PEBC (Qualifying Examination-Part I) Examples of the case scenario format
Categories: PEBC Canada
In these questions inclusive refer to the following:
EP is a 68 year old female with hypertension, type 2 diabetes, and a seizure disorder. EP has no known medication allergies or intolerances. Her current medications are:
Perindopril 4 mg po daily
Rosuvastatin 10 mg po at bedtime
Metformin 500 mg po bid
Linagliptin 5 mg po daily
Phenytoin 250 mg po at bedtime
For the past three days, EP has experienced fever, dysuria, increased urinary frequency, and urgency. She consulted her family physician who diagnosed a lower urinary tract infection. Urinary culture and sensitivity results are pending. The family physician prescribes the following empiric treatment:
Sulfamethoxazole/trimethoprim DS (800/160 mg) - 1 tab po bid for 7 days
Ques. Which of the following organisms is most likely to be the cause of EP's urinary tract infection?
a. Group A streptococcus
b. Coagulase-positive staphylococcus
c. Serratia marcescens
d. Escherichia coli
Answer: (d)
Ques. What drug therapy problem should the pharmacist identify for EP?
a. The length of treatment with sulfamethoxazole/trimethoprim should only be three days for EP.
b. Sulfamethoxazole/trimethoprim interacts with phenytoin and should be changed to another antibiotic.
c. Sulfamethoxazole/trimethoprim should be replaced with ciprofloxacin, as ciprofloxacin is the first line option for empiric treatment.
d. Antibiotic treatment should be started after the urinary culture and sensitivity report is obtained.
Answer: (b)
Ques. During the same appointment, EP's family physician orders a repeat phenytoin level. The following results are obtained:
Total phenytoin level = 38 µmol/L
Albumin = 30 g/L
The physician contacts the pharmacist to obtain a recommendation for adjusting the dose of phenytoin based on the following formula:
Corrected phenytoin level
Which of the following is the most appropriate recommendation for the pharmacist to provide to EP's physician?
a. Increase the dose of phenytoin to 300 mg po at bedtime and repeat the phenytoin level in one week
b. Decrease the dose of phenytoin to 200 mg po at bedtime and repeat the phenytoin level in one week
c. Increase the dose of phenytoin to 350 mg po at bedtime and repeat the phenytoin level in one week
d. Maintain the current dose of phenytoin and repeat the phenytoin level in three months
Answer: (d)
In these questions inclusive refer to the following:
DK is a 50 year old female who asks the pharmacist about using bismuth subsalicylate for indigestion. She has a stressful job and reports that she had a peptic ulcer which resolved approximately one year ago. She is training to run a 10 km race in two months. On training days (three to four days per week) she takes ibuprofen 200 mg po tid for shin pain. Her father died from a heart attack at the age of 60 years, so DK takes EC-ASA 81 mg po daily. Her other medications include:
Atorvastatin 10 mg po daily
Ferrous fumarate 300 mg po daily
Calcium carbonate (Tums®) 1000 mg po daily
Vitamin D 1000 units po daily
DK is a non-smoker and drinks two cups of coffee per day and has two alcoholic beverages daily with dinner.
Ques. The pharmacist should be concerned about DK's risk for NSAID-associated toxicity/adverse effects due to her:
a. lifestyle.
b. age.
c. medical history.
d. family history.
Answer: (c)
Ques. Which of the following is most appropriate advice for the pharmacist to provide to DK for managing her current Gl upset?
a. Eliminate coffee and alcohol from her diet
b. Discontinue the use of EC-ASA
c. Use bismuth subsalicylate 524 mg po qid for 14 days
d. Use omeprazole 20 mg po daily when taking ibuprofen
Answer: (d)
Ques. Three weeks later the pharmacist follows up with DK. DK states that she is still having occasional indigestion, especially after eating out. DK also states that she has switched from using ibuprofen to naproxen 220 mg po tid, since she continues to have shin pain after her daily runs. Her race is happening in four weeks. What is reasonable advice for the pharmacist to give to DK?
a. Advise DK to discontinue naproxen and start acetaminophen 1 g po tid
b. Refer DK to a physiotherapist for assessment
c. Advise DK to elevate her legs after each run and apply heat to her shins
d. Offer to sell DK graduated compression stockings to wear while running
Answer: (b)