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Pharmacie Clinique Prof. Vireak Part 2

The requirement for clinical pharmacy is the following. Which is the most appropriate answer?

Knowledge of drug therapy

Knowledge of pharmacology

Knowledge of pharmacokinetic

All of the above

For the level of action of clinical pharmacy like before the prescription, which is best answer?

Clinical monitoring

Clinical trial

Counseling

None of the above

The principle activities of clinical pharmacist is:

Counseling

Selection of drugs

Drug information

All of the above

An 87-year-old woman has been taking digoxin for atrial fibrillation for 15 years, but now complains of nausea and reduced mobility. Her current dose of digoxin is 187.5 micrograms orally daily. Her digoxin level is 3.0 nmol/L (therapeutic range 1.0-2.6 nmol/L).Which of the following is the most appropriate course of action?

Continue the current dose

Prescribe digoxin-specific antibody fragments

Reduce the dose

Stop the digoxin and restart at a lower dose one the level is therapeutic

You are asked to compare the cost of four different antibacterial medicines. Which of the following treatment courses is the lowest cost?

Medicine A costs 17 USD for 28 tablets. The adult dose is one tablet twice a day and the usual treatment duration is 7 days.

Medicine B costs 30 USD for 100 tablets. The adult dose is one tablet four times a day and the usual treatment duration is 7 days.

Medicine C costs 20 USD for 25 tablets. The adult dose is one tablet twice a day and the usual treatment duration is 5 days

Medicine D costs 25 USD for 14 tablets. The adult dose is one tablet each day and the usual treatment duration is 5 days.

You are asked to compare the cost of four different anti-inflammatory skin preparations. Compare the cost of a day's treatment for each of the following preparations and determine which is the lowest cost?

Cream M costs 12 USD for a 30g tube. It is applied once or twice a day and one tube normally lasts two weeks.

Cream N costs 30 USD for a 100g tube. It is applied once or twice a day and one tube normally lasts 42 days.

Ointment P costs 20 USD for a 50g tube. It is applied once or twice a day and one tube normally lasts 50 days.

Gel O costs 25 USD for a 90g tube. It is applied once or twice a day and one tube normally lasts three months (84 days)

Mrs Baker was prescribed medicine X at a dose of 20mg three times a day for the first time last month. The usual dosage range is 30mg to 120mg daily. She tells you that her symptoms are not well controlled. She is not taking any other medication. Her prescriber asks your advice. What would you recommend?

Change the formulation to 60mg MR which she only needs to take once a day.

Use Therapeutic Drug Monitoring (TDM) to determine the actual level of drug in her blood.

Increase her dose so she is now taking 30mg three times a day.

Determine whether the patient has any difficulties taking the medicine

Which of the following patients are most at risk of suffering from an adverse drug reaction?

An 8-month year old infant receiving a prescription for an antibiotic.

A 22-year-old patient with asthma receiving prescriptions for inhalers to relieve and prevent their asthma.

A 48-year-old patient who has hypertension and receives a prescription for an ACE inhibitor.

A 68-year-old patient who has edema receiving a prescription for a diuretic

A 24-year-old woman has had a pulmonary embolism 4 week after giving birth. She has been prescribed warfarin. Her last INR (measured 1 week ago) was 1.7 (taking 5 mg of warfarin), so she was prescribed 7 mg, and has had her INR rechecked. Her current INR is 2.8.Which of the following is now the most appropriate dose?

5 mg

6 mg

7 mg

8 mg

We need to do therapeutic drug monitoring (TDM) because:

Narrow therapeutic index and high toxicity

Variation of plasma drug concentration

The effect is not measurable

All of the above

What does ICH stand for?

International convention on homogenization

International conference on harmonization

International conference on homogenization

International convention on harmonization

A Serious Adverse Event (SAE) is any untoward medical occurrence that at any dose:

Is life threatening

Requires inpatient hospitalization or prolongation of existing hospitalization

Results in persistent or significant disability/incapacity

All the above

What is the adverse drug reaction?

An undesirable event experienced by a patient whilst taking a medicine, regardless of whether or not the medicine is suspected to be related to the event.

The reaction may be a known side effect of the drug or it may be new and previously unrecognized.

A noxious and unintended response to a medicine that occurs at normal therapeutic doses used in humans for prophylaxis, diagnosis, or therapy of disease, or for the modificatio of physiologic function

All the above

A patient has an anaphylactic reaction after taking medication containing penicillin, what is the appropriate answer?

Type A reaction

Type B reaction

Type C reaction

Type D reaction

Mr. Ben takes warfarin 5 mg at every evening, actually he is bleeding. What is the appropriate answer?

Type A reaction

Type B reaction

Type C reaction

Type D reaction

A side effect or complication from a medication is:

Drug overdose

Late effect

Transition point

Adverse drug event

A patient has a second cancer after using alkylating agents for the treatment of Hodgkin’s disease, this is:

Type A reaction

Type B reaction

Type D reaction

Type E reaction

A patient has adrenocortical insufficiency after he stops a treatment with prednisolone. This is:

Type A reaction

Type B reaction

Type D reaction

Type E reaction

Side effect is:

A noxious and unintended response to a medicine that occurs at normal therapeutic doses used in humans for prophylaxis, diagnosis, or therapy of disease, or for the modification of physiologic function

Any untoward medical occurrence that may be present during treatment with a medicine but does not necessarily have a causal relationship with this treatment. ADE include medication errors and overdoses.

Any unintended effect of a pharmaceutical product occurring at normal therapeutic doses and is related to its pharmacological properties. Such effects may be well-known and even expected and require little or no change in patient management

All the above

Adverse drug reaction is classified in:

Iatrogenic Crushing's syndrome with prednisolone is:

Type B reaction

Type C reaction

Type D reaction

Type E reaction

Type A reaction is defined as:

Adverse effect that are known to occur from the pharmacology of the drug and are dose-related

Adverse effect that occur unpredictably and often have a high rate of morbidity and mortality.

Adverse effect that only occur during prolonged treatment and not with single doses

Adverse effect that occur when the drug is stopped, especially when it is stopped suddenly.

Type B reaction is defined as:

Adverse effect that are known to occur from the pharmacology of the drug and are dose-related.

Adverse effect that occur unpredictably and often have a high rate of morbidity and mortality

Adverse effect that only occur during prolonged treatment and not with single doses

Adverse effect that occur when the drug is stopped, especially when it is stopped suddenly.

Type C reaction is defined as:

Adverse effect that are known to occur from the pharmacology of the drug and are dose-related.

Adverse effect that occur unpredictably and often have a high rate of morbidity and mortality

Adverse effect that only occur during prolonged treatment and not with single doses

Adverse effect that occur when the drug is stopped, especially when it is stopped suddenly.

Type D reaction is defined as:

Adverse effect that are known to occur from the pharmacology of the drug and are dose-related.

Adverse effect that occur unpredictably and often have a high rate of morbidity and mortality.

Adverse effect that occur remote from treatment, either in the children of treated patients, or in patients themselves year after treatment

Adverse effect that occur when the drug is stopped, especially when it is stopped suddenly.

Type E reaction is defined as:

Adverse effect that are known to occur from the pharmacology of the drug and are dose-related.

Adverse effect that occur unpredictably and often have a high rate of morbidity and mortality.

Adverse effect that only occur during prolonged treatment and not with single doses

Adverse effect that occur when the drug is stopped, especially when it is stopped suddenly

Concerning drug interaction, which is the appropriate answer:

Drug interaction is the modification of the action of one drug by another

There are three kinds of mechanism of drug interaction

Drug interaction can result from one or combination of their three kinds of mechanism

All the above

The mechanism of drug interaction is/are:

Pharmacokinetic

Pharmaceutical

Pharmacodynamic

All the above

There is different type of drug interaction, which is/are the best answer:

Useful interaction

Drug-patient interaction

Drug-food interaction

All the above

Concerning drug interaction, using Angiotensin Converting Enzyme Inhibitor and thiazide diuretic in a patient with a hypertension is:

Increased effect

Minimizing side effect

Block acutely an unwanted effect

None of the above

Levodopa is used with dopa decarboxylase inhibitor in order to:

Increasing effect

Minimizing side effect

Block acutely an unwanted effect

All the above

A patient use gentamicin together with hydrocortisone, the mechanism of this drug interaction is:

Pharmaceutical interaction

Pharmacokinetic interaction

Pharmacodynamic interaction

Biological interaction

A patient use warfarin together with aspirin, the mechanism of this drug interaction is:

Pharmaceutical interaction

Pharmacokinetic interaction

Pharmacodynamic interaction

Biological interaction

A patient use lithium together with diuretic, the mechanism of this drug interaction is:

Pharmaceutical interaction

Pharmacokinetic interaction

Pharmacodynamic interaction

Biological interaction

Which is the level of interaction between warfarin and metronidazole?

Absorption

Metabolism

Distribution

Excretion

Which is the level of interaction between penicillin and probenecid?

Absorption

Metabolism

Distribution

Excretion

Pharmacodynamic interaction:

Occur outside the body

Interaction between drug with a similar effect

Occur when one drug influences the way in which another is handle by the body

All the above

Medication errors are the most frequently source of preventable medical errors in a hospital. Which of the following is not preventable?

Selecting a drug that the patient is allergic to without knowing of the allergy

Selecting the wrong dose

Selecting the wrong duration

Overlooking drug-drug interactions

The medication use process steps are:

Diagnosing, prescribing, preparing, dispensing, administering and monitoring tasks performed in different departments by different people

Diagnosing, prescribing, preparing, dispensing, administering, billing and monitoring tasks performed in different departments by different people

Diagnosing, prescribing, dispensing, preparing, administering and monitoring tasks performed in different departments by different people

Documenting, prescribing, preparing, dispensing, administering and monitoring tasks performed in different departments by different people

The most common causes of medication errors are lack of knowledge about the drug and:

Lack of information about the patient

Lack of timely test results

Lack of communication between EHRs

Lack of time spent reviewing the case

Which is the following agent is preferred in the treatment of insomnia?

Barbiturate

Ethanol

Phenothiazide

Benzodiazepine

Which statement about the process of drug discovery is true?

It only encompasses the non-clinical laboratory and animal testing.

It is the process which ascertains the effectiveness and safety of potential drug candidates

It is the process by which therapeutic compounds are formulated into medicines

It ensures there are no side-effects associated with the potential drug candidates

What are adverse drug reactions (ADRs)?

The synergistic effects that are seen when some drugs are administered concurrently

Responses to increased drug doses required to achieve the same physiological outcome

Unintended alternative physiological responses caused by the drug that cause harm to the patient

Harmful chemical interactions between two drugs that are used to treat the same clinical symptoms

In pharmacokinetics what does the acronym ADME stand for?

Absorption, Distribution, Metabolism, and Excretion

Administration, Differentiation, Metabolism, and Excretion

Absorption, Disintegration, Metabolism, and Efficacy

Administration, Distribution, Metabolism, and Efficacy

Which of the following is the correct definition of bioavailability?

Bioavailability describes the proportion of the drug administered that is metabolized very quickly and thus is not available to induce a physiological effect.

Bioavailability describes the ability of the administered drug metabolites to cause undesirable physiological effects

Bioavailability is used to describe the fraction of the dose of drug administered that is present within the body and facilitates the desired physiological effects

Bioavailability is the length of time an administered drug is present in the body and thus is available to cause a physiological effec

The role of health professional:

Identifying and assessing ADRs in clinical practice

Preventing ADRs

Monitoring therapy

All of the above

In the classification of immunological reaction, hemolytic anemia is in:

Type I

Type II

Type III

Type IV

The factor affecting susceptibility to ADR:

Age

Co-morbidity and concomitant medicine use

Ethnicity

All of the above

Among the drugs with high risk of interaction, ciclosporin is: