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DD is a 67 yo woman who comes to your community pharmacy today (1/23/13) to pick up her monthly refil s and also presents with a new prescription for warfarin SIG: 25 mg po MWF, 4 mg po TTHS, 2 mg Su. While she waits at the pharmacy she checks her blood pressure, which is 120/80. The pharmacy profile includes the following 1. Which of the following factors may potential y or actually cause a DRP in DD? Patient required to split atorvastatin tablet Comment [MD1]: All 3 are present in this
patient and al are risk factors that can lead to DRPs 2. Which of the following DRPs are present in DD at this time? A. Therapeutic duplication: HCTZ and metoprolol, Patient nonadherence: esomeprazole B. Drug Allergy Interaction: Augmentin, Therapeutic duplication: simvastatin and atorvastatin C. Patient nonadherence: metoprolol, Drug overdose: warfarin Comment [MD2]: A is not correct because HCTZ
and metoprolol are not therapeutic duplication. A 59 yo male is hospitalized with the following information: antihypertensives to control patient’s BP which is B is not correct because augmentin is not prescribed at this time – the prescription was fil ed back in July and is not a problem now. PCN al ergy may have VS: BP 125/80, HR 62, RR 18, T 37 54 kg, been documented after patient took Augmentin. Piperacillin/Tazobactam (Zosyn) 4.5g IV q8h C is correct because there is evidence for metoprolol non-adherence – patient is filling the script 13 days late. The dose of warfarin is not appropriate. Typical dose is 5 mg a day. In this patient it’s likely that a dose should have been 3. What additional information would be most useful to you to identify DRPs in this patient at this time?
written as MWF 2.5 mg; 4mg TThS; 2 mg SU. B. What reaction does the patient have when he takes penicillin? Comment [MD3]: A is incorrect because
C. Has the patient ever had a surgical procedure before? patients’ HR is normal currently. C is incorrect because surgical procedures are unlikely to impact drug therapy. B is the best answer because patient What is the most appropriate DRP and recommendation to make at this time? is prescribed Zosyn which is a penicil in class A. Therapeutic duplication: discontinue atenolol 50 mg po daily B. Drug without indication: discontinue ASA 81 mg po daily C. Clinical indication without therapy: add insulin sc sliding scale (i.e. titrated based on glucose) Comment [MD4]: Patient should continue ASA
therapy and beta-blocker post MI, but BS are very 5. Which of the following patient assessment question(s) best matches the corresponding letter in “QuEST SCHOLAR”? [Obj: 6; ABO: 6]
Comment [CM5]: ANSWER D
I. History: What has been done so far? Has this
I. H – Is the patient healthy enough to self-treat? II – Onset: appropriate assessment question III – Establish: appropriate assessment question III. E – Is the patient an appropriate candidate for self-treatment? 6. Which of the following is the most appropriate wording in the “P” section in a progress note? [Obj: 3; ABO: 10]
A.
Should start Lantus 10 units once daily. Consider starting insulin 10 units daily. C. Consider starting Lantus 10 units SQ once daily. Comment [MD6]: This is the most
comprehensive and specific recommendation. A is missing route and B is missing type of insulin. 7. Which of the following are important to consider when assessing all possible drug therapy opinions? [Obj: 6; ABO: 6]
A. Strength, cost, ease of use B. Safety, efficiency, ease of use C. Safety, efficacy, cost 8. Patient A is a poor metabolizer of CYP2D6 while patient B is an extensive metabolizer. Both patients are taking the same dose of metoprolol. Which of the following is true regarding
metoprolol levels for both patients?. [Obj: 2,4 ; ABOs:1,2,3,10,11,16,19,20 ]
Comment [MD7]: Metoprolol is a substrate of
2D6. An extensive metabolizer has normal Levels are high in patient A compared with Patient B metabolism while a poor metabolizer has a slower Levels are lower in patient A compared with Patient B metabolism therefore they wil have increased 9. Which of the following mechanisms most accurately explains the interaction between ciprofloxacin and warfarin? [Obj:1,5; ABOs:1,2,10,20]
Comment [MD8]: Ciprofloxacin is an inhibitor of
CYP1A2 and warfarin is a substrate. Ciprofloxacin wil result in increased INR (measure we use to A. Ciprofloxacin inhibits the absorption of warfarin resulting in reduced warfarin effects evaluate how anticoagulated the patient is). Higher B. Ciprofloxacin inhibits warfarin metabolism resulting in an increased risk of side effects of INR wil lead to better efficacy in terms of clot prevention but higher incidence of side effects. C. Ciprofloxacin induces warfarin metabolism resulting in a decreased efficacy of warfarin 10. Which one of the following drugs will most likely result in an increased tacrolimus concentration? Comment [m9]: Tacrolimus is a 3A4 substrate.
[Obj: 1,5; ABOs:1,2,10,20]
Rifampin is a 3A4 inducer, voriconazole is a 3A4 inhibitor and losartan is a 3A4 substrate. Voriconazole is MOST likely to cause increased

Source: http://www.aacp.org/meetingsandevents/2013Institute/Documents/AssessmentWorkshopQuizExampleAnnotated%20(2).pdf