PEBC (Therapeutic) Sample Questions
Categories: PEBC Canada
Ques. A 36-yo female who presents to your outpatient clinic with a chief complaint of persistent dry cough x3 days. JJ is now on the following medications: Celebrex 100 mg po bid, docusate 100 mg po bid, fluoxetine 20 mg po qd, and captopril 12.5 mg po tid. She comes back to the clinic 6 months later and is complaining of a dry cough persistent for greater than 2 weeks. The cough she presented with at her last visit resolved within days of taking dextromethorphan. What would your assessment of this patient be?
a) She may have a chronic cough that will be unresponsive to any medication.
b) Fluoxetine causes cough unresponsive to antitussive. Therefore, you would recommend switching to another antihypertensive.
c) Captopril causes cough unresponsive to antitussive. Therefore, you would recommend switching to another antihypertensive.
d) You would recommend referring her to an allergist.
e) Captopril causes cough unresponsive to antitussives; therefore, you would recommend the patient’s doctor to change to the same class of antihypertensive.
Answer: (c)
Ques. A patient was scheduled for an endovascular coiling procedure to treat a brain aneurysm. Several days before the procedure, the neurosurgeon wrote a prescription for Plavix 150 mg po daily with acetylsalicylic acid (ASA) 325 mg po daily. The patient was to take these medications to prevent platelet aggregation and clot formation during, and as a result of, insertion of a foreign substance (the coils) into the vascular system. The day before the scheduled procedure, the patient was admitted to the hospital as planned. Fortunately, the patient had remembered to bring all current medications to the hospital. During medication reconciliation, the pharmacist noticed that the patient was taking Pradax 150 mg daily instead of the intended Plavix 150 mg daily. The hospital pharmacist called the community pharmacy to discuss the situation. It was determined that the order for Plavix had been misinterpreted and that Pradax had been dispensed in error.
The hospital pharmacist should inform this incident to?
I) The neurosurgeon should be notified before surgical procedure
II) Institute of Safe Medication Practices Canada
III) Pharmacy and Therapeutic Committee
(a) I only
(b) III only
(c) I and II only
(d) II and III only
(e) I, II, III
Answer: (c)
Ques. Which of the following measures can prevent these type mix ups!
A. Include the generic name throughout the prescription process like clopidogrel for Plavix and dabigatran etexilate for Pradaxa
B. Read label with patient at counselling point
C. Read label at the time taking drug from shelf and read label at the time of counting and placing bottle back into shelf
D. Consider automated alert system in computers
E. Academic detailing to enhance prescription practices
Answer: (a)
Ques. A physician asked for heparin 2,000 units during a procedure. The nurse retrieved two vials of heparin from an automated dispensing cabinet that was supposed to be stocked with 1,000 units/1 mL vials. But a pharmacy technician had accidentally stocked the cabinet with look-alike vials of 10,000 units/1 mL heparin vials. Both concentrations... are in the same size vials with similar orange-brown labels and vial caps... causing the nurse to overlook the stocking error. The patient received 20,000 units, but the nurse quickly noticed the mistake!
Which of the following is the management of heparin overdose?
I) Stop using heparin and test aPTT and INR
II) Protamine sulphate antidote administration
III) Treatment included administration of intravenous fluids, plasma volume expander, fresh frozen plasma, packed red blood cells, and platelets.
A) I only
B) III only
C) I and II only
D) II and III only
E) I, II, III
Answer: (e)
Ques. Multiple issues often underlie the inadvertent administration of high-concentration heparin. What are the examples of contributing factors to such incidents include:
A. The storage of high-concentration heparin vials close to low-concentration heparin flush products.
B. Confirmation bias that can cause a healthcare professional to read a label or select a drug product and “see” what they expect to see, rather than what is actually selected.
C. Often, more concentrations than necessary are present in both the pharmacy and patient care area stock.
D. Incomplete communication between physicians and nurses at the time of gathering drugs and supplies for central vascular line (CVL) insertion and during procedure
E. All of the above
Answer. (e)