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1. Off-label use of cetirizine (antihistamine) - what should you do?
2. What information should be provided to patients starting on diphenhydramine (antihistamine)?
3. A patient comes to the pharmacy with two cold medications asking if both can be used together. Drug A contains Desloratadine 5 mg (antihistamine) and pseudoephedrine 30 mg per tablet and Drug B contains Diphenhydramine 25 mg (antihistamine) and pseudoephedrine 30 mg per tablet. What should be the pharmacist's response?
4. Patient taking SABA, ICS, and Montelukast (LTRA), experiences side effects from Montelukast. What is an alternative option?
5. A 21-year-old boy came with complaints of shortness of breath; he has been on a Salbutamol inhaler for the last 10 years. X-ray shows no consolidation, and the patient becomes stable on the medication but experiences sleep disturbances, waking 3-4 times at night. What advice will the doctor give to the pharmacist?
6. A patient with asthma was brought to the hospital. She was already taking SABA and ICS for maintenance. However, she feels scared that another attack might cause her medications to not be effective anymore. What drug is the most helpful should she experience another attack?
7. A patient with asthma was brought to the hospital. She was already taking SABA and ICS for maintenance. However, she feels scared that another attack might cause her medications to not be effective anymore. What drug is the least helpful should she experience another attack?
8. In COPD patients, with what medication should ipratropium (SAMA) be administered?
9. A patient in the emergency department with asthma, no fever, and an x-ray showing consolidation. Which option is least appropriate?
10. A patient with COPD is taking Tiotropium (LAMA). The pharmacist knows that an additional drug should be added. What should be chosen?
11. When considering an additional medication for a patient with COPD who is already taking Tiotropium, which option would be suitable?
12. A 16-year-old girl with asthma recently had a routine laboratory follow-up showing potassium of 3.0 (indicating hypokalemia, normal range 3.5 – 5.1). Which medication is most likely to have contributed to her results?
13. A patient was admitted to the hospital with asthma, arrhythmia or AF, and a peptic ulcer. He is on multiple medications, including digoxin, and has a potassium level of 2.8 mmol/L (indicating hypokalemia, normal range 3.5 – 5.1). Which drug is responsible for his abnormality?
14. A case about an asthmatic patient from 2 years ago. He is taking Salbutamol 1-2 puffs PRN. His symptoms are exacerbated by exercise, and he recently had an asthmatic attack and went to the hospital. What is the advice?
15. Which ONE of the following beta-blockers would be LEAST likely to cause bronchospasm in an asthmatic patient at normal doses?
16. A patient came with a prescription of salbutamol, Prednisolone, beclomethasone, and co-amoxiclav. What is the diagnosis?
17. A 21-year-old boy with shortness of breath who has been on Salbutamol inhaler for the last 10 years and has no consolidation on X-ray. Which drug can be added to manage his condition?
18. A patient with asthma came to the emergency with a low respiration rate and other symptoms. She has been taking SABA and ICS for 10 years. What is the next medication to give after stabilizing the patient?
19. A patient with asthma was brought to the hospital. She was already taking SABA and ICS for maintenance. However, she fears that another attack might cause her medications to be ineffective. What drug is the LEAST helpful should she experience another attack?
20. A 43-year-old man with pneumonia has a history of Addison’s disease and takes hydrocortisone (20 mg morning, 10 mg afternoon). What is the most appropriate action with respect to his steroid dose?
21. Patient taking topical corticosteroid nasal spray. What condition is contraindicated except?
22. A patient came with a prescription of salbutamol, Prednisolone, beclomethasone, and amoxiclav. What is the diagnosis?
23. Corticosteroids are given in sepsis for?
24. Which one of the following is a side effect of chronic corticosteroid use?
25. A patient is taking beta-agonist and ICS for COPD and has developed oral thrush. What is NOT the correct technique to avoid it?
26. What is the MOST common side effect of inhaled corticosteroids?
27. A patient weighing 50 kg has a prescription for prednisolone 1 mg/kg with a reduction plan. The prescription states 50 mg for 2 weeks, then a reduction of 5 mg for the next 2 weeks, and once weekly for the next month. Tablets are 5 mg each. How many tablets are required?
28. A patient was prescribed prednisolone 10 mg for 14 days, then 7.5 mg for 1 week, then 5 mg for 1 week, then 2.5 mg for 4 weeks. How many 2.5 mg tablets are needed?
29. What is the best drug for treatment of acute gout with a renal clearance of 15 ml/hr?
30. A COPD patient with a penicillin allergy was prescribed an antibiotic with Prednisolone. Which antibiotic is the best choice?
31. A patient came as a representative for his father who has severe pneumonia. The physician advised a new drug for inhalation therapy. After administering the medication via nebulizer, the patient’s father developed severe bronchoconstriction. What counseling will you give to the patient?
32. A 31-year-old woman, three months pregnant, develops a urinary tract infection. What is the best antimicrobial therapy?
33. Which antidepressant drug must be avoided in a 21-year-old female with a history of seizures?
34. Steven-Johnson syndrome can appear when giving phenytoin IV after?
35. A company produces a product for colon cancer that is easily absorbed from the intestine. Which statement is not related to the drug?
36. An elderly patient suffering from depression was given St. John's wort. Which of the following drugs, if administered concomitantly, will have a clinically significant interaction?
37. Which of the following medications is considered a high-alert drug?
38. What is the recommendation regarding the air bubble in the syringe for a patient starting on enoxaparin subcutaneous injection?
39. A 72-year-old man with a history of hypertension and COPD has EKG findings suggestive of irregular rhythm. His blood pressure is 135/80 mmHg, and his heart rate is 80/min. What is the most appropriate drug to manage his atrial fibrillation?
40. What is the recommendation for administering a live vaccine and an antibody-containing product?
41. Which one of the following medications is known to induce pulmonary toxicity?
42. A 28-year-old man who was well-controlled on phenytoin is brought to the Emergency Department in a state of status epilepticus. What would be the best recommendation?
43. A 79-year-old man with Alzheimer's disease has mild to moderate dementia and is on oral rivastigmine 6 mg twice daily. He is not able to tolerate the medication due to nausea and vomiting. What would be the best recommendation?
44. The nurse asks about which type of dressing to use for a patient with a lower leg wound that is yellow (indicating infection) and exuding fluid.
45. Which one of the following is resistant to the penicillinase enzyme?
46. A 27-year-old pregnant woman has recently been diagnosed with iron deficiency anemia. Her hemoglobin is less than 11 g/dL. What would be the best recommendation?
47. Which of the following medications requires observing the patient for six hours with hourly heart rate monitoring after the first dose?
48. Which of the following is an important counseling point for a woman starting on fingolimod?
49. Which medication requires a negative pregnancy test before dispensing to a woman of childbearing age?
50. The physician is asking the pharmacist about the effects of low albumin and acute renal failure on phenytoin serum concentration. The patient is receiving phenytoin 300 mg once daily. What should be the most appropriate suggestion?
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