haad 3
問題一覧
1
A 21 year lady was on Carbamazepine and Phenytoin, but recurrent episode happened so she changed the medicine to Valproate, then she doesn’t have any seizures for the last five years, her husband come to pharmacy for medicine and he said she try to conceive. What advice will give you regarding medication
Consult a neurologist before conceiving and take opinion about continuation of Valproate
2
A 21 year lady was on Carbamazepine and Phenytoin, but recurrent episode happened so she changed the medicine to Valproate, then she doesn’t have any seizures for the last five years, her husband come to pharmacy for medicine and he said she try to conceive. What advice will give you regarding medication
Stop sodium valproate and wait for 14 days washout period then plan / switch to lamotrigine
3
A 21 year lady was on Carbamazepine and Phenytoin, but recurrent episode happened so she changed the medicine to Valproate, then she doesn’t have any seizures for the last five years, her husband come to pharmacy for medicine and he said she try to conceive. What advice will give you regarding medication
Withdraw valproate slowly prior to conception, by discussing with neurologist
4
Female on valproate wants to get pregnant what is your advice:
Ask prescriber to change to lamotrigine
5
A 28-year-old woman with seizure is planning to start a family. She is taking folic acid 400 mcg per day. She is asking about safe epilepsy medications during pregnancy. Which of the following would be the best medication?
Lamotrigine
6
A physician would like to replace patient's valproic acid with immediate release lamotrigine. What is the recommended maximum initial dose?
200 mg
7
A 28-year-old woman with a history of seizures that well controlled on valproic acid is asking for advice regarding her medications. She is planning to start a family and is now taking folic acid. She wants to optimize the medications before her pregnancy. What would be the best recommendation?
Introduce well controlled slowly and titrate the dose of valproic acid to discontinue before pregnancy
8
Which one of the following is considered first line therapy for the management of partial seizures?
Carbamazepine
9
Which one of the following parameters should be monitored regularly when starting a patient on clozapine?
Absolute neutrophil count
10
What is the appropriate treatment of poisoning by organophosphate nerve agents?
Pralidoxime
11
28-year-old woman has been taking fluoxetine for depression and now has worsening depressive episodes. The resident doctor on the floor has been asked by consultant to stop fluoxetine and initiate phenelzine. How long should the washout period be before starting phenelzine?
5 weeks
12
Drug is secreted at Brest fed infant and cause hypnosis.
Diazepam
13
A 70-year-old woman is taking multiple drugs According to Beers criteria, which one of the following drugs is potentially inappropriate since it might be associated with increased cognitive decline?
Amitriptyline
14
Most drug to cause side effects Associated with multiple adverse drug reactions:
Quetiapine fumarate
15
Which one of the following drugs is considered first line treatment for Alzheimer's disease?
Donepezil
16
24-year-old man is diagnosed with psychosis. He agrees to start drug therapy, however, he is asking for the least sedating medication. Which of the following drugs will be most appropriate?
Risperidone
17
Which of the following medications can be used for narcotic addiction?
Methadone
18
Pt. came to the pharmacy complaining about dizziness, resting tremors and difficulty in stepping the leg. She also has QT prolongation. These symptoms appears one week ago when the patient toke the restless leg syndrome medication. The pharmacy inspected the bottle of medicine the patient brought and saw that the label indicated Quinine sulfate but the appearance of the tablets didn’t match the medicine. What had contributed to this adverse effect
Quetiapine 200m
19
Which of the following is a drug with concern
Zopiclone
20
Patient with high degree of insomnia what is the most suitable option for him
Zopiclone for 28 days
21
A 75-year-old woman comes to the pharmacy with a new prescription for zolpidem. What is the maximum dose she can receive?
5 mg
22
Which of the following groups is with high physical dependence
Benzodiazepines
23
patient is for opioid withdrawal treatment but with QT prolongation, which will be the best drug for him
Buprenorphine
24
A diabetic patient on antipsychotic (Olanzapine) , and the doctor wants to change it to another antipsychotic, what is the best alternative?
Aripiprazole
25
Pt taking parkinsons disease medication, have symptoms dizziness, fatigue, heavy breathing his hb is 7 what to give him
Darbepoetin s.c every 3 weeks
26
Patient is on Capecitabine having lethargy and shortness of breath Hb in lab was 7.7
Darbepoetin
27
A 10-year-old obese girl with newly diagnosed depressive illness is being advised to start antidepressant treatment. Which of the following is best to initiate?
Bupropion
28
Which one of the following parameters should be monitored regularly when starting a patient on clozapine?
Absolute neutrophil count
29
Which of the following medication is most appropriate in a 71-year-old man to treat extrapyramidal effects emerging out of neuroleptics?
Benztropine
30
What is the effect of smoking on serum olanzapine levels?
Decrease in serum olanzapine levels
31
Which antidepressant drug must be avoided in a 21-year-old female with a history of seizure disorder?
Bupropion
32
What information should be provided to a patient on fentanyl transdermal patches?
Avoid increase in body core temperature
33
A 25-year-old man presents to the emergency room after ingesting 30 tablets of Alprazolam what should be the appropriate antidote?
Flumazenil
34
A 25-year-old man presents to the emergency room after ingesting 30 tablets of Alprazolam what should be the appropriate antidote?
Flumazenil
35
Diazepam bottle finished. Which antidote?
Flumazenil
36
Diazepam bottle finished. Which antidote?
Physostigmine
37
Patient took overdose of diazepam and treated with Flumazenil but patient is still hypnotized.. Why?
flumazenil dose is not enough
38
An 18-year-old boy with a history of illicit drug use is suspected to have an overdose of benzodiazepines and is experiencing ataxia, drowsiness and nystagmus. What would be the best antidote?
Flumazenil 300 mcg intravenously
39
A 21-year-old man with a history of illicit drug use is suspected to have overdose of an opioid and is experiencing severe toxicity with respiratory depression and pin-point pupils. What would be the best antidote?
Naloxone 400 mcg intramuscularly
40
A 68-year-old woman with type 2 diabetes, neuropathy, and seizures has been newly diagnosed with depressive illness. Which medication would be best to initiate?
Duloxetine
41
An elderly man presented to the Emergency Room with dizziness, altered consciousness, respiratory depression, and rhabdomyolysis. He was recently prescribed a medication for inability to sleep. Which is the most likely drug toxicity?
Benzodiazepines
42
An elderly patient is suffering from depression was given St. John's wort. Which of the following drug if administered concomitantly will have clinically significant interaction?
Sertraline
43
Steve-Johnson syndrome that will appear when giving phenytoin IV after
7-14 days after 1st dose
44
An 18-year-old girl is diagnosed with seizures. She is prescribed low dose lamotrigine, the dose to be increased slowly to reach the target dose. She is asking why she cannot take the full dose immediately. What is the reason?
Rash is a dose related side effect
45
A 28 year-old man who was well controlled on phenytoin is brought to the Emergency Department in a state of status epilepticus. What would be the best recommendation?
Intravenous lorazepam and stop phenytoin
46
A 79-year-old man with Alzheimer's disease has mild to moderate dementia and is on oral rivastigmine 6 mg twice daily. He is not able to tolerate the medication due to nausea and vomiting. What would be the best recommendation?
Change to transdermal application of rivastigmine 4.6 mg/ 24-hours
47
patient took iv infusion phenytoin dr changed to tablet 200 mg once daily. The blood level of phenytoin is 6 the ideal between 20-10. What should the dr do to achieve the optimum level Tablet half-life is 22 hours?
Change to 200 mg bid (bioavailability difference 10 percent)
48
Patient took IV infusion phenytoin. The doctor changed to tablet 200 mg once daily. The blood level of phenytoin is 6 and the ideal level is between 10-20. What should the doctor do to achieve the optimum level (Tablet half-life is 22 hours)?
Change to 200 mg bid
49
A 42 year old male has been admitted to the high dependency unit following a severe head injury and require phenytoin for seizer. He is initially prescribed by phenytoin infusion and then change to phenytoin orally. He has a total phenytoin time trough level of 6 microgram per ml three days after the initiation of treatment. Using the information below. What is the most appropriate action. target trough 10-20 those prescribed 200 mg once daily half life 22hra.
increase the dose to 200 mg twice daily and Retake level in 2 day's
50
increase the doors to 400 mg once daily and Retake level in 3 days.
wrong (choose this)
51
A Patient has high level of free drug level of phenytoin because of what?
Hypoalbuminemia
52
The physician is asking pharmacist about the effects of low albumin and acute renal failure on phenytoin serum concentration. The patient is receiving phenytoin 300 mg once daily. What should be the most appropriate suggestion?
In hypoalbuminemia and acute renal failure obtain free phenytoin serum concentration.
53
patient with serum phenytoin level is 11 mg/dl ( normal 10-20 ) what is your intervention?
no need to dose adjustments
54
Which route of administration results in faster absorption?
Rectal
55
A 48-year-old man is on phenytoin 100 mg TID for epilepsy. His dose is adjusted to 150 mg TID. When will it be appropriate to do plasma phenytoin concentration at the new steady state?
7 days
56
Which of the following signs correlate with phenytoin level of 200 micromole/L?
Coma
57
which of the following is an addictive drug?
fentanyl
58
Drug overdose caused agitation and irritability :
Cannabinoids
59
A 23-year-old drug addict man was brought to the Emergency Room with severe agitation and excitement. He was administered intravenous diazepam, with no improvement in his condition. Which of the following is the mostly likely drug the patient was addicted on?
Cannabinoids
60
A 75 year old lady with gfr greater than 75 ml /mint ,treatment including diazepam,indepamide Patient experience headache,dizziness,fainting and changes in pulse and heart rate ,what is not a least appropriate reason for patient fall ?
additive effect due to combination use of diazepam and indapamide
61
Patient taking drug “maybe Levodopa” he went to pharmacy to get some vitamins what vitamin you should concern about?
Vit B6
62
Which of the following drugs should be administered at the same time daily:
Levodopa
63
When dosing levodopa/carbidopa, on which component should the dose be based on?
Dose should be based on levodopa
64
A Parkinsonism patient have surgery . He have to go nil by mouth for 2 days what treatment have to be followed ?( he taking medicine 200mg 3 times a day before surgery)
Change cobeneldopa to levodopa equivalent dose and advice equivalent roticotine patch / Rotigotine
65
In Parkinson’s Disease which antiemetic can be used?
Domperidone
66
What is the effect of thiazide dietetics on serum lithium concentration?
Concentration will increase
67
A 45-year-old man with bipolar disorder has been stable on lithium for 12 months. He is due for his routine laboratory work up. Which of the following electrolyte imbalances will predispose him to lithium toxicity?
Na
68
A schizophrenic patient is on Lithium carbonate 300mg TID, his plasma level concentration of lithium found to be 0.7mcg/ml. In the next day plasma concentration. Comes down in to 0.4mcg/ml, what will do in the dose adjustment
Lithium carbonate 400mg TID
69
A 55-year-old man with bipolar disorder is stable on lithium for the last 12 months. Which of the following tests should be ordered on routine follow up?
Thyroid function tests
70
Effect of Loop Diuretics on lithium level
Minor variable effect
71
What is the best time to do lithium levels after the dose is administered
12 hours
72
Sumatriptan is known to be effective for migraine. Which of these situations are contraindicated from taking it?
Pt. with a cardiovascular disease
73
A 25-year-old woman with history of migraine associated with aura has taken ergotamine 2mg sublingual tablets at first sign of migraine, then 2 mg every 30 minutes as needed. What is the maximum number of ergotamine tablets that can be used in one week?
5
74
A 20-year-old woman with a history of periodic acute migraine attacks associated with aura is having another acute attack. What would be the first-choice drug?
Sumatriptan 50 mg at the onset of migraine
75
A 21-year-old woman with a history of chronic migraine associated with aura is asking to for medication to prevent another attack. What would be the recommended prophylaxis?
Propranolol 20 mg twice daily
76
A patient with a prescription of methotrexate and latanoprost come to you. What is the diagnosis:
Rheumatoid arthritis & glaucoma
77
Which of the following is an adverse drug reaction:
Alendronate acid increase osteonecrosis
78
Which one side effects is known to bisphosphonates?
Osteonecrosis of the jaw
79
The high prevalence of osteoporosis in the elderly results which incidence in geriatric population?
Bone fractures
80
A 65-year-old woman received a diagnosis of RA 1 year ago. At the time of her diagnosis, her RF titer was 1:64; she presented with joint inflammation in both hands and about 45 minutes of morning stiffness. She began therapy with oral methotrexate and currently receives 15 mg weekly, folic acid 2 mg daily, ibuprofen 800 mg three times daily, and omeprazole 20 mg daily. At today’s clinic visit, the patient reports the recur- rence of her symptoms. Radiographic evaluation of her hand joints shows progression of joint space narrow- ing and bone erosion. Which is the next best step for this patient’s treatment?
Administer etanercept.
81
is a 55-year-old woman with rheumatoid arthritis. On diagnosis 1 year ago, F.A. had an RF titer of 1:64 signs and symptoms of inflammation in the joints of both hands, and about 45 minutes of morning stiffness. She began therapy with methotrexate, and she is presently receiving 15 mg every week, folic acid 2 mg/day, ibuprofen 800 mg 3 times/day, and omeprazole 20 mg/day. At today’s clinic visit, F.A. reports a recurrence of her symptoms. Radiographic evaluation of her hand joints shows progression of joint space narrowing and bone erosion. Which one of the following is the best next step in therapy for F.A.?
Administer etanercept. (Trade name Enbrel)
82
Which one of the following medications for osteoporosis will significantly reduce the risk of hip fracture?
Risedronate
83
A 48-year-old women with rheumatoid arthritis and on ibuprofen and ranitidine for three months has been advised to start a DMARD therapy. Which of the following would be the recommended DMARD therapy?
Methotrexate 7.5 mg weekly with folic acid 5 mg weekly on any other day
84
Which one of the following medications can be dispensed without prescription?
Ibuprofen 400 mg
85
Side effect of Ibuprofen?
Heart burn
86
What is the total maximum daily dose of over-the-counter Ibuprofen?
1200 mg
87
20 years old male with mild knee pain because last week he was injured while playing football. He took full dose of paracetamol but didn’t relief him, Nurse asked the pharmacist what is the best analgesia for his condition?
Ibuprofen 400mg TID
88
20 years old male admitted to ER because of Asthma exacerbation. He has been taking salbutamol for 10 years. After getting better, he said to the nurse that he is having a mild knee pain because last week he was injured while playing football. He took full dose of paracetamol but didn’t relief him, Nurse asked the pharmacist what is the best analgesia for his condition?
Colchicine 500mcg three times a day
89
What is the total maximum daily dose of the over-the-counter paracetamol?
4g
90
Which of the following indications is appropriate for misoprostol
Misoprostol is effective for preventing NSAIDs-induced ulcer
91
What is the antidote of acetaminophen?
N-Acetylcysteine
92
Which of the following NSAIDs has the gastrointestinal side effect?
Naproxen
93
A 54-year-old man with reduced ejection fraction heart failure presented to the pharmacy with mild pain in his knees and requesting an OTC pain killer. Which of the following is the best OTC medication?
Paracetamol
94
A 60-year-old man with a history of angina pectoris is complaining of shoulder pain. Which of the following analgesics inversely affect his condition?
Celecoxib
95
morphine and opioids cause which of the following:
Increase pain threshold
96
A patient is in some sort of pain and he is allergic to diazepam. He needs analgesic. Which of the following he should take:
Amitriptyline
97
Patient is taking morphine tablets 60mg every 12 hours and a breakthrough dose when needed.. Doctor switched the patient to Fentanyl patch.. What would be the dose:
30 mcg every 12 hours
98
which of the following not used in treatment of acute pain.?
naloxone
99
Patient with depression and have headache that do go away although he used a lot of analgesics. What contributes to his headache? Patient with depression and have headache that do go away although he used a lot of analgesics. What contributes to his headache?
Headache is due to misuse of analgesics
100
A 75-year-old obese man has been recently diagnosed with osteoarthritis of the knee. He has tried non- pharmacological measures such as weight loss and various aids to improve symptoms, but he still has pain in the knee while walking. What would be the best initial treatment
Topical NSAIDs
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問題一覧
1
A 21 year lady was on Carbamazepine and Phenytoin, but recurrent episode happened so she changed the medicine to Valproate, then she doesn’t have any seizures for the last five years, her husband come to pharmacy for medicine and he said she try to conceive. What advice will give you regarding medication
Consult a neurologist before conceiving and take opinion about continuation of Valproate
2
A 21 year lady was on Carbamazepine and Phenytoin, but recurrent episode happened so she changed the medicine to Valproate, then she doesn’t have any seizures for the last five years, her husband come to pharmacy for medicine and he said she try to conceive. What advice will give you regarding medication
Stop sodium valproate and wait for 14 days washout period then plan / switch to lamotrigine
3
A 21 year lady was on Carbamazepine and Phenytoin, but recurrent episode happened so she changed the medicine to Valproate, then she doesn’t have any seizures for the last five years, her husband come to pharmacy for medicine and he said she try to conceive. What advice will give you regarding medication
Withdraw valproate slowly prior to conception, by discussing with neurologist
4
Female on valproate wants to get pregnant what is your advice:
Ask prescriber to change to lamotrigine
5
A 28-year-old woman with seizure is planning to start a family. She is taking folic acid 400 mcg per day. She is asking about safe epilepsy medications during pregnancy. Which of the following would be the best medication?
Lamotrigine
6
A physician would like to replace patient's valproic acid with immediate release lamotrigine. What is the recommended maximum initial dose?
200 mg
7
A 28-year-old woman with a history of seizures that well controlled on valproic acid is asking for advice regarding her medications. She is planning to start a family and is now taking folic acid. She wants to optimize the medications before her pregnancy. What would be the best recommendation?
Introduce well controlled slowly and titrate the dose of valproic acid to discontinue before pregnancy
8
Which one of the following is considered first line therapy for the management of partial seizures?
Carbamazepine
9
Which one of the following parameters should be monitored regularly when starting a patient on clozapine?
Absolute neutrophil count
10
What is the appropriate treatment of poisoning by organophosphate nerve agents?
Pralidoxime
11
28-year-old woman has been taking fluoxetine for depression and now has worsening depressive episodes. The resident doctor on the floor has been asked by consultant to stop fluoxetine and initiate phenelzine. How long should the washout period be before starting phenelzine?
5 weeks
12
Drug is secreted at Brest fed infant and cause hypnosis.
Diazepam
13
A 70-year-old woman is taking multiple drugs According to Beers criteria, which one of the following drugs is potentially inappropriate since it might be associated with increased cognitive decline?
Amitriptyline
14
Most drug to cause side effects Associated with multiple adverse drug reactions:
Quetiapine fumarate
15
Which one of the following drugs is considered first line treatment for Alzheimer's disease?
Donepezil
16
24-year-old man is diagnosed with psychosis. He agrees to start drug therapy, however, he is asking for the least sedating medication. Which of the following drugs will be most appropriate?
Risperidone
17
Which of the following medications can be used for narcotic addiction?
Methadone
18
Pt. came to the pharmacy complaining about dizziness, resting tremors and difficulty in stepping the leg. She also has QT prolongation. These symptoms appears one week ago when the patient toke the restless leg syndrome medication. The pharmacy inspected the bottle of medicine the patient brought and saw that the label indicated Quinine sulfate but the appearance of the tablets didn’t match the medicine. What had contributed to this adverse effect
Quetiapine 200m
19
Which of the following is a drug with concern
Zopiclone
20
Patient with high degree of insomnia what is the most suitable option for him
Zopiclone for 28 days
21
A 75-year-old woman comes to the pharmacy with a new prescription for zolpidem. What is the maximum dose she can receive?
5 mg
22
Which of the following groups is with high physical dependence
Benzodiazepines
23
patient is for opioid withdrawal treatment but with QT prolongation, which will be the best drug for him
Buprenorphine
24
A diabetic patient on antipsychotic (Olanzapine) , and the doctor wants to change it to another antipsychotic, what is the best alternative?
Aripiprazole
25
Pt taking parkinsons disease medication, have symptoms dizziness, fatigue, heavy breathing his hb is 7 what to give him
Darbepoetin s.c every 3 weeks
26
Patient is on Capecitabine having lethargy and shortness of breath Hb in lab was 7.7
Darbepoetin
27
A 10-year-old obese girl with newly diagnosed depressive illness is being advised to start antidepressant treatment. Which of the following is best to initiate?
Bupropion
28
Which one of the following parameters should be monitored regularly when starting a patient on clozapine?
Absolute neutrophil count
29
Which of the following medication is most appropriate in a 71-year-old man to treat extrapyramidal effects emerging out of neuroleptics?
Benztropine
30
What is the effect of smoking on serum olanzapine levels?
Decrease in serum olanzapine levels
31
Which antidepressant drug must be avoided in a 21-year-old female with a history of seizure disorder?
Bupropion
32
What information should be provided to a patient on fentanyl transdermal patches?
Avoid increase in body core temperature
33
A 25-year-old man presents to the emergency room after ingesting 30 tablets of Alprazolam what should be the appropriate antidote?
Flumazenil
34
A 25-year-old man presents to the emergency room after ingesting 30 tablets of Alprazolam what should be the appropriate antidote?
Flumazenil
35
Diazepam bottle finished. Which antidote?
Flumazenil
36
Diazepam bottle finished. Which antidote?
Physostigmine
37
Patient took overdose of diazepam and treated with Flumazenil but patient is still hypnotized.. Why?
flumazenil dose is not enough
38
An 18-year-old boy with a history of illicit drug use is suspected to have an overdose of benzodiazepines and is experiencing ataxia, drowsiness and nystagmus. What would be the best antidote?
Flumazenil 300 mcg intravenously
39
A 21-year-old man with a history of illicit drug use is suspected to have overdose of an opioid and is experiencing severe toxicity with respiratory depression and pin-point pupils. What would be the best antidote?
Naloxone 400 mcg intramuscularly
40
A 68-year-old woman with type 2 diabetes, neuropathy, and seizures has been newly diagnosed with depressive illness. Which medication would be best to initiate?
Duloxetine
41
An elderly man presented to the Emergency Room with dizziness, altered consciousness, respiratory depression, and rhabdomyolysis. He was recently prescribed a medication for inability to sleep. Which is the most likely drug toxicity?
Benzodiazepines
42
An elderly patient is suffering from depression was given St. John's wort. Which of the following drug if administered concomitantly will have clinically significant interaction?
Sertraline
43
Steve-Johnson syndrome that will appear when giving phenytoin IV after
7-14 days after 1st dose
44
An 18-year-old girl is diagnosed with seizures. She is prescribed low dose lamotrigine, the dose to be increased slowly to reach the target dose. She is asking why she cannot take the full dose immediately. What is the reason?
Rash is a dose related side effect
45
A 28 year-old man who was well controlled on phenytoin is brought to the Emergency Department in a state of status epilepticus. What would be the best recommendation?
Intravenous lorazepam and stop phenytoin
46
A 79-year-old man with Alzheimer's disease has mild to moderate dementia and is on oral rivastigmine 6 mg twice daily. He is not able to tolerate the medication due to nausea and vomiting. What would be the best recommendation?
Change to transdermal application of rivastigmine 4.6 mg/ 24-hours
47
patient took iv infusion phenytoin dr changed to tablet 200 mg once daily. The blood level of phenytoin is 6 the ideal between 20-10. What should the dr do to achieve the optimum level Tablet half-life is 22 hours?
Change to 200 mg bid (bioavailability difference 10 percent)
48
Patient took IV infusion phenytoin. The doctor changed to tablet 200 mg once daily. The blood level of phenytoin is 6 and the ideal level is between 10-20. What should the doctor do to achieve the optimum level (Tablet half-life is 22 hours)?
Change to 200 mg bid
49
A 42 year old male has been admitted to the high dependency unit following a severe head injury and require phenytoin for seizer. He is initially prescribed by phenytoin infusion and then change to phenytoin orally. He has a total phenytoin time trough level of 6 microgram per ml three days after the initiation of treatment. Using the information below. What is the most appropriate action. target trough 10-20 those prescribed 200 mg once daily half life 22hra.
increase the dose to 200 mg twice daily and Retake level in 2 day's
50
increase the doors to 400 mg once daily and Retake level in 3 days.
wrong (choose this)
51
A Patient has high level of free drug level of phenytoin because of what?
Hypoalbuminemia
52
The physician is asking pharmacist about the effects of low albumin and acute renal failure on phenytoin serum concentration. The patient is receiving phenytoin 300 mg once daily. What should be the most appropriate suggestion?
In hypoalbuminemia and acute renal failure obtain free phenytoin serum concentration.
53
patient with serum phenytoin level is 11 mg/dl ( normal 10-20 ) what is your intervention?
no need to dose adjustments
54
Which route of administration results in faster absorption?
Rectal
55
A 48-year-old man is on phenytoin 100 mg TID for epilepsy. His dose is adjusted to 150 mg TID. When will it be appropriate to do plasma phenytoin concentration at the new steady state?
7 days
56
Which of the following signs correlate with phenytoin level of 200 micromole/L?
Coma
57
which of the following is an addictive drug?
fentanyl
58
Drug overdose caused agitation and irritability :
Cannabinoids
59
A 23-year-old drug addict man was brought to the Emergency Room with severe agitation and excitement. He was administered intravenous diazepam, with no improvement in his condition. Which of the following is the mostly likely drug the patient was addicted on?
Cannabinoids
60
A 75 year old lady with gfr greater than 75 ml /mint ,treatment including diazepam,indepamide Patient experience headache,dizziness,fainting and changes in pulse and heart rate ,what is not a least appropriate reason for patient fall ?
additive effect due to combination use of diazepam and indapamide
61
Patient taking drug “maybe Levodopa” he went to pharmacy to get some vitamins what vitamin you should concern about?
Vit B6
62
Which of the following drugs should be administered at the same time daily:
Levodopa
63
When dosing levodopa/carbidopa, on which component should the dose be based on?
Dose should be based on levodopa
64
A Parkinsonism patient have surgery . He have to go nil by mouth for 2 days what treatment have to be followed ?( he taking medicine 200mg 3 times a day before surgery)
Change cobeneldopa to levodopa equivalent dose and advice equivalent roticotine patch / Rotigotine
65
In Parkinson’s Disease which antiemetic can be used?
Domperidone
66
What is the effect of thiazide dietetics on serum lithium concentration?
Concentration will increase
67
A 45-year-old man with bipolar disorder has been stable on lithium for 12 months. He is due for his routine laboratory work up. Which of the following electrolyte imbalances will predispose him to lithium toxicity?
Na
68
A schizophrenic patient is on Lithium carbonate 300mg TID, his plasma level concentration of lithium found to be 0.7mcg/ml. In the next day plasma concentration. Comes down in to 0.4mcg/ml, what will do in the dose adjustment
Lithium carbonate 400mg TID
69
A 55-year-old man with bipolar disorder is stable on lithium for the last 12 months. Which of the following tests should be ordered on routine follow up?
Thyroid function tests
70
Effect of Loop Diuretics on lithium level
Minor variable effect
71
What is the best time to do lithium levels after the dose is administered
12 hours
72
Sumatriptan is known to be effective for migraine. Which of these situations are contraindicated from taking it?
Pt. with a cardiovascular disease
73
A 25-year-old woman with history of migraine associated with aura has taken ergotamine 2mg sublingual tablets at first sign of migraine, then 2 mg every 30 minutes as needed. What is the maximum number of ergotamine tablets that can be used in one week?
5
74
A 20-year-old woman with a history of periodic acute migraine attacks associated with aura is having another acute attack. What would be the first-choice drug?
Sumatriptan 50 mg at the onset of migraine
75
A 21-year-old woman with a history of chronic migraine associated with aura is asking to for medication to prevent another attack. What would be the recommended prophylaxis?
Propranolol 20 mg twice daily
76
A patient with a prescription of methotrexate and latanoprost come to you. What is the diagnosis:
Rheumatoid arthritis & glaucoma
77
Which of the following is an adverse drug reaction:
Alendronate acid increase osteonecrosis
78
Which one side effects is known to bisphosphonates?
Osteonecrosis of the jaw
79
The high prevalence of osteoporosis in the elderly results which incidence in geriatric population?
Bone fractures
80
A 65-year-old woman received a diagnosis of RA 1 year ago. At the time of her diagnosis, her RF titer was 1:64; she presented with joint inflammation in both hands and about 45 minutes of morning stiffness. She began therapy with oral methotrexate and currently receives 15 mg weekly, folic acid 2 mg daily, ibuprofen 800 mg three times daily, and omeprazole 20 mg daily. At today’s clinic visit, the patient reports the recur- rence of her symptoms. Radiographic evaluation of her hand joints shows progression of joint space narrow- ing and bone erosion. Which is the next best step for this patient’s treatment?
Administer etanercept.
81
is a 55-year-old woman with rheumatoid arthritis. On diagnosis 1 year ago, F.A. had an RF titer of 1:64 signs and symptoms of inflammation in the joints of both hands, and about 45 minutes of morning stiffness. She began therapy with methotrexate, and she is presently receiving 15 mg every week, folic acid 2 mg/day, ibuprofen 800 mg 3 times/day, and omeprazole 20 mg/day. At today’s clinic visit, F.A. reports a recurrence of her symptoms. Radiographic evaluation of her hand joints shows progression of joint space narrowing and bone erosion. Which one of the following is the best next step in therapy for F.A.?
Administer etanercept. (Trade name Enbrel)
82
Which one of the following medications for osteoporosis will significantly reduce the risk of hip fracture?
Risedronate
83
A 48-year-old women with rheumatoid arthritis and on ibuprofen and ranitidine for three months has been advised to start a DMARD therapy. Which of the following would be the recommended DMARD therapy?
Methotrexate 7.5 mg weekly with folic acid 5 mg weekly on any other day
84
Which one of the following medications can be dispensed without prescription?
Ibuprofen 400 mg
85
Side effect of Ibuprofen?
Heart burn
86
What is the total maximum daily dose of over-the-counter Ibuprofen?
1200 mg
87
20 years old male with mild knee pain because last week he was injured while playing football. He took full dose of paracetamol but didn’t relief him, Nurse asked the pharmacist what is the best analgesia for his condition?
Ibuprofen 400mg TID
88
20 years old male admitted to ER because of Asthma exacerbation. He has been taking salbutamol for 10 years. After getting better, he said to the nurse that he is having a mild knee pain because last week he was injured while playing football. He took full dose of paracetamol but didn’t relief him, Nurse asked the pharmacist what is the best analgesia for his condition?
Colchicine 500mcg three times a day
89
What is the total maximum daily dose of the over-the-counter paracetamol?
4g
90
Which of the following indications is appropriate for misoprostol
Misoprostol is effective for preventing NSAIDs-induced ulcer
91
What is the antidote of acetaminophen?
N-Acetylcysteine
92
Which of the following NSAIDs has the gastrointestinal side effect?
Naproxen
93
A 54-year-old man with reduced ejection fraction heart failure presented to the pharmacy with mild pain in his knees and requesting an OTC pain killer. Which of the following is the best OTC medication?
Paracetamol
94
A 60-year-old man with a history of angina pectoris is complaining of shoulder pain. Which of the following analgesics inversely affect his condition?
Celecoxib
95
morphine and opioids cause which of the following:
Increase pain threshold
96
A patient is in some sort of pain and he is allergic to diazepam. He needs analgesic. Which of the following he should take:
Amitriptyline
97
Patient is taking morphine tablets 60mg every 12 hours and a breakthrough dose when needed.. Doctor switched the patient to Fentanyl patch.. What would be the dose:
30 mcg every 12 hours
98
which of the following not used in treatment of acute pain.?
naloxone
99
Patient with depression and have headache that do go away although he used a lot of analgesics. What contributes to his headache? Patient with depression and have headache that do go away although he used a lot of analgesics. What contributes to his headache?
Headache is due to misuse of analgesics
100
A 75-year-old obese man has been recently diagnosed with osteoarthritis of the knee. He has tried non- pharmacological measures such as weight loss and various aids to improve symptoms, but he still has pain in the knee while walking. What would be the best initial treatment
Topical NSAIDs