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Liver toxicity with acetaminophen may occur and is a serious, dose-dependent effect. The maximum recommended dosage is:

a. 15mg/kg/day
b. 30mg/kg/day
c. 45mg/kg/day
d. 75mg/kg/day
e. 100mg/kg/day


Liver toxicity with acetaminophen may occur and is a serious, dose-dependent effect. The maximum recommended dosage is:

a. 15mg/kg/day
b. 30mg/kg/day
c. 45mg/kg/day
d. 75mg/kg/day
e. 100mg/kg/day

Answer: (d). Liver toxicity with acetaminophen may occur and is a serious, dose-dependent effect. The maximum recommended dosage is 75 mg/kg/day (adults not to exceed 4 g/d), and products carry warnings about exceeding this dose.

Signs associated with acetaminophen toxicity can mimic influenza symptoms and may include nausea, vomiting, diarrhea, and excessive sweating.

This may lead parents and caregivers to administer more medication to the child. Care should be taken not to exceed this threshold by administering higher doses more frequently than recommended.

In 2011 and 2012, the manufacturer of brand-name Tylenol products voluntarily reduced the maximum daily dosage to 3000 mg (6 tablets), with the dosing interval changed from 2 tablets every 4 to 6 hours to 2 tablets every 6 hours; the maximum daily dosage for Regular Strength Tylenol has been reduced to 3250 mg.

However, generic manufacturers may still have a maximum dose of 4000 mg on the product label.


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The probable mechanism of action of Baloxavir Marboxil?

a. HMG-CoA inhibitor
b. Neuraminidase inhibitor
c. Cap-dependent endonuclease inhibitor
d. DNA dependent RNA polymerase inhibitor
e. PABA inhibitor


The probable mechanism of action of Baloxavir Marboxil?

a. HMG-CoA inhibitor
b. Neuraminidase inhibitor
c. Cap-dependent endonuclease inhibitor
d. DNA dependent RNA polymerase inhibitor
e. PABA inhibitor

Answer: (c) The active ingredient found in Xofluza (Baloxavir marboxil) is Baloxavir marboxil. Xofluza (Baloxavir marboxil) is a polymerase acidic (PA) endonuclease inhibitor.

Baloxavir marboxil is a prodrug that is converted by hydrolysis to baloxavir, the active form that exerts anti-influenza virus activity. Baloxavir inhibits the endonuclease activity of the polymerase acidic (PA) protein, an influenza virus-specific enzyme in the viral RNA polymerase complex required for viral gene transcription, resulting in inhibition of influenza virus replication.


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Prescription antiviral medications with influenza virus activity may be useful adjuncts in influenza prevention and treatment and are most effective when administered within _______ of symptom onset.

a. 24 hours
b. 48 hours
c. 72 hours
d. 4 days
e. 12 hours



Prescription antiviral medications with influenza virus activity may be useful adjuncts in influenza prevention and treatment and are most effective when administered within _______ of symptom onset.

a. 24 hours
b. 48 hours
c. 72 hours
d. 4 days
e. 12 hours

Answer: (b). Prescription antiviral medications with influenza virus activity may be useful adjuncts in influenza prevention and treatment and are most effective when administered within 48 hours of symptom onset.


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In which aspect, Salicylate is different from NSAIDs? [Select ALL THAT APPLY]

a. Provide greater pain control with equivalent doses.
b. May cause GI side effects more frequently than NSAIDs.
c. May inhibit prostaglandin synthesis irreversibly; whereas NSAIDs do reversibly.
d. May cause more renal damage than NSAIDs.
e. Risk of bleeding is more with Salicylate compared to NSAIDs.


In which aspect, Salicylate is different from NSAIDs? [Select ALL THAT APPLY]

a. May provide greater pain control with equivalent doses.
b. May cause more GI side effects than NSAIDs.
c. Inhibits prostaglandin synthesis irreversibly; where NSAIDs do reversibly.
d. May cause more renal damage than NSAIDs.
e. May increase the risk of bleeding more compared to NSAIDs.

Answer (b,c): Salicylates, like NSAIDs, work by inhibiting prostaglandin synthesis by inhibiting both COX-1 and COX-2 enzymes; however, salicylates do so in an irreversible manner, while NSAIDs do so reversibly.

Absorption in the gut is affected by the dosage form, gastric pH, gastric emptying time, dissolution rate, and food/antacids.

Aspirin is widely bioavailable with an onset of analgesia within 30 minutes and lasting 4 to 6 hours.

FDA-approved uses for salicylates include treatment of symptoms for osteoarthritis, rheumatoid arthritis, and other rheumatologic diseases, as well as temporary relief of minor aches and pains associated with backache or muscle aches.

High-dose aspirin (900-1000 mg) has been established as an effective treatment option for acute migraine.

Aspirin causes dyspepsia and GI irritation even more frequently than OTC NSAIDs.

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At 1000 mg dose, Acetaminophen is usually effective treating which of the following Migraine related symptoms? [Select ALL THAT APPLY]

a. Nausea
b. Vomiting
c. Blurry vision
d. Photophobia
e. Phonophobia



At 1000 mg dose, Acetaminophen is usually effective treating which of the following Migraine related symptoms?[Select ALL THAT APPLY]

a. Nausea
b. Vomiting
c. Blurry vision
d. Photophobia
e. Phonophobia

Answer: (d,e). Acetaminophen has been shown in studies to reduce pain, as well as improve photophobia and phonophobia in individuals with migraine and tension-type headache. They have not been shown to improve symptoms of nausea, vomiting, or blurry vision with migraine.

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Which of the following statements is NOT TRUE about the tension-type headaches? [Select ALL THAT APPLY]

a. Pain associated with this type of headache is unilateral
b. Mild photophobia or phonophobia is reported with the headache
c. Routine physical activity usually aggravates the headache
d. Headache has fast onset of action and last for few hours.
e. It is also known as stress headache.


Which of the following statements is NOT TRUE about the tension-type headaches? [Select ALL THAT APPLY]

a. Pain associated with this type of headache is unilateral
b. Mild photophobia or phonophobia is reported with the headache
c. Routine physical activity usually aggravates the headache
d. Headache has fast onset of action and last for few hours.
e. It is also known as stress headache.

Answer: (a,c,d)

1. Tension-type headaches often are caused by stress, depression, anxiety, emotional conflicts, or other stimuli.

2. They are sometimes called stress headaches and may result from pericranial muscle contraction.

3. Patients experience bilateral symptoms that may be over the top of the head to the neck and vary from diffuse ache to tight, pressing, and constricting pain.

4. They have gradual onset and may last minutes to days.

5. They are not accompanied by nausea or vomiting but may have either mild photophobia or phonophobia.

6. Routine physical activity such as walking or climbing stairs does not aggravate the headache.

7. Tension-type headaches may be episodic or chronic. Episodic headaches occur less than 15 days per month. Chronic headaches occur 15 or more days per month for at least 3 months.


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Medication-overuse headache is generally classified as a:

a. Primary-headache
b. Secondary-headache
c. Tertiary-headache
d. Category II-headache
e. Category V-headache


Medication-overuse headache is generally classified as a:

a. Primary-headache
b. Secondary-headache
c. Tertiary-headache
d. Category II-headache
e. Category V-headache

Answer (b): Headaches are classified as primary or secondary according to the International Classification of Headache Disorders (ICHD) 2018.

Primary headaches are not caused by underlying illness. ICHD further classifies primary headaches as tension-type headache, migraine, trigeminal autonomic cephalalgias, or other primary headache disorders.

Secondary headaches are associated with an underlying condition (e.g., head injury or trauma, infection, stroke, substance withdrawal, or facial or cranial disorders).

Medication-overuse headaches are considered secondary by ICHD although they are not caused by an underlying disease (but are attributed to the withdrawal effect of analgesic medication).

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The simultaneous administration of which of the following with Qdolo is considered as a duplication of therapy?

a. Lopressor
b. Humira
c. Ultram
d. Ritalin
e. Levaquin


The simultaneous administration of which of the following with Qdolo is considered as a duplication of therapy?

a. Lopressor
b. Humira
c. Ultram
d. Ritalin
e. Levaquin

Answer: (c).

The active ingredient found in Qdolo is Tramadol hydrochloride. It is available as an oral solution. It is a schedule IV controlled substance. The simultaneous administration of Ultram (Tramadol) with Qdolo (Tramadol) is considered duplication of therapy; concurrent use should be avoided.

Qdolo is an opioid agonist indicated in adults for the management of pain severe enough to require an opioid analgesic and for which alternative treatments are inadequate.
Start at 25 mg/day and titrate in 25 mg increments as separate doses every 3 days to reach 100 mg/day (25 mg four times a day). Thereafter the total daily dose may be increased by 50 mg as tolerated every 3 days to reach 200 mg /day (50 mg four times a day). After titration, Qdolo 50 mg to 100 mg can be administered as needed for pain relief every 4 to 6 hours not to exceed 400 mg/day.

Concomitant use of opioids with benzodiazepines or other central nervous system (CNS) depressants, including alcohol, may result in profound sedation, respiratory depression, coma, and death. Reserve concomitant prescribing for use in patients for whom alternative treatment options are inadequate; limit dosages and durations to the minimum required; and follow patients for signs and symptoms of respiratory depression and sedation.

Monitor patients closely for respiratory depression, especially within the first 24-72 hours of initiating therapy and following dosage increases with Qdolo and adjust the dosage accordingly.

The most common incidence of treatment-emergent adverse events in patients from clinical trials were dizziness/vertigo, nausea, constipation, headache, somnolence, vomiting and pruritus.


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Which of the following statements is/are TRUE ABOUT Spravato? [Select ALL THAT APPLY].

a. It is indicated for the treatment of treatment-resistant depression.
b. Lketamine is its active ingredient.
c. It is a schedule IV controlled substance.
d. It is a non-competitive N-methyl D-aspartate (NMDA) receptor antagonist.
e. It is available as a nasal spray.


Which of the following statements is/are TRUE ABOUT Spravato? [Select ALL THAT APPLY].

a. It is indicated for the treatment of treatment-resistant depression.
b. Lketamine is its active ingredient.
c. It is a schedule IV controlled substance.
d. It is a non-competitive N-methyl D-aspartate (NMDA) receptor antagonist.
e. It is available as a nasal spray.

Answer: (a,d,e)

The active ingredient found in Spravato is Esketamine. It is available in a nasal spray. It is a schedule III controlled substance.

Spravato is a non-competitive N-methyl D-aspartate (NMDA) receptor antagonist indicated, in conjunction with an oral antidepressant, for the treatment of:

1. Treatment-resistant depression (TRD) in adults.

2. Depressive symptoms in adults with major depressive disorder (MDD) with acute suicidal ideation or behavior.

Spravato is administered intranasally under the supervision of a healthcare provider.

The recommended dosage of Spravato (Esketamine) for the treatment of depressive symptoms in adults with MDD with acute suicidal ideation or behavior is 84 mg twice per week for 4 weeks. Dosage may be reduced to 56 mg twice per week based on tolerability.

Spravato (Esketamine) is for nasal use only. The nasal spray device delivers a total of 28 mg of Esketamine. To prevent loss of medication, do not prime the device before use. Use 2 devices (for a 56 mg dose) or 3 devices (for an 84 mg dose), with a 5-minute rest between use of each device.

Dissociation, dizziness, nausea, sedation, vertigo, hypoesthesia, anxiety, lethargy, blood pressure increased, vomiting, and feeling drunk are commonly reported side effects of Spravato.

Because of the risks for sedation, dissociation, and abuse and misuse, Spravato (Esketamine) is only available through a restricted program called the Spravato (Esketamine) Risk Evaluation and Mitigation Strategy (REMS) Program.

Spravato (Esketamine) can only be administered at healthcare settings certified in the Spravato (Esketamine) REMS Program and to patients enrolled in the program.



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Kesimpta (Ofatumumab) is indicated for the treatment of:

a. Hypertension
b. Gout
c. Multiple sclerosis
d. Type II diabetes
e. Parkinsonism


Kesimpta (Ofatumumab) is indicated for the treatment of:

a. Hypertension
b. Gout
c. Multiple sclerosis
d. Type II diabetes
e. Parkinsonism

The active ingredient found in Kesimpta is Ofatumumab. It is available in a single-dose prefilled syringe.

Kesimpta (Ofatumumab) is a CD20-directed cytolytic antibody indicated for the treatment of relapsing forms of multiple sclerosis (MS), to include clinically isolated syndrome, relapsing-remitting disease, and active secondary progressive disease, in adults.

The precise mechanism by which Ofatumumab exerts its therapeutic effects in multiple sclerosis is unknown, but is presumed to involve binding to CD20, a cell surface antigen present on pre-B and mature B lymphocytes. Following cell surface binding to B lymphocytes, ofatumumab results in antibody-dependent cellular cytolysis and complement-mediated lysis.

Hepatitis B virus (HBV) and quantitative serum immunoglobulins screening are required before the first dose.

Initial Dosing: 20 mg subcutaneously administered at Week 0, 1, and 2.

Subsequent Dosing: 20 mg subcutaneously administered monthly starting at Week 4.

Respiratory tract infection, headache, injection-related reactions, and local injection site reactions are reported side effects of drug.

Try our Naplex QBank. www.pharmacyexam.com **Please note: This type of question will not show up in an MPJE. We are just posting to MPJE group for knowledge.