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Poison Ivy rash is an example of:

a. Type I Hypersensitivity
b. Type II Hypersensitivity
c. Type III Hypersensitivity
d. Type IV Hypersensitivity
e. Type V Hypersensitivity


Answer: (d), Type 4 hypersensitivity is often called delayed type. Delayed hypersensitivity does not start to be noticeable until several hours to a full day after exposure to the antigen. It may last for over a week.

Poison ivy rash is caused by an allergic reaction to an oily resin called urushiol (u-ROO-she-ol). This oil is in the leaves, stems and roots of poison ivy, poison oak and poison sumac. Urushiol, which is a hapten, when absorbed through the skin from a poison ivy plant, it (urushiol) undergoes oxidation in the skin cells to generate the actual hapten, a reactive molecule called a quinone, which then reacts with skin proteins to form hapten adducts.

T lymphocytes recognize the foreign substances, usually after the antigen is eaten, degraded, and presented (in pieces) by so-called antigen-presenting cells such as Langerhans cells in the skin, or macrophages. Urushiol metabolites (metabolite of Poison Ivy) are presented by this and other mechanisms. The T lymphocytes pour out inflammatory signal substances called cytokines. These call in armies of white blood cells called monocytes, which become macrophages. The macrophages become activated by the cytokines and attack everything in the vicinity, and can cause severe tissue damage.

Usually, the first exposure causes only sensitization, in which there is a proliferation of effector T-cells. After a subsequent, second exposure, the proliferated T-cells can become activated, generating an immune reaction that produces typical blisters of a poison ivy exposure.


In addition to poison ivy, a good example is the skin reaction to injected tuberculosis antigen. In fact, when tuberculosis bacteria infect the lung, it is the delayed hypersensitivity against them which destroys the lung. Unlike the other types, it is not antibody mediated but rather is a type of cell-mediated response.

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Which of the following information about Zurampic is/are TRUE? [Select All that apply].

a. Acute liver failure has reported with Zurampic.
b. Zurampic should be used in combination with a xanthine oxidase inhibitor.
c. An active ingredient found in Zurampic is Lesinurad.
d. Zurampic is a xanthine oxidase inhibitor.
e. Zurampic is indicated for the treatment of hyperuricemia associated with gout.


Which of the following information about Zurampic is/are TRUE? [Select All that apply].

a. Acute liver failure has reported with Zurampic.
b. Zurampic should be used in combination with a xanthine oxidase inhibitor.
c. An active ingredient found in Zurampic is Lesinurad.
d. Zurampic is a xanthine oxidase inhibitor.
e. Zurampic is indicated for the treatment of hyperuricemia associated with gout.

Answer: (b,c,e). Zurampic (Lesinurad) is a URAT1 inhibitor. It is available as blue film-coated tablets for oral administration containing 200 mg Lesinurad. It should be used in combination with a xanthine oxidase inhibitor. Lesinurad reduces serum uric acid levels by inhibiting the function of transporter proteins involved in uric acid reabsorption in the kidney. It is indicated in combination with a xanthine oxidase inhibitor for the treatment of hyperuricemia associated with gout in patients who have not achieved target serum uric acid levels with a xanthine oxidase inhibitor alone.

Zurampic (Lesinurad) is not recommended for the treatment of asymptomatic hyperuricemia. Zurampic (Lesinurad) should not be used as monotherapy.

Zurampic (Lesinurad) tablets are for oral use and should be co-administered with a xanthine oxidase inhibitor, including allopurinol or febuxostat. Zurampic (Lesinurad) is recommended at 200 mg once daily. This is also the maximum daily dose. Zurampic (Lesinurad) should be taken by mouth, in the morning with food and water.

Zurampic (Lesinurad) causes an increase in renal uric acid excretion, which may lead to renal events including transient increases in serum creatinine, renal-related adverse reactions, and kidney stones. These renal events occurred more frequently in patients receiving Zurampic (Lesinurad) 400 mg, when used as monotherapy or in combination with a xanthine oxidase inhibitor. Kidney function is required to monitor.

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Which of the following HMG-CoA inhibitors can be taken during any time of the day with or without food? [Select All that apply]

a. Atorvastatin
b. Pravastatin
c. Simvastatin
d. Pitavastatin
e. Rosuvastatin


Which of the following HMG-CoA inhibitors can be taken during any time of the day with or without food? [Select All that apply]

a. Atorvastatin
b. Pravastatin
c. Simvastatin
d. Pitavastatin
e. Rosuvastatin

Answer: (a,b,d,e).



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Which of the following information is/are TRUE about preparing TPN formulation? [Select ALL THAT APPLY].

a. A lipid emulsion in a three-in-one admixture obscures the presence of calcium phosphate precipitates.
b. The solubility of the added calcium should be calculated from the volume at the time the calcium is added and should NOT be based upon the final volume.
c. If the amount of calcium or phosphate which must be added is likely to cause a precipitate, some or all of the calcium should be administered separately.
d. If a three-in-one admixture is medically necessary, then add the calcium before the lipid emulsion.
e. When adding calcium and phosphate to an admixture, the calcium should be added first.


Which of the following information is/are TRUE about preparing TPN formulation? [Select ALL THAT APPLY].

a. A lipid emulsion in a three-in-one admixture obscures the presence of calcium phosphate precipitates.
b. The solubility of the added calcium should be calculated from the volume at the time the calcium is added and should NOT be based upon the final volume.
c. If the amount of calcium or phosphate which must be added is likely to cause a precipitate, some or all of the calcium should be administered separately.
d. If a three-in-one admixture is medically necessary, then add the calcium before the lipid emulsion.
e. When adding calcium and phosphate to an admixture, the calcium should be added first.

Answer: (a,b,c,d). TPN solutions are made according to a variety of formulations and compounding protocols. Thus, there are possibilities of calcium phosphate precipitates and many other chemical incompatibilities. Precipitates could develop because of a number of factors such as: the concentration, pH, and phosphate content of the amino acid solutions; the calcium and phosphorous additives; the order of mixing; the mixing process; or the compounder. The presence of a lipid emulsion in the TPN admixture would obscure the presence of any precipitate.

Because of the potential for life threatening events, caution should be taken to ensure that precipitates have not formed in any parenteral nutrition admixtures.

1. The amounts of phosphorous and of calcium added to the admixture are critical. The solubility of the added calcium should be calculated from the volume at the time the calcium is added. It should not be based upon the final volume.

Some amino acid injections for TPN admixtures contain phosphate ions (as a phosphoric acid buffer). These phosphate ions and the volume at the time the phosphate is added should be considered when calculating the concentration of phosphate additives. Also, when adding calcium and phosphate to an admixture, the phosphate should be added first.

2. The line should be flushed between the addition of any potentially incompatible components.

3. A lipid emulsion in a three-in-one admixture obscures the presence of a precipitate. Therefore, if a lipid emulsion is needed, either:

(1). use a two-in-one admixture with the lipid infused separately, or
(2). if a three-in-one admixture is medically necessary, then add the calcium before the lipid emulsion and according to the recommendations in number 1 above.

If the amount of calcium or phosphate which must be added is likely to cause a precipitate, some or all of the calcium should be administered separately. Such separate infusions must be properly diluted and slowly infused to avoid serious adverse events related to the calcium.

4. A filter should be used when infusing either central or peripheral parenteral nutrition admixtures. Standards of practice vary, but the following is suggested: a 1.2 micron air eliminating filter for lipid containing admixtures, and a 0.22 micron air eliminating filter for nonlipid containing admixtures.

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Which of the following is strong CYP1A2 inhibitor? [Select All that apply].

a. Fluvoxamine
b. Ciprofloxacin
c. Caffeine
d. Fluoxetine
e. Cimetidine


Which of the following is strong CYP1A2 inhibitor? [Select All that apply].

a. Fluvoxamine
b. Ciprofloxacin
c. Caffeine
d. Fluoxetine
e. Cimetidine

Answer: (a,b). Dose adjustments may be necessary in patients with concomitant use of:

Strong CYP1A2 inhibitors (e.g., fluvoxamine, ciprofloxacin, or enoxacin);

Moderate or weak CYP1A2 inhibitors (e.g., oral contraceptives, or caffeine);

CYP2D6 or CYP3A4 inhibitors (e.g., cimetidine, escitalopram, erythromycin, paroxetine, bupropion, fluoxetine, quinidine, duloxetine, terbinafine, or sertraline);

CYP3A4 inducers (e.g., phenytoin, carbamazepine, St. John's wort, and rifampin); or

CYP1A2 inducers (e.g., tobacco smoking).

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With the ICD-10-PCS, the length of inpatient procedure codes are:

a. 7 alphanumeric characters
b. 3 alphanumeric characters
c. 13 alphanumeric characters
d. 10 alphanumeric characters
e. 17 alphanumeric characters


With the ICD-10-PCS, the length of inpatient procedure codes are:

a. 7 alphanumeric characters
b. 3 alphanumeric characters
c. 13 alphanumeric characters
d. 10 alphanumeric characters
e. 17 alphanumeric characters

Answer: 7 alphanumeric characters. The U.S. Department of Health and Human Services (HHS) announced a final rule that will facilitate the United States' ongoing transition to an electronic health care environment through adoption of new healthcare code sets for use in electronic health care transactions. This rule adopts updated versions of the code sets, under the authority of HIPAA (ICD-10 final rule). The ICD-10 code sets replace the ICD-9-CM code set.

In past, the industry was using about 4,000 unique ICD-9-CM volume 3 codes to describe inpatient procedures. ICD-9 procedure codes were 3-4 digits in length (e.g., 47.01 - Laparoscopic appendectomy). With the ICD-10-PCS mandate, the length of inpatient procedure codes increase to 7 alphanumeric characters (e.g., ODTJ4ZZ - Laparoscopic appendectomy).

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Which of the following information is/are TRUE about Durlaza?

I. Clopidogrel is an active ingredient.

II. Indicated for the secondary prevention of stroke and acute cardiac events, including myocardial infarction (heart attack).

III. Available as 24-hour, extended release capsules formulation containing 162.5mg active ingredient.

a. I only
b. III only
c. I and II only
d. II and III only
e. All


Which of the following information is/are TRUE about Durlaza?

I. Clopidogrel is an active ingredient.

II. Indicated for the secondary prevention of stroke and acute cardiac events, including myocardial infarction (heart attack).

III. Available as 24-hour, extended release capsules formulation containing 162.5mg active ingredient.

a. I only
b. III only
c. I and II only
d. II and III only
e. All

Answer: (d) II and III are true. Durlaza is an aspirin formulation for secondary prevention in high-risk CVD patients. The aspirin delivery technology in Durlaza extends the release of aspirin in a manner designed to provide a stable antiplatelet effect over the course of the day.

Low-dose aspirin has been proven to reduce the risk of secondary cardiovascular events and mortality in high-risk patients with stable cardiovascular disease. This is primarily due to aspirin's ability to inhibit platelet aggregation (blood clotting).

While the body is making platelets 24-hours a day, current immediate-release traditional aspirin only stays in the blood for about a mean duration of four to six hours, with peak plasma concentrations peaking after just 30 minutes.

Durlaza utilizes extended-release, microcapsule technology to prolong aspirin release. Durlaza offers the only once-daily, 24-hour antiplatelet therapy through the extended release of its 162.5mg dose, resulting in prolonged absorption, and sustained platelet exposure to aspirin. Durlaza, like immediate-release aspirin, increases the risk of bleeding and gastric ulceration, and may cause fetal harm when administered to a pregnant woman.

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Rolapitant is indicated for the treatment of:

a. Hypertension
b. Diabetes
c. Nausea and vomiting
d. Schizophrenia
e. Rheumatoid arthritis


Rolapitant is indicated for the treatment of:

a. Hypertension
b. Diabetes
c. Nausea and vomiting
d. Schizophrenia
e. Rheumatoid arthritis

Answer: (c). The U.S. Food and Drug Administration approved Rolapitant (Varubi) to prevent delayed phase chemotherapy-induced nausea and vomiting (emesis). Rolapitant (Varubi) is approved in adults in combination with other drugs (antiemetic agents) that prevent nausea and vomiting associated with initial and repeat courses of vomit-inducing (emetogenic and highly emetogenic) cancer chemotherapy.

Rolapitant (Varubi) is a substance P/neurokinin-1 (NK-1) receptor antagonist. Activation of NK-1 receptors plays a central role in nausea and vomiting induced by certain cancer chemotherapies, particularly in the delayed phase. It is available in tablet form.

Rolapitant (Varubi) inhibits the CYP2D6 enzyme, which is responsible for metabolizing certain drugs. Varubi is contraindicated with the use of thioridazine, a drug metabolized by the CYP2D6 enzyme, because use of the two drugs together may increase the amount of thioridazine in the blood and cause an abnormal heart rhythm that can be serious.

The most common side effects in patients treated with Rolapitant (Varubi) include a low white blood cell count (neutropenia), hiccups, decreased appetite and dizziness.

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Which of the following information is/are TRUE about Homocysteine?

I. It is not possible to get homocysteine from the diet.

II. Homocysteine can be recycled back into methionine using vitamin B12-related enzymes.

III. Elevated homocysteine levels have been associated with severe bleeding.

a. I only
b. III only
c. I and II only
d. II and III only
e. All


Which of the following information is/are TRUE about Homocysteine?

I. It is not possible to get homocysteine from the diet.

II. Homocysteine can be recycled back into methionine using vitamin B12-related enzymes.

III. Elevated homocysteine levels have been associated with severe bleeding.

a. I only
b. III only
c. I and II only
d. II and III only
e. All

Answer: I and II only. Homocysteine is an amino acid. Amino acids are the building blocks of proteins. It is not possible to get homocysteine from the diet. It must be made from methionine, another amino acid that is found in meat, fish, and dairy products. Vitamins B6 (pyridoxine), B12 and folic acid are needed to make this reaction occur.

Foods containing methionine are transformed into homocysteine in the bloodstream. Homocysteine is converted in the body to cysteine, with vitamin B6 facilitating this reaction. Homocysteine can also be recycled back into methionine using vitamin B12-related enzymes.

Cysteine is an important protein in the body that has many roles. It is involved in the way proteins within cells are folded, maintain their shape, and link to each other. Cysteine is a source of sulfide and is part of the metabolism of different metals in the body including iron, zinc and copper. Cysteine also acts as an anti-oxidant.

If homocysteine cannot be converted into cysteine or returned to the methionine form, levels of homocysteine in the body increase. Elevated homocysteine levels have been associated with heart attack, stroke, blood clot formation, and perhaps the development of Alzheimer's disease.

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Onfi is available in which of the following dosage forms?

I. Tablet
II. Oral Suspension
III. Capsule

a. I only
b. III only
c. I and II only
d. II and III only
e. All


Onfi is available in which of the following dosage forms?

I. Tablet
II. Oral Suspension
III. Capsule

a. I only
b. III only
c. I and II only
d. II and III only
e. All

Answer: (c). The active ingredient found in Onfi is Clobazam. Each Onfi (Clobazam) tablet contains 10 mg or 20 mg of clobazam. It is also available for oral administration as an off-white suspension containing clobazam at a concentration of 2.5 mg/mL.

Onfi (Clobazam) is classified as benzodiazepine. Clobazam potentiates the GABAergic neurotransmission by binding at the benzodiazepine site of the GABAa receptor.

Onfi (Clobazam) is indicated for the adjunctive treatment of seizures associated with Lennox-Gastaut syndrome (LGS) in patients 2 years of age or older.

A daily dose of Onfi (Clobazam) greater than 5 mg should be administered in divided doses twice daily; a 5 mg daily dose can be administered as a single dose.

As with all antiepileptic drugs and benzodiazepines, withdraw Onfi (Clobazam) gradually. The patient should taper by decreasing the total daily dose by 5-10 mg/day on a weekly basis until discontinued.

Somnolence, depression, sedation, withdrawal symptoms, serious dermatological reactions and suicidal behavior and ideation are commonly reported side effects of Onfi (Clobazam).

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