. A rise in this hormone signals the ovary to release the egg.
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74. Slow channel blocking drugs will reduce the movement of which substance into smooth muscle cells? (Select All that apply) a. Renin b. Kinin c. Calcium d. Sodium e. Bradykinin View Answer
74. Slow channel blocking drugs will reduce the movement of which substance into smooth muscle cells? (Select All that apply) a. Renin b. Kinin c. Calcium d. Sodium e. Bradykinin Answer: (c). Slow channel blockers inhibit the slow inward calcium current, which may prolong conduction and refractoriness in the AV node.
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75. Which of the following inhibits CYP 3A4? (Select All that apply) a. Omeprazole b. Lansoprazole c. Pantoprazole d. Rabeprazole e. Esomeprazole View Answer
75. Which of the following inhibits CYP 3A4? (Select All that apply) a. Omeprazole b. Lansoprazole c. Pantoprazole d. Rabeprazole e. Esomeprazole Answer: (a) Below is the list of drugs that inhibit specifically CYP 3A4: 1. Amiodarone 2. Anastrozole 3. Azithromycin 4. Cannabinoids 5. Cimetidine 6. Clarithromycin 7. Clotrimazole 8. Cyclosporine 9. Danazol 10. Delavirdine 11. Dexamethasone 12. Diethyldithiocarbamate 13. Diltiazem 14. Dirithromycin 15. Disulfiram 16. Entacapone (high dose) 17. Erythromycin 18. Ethinyl estradiol 19. Fluconazole 20. Fluoxetine 21. Fluvoxamine 22. Gestodene 23. Grapefruit juice 24. Indinavir 25. Isoniazid 26. Ketoconazole 27. Metronidazole 28. Mibefradil 29. Miconazole 30. Nefazodone 31. Nelfinavir 32. Nevirapine 33. Norfloxacin 34. Norfluoxetine 35. Omeprazole 36. Oxiconazole 37. Paroxetine (weak) 38. Propoxyphene 39. Quinidine 40. Quinine 41. Quinupristin and Dalfopristin 42. Ranitidine 43. Ritonavir 44. Saquinavir 45. Sertindole 46. Sertraline 47. Troglitazone 48. Troleandomycin 49. Valproic acid
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76. Which of the following information is TRUE ABOUT anaerobic respiration? (Select All that apply) a. Waste products are carbon dioxide and water. b. It may produce between 36 and 38 ATP molecules. c. In animals, including humans, the anaerobic cycle produces lactic acid, which causes muscle cramps. d. The fermentation process in anaerobic respiration is roughly 5 percent as effective as what cells can do when they have access to oxygen. e. In bacteria, it may produce nitrite, nitrogen gas, hydrogen sulfide, methane and acetic acid.
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76. Which of the following information is TRUE ABOUT anaerobic respiration? (Select All that apply) a. Waste products are carbon dioxide and water. b. It may produce between 36 and 38 ATP molecules. c. In animals, including humans, the anaerobic cycle produces lactic acid, which causes muscle cramps. d. The fermentation process in anaerobic respiration is roughly 5 percent as effective as what cells can do when they have access to oxygen. e. In bacteria, it may produce nitrite, nitrogen gas, hydrogen sulfide, methane and acetic acid. Answer (c, d and e). "Anaerobic" means without oxygen, and respiration refers to the processes in a cell that convert biochemical energy, such as that found in glucose, into usable energy in the form of ATP. Waste products like carbon dioxide are also produced during this process. The fermentation process in anaerobic respiration is roughly 5 percent as effective as what cells can do when they have access to oxygen. An aerobic cycle may produce between 36 and 38 ATP molecules, while anaerobic respiration only creates 2 ATP molecules. Since muscles often run out of oxygen during extreme exertion, anaerobic respiration keeps them running. In animals, including humans, the anaerobic cycle produces lactic acid, which causes muscle cramps. In order for these cramps to stop, oxygen must find its way back into the muscle again so these cells can switch back to aerobic respiration and stop building up lactic acid. Anaerobic respiration is also common in bacteria that live in environments without oxygen; depending on the bacteria, the products of their respiration include nitrite, nitrogen gas, hydrogen sulfide, methane and acetic acid.
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77. Which of the following best describes the Capitation System? a. Risk free income for healthcare service providers. b. Healthcare provider may get more incentive to provide an extended treatment to a patient. c. A fixed amount of money per patient per unit of time paid in advance to the physician for the delivery of health care services. d. A patient gets more benefit if he/she gets services from Healthcare provider receiving reimbursement through capitation. e. Free prescription benefits to patients.
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77. Which of the following best describes the Capitation System? a. Risk free income for healthcare service providers. b. Healthcare provider may get more incentive to provide an extended treatment to a patient. c. A fixed amount of money per patient per unit of time paid in advance to the physician for the delivery of health care services. d. A patient gets more benefit if he/she gets services from Healthcare provider receiving reimbursement through capitation. e. Free prescription benefits to patients. Answer: Capitation payments are used by managed care organizations to control health care costs. Capitation payments control use of health care resources by putting the physician at financial risk for services provided to patients. At the same time, in order to ensure that patients do not receive suboptimal care through under-utilization of health care services, managed care organizations measure rates of resource utilization in physician practices. These reports are made available to the public as a measure of health care quality, and can be linked to financial rewards, such as bonuses. Capitation is a fixed amount of money per patient per unit of time paid in advance to the physician for the delivery of health care services. The actual amount of money paid is determined by the ranges of services that are provided, the number of patients involved, and the period of time during which the services are provided. Capitation rates are developed using local costs and average utilization of services and therefore can vary from one region of the country to another. In many plans, a risk pool is established as a percentage of the capitation payment. Money in this risk pool is withheld from the physician until the end of the fiscal year. If the health plan does well financially, the money is paid to the physician; if the health plan does poorly, the money is kept to pay the deficit expenses. When the primary care provider signs a capitation agreement, a list of specific services that must be provided to patients is included in the contract. The amount of the capitation will be determined in part by the number of services provided and will vary from health plan to health plan, but most capitation payment plans for primary care services include the following: · Preventive, diagnostic, and treatment services · Injections, immunizations, and medications administered in the office · Outpatient laboratory tests done either in the office or at a designated laboratory · Health education and counseling services performed in the office · Routine vision and hearing screening
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78. Thiazide diuretics should NOT be used as a first line treatment for hypertension in patient suffering from: a. Hyperlipidemia b. Heart failure c. COPD d. Gout e. Peripheral artery disease View Answer
78. Thiazide diuretics should NOT be used as a first line treatment for hypertension in patient suffering from: a. Hyperlipidemia b. Heart failure c. COPD d. Gout e. Peripheral artery disease Answer :(d). Thiazide diuretics may increase the reabsorption of uric acid from renal tubules and may cause hyperuricemia. It should NOT be used as a first line treatment for hypertension in patient suffering from gout.
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79. Which of the following is/are false positive tuberculin skin test reactions? (Select All that apply) a. Infection with non-tuberculosis mycobacteria b. Cutaneous anergy c. Previous BCG vaccination d. Very old TB infection e. Recent live-virus vaccination View Answer
79. Which of the following is/are false positive tuberculin skin test reactions? (Select All that apply) a. Infection with non-tuberculosis mycobacteria b. Cutaneous anergy c. Previous BCG vaccination d. Very old TB infection e. Recent live-virus vaccination Answer: (a,c). The Mantoux tuberculin skin test (TST) is the standard method of determining whether a person is infected with Mycobacterium tuberculosis. Reliable administration and reading of the TST requires standardization of procedures, training, supervision, and practice. The TST is performed by injecting 0.1 ml of tuberculin purified protein derivative (PPD) into the inner surface of the forearm. The injection should be made with a tuberculin syringe, with the needle bevel facing upward. The TST is an intradermal injection. When placed correctly, the injection should produce a pale elevation of the skin (a wheal) 6 to 10 mm in diameter. The skin test reaction should be read between 48 and 72 hours after administration. A patient who does not return within 72 hours will need to be rescheduled for another skin test. The reaction should be measured in millimeters of the induration (palpable, raised, hardened area or swelling). The reader should not measure erythema (redness). The diameter of the indurated area should be measured across the forearm (perpendicular to the long axis). Skin test interpretation depends on two factors: 1. Measurement in millimeters of the induration 2. Person’s risk of being infected with TB and of progression to disease if infected What Are False-Positive Reactions? Some persons may react to the TST even though they are not infected with M. tuberculosis. The causes of these false-positive reactions may include, but are not limited to, the following: 1. Infection with non-tuberculosis mycobacteria 2. Previous BCG vaccination 3. Incorrect method of TST administration 4. Incorrect interpretation of reaction 5. Incorrect bottle of antigen used What Are False-Negative Reactions? Some persons may not react to the TST even though they are infected with M. tuberculosis. The reasons for these false-negative reactions may include, but are not limited to, the following: 1. Cutaneous anergy (anergy is the inability to react to skin tests because of a weakened immune system) 2. Recent TB infection (within 8-10 weeks of exposure) 3. Very old TB infection (many years)
4. Very young age (less than 6 months old) 5. Recent live-virus vaccination (e.g., measles and smallpox) 6. Overwhelming TB disease 7. Some viral illnesses (e.g., measles and chicken pox) 8. Incorrect method of TST administration 9. Incorrect interpretation of reaction
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80. After completing the therapy, H. pylori follow-up status testing shall be done within what time frame to ensure H. Pylori has been completely eradicated? a. 7 days b. 72 hours c. 4 weeks d. 6 months e. a month View Answer
80. After completing the therapy, H. pylori follow-up status testing shall be done within what time frame to ensure H. Pylori has been completely eradicated? a. 7 days b. 72 hours c. 4 weeks d. 6 months e. a month Answer: (c) Before the seriousness of H. pylori infections was fully appreciated and when it was still believed that H. pylori eradication therapy could routinely cure more than 90% of patients, confirmation of cure testing was not routinely recommended. Although confirmation for cure testing is currently considered the standard of care, preferably with noninvasive tests such as the stool antigen or a urea breath test, it is often not done. Post eradication testing is not only useful to confirm H. pylori eradication but also serves to alert the clinician when resistance begins to undermine their locally effective current regimens. In this issue of Clinical Gastroenterology and Hepatology, Gatta et al report a pilot study suggesting that it may be possible to accurately assess cure using changes in serum pepsinogen II levels. A positive urea breath test (UBT), histology, culture, or rapid urease test (RUT) any time after therapy is considered as evidence of treatment failure. However, it has been recommended that posttreatment testing be delayed for at least 4 weeks after the end of therapy. This recommendation is based on the fact that it takes time for any remaining bacteria to recover and repopulate the stomach in sufficient numbers to be detected reliably. By 4 weeks, the accuracy of a negative test is in the range of 98% to 100%. There is little or no gain by repeating negative tests to ensure success (eg, 2 negative urea breath tests) as a second urea breath test has not shown an increase in accuracy and adds an incremental cost with little clinical benefit. One caveat among available noninvasive tests is that when using the stool antigen to assess outcome, it may be best to increase the interval from 4 to 6 or 8 weeks to ensure that a positive result is not false positive. The available data show that the stool antigen tests that use monoclonal anti-H. pylori antibodies are more reliable than polyclonal stool antigen tests and monoclonal antibody-based stool antigen tests are recommended.
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81. Which of the following information is TRUE about Invokana (Canagliflozin)? (Select All that apply) a. The 300-mg dose of Invokana is proven to show greater A1C reductions than Januvia. b. It is a once-daily pill that works around the clock. c. It is not for weight loss, but may help a patient to lose weight—on average 3%. d. In most clinical trials, the majority of people taking Invokana reached an A1C goal of less than 7%. e. The most common side effect associated with the use of Invokana is hypoglycemia. View Answer
81. Which of the following information is TRUE about Invokana (Canagliflozin)? (Select All that apply) a. The 300-mg dose of Invokana is proven to show greater A1C reductions than Januvia. b. It is a once-daily pill that works around the clock. c. It is not for weight loss, but may help a patient to lose weight—on average 3%. d. In most clinical trials, the majority of people taking Invokana reached an A1C goal of less than 7%. e. The most common side effect associated with the use of Invokana is hypoglycemia. Answer: (a,b,c, and d). Invokana (Canagliflozin) is a sodium-glucose co-transporter 2 (SGLT2) inhibitor indicated as an adjunct to diet and exercise to improve glycemic control in adults with type 2 diabetes mellitus. The recommended starting dose is 100 mg once daily, taken before the first meal of the day. Dose can be increased to 300 mg once daily in patients tolerating Invokana (Canagliflozin) 100 mg once daily who have an eGFR of 60 mL/min/1.73 m2 or greater and require additional glycemic control. Invokana (Canagliflozin) is limited to 100 mg once daily in patients who have an eGFR of 45 to less than 60 mL/min/1.73 m2. Assess renal function before initiating Invokana (Canagliflozin). Do not initiate Invokana (Canagliflozin) if eGFR is below 45 mL/min/1.73 m2. Discontinue Invokana (Canagliflozin) if eGFR falls persistently below 45 mL/min/1.73 m2. It can increase the risk of hypoglycemia when combined with insulin or an insulin secretagogue. A lower dose of insulin or insulin secretagogue may be required to minimize the risk of hypoglycemia when used in combination with Invokana (Canagliflozin). It causes intravascular volume contraction. Symptomatic hypotension can occur after initiating Invokana (Canagliflozin)®, particularly in patients with impaired renal function (eGFR