BCPS Exam 1 Questions & Answers
100% Correct!!
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 - ANSWERAnswer: 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.
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 - ANSWERAnswer: 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 - ANSWERAnswer: 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.
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 - ANSWERAnswer: 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.
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 - ANSWERAnswer: 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.
A patient presents with muscle rigidity, fever, and delirium. Labwork reveals normal LFT's, normal
renal panel, elevations in creatinine phosphokinase. Current medications include lisinopril, aspirin,
citalopram, valproic acid, risperidone, tramadol, and baclofen. Which agent is the likely cause?
A. Citalopram
, B. Risperidone
C. Valproic acid
D. Baclofen - ANSWERAnswer: B. Risperidone - This is likely a case of NMS and antipsychotics have a
much higher incidence of causing this versus other medications.
A 68 year old male has a medical history of atrial fibrillation, essential tremor, diabetes, and CHF.
Over the past year, he has had worsening respiratory symptoms and albuterol/ipratropium as needed
and fluticasone/salmeterol has been added. Other medications include warfarin, amiodarone,
primidone, metformin, and aspirin. Which medication is most likely to cause the respiratory
symptoms?
A. Warfarin
B. Amiodarone
C. Primidone
D. Metformin - ANSWERAnswer: B. Amiodarone has the potential to cause pulmonary fibrosis.
What is the most likely agent that would cause the worsening confusion?
A. Propranolol
B. Insulin glargine
C. Naproxen
D. Ranitidine - ANSWERAnswer: D. Ranitidine - While propranolol can certainly cause some
cognition/sedation issues, the likely cause here with the change in kidney function is the
accumulation of ranitidine. H2 blockers are primarily eliminated via the kidney. Propranolol is
primarily eliminated via the liver.
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 - ANSWERAnswer: 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.
