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MOHAP Pharmacist Exam study materials
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MOHAP Pharmacist Exam practice questions

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Question 1Pharmacy Practice and Pharmaceutical Care

Which counseling point is most important to give a patient starting a new prescription of sublingual nitroglycerin tablets?

  1. Swallow the tablet whole with a full glass of water
  2. Take the tablet only after meals to reduce stomach upset
  3. Place the tablet under the tongue and sit down before taking it Correct answer.
  4. Store the tablets in the refrigerator to keep them potent

Explanation

Sublingual nitroglycerin is absorbed through the oral mucosa, so it must be dissolved under the tongue rather than swallowed. Because it can cause hypotension and syncope, the patient should be seated before each dose.

Question 2Pharmacy Practice and Pharmaceutical Care

A patient is prescribed warfarin and asks which of the following should be reported to the clinic immediately. Which finding warrants the most urgent contact?

  1. Occasional constipation
  2. Mild headache relieved by acetaminophen
  3. Black tarry stools Correct answer.
  4. A 0.5 kg weight gain over one month

Explanation

Black tarry stools suggest gastrointestinal bleeding, which is the principal serious adverse effect of warfarin and requires immediate assessment. Other findings are common and not specific to anticoagulant toxicity.

Question 3Pharmacy Practice and Pharmaceutical Care

Which parameter is the most appropriate primary measure for assessing glycemic control over the preceding two to three months?

  1. Fasting plasma glucose
  2. Glycated hemoglobin (HbA1c) Correct answer.
  3. Random capillary glucose
  4. Urine glucose dipstick

Explanation

HbA1c reflects average glucose exposure over the lifespan of red blood cells, roughly two to three months. Single glucose measurements reflect only the moment of sampling.

Question 4Pharmacy Practice and Pharmaceutical Care

A prescription reads 'amoxicillin 500 mg PO TID for 7 days.' How many capsules of 500 mg are needed to complete the course?

  1. 28
  2. 7
  3. 21 Correct answer.
  4. 14

Explanation

Three doses per day for seven days equals 21 doses, and each dose is one 500 mg capsule. Therefore 21 capsules are required.

Question 5Pharmacy Practice and Pharmaceutical Care

Which storage instruction correctly applies to most insulin products in use?

  1. All insulin must be kept frozen until the day of use
  2. Unopened vials should be refrigerated and in-use pens kept at room temperature Correct answer.
  3. Opened vials should be kept above 30 °C to maintain potency
  4. Insulin should be stored in direct sunlight to prevent precipitation

Explanation

Unopened insulin is refrigerated at 2–8 °C, while in-use pens or vials are typically kept at room temperature for a limited period. Insulin must never be frozen and must be protected from heat and light.

Question 6Pharmacy Practice and Pharmaceutical Care

A patient on a proton pump inhibitor reports new onset of watery diarrhea after recent antibiotic use. Which action is most appropriate for the pharmacist?

  1. Advise the patient to seek medical assessment for possible Clostridioides difficile infection Correct answer.
  2. Recommend immediate use of an antimotility agent such as loperamide
  3. Reassure the patient that diarrhea is expected and requires no action
  4. Suggest doubling the PPI dose to reduce acid-related symptoms

Explanation

Antibiotic-associated watery diarrhea, particularly with recent healthcare exposure, raises concern for C. difficile colitis, which needs medical evaluation. Antimotility agents can worsen toxin-mediated disease.

Question 7Pharmacy Practice and Pharmaceutical Care

Which route of administration is most appropriate for a patient who is actively vomiting and requires an antiemetic?

  1. Oral
  2. Sublingual tablet
  3. Intravenous Correct answer.
  4. Rectal suppository

Explanation

Intravenous administration bypasses absorption problems caused by vomiting and provides rapid, reliable delivery. Oral routes are unreliable in an actively vomiting patient.

Question 8Pharmacy Practice and Pharmaceutical Care

Which of the following best describes the purpose of pharmaceutical care as a practice philosophy?

  1. Ensuring that all products are stored in alphabetical order
  2. Maximizing the volume of prescriptions dispensed per shift
  3. Identifying and resolving drug-related problems to improve patient outcomes Correct answer.
  4. Reducing pharmacy inventory costs as the primary goal

Explanation

Pharmaceutical care is a patient-centered practice in which the pharmacist accepts responsibility for identifying and resolving drug-related problems to achieve defined therapeutic outcomes.

Question 9Pharmacy Practice and Pharmaceutical Care

A patient taking metformin is scheduled for a procedure with iodinated contrast. Which action reflects current guidance regarding metformin?

  1. Stop metformin permanently after contrast exposure
  2. Double the metformin dose before the procedure
  3. Withhold metformin at the time of the procedure and resume after renal function is confirmed stable Correct answer.
  4. Continue metformin without interruption in all cases

Explanation

Contrast media can transiently impair renal function, and metformin accumulation in that setting increases the risk of lactic acidosis. Metformin is typically withheld around the procedure and restarted once renal function is confirmed acceptable.

Question 10Pharmacy Practice and Pharmaceutical Care

Which instruction is correct for a patient using a metered-dose inhaler with a spacer?

  1. Actuate several puffs rapidly into the spacer and inhale once
  2. Shake the inhaler only after actuation
  3. Actuate one puff into the spacer and inhale slowly and deeply, then wait before the next puff Correct answer.
  4. Rinse the spacer with soap and water after every single dose

Explanation

A spacer holds one actuated dose so the patient can inhale slowly and deeply, improving lung deposition. Separate puffs with a short interval and follow the device's cleaning schedule rather than washing after every dose.

Question 11Pharmacy Practice and Pharmaceutical Care

A patient on lithium presents with tremor, vomiting, and confusion. Which finding would most support lithium toxicity?

  1. A serum lithium concentration of 2.1 mmol/L Correct answer.
  2. A random blood glucose of 5.5 mmol/L
  3. A serum lithium concentration of 0.6 mmol/L
  4. A serum sodium concentration of 140 mmol/L

Explanation

Lithium has a narrow therapeutic range, generally around 0.6–1.0 mmol/L for maintenance, and concentrations above about 1.5 mmol/L are associated with toxicity. Symptoms of tremor, vomiting, and confusion fit this picture.

Question 12Pharmacy Practice and Pharmaceutical Care

Which advice should a pharmacist give a patient starting an oral bisphosphonate such as alendronate?

  1. Take it on an empty stomach with water and remain upright for at least 30 minutes Correct answer.
  2. Take it with breakfast and lie down afterward
  3. Take it at bedtime with calcium supplements
  4. Crush the tablet and mix it with milk

Explanation

Oral bisphosphonates have very low bioavailability that is reduced by food, drink, and minerals, so they are taken on an empty stomach with plain water. Staying upright reduces the risk of esophageal irritation.

Question 13Pharmacy Practice and Pharmaceutical Care

A pregnant patient with a urinary tract infection requires antibiotic therapy. Which agent is generally considered the preferred first-line option in pregnancy for uncomplicated cystitis?

  1. Nitrofurantoin Correct answer.
  2. Doxycycline
  3. Ciprofloxacin
  4. Tetracycline

Explanation

Nitrofurantoin is generally regarded as an acceptable first-line option for uncomplicated cystitis in pregnancy, with avoidance near term. Tetracyclines and fluoroquinolones carry significant fetal concerns and are not first-line.

Question 14Pharmacy Practice and Pharmaceutical Care

Which statement about the mechanism of action of beta-lactam antibiotics is accurate?

  1. They inhibit DNA gyrase and topoisomerase IV
  2. They inhibit bacterial cell wall synthesis by binding penicillin-binding proteins Correct answer.
  3. They disrupt fungal cell membrane ergosterol synthesis
  4. They inhibit bacterial protein synthesis at the 50S ribosomal subunit

Explanation

Beta-lactams acylate penicillin-binding proteins, blocking transpeptidation and cross-linking of peptidoglycan, which weakens the cell wall. The other mechanisms describe macrolides, fluoroquinolones, and azoles, respectively.

Question 15Pharmacy Practice and Pharmaceutical Care

A patient with asthma is prescribed a beta-blocker after myocardial infarction. Which consideration is most relevant?

  1. Any beta-blocker is contraindicated and must never be used
  2. Beta-blockers should be combined with a short-acting beta-agonist to prevent bronchospasm
  3. Cardioselective agents are preferred, and respiratory status should be monitored Correct answer.
  4. Non-selective beta-blockers are safer than cardioselective agents in asthma

Explanation

Cardioselective beta-blockers have less beta-2 blockade at usual doses, so they are preferred when beta-blockade is required in a patient with reactive airway disease, with monitoring for bronchospasm.

Question 16Pharmacy Practice and Pharmaceutical Care

Which laboratory monitoring parameter is most important for a patient receiving long-term amiodarone therapy?

  1. Complete blood count only
  2. Serum magnesium only
  3. Thyroid-stimulating hormone Correct answer.
  4. Serum amylase

Explanation

Amiodarone is iodine-rich and can cause both hypothyroidism and hyperthyroidism, so thyroid function should be monitored periodically. Liver enzymes, pulmonary status, and ophthalmic assessment are also relevant.

Question 17Pharmacy Practice and Pharmaceutical Care

A patient reports taking St John's wort along with a combined oral contraceptive. What is the most likely clinical concern?

  1. The combination causes irreversible hepatic failure
  2. There is no clinically significant interaction
  3. Enzyme induction may reduce contraceptive efficacy Correct answer.
  4. Enzyme inhibition may cause contraceptive toxicity

Explanation

St John's wort induces CYP3A4 and can accelerate metabolism of ethinylestradiol and progestins, reducing contraceptive effectiveness. Additional contraceptive precautions are generally advised.

Question 18Pharmacy Practice and Pharmaceutical Care

Which method is most appropriate for verifying a patient's adherence to a newly prescribed inhaler regimen?

  1. Assume adherence if the prescription was refilled once
  2. Ask only whether the patient 'takes it as prescribed'
  3. Count the remaining tablets in the bottle
  4. Ask open-ended questions about how often doses are actually taken and demonstrate technique Correct answer.

Explanation

Open-ended questioning combined with a technique demonstration elicits more accurate information about real-world use than closed questions or refill data alone. Poor inhaler technique is a common cause of apparent treatment failure.

Question 19Pharmacy Practice and Pharmaceutical Care

A patient on warfarin is prescribed a course of trimethoprim-sulfamethoxazole. What is the most appropriate monitoring plan?

  1. Reduce the warfarin dose by half without checking the INR
  2. No additional monitoring is needed
  3. Check the INR more frequently and counsel on bleeding signs Correct answer.
  4. Increase the warfarin dose to offset the antibiotic

Explanation

Trimethoprim-sulfamethoxazole inhibits warfarin metabolism and can also displace protein binding, raising INR and bleeding risk. Close INR monitoring and bleeding counseling are required.

Question 20Pharmacy Practice and Pharmaceutical Care

A patient with chronic kidney disease has an estimated creatinine clearance of 25 mL/min. Which principle should guide dosing of renally eliminated drugs?

  1. Renal function does not affect dosing of any drug
  2. The dose should always be doubled to overcome reduced clearance
  3. Dose or interval should be adjusted according to validated renal dosing references Correct answer.
  4. Only hepatic function matters for drug dosing

Explanation

For drugs predominantly cleared by the kidney, reduced clearance leads to accumulation, so doses or intervals are adjusted using validated references. Serum creatinine alone can overestimate renal function in low muscle mass.

Question 21Pharmacy Practice and Pharmaceutical Care

A patient is receiving a continuous intravenous infusion of a drug with a short half-life. Which statement about reaching steady state is most accurate?

  1. Steady state is reached only after the infusion is stopped
  2. Steady state is generally reached after about four to five half-lives Correct answer.
  3. Steady state is reached immediately after the infusion starts
  4. Steady state depends only on the infusion volume

Explanation

With a constant infusion, plasma concentration approaches steady state exponentially, and clinically relevant steady state is reached after roughly four to five half-lives.

Question 22Pharmacy Practice and Pharmaceutical Care

A patient with heart failure and reduced ejection fraction is being optimized. Which combination represents guideline-directed medical therapy?

  1. Calcium channel blocker, loop diuretic, and nitrate only
  2. Beta-blocker and calcium channel blocker only
  3. Alpha-blocker, thiazide, and statin only
  4. ACE inhibitor or ARB/ARNI, beta-blocker, mineralocorticoid receptor antagonist, and SGLT2 inhibitor Correct answer.

Explanation

Contemporary guidelines for heart failure with reduced ejection fraction recommend a foundation of renin-angiotensin system inhibition (ACE inhibitor, ARB, or ARNI), a beta-blocker, a mineralocorticoid receptor antagonist, and an SGLT2 inhibitor.

Question 23Pharmacy Practice and Pharmaceutical Care

A patient develops serotonin syndrome after receiving a serotonergic agent. Which combination of features best supports the diagnosis?

  1. Mental status change, autonomic instability, and neuromuscular hyperactivity Correct answer.
  2. Localized rash with arthralgia
  3. Isolated hypertension without neuromuscular findings
  4. Bradycardia, hypothermia, and flaccid paralysis

Explanation

Serotonin syndrome is characterized by the triad of altered mental status, autonomic instability, and neuromuscular abnormalities such as clonus, hyperreflexia, and tremor. Recognition is critical because severe cases can be life-threatening.

Question 24Pharmacy Practice and Pharmaceutical Care

A patient with a history of angioedema on an ACE inhibitor requires renin-angiotensin system blockade. Which option is most appropriate?

  1. Combination of two ACE inhibitors at reduced doses
  2. Rechallenge with the same ACE inhibitor at a lower dose
  3. An angiotensin receptor blocker, with counseling and monitoring for angioedema Correct answer.
  4. An ACE inhibitor of a different chemical class

Explanation

ACE inhibitor–induced angioedema is bradykinin-mediated, and ARBs carry a much lower but non-zero risk, so they may be used with caution and monitoring in patients who need RAS blockade. Rechallenge with an ACE inhibitor risks recurrence.

Question 25Pharmacy Practice and Pharmaceutical Care

A patient with type 2 diabetes and established atherosclerotic cardiovascular disease is being optimized. Which agent provides cardiovascular benefit in addition to glycemic control?

  1. A sulfonylurea as first-line therapy
  2. A thiazolidinedione as first-line therapy
  3. An alpha-glucosidase inhibitor as first-line therapy
  4. An SGLT2 inhibitor or GLP-1 receptor agonist with proven cardiovascular benefit Correct answer.

Explanation

SGLT2 inhibitors and certain GLP-1 receptor agonists have demonstrated cardiovascular benefit in patients with established atherosclerotic disease, heart failure, or chronic kidney disease. These agents are prioritized independent of baseline HbA1c in such patients.

Question 26Pharmacy Practice and Pharmaceutical Care

A patient is prescribed a transdermal patch. Which instruction is most appropriate for the pharmacist to provide?

  1. Place the patch on the palms of the hands for best absorption.
  2. Apply the patch to the same site each time to ensure consistent absorption.
  3. Apply the patch to clean, dry, hairless skin and rotate sites. Correct answer.
  4. Cut the patch to adjust the dose if needed.

Explanation

Transdermal patches should be applied to clean, dry, intact skin, and the site should be rotated to prevent skin irritation. Cutting a patch can alter the release rate and is generally not recommended unless specifically instructed. Palms and soles are not ideal due to thick stratum corneum.

Question 27Pharmacy Practice and Pharmaceutical Care

Which auxiliary label is most appropriate for a prescription of oral amoxicillin suspension?

  1. Shake well before use. Correct answer.
  2. Keep refrigerated until expiration.
  3. Avoid dairy products for 2 hours after dosing.
  4. Take with food to enhance absorption.

Explanation

Oral suspensions should be shaken well before each use to ensure uniform drug distribution. Amoxicillin suspension is stable at room temperature but may be refrigerated for taste; however, refrigeration is not required. Dairy does not significantly interact with amoxicillin.

Question 28Pharmacy Practice and Pharmaceutical Care

A patient with a history of peptic ulcer disease is prescribed a nonsteroidal anti-inflammatory drug (NSAID). Which gastroprotective strategy is most appropriate?

  1. Substitute with aspirin at analgesic doses.
  2. Use the NSAID at the lowest effective dose without gastroprotection.
  3. Recommend taking the NSAID on an empty stomach.
  4. Add a proton pump inhibitor for gastroprotection. Correct answer.

Explanation

For patients at high risk of NSAID-induced ulcers, guidelines recommend adding a proton pump inhibitor or misoprostol for gastroprotection. Low-dose aspirin is not gastroprotective and can also cause ulcers. Taking NSAIDs on an empty stomach does not reduce ulcer risk.

Question 29Pharmacy Practice and Pharmaceutical Care

Which counseling point is most important for a patient starting warfarin therapy?

  1. Avoid all green vegetables to prevent interactions.
  2. Use aspirin for minor pain without consulting the prescriber.
  3. Maintain a consistent intake of vitamin K-rich foods. Correct answer.
  4. Double the dose if a dose is missed.

Explanation

Warfarin's anticoagulant effect is influenced by vitamin K intake; patients should keep their intake of vitamin K-rich foods consistent to avoid fluctuations in INR. They should not eliminate green vegetables entirely, as this can lead to instability. Missed doses should not be doubled, and aspirin should be avoided without consultation due to bleeding risk.

Question 30Pharmacy Practice and Pharmaceutical Care

A patient with asthma uses a short-acting beta-agonist (SABA) inhaler. Which statement best reflects appropriate as-needed use?

  1. Use the SABA in place of a controller inhaler.
  2. Use the SABA only when the peak flow meter shows a green zone.
  3. Use the SABA daily to prevent symptoms.
  4. Use the SABA when experiencing acute symptoms or before exercise if prescribed. Correct answer.

Explanation

SABAs are intended for quick relief of acute bronchospasm and may be used before exercise to prevent exercise-induced bronchoconstriction if prescribed. Daily use of SABA alone is not controller therapy and may indicate poor asthma control. The green zone indicates good control, so SABA is not routinely needed then.

Question 31Pharmacy Practice and Pharmaceutical Care

Which parameter is most useful for monitoring the efficacy of statin therapy?

  1. Liver function tests (ALT/AST)
  2. Low-density lipoprotein cholesterol (LDL-C) Correct answer.
  3. Creatine kinase (CK)
  4. International normalized ratio (INR)

Explanation

LDL-C is the primary target for assessing statin efficacy in reducing cardiovascular risk. Liver enzymes and CK are monitored for potential adverse effects, not efficacy. INR is used for warfarin monitoring, not statins.

Question 32Pharmacy Practice and Pharmaceutical Care

A patient is prescribed a course of oral prednisone. Which instruction is most appropriate regarding administration?

  1. Take on an empty stomach to enhance absorption.
  2. Take in the morning with food to mimic circadian cortisol release. Correct answer.
  3. Discontinue abruptly if side effects occur.
  4. Take at bedtime to reduce insomnia.

Explanation

Glucocorticoids are best taken in the morning to mimic the natural circadian peak of cortisol and reduce adrenal suppression; taking with food minimizes gastrointestinal irritation. Bedtime dosing can cause insomnia. Abrupt discontinuation after prolonged use can precipitate adrenal insufficiency.

Question 33Pharmacy Practice and Pharmaceutical Care

Which medication is considered a preferred initial treatment for hypertension in a patient with diabetes and albuminuria?

  1. A beta-blocker
  2. A thiazide diuretic
  3. A calcium channel blocker
  4. An angiotensin-converting enzyme inhibitor (ACEI) Correct answer.

Explanation

ACE inhibitors (or angiotensin receptor blockers) are preferred in patients with diabetes and albuminuria because they reduce intraglomerular pressure and slow progression of nephropathy. Thiazides, beta-blockers, and calcium channel blockers are not first-line for renoprotection in this context.

Question 34Pharmacy Practice and Pharmaceutical Care

A patient with an acute gout flare is prescribed colchicine. Which counseling point is most important?

  1. Increase dose if diarrhea occurs.
  2. Take at the first sign of flare and do not exceed the prescribed dose due to risk of toxicity. Correct answer.
  3. Take with grapefruit juice to enhance absorption.
  4. Use as a maintenance medication to prevent flares.

Explanation

Colchicine is most effective when started early in a gout flare, and dosing must not exceed prescribed limits because it has a narrow therapeutic index and can cause severe toxicity. Grapefruit juice can interact and increase colchicine levels. Diarrhea is a sign of toxicity and the dose should not be increased.

Question 35Pharmacy Practice and Pharmaceutical Care

Which vaccine is contraindicated in a patient with a history of anaphylaxis to gelatin?

  1. Hepatitis B vaccine
  2. Inactivated influenza vaccine
  3. Tetanus-diphtheria toxoid vaccine
  4. Measles, mumps, rubella (MMR) vaccine Correct answer.

Explanation

The MMR vaccine contains gelatin as a stabilizer and is contraindicated in individuals with severe gelatin allergy. Inactivated influenza, hepatitis B, and tetanus-diphtheria vaccines generally do not contain gelatin or are not contraindicated for this reason.

Question 36Pharmacy Practice and Pharmaceutical Care

A patient is receiving vancomycin intravenously. Which monitoring parameter is most important to assess for toxicity?

  1. Liver function tests
  2. Complete blood count with differential
  3. Electrocardiogram
  4. Serum creatinine and vancomycin trough levels Correct answer.

Explanation

Vancomycin can cause nephrotoxicity, so monitoring serum creatinine and trough levels helps ensure therapeutic dosing and prevent kidney injury. Liver enzymes, CBC, and ECG are not primary monitoring parameters for vancomycin toxicity.

Question 37Pharmacy Practice and Pharmaceutical Care

Which action is most appropriate when a pharmacist receives a prescription for a medication with a narrow therapeutic index and the dose exceeds the usual maximum?

  1. Refuse to dispense and ask the patient to see another pharmacy.
  2. Adjust the dose to the usual maximum without consulting.
  3. Dispense the medication as prescribed to avoid delay.
  4. Contact the prescriber to verify the dose before dispensing. Correct answer.

Explanation

For narrow therapeutic index drugs, doses exceeding the usual maximum should be verified with the prescriber to prevent harm. Dispensing without verification or unilaterally adjusting the dose can be unsafe. Refusing without clarification does not serve the patient's needs.

Question 38Pharmacy Practice and Pharmaceutical Care

A patient with chronic obstructive pulmonary disease (COPD) is prescribed tiotropium. Which instruction is correct?

  1. Use the inhaler as needed for acute shortness of breath.
  2. Use the inhaler once daily at the same time each day. Correct answer.
  3. Double the dose if symptoms worsen.
  4. Rinse the mouth after use to prevent thrush.

Explanation

Tiotropium is a long-acting muscarinic antagonist indicated for maintenance therapy in COPD and is dosed once daily. It is not for acute relief of symptoms. Rinsing the mouth is more relevant for inhaled corticosteroids. Doubling the dose is not appropriate.

Question 39Pharmacy Practice and Pharmaceutical Care

Which laboratory test is most appropriate to monitor for a patient receiving long-term therapy with methotrexate for rheumatoid arthritis?

  1. Urinalysis for glucose
  2. Thyroid-stimulating hormone
  3. Serum potassium and magnesium
  4. Complete blood count and liver function tests Correct answer.

Explanation

Methotrexate can cause bone marrow suppression and hepatotoxicity, so periodic monitoring of CBC and liver enzymes is recommended. Potassium, magnesium, TSH, and urine glucose are not primary monitoring parameters for methotrexate toxicity.

Question 40Pharmacy Practice and Pharmaceutical Care

A patient is prescribed a new medication that is a potent inhibitor of CYP3A4. Which potential interaction should the pharmacist consider?

  1. No effect on drugs metabolized by CYP3A4.
  2. Decreased levels of drugs metabolized by CYP3A4, such as simvastatin.
  3. Increased levels of drugs metabolized by CYP3A4, such as simvastatin. Correct answer.
  4. Increased renal clearance of drugs eliminated unchanged.

Explanation

CYP3A4 inhibitors can increase plasma concentrations of co-administered CYP3A4 substrates, raising the risk of toxicity (e.g., myopathy with simvastatin). They do not decrease levels of CYP3A4 substrates. Renal clearance of unchanged drugs is not directly affected by CYP3A4 inhibition.

Question 41Pharmacy Practice and Pharmaceutical Care

Which counseling point is most important for a patient using a nicotine transdermal patch?

  1. Apply to a different site each day and avoid lotions at the site. Correct answer.
  2. Cut the patch to adjust the dose.
  3. Apply to the same site daily to ensure consistent absorption.
  4. Use the patch and continue smoking to reduce withdrawal.

Explanation

Rotating application sites helps prevent skin irritation, and lotions or oils can interfere with adhesion. Using the same site can cause dermatitis. Cutting the patch can alter release kinetics. Continuing to smoke while using nicotine replacement increases the risk of nicotine toxicity.

Question 42Pharmacy Practice and Pharmaceutical Care

A patient with type 2 diabetes is prescribed empagliflozin. Which adverse effect should the pharmacist counsel the patient about?

  1. Bradycardia
  2. Weight gain
  3. Genital mycotic infections and urinary tract infections Correct answer.
  4. Hypoglycemia when used as monotherapy

Explanation

SGLT2 inhibitors like empagliflozin increase urinary glucose excretion, which can promote genital mycotic infections and UTIs. They carry a low risk of hypoglycemia when used alone and are associated with weight loss, not gain. Bradycardia is not a typical effect.

Question 43Pharmacy Practice and Pharmaceutical Care

Which instruction is correct for a patient using a sublingual nitroglycerin tablet for angina?

  1. Chew the tablet to release the medication quickly.
  2. Take the tablet with food to reduce stomach upset.
  3. Swallow the tablet with water for faster absorption.
  4. Sit down and place the tablet under the tongue; do not swallow it. Correct answer.

Explanation

Sublingual nitroglycerin is absorbed through the oral mucosa and should be placed under the tongue and allowed to dissolve; swallowing reduces efficacy due to first-pass metabolism. Sitting down helps prevent syncope from hypotension. Chewing or taking with food is not appropriate for sublingual administration.

Question 44Pharmacy Practice and Pharmaceutical Care

A patient is prescribed a 10-day course of antibiotics. Which statement best supports adherence?

  1. Take the antibiotic only when symptoms are severe.
  2. Complete the full course even if symptoms improve to prevent resistance. Correct answer.
  3. Stop the antibiotic once symptoms resolve to avoid side effects.
  4. Save leftover antibiotics for future use.

Explanation

Completing the prescribed course helps ensure eradication of the infection and reduces the risk of resistance. Stopping early or saving leftovers can lead to incomplete treatment and promote resistance. Taking antibiotics only for severe symptoms is not appropriate for a prescribed course.

Question 45Pharmacy Practice and Pharmaceutical Care

Which medication is most appropriate for the treatment of acute migraine in a patient with significant nausea and vomiting?

  1. Oral ibuprofen
  2. Oral acetaminophen
  3. Oral sumatriptan tablet
  4. Sumatriptan subcutaneous injection Correct answer.

Explanation

When nausea and vomiting are prominent, parenteral or non-oral routes (e.g., subcutaneous sumatriptan) are preferred to ensure absorption. Oral medications may be vomited before absorption. Oral triptans and analgesics are less reliable in this setting.

Question 46Pharmacy Practice and Pharmaceutical Care

A patient with heart failure is prescribed furosemide. Which monitoring parameter is most important to assess for efficacy?

  1. Serum potassium only
  2. Daily weight and signs of edema Correct answer.
  3. Liver function tests
  4. Thyroid-stimulating hormone

Explanation

Daily weight and assessment of edema are practical indicators of diuretic efficacy in heart failure. Serum potassium is important for safety but not efficacy. Liver function and TSH are not primary monitoring parameters for furosemide efficacy.

Question 47Pharmacy Practice and Pharmaceutical Care

Which statement about the use of metformin in a patient with type 2 diabetes and stable heart failure is accurate?

  1. Metformin should be stopped in all patients with an ejection fraction below 50%.
  2. Metformin is absolutely contraindicated in any patient with heart failure.
  3. Metformin increases the risk of heart failure exacerbation.
  4. Metformin can be continued if renal function is adequate and the heart failure is stable. Correct answer.

Explanation

Metformin is generally safe in stable heart failure if renal function is adequate; it should be avoided in unstable or hospitalized heart failure due to risk of lactic acidosis. It is not absolutely contraindicated in all heart failure. Metformin does not increase heart failure risk.

Question 48Pharmacy Practice and Pharmaceutical Care

A patient is prescribed levothyroxine. Which instruction is most appropriate for optimal absorption?

  1. Take with breakfast to reduce stomach upset.
  2. Take with calcium supplements to prevent hypocalcemia.
  3. Take on an empty stomach 30-60 minutes before breakfast. Correct answer.
  4. Take at bedtime with a glass of milk.

Explanation

Levothyroxine absorption is enhanced when taken on an empty stomach, typically 30-60 minutes before breakfast. Food, calcium, and milk can interfere with absorption. Bedtime dosing with milk is not optimal.

Question 49Pharmacy Practice and Pharmaceutical Care

Which medication requires monitoring of serum potassium levels due to the risk of hyperkalemia?

  1. Furosemide
  2. Spironolactone Correct answer.
  3. Hydrochlorothiazide
  4. Insulin

Explanation

Spironolactone is a potassium-sparing diuretic that can cause hyperkalemia, especially in patients with renal impairment or those taking ACE inhibitors. Furosemide and hydrochlorothiazide can cause hypokalemia. Insulin can lower potassium levels.

Question 50Pharmacy Practice and Pharmaceutical Care

A patient with a history of angioedema while taking an ACE inhibitor requires hypertension management. Which class is most appropriate to avoid a similar reaction?

  1. Another ACE inhibitor
  2. Direct renin inhibitor
  3. Neprilysin inhibitor combined with an ARB
  4. Angiotensin receptor blocker (ARB) Correct answer.

Explanation

ARBs are generally considered safe alternatives in patients with ACE inhibitor–induced angioedema because they do not inhibit bradykinin degradation to the same extent. Another ACE inhibitor is contraindicated. Direct renin inhibitors and sacubitril (a neprilysin inhibitor) can also increase bradykinin and are not preferred.