BCPS Exam 1 questions and answers
A+ updated to pass
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. - correct
answer ✔✔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
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. - correct answer ✔✔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
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. - correct answer ✔✔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
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. - correct answer ✔✔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
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. - correct answer ✔✔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.
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. - correct answer ✔✔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
Answer: A. 1 liter - Remember that albumin is a large protein that cannot escape the
intravascular space - water will flow in to try to dilute the albumin out. More concentrated
albumin, the more fluid will flow into the intravascular space. - correct answer ✔✔How much
volume will the intravascular space increase with 1 liter of 5% albumin?
A. 1 liter
B. 500 mls
C. 250 mls
D. 100 mls
A+ updated to pass
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. - correct
answer ✔✔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
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. - correct answer ✔✔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
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. - correct answer ✔✔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
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. - correct answer ✔✔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
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. - correct answer ✔✔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.
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. - correct answer ✔✔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
Answer: A. 1 liter - Remember that albumin is a large protein that cannot escape the
intravascular space - water will flow in to try to dilute the albumin out. More concentrated
albumin, the more fluid will flow into the intravascular space. - correct answer ✔✔How much
volume will the intravascular space increase with 1 liter of 5% albumin?
A. 1 liter
B. 500 mls
C. 250 mls
D. 100 mls
