A newly added medication to the formulary has been causing a significant number of drug interactions and adverse effects. You are part of the P&T committee and are of the opinion that this medication should be removed from formulary as other reasonable alternatives exist. Which of the following act...
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BCPS EXAM QUESTIONS WITH
DETAILED ANSWERS // 100%
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,A newly added medication to the formulary has been causing a significant number of drug
interactions and adverse effects. You are part of the P&T committee and are of the opinion that
this medication should be removed from formulary as other reasonable alternatives exist. Which
of the following actions would NOT be appropriate?
A. Remove the medication from the formulary as perceived harm outweighs potential risks, this
can be done unilaterally by the P&T committee if necessary to minimize patient risk and
maximize patient safety
B. Continue to monitor the safety and reactions until removal of the drug from the formulary is
approved
C. Discuss the issue with colleagues to obtain as much information as possible
D. Establish special monitoring procedures in the pharmacy department to help track the safety
profile of this particular medication - ANS Answer: A. Remove the medication from the
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formulary as perceived harm outweighs potential risks, this can be done unilaterally by the P&T
committee if necessary to minimize patient risk and maximize patient safety - Actions of the P&T
committee are subject to the medical board's approval and the P&T committee cannot act
unilaterally. The other answers all represent reasonable approaches to address and monitor the
safety risk of the medication.
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38 year old male with a history of Multiple Sclerosis. Past medical history is minimal other than
MS. With treatment of Interferon Beta 1a for MS, what is the best choice for prevention of side
effects?
A. Low dose corticosteroid
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B. Acetaminophen scheduled three times daily
C. Ibuprofen 600 mg with injection
D. Benadryl 50 mg with injection - ANS Answer: C. Ibuprofen 600 mg with injection - Flu like
symptoms are common with Interferon Beta 1a. Acetaminophen or Ibuprofen would be
appropriate. Three times daily acetaminophen would be excessive for prevention of injection
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site reaction. Steroids would not be indicated due to long term adverse effects risk like
hyperglycemia, osteoporosis, adrenal suppression, etc. Benadryl doesn't have any analgesic
properties.
A 78 year old male has an extensive seizure history, but no recent seizures within the last year.
Currently receives Dilantin 300 mg daily. Dilantin level drawn today was low at 8.3 (Normal
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range 10-20). Previous total levels have ranged in the 10-15 range. Other labs LFT - normal
limit, hemoglobin 13.3, WBC - 8.7, Platelets 164, Albumin 3.2, Alkaline Phosphatase 174. What
is your recommendation?
A. Leave current dosing as is
B. Increase phenytoin to 330 mg daily
C. Increase phenytoin to 400 mg daily
D. Increase phenytoin to 600 mg daily - ANS Answer: A. Leave current dosing as is - No
recent seizures, so why risk toxicity? Corrected level will actually give you a value higher than
8.3. Also remember that phenytoin can cause transient increases in alkaline phosphatase which
is generally not an issue. If you get a case where you are recommending an increase,
remember the dose dependent kinetics. Small increases in dose can lead to huge increases in
, serum concentration. Never double a maintenance dose, and if you see it done, watch for
toxicity because it will likely happen. Albumin and BUN also have the potential to affect
phenytoin levels.
Newly diagnosed 85 year old patient with atrial fibrillation at a routine visit to the clinic. Past
medical history includes hypertension, rheumatoid arthritis, constipation, heart failure, diabetes
and GERD. What is appropriate recommendation regarding the possible use of anticoagulation?
A. Aspirin use is acceptable
B. Initiate warfarin with goal of 2-3 INR
C. Initiate dabigatran
D. Anticoagulation is not necessary - ANS Answer: B. Initiate warfarin with goal of 2-3 INR -
CHADS-2Vasc score is three, so anticoagulation is definitely indicated. Dabigatran bleed risk
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caution in an 85 year old would probably not be the ideal choice. Initiating warfarin would be the
best choice barring any other contraindications.
EC is receiving cycle 1 dose-dense AC, which is true about growth factor support in this patient.
A. This regimen is considered high risk for febrile neutropenia> 20% and patient should receive
pegfilgrastim
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B. This regimen is considered intermediate risk for febrile neutropenia 10-20% but patient does
not have any additional risk factors to recommend pegfilgrastim
C. This regimen is considered low risk for febrile neutropenia < 10% therefore, this patient
should not receive pegfilgrastim
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D. This regimen is considered intermediate risk for febrile neutropenia 10 -20% and since
patient has other risk factors he should receive pegfilgrastim. - ANS Answer: A. This regimen
is considered high risk for febrile neutropenia >20% and patient should receive pegfilgrastim - In
this case, the regimen is high risk for neutropenia and CSF should be given.
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An infant female is now 4 months old and was born premature at 27 weeks. Due to premature
nature of birth the infant had received 2 doses of palivizumab each separated by a month for
RSV prophylaxis. She is now presenting with respiratory symptoms and is RSV positive. What
should be your recommendation in regards to palivizumab therapy?
A. Continue palivizumab at monthly intervals up to 5 total doses
B. Discontinue palivizumab treatments
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C. Increase frequency to weekly for a max of 5 doses or until symptoms resolve
D. Continue palivizumab monthly until the infant reaches 1 year of age - ANS Answer: B.
Discontinue palivizumab treatments - The infant has contracted the virus and prophylaxis would
no longer be necessary. Palivizumab is not intended for treatment of RSV, only prophylaxis.
How much volume will the intravascular space increase with 1 liter of 5% albumin?
A. 1 liter
B. 500 mls
C. 250 mls
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