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