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BCPS practice questions

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Question 1Patient-Centered Pharmacotherapy Care and Clinical Management

After counseling a patient on a new insulin regimen, which approach best verifies that the patient can safely use the medication at home?

  1. Documenting the teaching encounter in the electronic medical record
  2. Asking the patient to explain the technique back in their own words Correct answer.
  3. Providing a written handout written at a sixth-grade reading level for later review
  4. Asking the patient whether they have any questions about the plan

Explanation

Teach-back asks the patient to restate or demonstrate information in their own words, which reveals whether the message was actually understood. Handouts support but do not confirm comprehension, and patients frequently say they have no questions when they do not understand. Documentation records that teaching occurred, not that learning occurred.

Question 2Patient-Centered Pharmacotherapy Care and Clinical Management

A trial reports that a new therapy reduces the absolute risk of stroke from 3% to 1% over 5 years. What is the number needed to treat to prevent one stroke?

  1. 100
  2. 200
  3. 2
  4. 50 Correct answer.

Explanation

NNT is the reciprocal of the absolute risk reduction. The ARR here is 3% − 1% = 2% (0.02), so NNT = 1 ÷ 0.02 = 50 patients treated for 5 years to prevent one stroke.

Question 3Patient-Centered Pharmacotherapy Care and Clinical Management

The American Geriatrics Society Beers Criteria are best described as a tool to:

  1. Flag medications that are potentially inappropriate in older adults Correct answer.
  2. Establish mandatory formulary exclusions in nursing homes
  3. Set maximum dose limits for all drugs used in older adults
  4. Replace clinical judgment when prescribing for older adults

Explanation

The Beers Criteria catalog medications that are generally best avoided or used with caution in adults aged 65 years and older because of unfavorable risk-benefit profiles. It is decision support, not a mandate, and does not replace individualized clinical judgment or set universal dose ceilings.

Question 4Patient-Centered Pharmacotherapy Care and Clinical Management

A patient undergoing percutaneous coronary intervention is found to be a CYP2C19 poor metabolizer. Which antiplatelet agent is most likely to have reduced efficacy?

  1. Prasugrel
  2. Aspirin
  3. Ticagrelor
  4. Clopidogrel Correct answer.

Explanation

Clopidogrel is a prodrug that requires CYP2C19-mediated activation, so poor metabolizers generate less active metabolite and achieve weaker platelet inhibition. Ticagrelor is active without bioactivation, and prasugrel activation depends mainly on CYP3A4 and CYP2B6. Aspirin acts through irreversible COX-1 inhibition.

Question 5Patient-Centered Pharmacotherapy Care and Clinical Management

Which set of variables is used by the Cockcroft-Gault equation to estimate creatinine clearance?

  1. Weight, height, serum creatinine, and cystatin C
  2. Age, weight, serum creatinine, and albumin
  3. Age, weight, serum creatinine, and sex Correct answer.
  4. Age, height, serum creatinine, and sex

Explanation

Cockcroft-Gault calculates creatinine clearance as (140 − age) × weight ÷ (72 × serum creatinine), multiplied by 0.85 for women. The required variables are therefore age, weight, serum creatinine, and sex.

Question 6Patient-Centered Pharmacotherapy Care and Clinical Management

A patient's proportion of days covered for a statin over the past year is 62%. How is this best interpreted?

  1. The patient refilled the prescription on schedule 62% of the time
  2. The patient's LDL reduction was 62% of the expected effect
  3. The patient took exactly 62% of the prescribed tablets
  4. Medication was available to the patient on about 62% of days Correct answer.

Explanation

Proportion of days covered is calculated from dispensing records and represents the share of days in a period for which the patient had medication supply on hand. A value of 62% means drug was available on roughly 62% of days, below the commonly used 80% adherence threshold. Refill-based metrics cannot confirm that tablets were actually swallowed.

Question 7Patient-Centered Pharmacotherapy Care and Clinical Management

Which pharmacist statement best reflects the spirit of motivational interviewing?

  1. What would need to change for taking this medication to feel worth it? Correct answer.
  2. I can explain why taking this medication every day is important for you.
  3. If you keep skipping doses, you will end up back in the hospital.
  4. Here is the schedule I have set up for you to follow.

Explanation

Motivational interviewing uses open-ended questions and reflective listening to evoke the patient's own reasons for change, supporting autonomy. Confrontation, warning, and prescribing solutions from the clinician's perspective tend to increase resistance.

Question 8Patient-Centered Pharmacotherapy Care and Clinical Management

Which action best describes deprescribing?

  1. Switching a patient from a brand product to a generic
  2. Stopping a medication that no longer provides net benefit Correct answer.
  3. Adjusting a dose for a newly diagnosed renal impairment
  4. Removing a drug from a hospital formulary after review

Explanation

Deprescribing is the planned, supervised withdrawal or dose reduction of a medication when its harms outweigh its benefits given the patient's current goals and prognosis. It is an individualized clinical decision, distinct from product substitution, formulary management, or routine organ-function dose adjustment.

Question 9Patient-Centered Pharmacotherapy Care and Clinical Management

A 78-year-old patient with atrial fibrillation weighs 58 kg and has a serum creatinine of 1.5 mg/dL. Which apixaban regimen is appropriate for stroke prevention?

  1. 10 mg twice daily
  2. 2.5 mg twice daily Correct answer.
  3. 5 mg twice daily
  4. 2.5 mg once daily

Explanation

Apixaban is reduced to 2.5 mg twice daily when at least two of three criteria are present: age 80 years or older, weight 60 kg or less, and serum creatinine 1.5 mg/dL or higher. This patient meets the weight and creatinine criteria, so the reduced dose is required.

Question 10Patient-Centered Pharmacotherapy Care and Clinical Management

Which antihypertensive agent is preferred for treatment of chronic hypertension in pregnancy?

  1. Labetalol Correct answer.
  2. Lisinopril
  3. Valsartan
  4. Spironolactone

Explanation

Labetalol, extended-release nifedipine, and methyldopa are the preferred agents for chronic hypertension in pregnancy. ACE inhibitors and angiotensin receptor blockers are fetotoxic and are avoided, and spironolactone's antiandrogenic effects limit its use.

Question 11Patient-Centered Pharmacotherapy Care and Clinical Management

An 82-year-old with mild cognitive impairment develops new confusion and urinary retention one week after oxybutynin is started for urge incontinence. What is the most appropriate action?

  1. Stop oxybutynin and reassess the symptoms Correct answer.
  2. Add tamsulosin to relieve the urinary retention
  3. Continue oxybutynin and monitor for another two weeks
  4. Add donepezil to counteract the confusion

Explanation

Oxybutynin is a strongly anticholinergic agent that can precipitate delirium and urinary retention in older adults, and it appears on the Beers list for this reason. The initial step is to withdraw the offending drug and reassess, rather than adding medications to treat its adverse effects.

Question 12Patient-Centered Pharmacotherapy Care and Clinical Management

A 4-year-old child weighing 16 kg is prescribed amoxicillin 45 mg/kg/day divided into two doses for acute otitis media. How many milligrams should be given per dose?

  1. 360 mg Correct answer.
  2. 540 mg
  3. 720 mg
  4. 180 mg

Explanation

The total daily dose is 45 mg/kg × 16 kg = 720 mg per day. Dividing that daily total into two doses gives 360 mg per dose.

Question 13Patient-Centered Pharmacotherapy Care and Clinical Management

A 55-year-old man who weighs 130 kg and is 175 cm tall requires an initial gentamicin dose. Which weight descriptor is most appropriate for calculating that dose?

  1. Adjusted body weight Correct answer.
  2. Actual body weight
  3. Ideal body weight
  4. Body surface area–derived weight

Explanation

In patients with obesity, adjusted body weight (ideal body weight plus 0.4 times the difference between actual and ideal weight) is commonly used for initial aminoglycoside dosing because it better approximates drug distribution than total body weight. Using actual body weight in this patient risks a substantial overdose.

Question 14Patient-Centered Pharmacotherapy Care and Clinical Management

A patient stabilized on warfarin is started on trimethoprim-sulfamethoxazole for a urinary tract infection. Which change in the INR is most likely?

  1. Decrease in INR with loss of anticoagulant effect
  2. Increase in INR with increased bleeding risk Correct answer.
  3. Initial decrease followed by a return to baseline
  4. No meaningful change in INR

Explanation

Trimethoprim-sulfamethoxazole inhibits CYP2C9-mediated metabolism of warfarin and displaces it from plasma protein binding, so the INR typically rises within several days. Close INR monitoring, dose reduction, or selection of a non-interacting antibiotic is often required.

Question 15Patient-Centered Pharmacotherapy Care and Clinical Management

A patient taking sertraline is started on linezolid and three days later develops agitation, hyperthermia, and inducible clonus. Which is the most likely explanation?

  1. Anticholinergic toxicity
  2. Serotonin syndrome Correct answer.
  3. Malignant hyperthermia
  4. Neuroleptic malignant syndrome

Explanation

Linezolid is a reversible monoamine oxidase inhibitor, and combining it with an SSRI can precipitate serotonin syndrome, which is characterized by clonus, agitation, hyperthermia, and autonomic instability. Neuroleptic malignant syndrome requires dopamine antagonist exposure and typically presents with lead-pipe rigidity and bradyreflexia rather than clonus.

Question 16Patient-Centered Pharmacotherapy Care and Clinical Management

A patient taking simvastatin 40 mg daily is prescribed a 7-day course of clarithromycin. What is the most appropriate recommendation?

  1. Increase the simvastatin dose during the antibiotic course
  2. Add coenzyme Q10 to prevent statin-related myopathy
  3. Hold simvastatin during the clarithromycin course Correct answer.
  4. Continue simvastatin unchanged and monitor for muscle pain

Explanation

Clarithromycin is a strong CYP3A4 inhibitor and markedly increases simvastatin exposure, raising the risk of rhabdomyolysis. Standard practice is to hold simvastatin during the course or select a macrolide or antibiotic without this interaction.

Question 17Patient-Centered Pharmacotherapy Care and Clinical Management

Which intervention most reliably reduces medication discrepancies after hospital discharge?

  1. Providing the patient with a general brochure on medication safety at discharge
  2. Asking the patient to bring all pill bottles to the first follow-up visit
  3. Pharmacist-led reconciliation with a reconciled list given to the patient and next prescriber Correct answer.
  4. Mailing the hospital discharge summary to the primary care office within one week of discharge

Explanation

Pharmacist-led reconciliation that produces a single verified list, shared with both the patient and the next prescriber, consistently reduces discrepancies at transitions of care. Generic brochures and summaries mailed without reconciliation do not resolve conflicting regimens.

Question 18Patient-Centered Pharmacotherapy Care and Clinical Management

A patient reports missing doses because a twice-daily schedule does not fit their routine. Which intervention most directly addresses this unintentional nonadherence?

  1. Using motivational interviewing to explore ambivalence
  2. Reinforcing education about the purpose of the medication
  3. Switching to an equivalent once-daily formulation, if available Correct answer.
  4. Asking a family member to supervise each dose

Explanation

Unintentional nonadherence reflects practical barriers such as regimen complexity, so simplifying to once-daily dosing removes the barrier directly. Education and motivational interviewing target knowledge and motivation, which are not the limiting issue here.

Question 19Patient-Centered Pharmacotherapy Care and Clinical Management

Which element is essential to shared decision-making about starting a new medication?

  1. Presenting the guideline-recommended therapy as the default choice
  2. Recommending only the option preferred by the prescriber
  3. Discussing benefits and harms in light of the patient's goals and values Correct answer.
  4. Limiting the discussion to the medication's most common adverse effects and cost

Explanation

Shared decision-making requires a two-way exchange in which the clinician presents the evidence on benefits and harms and the patient contributes preferences, values, and goals. Limiting the conversation to one option or to adverse effects alone does not meet this standard.

Question 20Patient-Centered Pharmacotherapy Care and Clinical Management

For serious MRSA infections, which vancomycin exposure target is currently recommended?

  1. AUC24/MIC of 200 to 300
  2. AUC24/MIC of 400 to 600 Correct answer.
  3. Trough concentration of 5 to 10 mcg/mL
  4. Peak concentration of 40 to 60 mcg/mL

Explanation

Consensus guidelines recommend an AUC24/MIC of 400 to 600 (assuming an MIC of 1 mg/L or less) for serious MRSA infections, estimated by Bayesian methods or two levels. Trough-only monitoring is no longer the preferred approach for serious infection.

Question 21Patient-Centered Pharmacotherapy Care and Clinical Management

A screening test has 90% sensitivity and 95% specificity. When applied in a population with a 1% prevalence of the disease, which positive predictive value is expected?

  1. About 95%
  2. About 90%
  3. About 45%
  4. About 15% Correct answer.

Explanation

PPV equals (sensitivity × prevalence) divided by that quantity plus (1 − specificity) × (1 − prevalence). Here that is 0.009 ÷ (0.009 + 0.0495), or roughly 15%. Even a highly accurate test yields a low PPV when disease prevalence is very low.

Question 22Patient-Centered Pharmacotherapy Care and Clinical Management

A breastfeeding mother is found to be a CYP2D6 ultrarapid metabolizer and requests codeine for postpartum pain. What is the most appropriate recommendation?

  1. Avoid codeine and choose a non-opioid or a non-CYP2D6 opioid Correct answer.
  2. Use half the usual codeine dose and monitor the infant closely
  3. Use codeine only after the infant reaches 6 months of age
  4. Use codeine as usual because ultrarapid metabolism lowers opioid exposure

Explanation

Ultrarapid CYP2D6 metabolizers convert codeine to morphine rapidly, producing high morphine concentrations in breast milk and risking infant respiratory depression. Codeine should be avoided in breastfeeding, and non-opioid analgesia or an opioid not dependent on CYP2D6 is preferred.

Question 23Patient-Centered Pharmacotherapy Care and Clinical Management

In a noninferiority trial, the upper bound of the 95% confidence interval for the difference in event rates lies below the prespecified noninferiority margin. How should this be interpreted?

  1. The new therapy is not unacceptably worse than the comparator Correct answer.
  2. The new therapy is statistically superior to the comparator
  3. The therapies are equivalent in every respect
  4. The trial failed to establish noninferiority

Explanation

Noninferiority is established when the confidence interval excludes a difference larger than the prespecified margin, meaning the new therapy has not been shown to be worse by a clinically unacceptable amount. It does not demonstrate superiority or complete equivalence across all outcomes.

Question 24Patient-Centered Pharmacotherapy Care and Clinical Management

Which drug property most favors substantial removal by hemodialysis?

  1. Large volume of distribution and high protein binding
  2. Low molecular weight and low protein binding Correct answer.
  3. High molecular weight and high protein binding
  4. Low volume of distribution and high protein binding

Explanation

Hemodialysis removes small, water-soluble molecules that are not tightly bound to plasma proteins and that distribute mainly within the vascular space. Large molecules, highly protein-bound drugs, and drugs with large volumes of distribution are poorly cleared by dialysis.

Question 25Patient-Centered Pharmacotherapy Care and Clinical Management

A patient with septic shock is started on an aminoglycoside. Compared with a stable patient, which pharmacokinetic change is expected, and what does it imply for the initial dose?

  1. Reduced clearance; a lower loading dose is needed
  2. Reduced volume of distribution; a lower loading dose is needed
  3. Increased volume of distribution; a higher loading dose is needed Correct answer.
  4. Increased protein binding; a higher loading dose is needed

Explanation

Sepsis increases capillary permeability and fluid resuscitation expands plasma volume, raising the volume of distribution for hydrophilic antibiotics and lowering peak concentrations. Because the loading dose is determined by volume of distribution, a larger initial dose is needed; clearance changes mainly influence maintenance dosing.

Question 26Patient-Centered Pharmacotherapy Care and Clinical Management

A pharmacist wants to confirm that a patient understands a new insulin regimen. Which technique best assesses comprehension?

  1. Give a printed handout and obtain the patient's signature.
  2. Ask the patient to restate the steps in their own words. Correct answer.
  3. Repeat the instructions slowly a second time.
  4. Ask the patient whether they have any questions about how to use the regimen.

Explanation

Teach-back, also called closing the loop, asks the patient to explain or demonstrate the regimen in their own words. It reveals gaps in understanding that a signature or a general question can miss.

Question 27Patient-Centered Pharmacotherapy Care and Clinical Management

Which pneumococcal vaccination approach is recommended for a healthy 67-year-old who has never received a pneumococcal vaccine?

  1. A single dose of PCV20 Correct answer.
  2. PCV13 followed by PPSV23 one year later
  3. No vaccination unless a risk condition develops
  4. PPSV23 now and PCV15 in five years

Explanation

For adults 65 years and older who have not previously received pneumococcal vaccine, ACIP recommends a single dose of PCV20 or PCV21. PCV15 followed by PPSV23 is an alternative regimen.

Question 28Patient-Centered Pharmacotherapy Care and Clinical Management

A conscious adult with diabetes has a capillary glucose of 58 mg/dL and can swallow safely. What is the most appropriate initial treatment?

  1. Give 15 to 20 g of fast-acting carbohydrate Correct answer.
  2. Administer intramuscular glucagon
  3. Start an intravenous dextrose infusion immediately
  4. Provide a meal that contains complex carbohydrates

Explanation

Conscious patients who can swallow should receive the rule of 15: 15 to 20 g of fast-acting carbohydrate, followed by rechecking glucose in 15 minutes. Glucagon or IV dextrose is reserved for patients who cannot take oral therapy or have severe hypoglycemia.

Question 29Patient-Centered Pharmacotherapy Care and Clinical Management

Which regimen represents high-intensity statin therapy for a patient with established atherosclerotic cardiovascular disease?

  1. Pravastatin 40 mg by mouth every day
  2. Rosuvastatin 5 mg by mouth every day
  3. Simvastatin 20 mg daily
  4. Atorvastatin 40 to 80 mg daily Correct answer.

Explanation

High-intensity statin therapy lowers LDL cholesterol by at least 50% and includes atorvastatin 40 to 80 mg or rosuvastatin 20 to 40 mg daily. Patients with established ASCVD should generally receive high-intensity therapy unless contraindicated.

Question 30Patient-Centered Pharmacotherapy Care and Clinical Management

Which first-line smoking cessation medication works as a partial agonist at nicotinic acetylcholine receptors?

  1. Nicotine polacrilex
  2. Clonidine
  3. Varenicline Correct answer.
  4. Bupropion SR

Explanation

Varenicline is a partial nicotinic acetylcholine receptor agonist approved as first-line smoking cessation therapy. It reduces craving and the rewarding effects of nicotine.

Question 31Patient-Centered Pharmacotherapy Care and Clinical Management

How should an unopened vial of insulin be stored before first use?

  1. In a warm water bath before first use
  2. Refrigerated at 36°F to 46°F until the expiration date Correct answer.
  3. At room temperature away from light for up to 28 days
  4. In the freezer to extend shelf life

Explanation

Unopened insulin vials should be refrigerated at 36°F to 46°F and kept away from freezing until the expiration date. Once in use, vials may be kept at room temperature for a limited period specified by the manufacturer.

Question 32Patient-Centered Pharmacotherapy Care and Clinical Management

Which patient is the best candidate for a naloxone co-prescription?

  1. A patient using topical diclofenac gel for knee osteoarthritis
  2. A patient receiving long-term morphine for cancer pain Correct answer.
  3. A patient taking metformin for type 2 diabetes
  4. A patient taking lisinopril for hypertension

Explanation

Naloxone should be offered to patients at increased risk of opioid overdose, including those on long-term opioids or high daily doses. Co-prescribing naloxone expands access to an antidote for unintentional overdose.

Question 33Patient-Centered Pharmacotherapy Care and Clinical Management

When obtaining a best possible medication history at hospital admission, which source combination is most reliable?

  1. The discharge summary from a prior hospital admission only
  2. The patient interview plus a pharmacy fill record Correct answer.
  3. A family member's verbal recollection of the medication list
  4. The patient's pill bottles alone

Explanation

A best possible medication history combines the patient interview with at least one additional source, such as a pharmacy fill record, pill bottles, or a caregiver. Corroboration improves accuracy and reduces omissions and duplications.

Question 34Patient-Centered Pharmacotherapy Care and Clinical Management

A patient with heart failure and reduced ejection fraction is transitioning from enalapril to sacubitril/valsartan. What washout period is required between the two drugs?

  1. 36 hours Correct answer.
  2. No washout is needed
  3. 12 hours
  4. 7 days

Explanation

A 36-hour washout is required when switching from an ACE inhibitor to sacubitril/valsartan because concurrent neprilysin and ACE inhibition increases the risk of angioedema. The ARNI should be started after that interval.

Question 35Patient-Centered Pharmacotherapy Care and Clinical Management

A patient with type 2 diabetes, an eGFR of 45 mL/min/1.73 m², and persistent albuminuria is already taking metformin. Which addition best slows CKD progression?

  1. Pioglitazone
  2. Sitagliptin
  3. Dapagliflozin Correct answer.
  4. Glipizide

Explanation

SGLT2 inhibitors reduce albuminuria and slow kidney function decline in patients with type 2 diabetes and CKD, with or without heart failure. They are recommended in addition to metformin when kidney or cardiovascular risk is present.

Question 36Patient-Centered Pharmacotherapy Care and Clinical Management

Which regimen is first-line for uncomplicated cystitis in a nonpregnant woman?

  1. Amoxicillin 500 mg three times daily for 10 days
  2. Ciprofloxacin 500 mg twice daily for 7 days
  3. Azithromycin 500 mg once
  4. Nitrofurantoin 100 mg twice daily for 5 days Correct answer.

Explanation

Nitrofurantoin for 5 days is a first-line regimen for uncomplicated cystitis because of its efficacy and low collateral damage. Fluoroquinolones are reserved for more serious infections.

Question 37Patient-Centered Pharmacotherapy Care and Clinical Management

Which maintenance regimen is preferred for a patient with COPD and persistent dyspnea despite a long-acting muscarinic antagonist alone?

  1. Add an inhaled corticosteroid alone
  2. Use a short-acting beta2 agonist as needed only
  3. Add a long-acting beta2 agonist Correct answer.
  4. Add oral theophylline

Explanation

For persistent dyspnea despite LAMA therapy, adding a LABA is preferred because dual bronchodilation improves symptoms and reduces exacerbations. Inhaled corticosteroids are generally added for patients with frequent exacerbations and eosinophilic inflammation.

Question 38Patient-Centered Pharmacotherapy Care and Clinical Management

Which approach is recommended for a patient with mild persistent asthma to reduce exacerbations?

  1. As-needed short-acting beta2 agonist alone for symptom relief
  2. Daily long-acting beta2 agonist alone
  3. Daily montelukast alone
  4. As-needed low-dose inhaled corticosteroid-formoterol Correct answer.

Explanation

Guidelines recommend as-needed low-dose ICS-formoterol for mild persistent asthma to provide both reliever and anti-inflammatory therapy. SABA-only treatment is no longer preferred because it does not address airway inflammation.

Question 39Patient-Centered Pharmacotherapy Care and Clinical Management

A pregnant patient requires anticoagulation for a prior provoked deep vein thrombosis. Which agent is preferred during pregnancy?

  1. Aspirin 81 mg daily
  2. Rivaroxaban
  3. Warfarin
  4. Low-molecular-weight heparin Correct answer.

Explanation

Low-molecular-weight heparin is preferred for anticoagulation during pregnancy because it does not cross the placenta and has predictable pharmacokinetics. Warfarin is teratogenic, and direct oral anticoagulants are generally avoided in pregnancy.

Question 40Patient-Centered Pharmacotherapy Care and Clinical Management

A patient with a CYP2C19 poor metabolizer phenotype undergoes PCI with stent placement. Which antiplatelet is preferred over clopidogrel?

  1. Ticagrelor Correct answer.
  2. Dipyridamole
  3. Cilostazol
  4. Aspirin monotherapy

Explanation

Clopidogrel is a prodrug requiring CYP2C19 activation, so poor metabolizers have reduced antiplatelet effect. Ticagrelor or prasugrel is preferred after PCI in these patients when not contraindicated.

Question 41Patient-Centered Pharmacotherapy Care and Clinical Management

Before starting abacavir, which pharmacogenomic test should be performed?

  1. HLA-B*57:01 screening Correct answer.
  2. Cytochrome P450 2D6 genotype
  3. Thiopurine methyltransferase activity
  4. G6PD activity

Explanation

HLA-B*57:01 screening is required before abacavir initiation because carriers have a high risk of a potentially fatal hypersensitivity reaction. Abacavir should not be used in HLA-B*57:01-positive patients.

Question 42Patient-Centered Pharmacotherapy Care and Clinical Management

A patient stabilized on lithium develops tremor and confusion after starting a new medication. Which added drug most likely caused lithium toxicity?

  1. Metformin extended release
  2. Atorvastatin calcium
  3. Amoxicillin-clavulanate
  4. Hydrochlorothiazide Correct answer.

Explanation

Thiazide diuretics increase lithium reabsorption by causing sodium depletion, which can raise lithium concentrations and precipitate toxicity. Lithium levels should be monitored closely when thiazides are started.

Question 43Patient-Centered Pharmacotherapy Care and Clinical Management

A patient who takes long-term prednisone 20 mg daily is admitted with sepsis. How should the corticosteroid be managed?

  1. Switch the prednisone to every-other-day dosing
  2. Reduce the dose by half
  3. Continue prednisone and add stress-dose hydrocortisone Correct answer.
  4. Stop prednisone immediately and monitor for adrenal insufficiency

Explanation

Patients with chronic adrenal suppression require stress-dose corticosteroids during serious illness to prevent adrenal crisis. The baseline dose is continued and additional hydrocortisone is given.

Question 44Patient-Centered Pharmacotherapy Care and Clinical Management

Which intervention is most effective for preventing delirium in hospitalized older adults?

  1. Multicomponent nonpharmacologic interventions Correct answer.
  2. Scheduled antipsychotics
  3. Indwelling urinary catheter placement on admission
  4. Routine nighttime benzodiazepine administration

Explanation

Multicomponent nonpharmacologic programs addressing orientation, sleep, hydration, mobility, and sensory aids reduce the incidence of delirium. Antipsychotics and benzodiazepines are not recommended for prevention and may worsen outcomes.

Question 45Patient-Centered Pharmacotherapy Care and Clinical Management

Which medication is potentially inappropriate in an older adult because it increases the risk of falls and fractures?

  1. Zolpidem Correct answer.
  2. Atorvastatin
  3. Metformin
  4. Lisinopril

Explanation

Z-drugs such as zolpidem are potentially inappropriate in older adults because they increase falls, fractures, and cognitive impairment. Nonpharmacologic sleep interventions are preferred.

Question 46Patient-Centered Pharmacotherapy Care and Clinical Management

In a clinical trial, a new drug reduces the absolute risk of an event by 2%. What is the number needed to treat?

  1. 200
  2. 50 Correct answer.
  3. 20
  4. 2

Explanation

Number needed to treat is the reciprocal of the absolute risk reduction: 1 divided by 0.02 equals 50. This means 50 patients must be treated for one additional event to be prevented.

Question 47Patient-Centered Pharmacotherapy Care and Clinical Management

Which genotype combination is associated with increased warfarin sensitivity and a lower required dose?

  1. CYP3A4 poor metabolizer with VKORC1 wild type
  2. CYP2C9 extensive metabolizer with VKORC1 wild type
  3. CYP2D6 ultrarapid metabolizer with VKORC1 wild type
  4. CYP2C9 reduced function with VKORC1 -1639A allele Correct answer.

Explanation

Reduced-function CYP2C9 alleles decrease warfarin metabolism, and the VKORC1 -1639A allele increases sensitivity to warfarin. Together they predict a lower warfarin dose requirement and higher bleeding risk.

Question 48Patient-Centered Pharmacotherapy Care and Clinical Management

Which method is recommended by the US Food and Drug Administration for estimating renal function when dosing most medications?

  1. 24-hour urine creatinine clearance only
  2. Cockcroft-Gault equation Correct answer.
  3. CKD-EPI 2021 equation
  4. MDRD equation

Explanation

FDA product labeling generally uses Cockcroft-Gault creatinine clearance for renal dose adjustments. Other equations may estimate GFR differently and can lead to discordant dosing decisions.

Question 49Patient-Centered Pharmacotherapy Care and Clinical Management

Which combination carries the highest risk of torsades de pointes?

  1. Amoxicillin plus ibuprofen
  2. Ondansetron plus citalopram Correct answer.
  3. Metformin plus glipizide
  4. Lisinopril plus atorvastatin calcium

Explanation

Ondansetron and citalopram both prolong the QT interval, and combining them increases the risk of torsades de pointes. Risk is higher with other QT-prolonging drugs, electrolyte abnormalities, or cardiac disease.

Question 50Patient-Centered Pharmacotherapy Care and Clinical Management

A patient with chronic cancer pain is being converted to a transdermal fentanyl patch. Which statement is correct?

  1. The patch should not be used in an opioid-naive patient. Correct answer.
  2. The patch is preferred for patients with fever.
  3. The patch provides rapid relief of acute pain.
  4. The patch should be applied to hairy skin for better absorption.

Explanation

Transdermal fentanyl is contraindicated in opioid-naive patients because of the risk of fatal respiratory depression. It is reserved for opioid-tolerant patients with persistent pain and is not for acute pain.