PEBC (Qualifying Examination-Part I) Examples of the case scenario format
Categories: PEBC Canada
In these questions inclusive refer to the following:
WW is a 55 year old, obese male (BMI 35) with newly diagnosed type 2 diabetes. His most recent fasting blood glucose is 9.6 mmol/L and A1C is 8%. He also suffers from hypertension and osteoarthritis in his knees. His current medications are: ramipril 20 mg po daily and acetaminophen 500 mg po qid.
Ques. Which of the following agents is the most appropriate choice for WW at this time?
a. Gliclazide
b. Sitagliptin
c. Canagliflozin
d. Metformin
Answer: (d)
Ques. If the anti-hyperglycemic agent chosen for WW is having its intended benefit, the most appropriate therapeutic outcome would be:
a. achieving target A1C in three months.
b. fasting blood glucose < 6.1 mmol/L within two weeks.
c. decreased BMI within three months.
d. no episodes of hyperglycemia.
Answer: (a)
Ques. After starting on the anti-hyperglycemic agent, WE would like advice regarding self-monitoring of his blood glucose. Which of the following statements is most appropriate for WW?
a. Blood glucose should be tested upon waking and before each meal.
b. Self-monitoring of blood glucose is not warranted at this time.
c. WW should avoid testing at alternate sites (e.g., forearm) since accuracy is reduced in obese patients.
d. Self-monitoring will help WW to adjust the dosing of oral therapy in relation to meal size.
Answer: (b)
In these questions inclusive refer to the following:
TK is a 63 year old male with chronic kidney disease (Cr CI = 29 mL/min/1.73 m2) and gout. He experienced his last gout attack about two months ago. Today his toe is extremely painful, hot, red and swollen. At a walk-in clinic, he receives a prescription for naproxen 500 mg po bid for five days. TK's other current medication is pravastatin 20 mg po at bedtime.
Ques. What drug therapy problem should the pharmacist identify for IK?
a. Naproxen is inferior to indomethacin for the treatment of acute gout.
b. The duration of naproxen treatment is too short.
c. Naproxen should be avoided in patients taking pravastatin.
d. Naproxen should be avoided in patients with renal dysfunction.
Answer: (d)
Ques. Following successful resolution of the acute episode, TK's physician decides that he should initiate allopurinol. TK should be advised to:
a. limit fluid intake.
b. take medication on an empty stomach.
c. use precautions to avoid photosensitivity.
d. report any skin rash or itching to the physician.
Answer: (d)
In these questions inclusive refer to the following:
TK is a 54 year old male who is a new patient at the pharmacy. He presents today with a new prescription for 20 diazepam 10 mg, i po qid and taper as directed over five to seven days. In discussion with the pharmacist, TK admits that he has abused alcohol for the last three years, but that he stopped drinking yesterday when he went to an alcohol treatment centre. He discloses that he has not been looking after himself or eating well in recent months. His current symptoms include agitation, insomnia, and tremulousness. His medical history is otherwise insignificant.
Ques. Which of the following drug therapy problems is the most important current issue for the pharmacist to identify for TK?
a. TK is receiving too high a dose of diazepam.
b. Diazepam is not indicated for TK.
c. TK requires treatment with thiamine.
d. TK is not currently experiencing any drug therapy problems.
Answer: (c)
Ques. During the consultation, TK notices that his neighbour's daughter, Cheryl, is employed as a front-shop cashier in the pharmacy. He feels uncomfortable about providing further information about his medical condition. What is the most appropriate initial action to be taken by the pharmacist?
a. Advise TK that disclosure of information is necessary to address his medical needs
b. Suggest that TK can go to another pharmacy if he wishes to avoid this concern
c. Offer a private counselling area and advise TK that no information will be disclosed to Cheryl
d. Advise TK that alcohol abuse is a medical problem and he should not feel uncomfortable about it
Answer: (c)
Ques. Later that same day, TK returns to the pharmacy with his vial of diazepam. He tells the pharmacist that he did not receive the labelled quantity of the medication. The pharmacist determines that a counting error did occur. What is the best way for the pharmacist to prevent this type of error in the pharmacy in the future?
a. Require that all narcotics and benzodiazepine prescriptions be counted only by pharmacist staff
b. Obtain signatures from patients picking up orders to confirm receipt of the correct labelled quantity
c. Double count all narcotics and benzodiazepines and document on the prescription hardcopy
d. Use an electronic pill counter to ensure accurate prescription quantities for these medications
Answer: (c)
In these questions inclusive refer to the following:
AE is a 54 year old female with obesity (BMI 42) and osteoporosis, who takes the following medications:
Alendronate/vitamin D (Fosavance®)
Metformin extended-release (Glumetza®)
Gliclazide modified-release (Diamicron MR®)
Calcium citrate
Ranitidine
AE is scheduled to undergo bariatric surgery that will result in a bypass of the duodenum, proximal jejunum, and all of her stomach except for the cardia. Her surgeon has asked AE to discuss any necessary modifications to her medication regimen with her pharmacist.
Ques. Which of the following physiologic factors would be expected to increase following AE's gastric bypass surgery?
a. Gastric pH
b. Surface area of the gastric mucosa
c. Gastric emptying time
d. Enterohepatic recirculation
Answer: (a)
Ques. Which of the following online resources is the most useful for determining appropriate postsurgical modifications to AE's medication regimen?
a. RxFiles
b. CredibleMeds
c. PubMed
d. CPS Drug Information
Answer: (d)
Ques. Which of the following alternatives is the most appropriate recommendation for the pharmacist to suggest for switching AE's osteoporosis therapy?
a. Teriparatide
b. Etidronate
c. Denosumab
d. Raloxifene
Answer: (c)