SCF Pharmacist Education Review

Contraception

100

A 31 yo Alaska Native woman presents to the fast track window to pick up a refill of her Xulane Patch. You notice that her weight has been 95-97 kg for the past few years. Which action is best? A. Dispense the refill and move on to the next customer. B. Tell her that the patch may be less effective in women weighing 90+ kg and advise her to contact her primary care team to discuss alternative forms of contraception.

B. Tell her that the patch may be less effective in women weighing 90+ kg and advise her to contact her primary care team to discuss alternative forms of contraception.

200

A 22 yo Alaska Native woman presents to the pharmacy window to pick up a combined oral contraceptive for the first time. She wonders about the effectiveness of the medication. You inform her that ___ of women experience an unintended pregnancy within one year of perfect use. A. <1% B. 8% C. 12% D. 17%

A. <1% 8% failure for TYPICAL use

300

A 35 yo Alaska Native woman who smokes ½ pack/day presents to the pharmacy window to pick up a prescription for norethindrone 0.35 mg daily. The provider wrote a note on the prescription, “Please counsel on adherence.” You emphasize the importance of taking her medication at the same time each day. You also educate her that a dose would be considered late if it has been ___ hours or more. A. 3 B. 6 C. 12 D. 24

A. 3

400

A 19 yo Alaska Native woman presents to the pharmacy window to pick up a combined oral contraceptive. She has never used birth control before and her provider did not give any instructions about when to start it. What is best to tell her? A. If you start on the first Sunday after menstrual bleeding starts, a backup method is needed for 1 week. B. If you start on the same day as menstrual bleeding starts, no backup method is needed. C. Both of the above D. None of the above

C. Both of the above

500

A 33 yo Alaska Native woman calls the pharmacy on her cell phone. She is on vacation and her Nuva Ring fell out 4-5 hours ago. She is on week 2. What is best to tell her? A. Discard old ring and insert new ring. This is now starting a new 3 week cycle. Backup contraception required until there has been 7 consecutive days with a ring in place. B. Rinse with cool or lukewarm water and reinsert. Backup contraception required until there has been 7 consecutive days with a ring in place. C. Rinse with cool or lukewarm water and reinsert. No backup contraception needed. D. None of the above

B. Rinse with cool or lukewarm water and reinsert. Backup contraception required until there has been 7 consecutive days with a ring in place.

Resistant Hypertension

100

Per JNC8, what is the recommended goal blood pressure in the general population ≥ 60 years of age? A. < 120/80 mmHg B. < 130/80 mmHg C. < 140/90 mmHg D. < 150/90 mmHg

D. < 150/90 mmHg

200

Per JNC8, which of these indications warrants a goal blood pressure of < 130/80 mmHg? A. Diabetes B. Heart failure C. Previous stroke D. Renal dysfunction + proteinuria

D. Renal dysfunction + proteinuria

300

Beta blockers are generally considered 5th line, but may be 1st line in customer-owners with Coronary Artery Disease or 2nd line in which condition? A. Diabetes B. Heart failure C. Previous stroke D. Renal dysfunction + proteinuria

B. Heart failure

400

Which condition has 60-70% prevalence in resistant hypertension? A. Primary aldosteronism B. Obstructive sleep apnea C. Renal artery stenosis D. Thyroid disorders

B. Obstructive sleep apnea

500

A primary care provider calls the pharmacy to ask about hypertension treatment options for an Alaska Native woman who tested HCG+ today. What antihypertensives are considered first-line in pregnancy? Name 2 of 3.

Labetalol, Methyldopa, Nifedipine ER

Chronic Pain

100

A case manager reports that an Alaska Native man is suffering from opioid withdrawal. He usually takes 60 mg oxycodone daily which he gets from the street, but he is trying to cut down and reports withdrawal symptoms. According to the SCF Opioid Guidelines, which of the following medications is an appropriate option for the ambulatory treatment of opioid withdrawal? A. Ondansetron for nausea/vomiting and a possible reduction in motor symptoms B. Hydroxyzine for anxiety and/or nausea/vomiting C. Clonidine for noradrenergic symptoms, e.g. tachycardia, hypertension, insomnia D. All of the above

D. All of the above

200

Which of the following is NOT considered a long term risk of opioid use? A. GI bleed B. Myocardial infarction C. Depression D. Immunosuppression E. All of the above are considered longterm risks of opioid use

E. All of the above are considered long term risks of opioid use

300

A team coverage provider on 1 East asks you about LS, a 36-year-old Alaska Native man whose Urine Drug Screen was positive for hydrocodone. He has been prescribed only oxycodone for pain and claims he has taken only oxycodone, not hydrocodone. What do you tell the provider? A. LS could be telling the truth. B. LS is not telling the truth.

B. LS is not telling the truth.

400

A primary care provider wishes to start a tricyclic antidepressant to treat neuropathic pain and comorbid insomnia in a 67 yo Alaska Native woman. Which option is best? A. Nortriptyline, because it is less anticholinergic than amitriptyline B. Amitriptyline, because it does not carry the risk of prolonged QT syndrome C. Nortriptyline, because it has a shorter elimination half-life than amitriptyline D. Amitriptyline, because it is not dangerous on accidental overdose

A. Nortriptyline, because it is less anticholinergic than amitriptyline

500

A provider wishes to start a short-term NSAID in a 54 yo Alaska Native man with coronary artery disease. Which option is best because of lower cardiovascular risk? A. Diclofenac B. Naproxen C. Celecoxib D. Meloxicam

B. Naproxen

Drugs of Abuse

100

This addictive CNS stimulant causes a flood of dopamine. It can be snorted or dissolved in water and injected. The crack form is processed to make a rock crystal that can be smoked. A. Cocaine B. Peyote C. LSD D. Anabolic steroids

A. Cocaine

200

A 19 yo Alaska Native man presents to the pharmacy window to pick up a nasal naloxone kit, yet has not been prescribed any opioids. There is no record opioid dispenses per the Alaska Prescription Drug Monitoring Program. Upon further questioning, he tells you that he is taking which substance on the street? A. Shrooms B. Methylphenidate C. Heroin D. Khat

C. Heroin

300

This substance is composed of synthetic cannabinoids +/- other hallucinogens which sprayed onto shredded plant materials then smoked. It binds to the same receptors as marijuana. A. K2/Spice B. Salvia C. PCP D. Ketamine

A. K2/Spice

400

This depressant, also known as the Date Rape Drug, tastes salty when dissolved in a drink.

GHB

500

This substance is a benzodiazepine not approved in the US for medical use; it has been reformulated with blue dye. A. Rohypnol B. Dabs C. Bath salts D. PCP

A. Rohypnol (Flunitrazepam)

HIV

100

You receive a prescription for tenofovir 200 mg/emtricitabine 300 mg (Truvada) – 1 tablet daily. No other antiretrovirals are prescribed. The customer-owner just came down to pharmacy from the provider, so there is no documentation yet. A. Truvada should never be dispensed by itself as it is not a complete regimen. B. Truvada may be dispensed by itself under certain circumstances.

B. Truvada may be dispensed by itself under certain circumstances.

200

Stribild and Genvoya are both 1-tablet first-line integrase inhibitor-based regimens. What is the difference? A. Stribild has a safer renal function and bone mineral density profile compared to Genvoya. B. Genvoya does not require pharmocogenomic testing before use, while Stribild does. C. Stribild is recommended to be taken with food, while Genvoya can be taken without regard to meals. D. Genvoya should not be used if CrCl < 30 ml/min, while Stribild should not be used if eGFR < 70 ml/min.

D. Genvoya should not be used if CrCl < 30 ml/min, while Stribild should not be used if eGFR < 70 ml/min.

300

Name a pharmacokinetic enhancer (used to boost other antiretrovirals), a potent CYP3A4 inhibitor, which can greatly increase levels of CYP 3A4 substrates such as fluticasone (including inhaled and nasal), sildenafil, and simvastatin.

Ritonavir or cobicistat

400

A medical assistant in Primary Care had a needlestick injury with a customer-owner who is HIV positive. What post-exposure prophylaxis (PEP) regimen is best to recommend? A. Tenofovir 200 mg/emtricitabine 300 mg (Truvada) daily + dolutegravir 50 mg daily X 28 days B. Tenofovir 200 mg/emtricitabine 300 mg (Truvada) daily + raltegravir 400 mg daily X 28 days C. Tenofovir 200 mg/emtricitabine 300 mg (Truvada) daily + dolutegravir 50 mg BID X 28 days D. Tenofovir 200 mg/emtricitabine 300 mg (Truvada) daily + raltegravir 400 mg BID X 28 days

Tenofovir 200 mg/emtricitabine 300 mg (Truvada) daily + raltegravir 400 mg BID X 28 days

500

A provider wishes to start Mycobacterium avium complex (MAC) prophylaxis in a customer-owner whose CD4 count is 24 cells/mm3. Which regimen is best? A. Azithromycin 1200 mg PO weekly B. Isoniazid 300 mg PO daily + Pyridoxine 25 mg PO daily C. Dapsone 100 mg PO daily D. Septra DS 1 tab PO daily

A. Azithromycin 1200 mg PO weekly