In which way is Tolsura (Itraconazole) different from Sporanox (Itraconazole)?

a. Different dosing frequency
b. Less side effects
c. Different indication
d. Different dosage form
e. No difference

In which way is Tolsura (Itraconazole) different from Sporanox (Itraconazole)?

a. Different dosing frequency
b. Less side effects
c. Different indication
d. Different dosage form
e. No difference

Answer: (c) different indication.

Tolsura (itraconazole capsules) and Sporanox (itraconazole) are azole antifungals used to treat different types of infections. Tolsura is used to treat blastomycosis, pulmonary and extrapulmonary; histoplasmosis, including chronic cavitary pulmonary disease and disseminated, non-meningeal histoplasmosis; and aspergillosis, pulmonary and extrapulmonary, in patients who are intolerant of or who are refractory to amphotericin B therapy.

Sporanox is used to treat fungal infections of the lungs, mouth or throat, toenails, or fingernails.

The dose of Tolsura to treat blastomycosis and histoplasmosis is 130 mg to 260 mg daily. The dose of Tolsura to treat aspergillosis is 130 mg to 260 mg daily.

Dosage of Sporanox depends upon the condition for which it is being used to treat.

Side effects of Tolsura and Sporanox that are similar include nausea, vomiting, skin rash, headache, diarrhea, itching, and dizziness.

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Levomilnacipran is indicated for the treatment of:
 
a. Hypertension
b. Depression
c. Epilepsy
d. Renal carcinoma
e. Arrhythmia

Levomilnacipran is indicated for the treatment of:
 
a. Hypertension
b. Depression
c. Epilepsy
d. Renal carcinoma
e. Arrhythmia

Answer:(b). Levomilnacipran (Fetzima), a selective serotonin and norepinephrine reuptake inhibitor (SNRI), is indicated for the treatment of major depressive disorder (MDD).
 
The recommended dose range for Levomilnacipran (Fetzima) is 40 mg to 120 mg once daily, with or without food. Levomilnacipran (Fetzima) should be initiated at 20 mg once daily for 2 days and then increased to 40 mg once daily. Based on efficacy and tolerability, Levomilnacipran (Fetzima) may then be increased in increments of 40 mg at intervals of 2 or more days. The maximum recommended dose is 120 mg once daily.
 
At least 14 days should elapse between discontinuation of an MAOI intended to treat psychiatric disorders and initiation of therapy with Levomilnacipran (Fetzima). Conversely, at least 7 days should be allowed after stopping Levomilnacipran (Fetzima) before starting an MAOI antidepressant.
 
Suicidal thoughts and behaviors in adolescents and young adults, serotonin syndromes, elevated blood pressure, activation of mania/hypomania, seizure and hyponatremia are reported side effects of Levomilnacipran.

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A pharmacist receives a new prescription for Meloxicam (Mobic). The prescription reads:

Take 7.5 mg by mouth every 8 hours with or without meals for the pain associated with rheumatoid arthritis x 30 days. Refill: 5 times.

Which of the following is True?
 
a. Fill it.
b. Call physician to clarify dosage strength.
c. Call physician to clarify indication of drug.
d. Call physician to clarify the frequency of dosing.
e. Change direction to take with meals after verifying with physician.

A pharmacist receives a new prescription for Meloxicam (Mobic). The prescription reads:

Take 7.5 mg by mouth every 8 hours with or without meals for the pain associated with rheumatoid arthritis x 30 days. Refill: 5 times.

Which of the following is True?
 
a. Fill it.
b. Call physician to clarify dosage strength.
c. Call physician to clarify indication of drug.
d. Call physician to clarify the frequency of dosing.
e. Change direction to take with meals after verifying with physician.

Answer: (d). Meloxicam (Mobic), an oxicam derivative, is a member of the enolic acid group of nonsteroidal anti-inflammatory drugs (NSAIDs). Each pastel yellow tablet contains 7.5 mg or 15 mg Meloxicam (Mobic) for oral administration.
 
Meloxicam (Mobic) is indicated for relief of the signs and symptoms of osteoarthritis, rheumatoid arthritis and pauciarticular or polyarticular course Juvenile rheumatoid arthritis in patients 2 years of age and older.
 
For the relief of the signs and symptoms of arthritis the recommended starting and maintenance oral dose of Meloxicam (Mobic) is 7.5 mg once daily since the mean elimination half-life (t½) ranges from 15 hours to 20 hours. Some patients may receive additional benefit by increasing the dose to 15 mg once daily. It may be taken without regard to timing of meals.
 
Nonsteroidal anti-inflammatory drugs (NSAIDs) may cause an increased risk of serious cardiovascular (CV) thrombotic events, myocardial infarction, and stroke, which can be fatal. This risk may increase with duration of use. Patients with cardiovascular disease or risk factors for cardiovascular disease may be at greater risk.
 
NSAIDs cause an increased risk of serious gastrointestinal (GI) adverse reactions including bleeding, ulceration, and perforation of the stomach or intestines, which can be fatal. These events can occur at any time during use and without warning symptoms. Elderly patients are at greater risk for serious gastrointestinal events.

A pharmacist receives a new prescription for Propecia. The prescription reads:
 
Take 5 mg by mouth once daily with or without meals for male pattern baldness x 30 days.
 
Refill: 5 times
 
Which of the following is True?
 
a. Fill it.
b. Call physician to clarify dosage strength.
c. Call physician to clarify indication of drug.
d. Call physician to clarify a number of refills of drug.
e. Change direction to take with meals after verifying with physician.

A pharmacist receives a new prescription for Propecia. The prescription reads:
 
Take 5 mg by mouth once daily with or without meals for male pattern baldness x 30 days.
 
Refill: 5 times
 
Which of the following is True?
 
a. Fill it.
b. Call physician to clarify dosage strength.
c. Call physician to clarify indication of drug.
d. Call physician to clarify a number of refills of drug.
e. Change direction to take with meals after verifying with physician.

Answer: b
 
The active ingredient found in Propecia and Proscar is Finasteride.
 
Finasteride is a competitive and specific inhibitor of Type II 5-alpha-reductase. The development and enlargement of the prostate gland is dependent on the potent androgen, 5-alpha-dihydrotestosterone (DHT). By reducing the levels of dihydrotestosterone, Finasteride prevents the development and enlargement of the prostate gland.
 
Finasteride (Proscar) is indicated for the treatment of symptomatic benign prostatic hyperplasia (BPH) in men with an enlarged prostate to:
 
1. Improve symptoms
2. Reduce the risk of acute urinary retention
3. Reduce the risk of the need for surgery including transurethral resection of the prostate (TURP) and prostatectomy.
 
The recommended dose of Proscar is 5 mg once daily taken with or without meals.
 
Finasteride (Propecia) is indicated for the treatment of male pattern hair loss (androgenetic alopecia) in MEN ONLY. The recommended dose of Propecia is 1 mg once daily taken with or without meals.
 
Therefore, the pharmacist should clarify the dosage strength with a prescribing physician since the prescription is written for Propecia but prescribed on bases of Proscar dose.
 
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Nymalize, a calcium channel blocker, is indicated for which of the following?
 
a. Hypertension
b. Arrhythmia
c. Parkinson's
d. Subarachnoid hemorrhage
e. Depression

Nymalize, a calcium channel blocker, is indicated for which of the following?
 
a. Hypertension
b. Arrhythmia
c. Parkinson's
d. Subarachnoid hemorrhage
e. Depression

Answer:d.

Nymalize contains Nimodipine, a dihydropyridine calcium channel blocker. An oral solution of Nymalize contains 60 mg of Nimodipine per 20 mL.

It is indicated for the improvement of neurological outcome by reducing the incidence and severity of ischemic deficits in adult patients with subarachnoid hemorrhage (SAH) from ruptured intracranial berry aneurysms regardless of their post-ictus neurological condition (i.e., Hunt and Hess Grades I-V).

The recommended oral dosage is 20 mL (60 mg) every 4 hours for 21 consecutive days.

Hypotension is the major side effect of Nymalize.

Which of the following is/are non-economic costs associated with Medication Error?

I. loss of trust
II. reduced satisfaction
III. physical and psychological discomfort

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

Which of the following is/are non-economic costs associated with Medication Error?

I. loss of trust
II. reduced satisfaction
III. physical and psychological discomfort

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

Answer (e): In the two decades since the Institute of Medicine (IOM) released its landmark report providing recommendations for addressing medication errors, the focus on medication safety continues.

A recent meta-analysis of studies spanning from 2000 to 2019 suggest one in 20 patients are exposed to preventable harm in medical care with 25% of incidents being medication-related.

Medication errors impact an estimated 1.5 million people every year.

In 2019, Americans filled 5.96 billion prescriptions (30-day equivalent) which would result in an estimated 93,600,000 errors given a medication dispensing error rate of 1.57%.
The burden of medication errors is high.

Costs of treating drug-related injuries in hospitals are $3.5 billion a year,3 and the morbidity and mortality associated with medication errors is estimated to be $77 billion each year.

Beyond economic costs, errors are costly in terms of patients' loss of trust, reduced satisfaction and physical and psychological discomfort.

They are costly as health professionals lose morale and frustration at providing less than the best care possible.

Continued efforts to address medication error causes are critical to improve medication safety and public health. Pharmacists and the pharmacy team have important roles to play in preventing medication errors.

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

a. The active ingredient found in Palforzia is Arachis hypogaea.
b. It is indicated to prevent peanut hypersensitivity.
c. It indicated for the emergency treatment of allergic reactions, including anaphylaxis.
d. It should not be administered in patients with uncontrolled asthma.
e. It is available only through a restricted program Palforzia REMS.

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

a. The active ingredient found in Palforzia is Arachis hypogaea.
b. It is indicated to prevent peanut hypersensitivity.
c. It indicated for the emergency treatment of allergic reactions, including anaphylaxis.
d. It should not be administered in patients with uncontrolled asthma.
e. It is available only through a restricted program Palforzia REMS.

Answer: (a,b,d,e). The active ingredient found in Palforzia is (Peanut (Arachis hypogaea) Allergen Powder-dnfp). It is an oral immunotherapy indicated for the mitigation of allergic reactions, including anaphylaxis, that may occur with accidental exposure to peanut. Palforzia is approved for use in patients with a confirmed diagnosis of peanut allergy.

Palforzia can cause anaphylaxis, which may be life-threatening and can occur at any time during Palforzia therapy. It is NOT indicated for the emergency treatment of allergic reactions, including anaphylaxis.

Prescribe injectable epinephrine, instruct and train patients on its appropriate use, and instruct patients to seek immediate medical care upon its use.

Do not administer Palforzia to patients with uncontrolled asthma. Observe patients during and after administration of the Initial Dose Escalation and the first dose of each Up-Dosing level, for at least 60 minutes.

Palforzia is available only through a restricted program called the Palforzia REMS.

Patients should be advised to report immediately which of the following signs or symptoms when on Clozapine therapy? [Select ALL THAT APPLY].

a. Lethargy
b. Fever
c. Sore throat
d. Weakness
e. Severe nausea and vomiting

Patients should be advised to report immediately which of the following signs or symptoms when on Clozapine therapy? [Select ALL THAT APPLY].

a. Lethargy
b. Fever
c. Sore throat
d. Weakness
e. Severe nausea and vomiting

Answer: (a,b,c,d). Clozaril (Clozapine), an atypical antipsychotic drug, is indicated for:

1. Treatment-Resistant Schizophrenia
2. Reduction in the Risk of Recurrent Suicidal Behavior in Schizophrenia or Schizoaffective Disorders

Because of a significant risk of agranulocytosis, a potentially Life-threatening adverse event, Clozaril (Clozapine) should be Reserved for use in

(1). the treatment of severely ill patients with Schizophrenia who fail to show an acceptable response to Adequate courses of standard antipsychotic drug treatment,

Or

(2). for reducing the risk of recurrent suicidal behavior in patients With schizophrenia or schizoaffective disorder who are judged to Be at risk of reexperiencing suicidal behavior.
Patients being treated with Clozapine must have a baseline white Blood cell (WBC) count and absolute neutrophil count (ANC) before initiation of treatment as well as regular WBC counts and ANCs during treatment and for at least 4 weeks after Discontinuation of treatment.

Clozapine is available only through a distribution system that Ensures monitoring of WBC count and ANC according to the Schedule described below prior to delivery of the next supply of Medication.

Agranulocytosis, defined as an ANC of less than 500/mm³, has been reported with Clozaril (Clozapine). Patients should be advised to report immediately the appearance of lethargy, weakness, fever, sore throat or any other signs of infection occurring at any time during Clozaril (Clozapine) therapy. Such patients should have a WBC count and ANC performed promptly.

Based on the genetic make-up of SARS-CoV-2, which of the following drug classes is most likely to prove effective?

a. Angiotensin converting enzyme inhibitors
b. Protease inhibitors
c. Nucleoside analogues
d. Neuraminidase inhibitors
e. Calcium channel blockers

Based on the genetic make-up of SARS-CoV-2, which of the following drug classes is most likely to prove effective?

a. Angiotensin converting enzyme inhibitors
b. Protease inhibitors
c. Nucleoside analogues
d. Neuraminidase inhibitors
e. Calcium channel blockers

Answer: (b). The SARS-CoV-2 RNA codes for a pair of protease enzymes that are essential to production of viable virions upon release. Since protease inhibitors have been highly effective for treating patients with infections of human immunodeficiency virus and hepatitis C virus, that is the best choice.

Use of neuraminidase inhibitors (e.g., oseltamivir, peramivir, zanamivir) is not logical, since coronaviruses do not have a gene for neuraminidase.

Nucleoside analogues (e.g., acyclovir, ganciclovir, ribavirin) would be expected to exert effects only at high levels since the coronavirus has an exonuclease that would recognize and remove the analogues when incorporated into the viral genome.

It is currently unknown as to whether angiotensin converting enzyme (ACE) inhibitors or angiotensin-2 receptor blockers (ARBs) are beneficial or harmful based on changes in the ACE2 protein involved in viral entry in lung tissue.

The recommended dose of Olumiant in patients taking strong Organic Anion Transporter 3 (OAT3) inhibitors is _____________.

a. 1 mg once daily
b. 2 mg once daily
c. 3 mg once daily
d. 4 mg once daily
e. Cannot be used with OAT3 inhibitors

The recommended dose of Olumiant in patients taking strong Organic Anion Transporter 3 (OAT3) inhibitors is _____________.

a. 1 mg once daily
b. 2 mg once daily
c. 3 mg once daily
d. 4 mg once daily
e. Cannot be used with OAT3 inhibitors

Answer: (a). The active ingredient found in Olumiant is Baricitinib. It is a Janus kinase (JAK) inhibitor indicated for the treatment of adult patients with moderately to severely active rheumatoid arthritis who have had an inadequate response to one or more TNF antagonist therapies.

1. The recommended dose of Olumiant (Baricitinib) in patients taking strong Organic Anion Transporter 3 (OAT3) inhibitors (e.g., probenecid) is 1 mg once daily.

2. The recommended dose of Olumiant (Baricitinib) in patients with moderate renal impairment is 1 mg once daily.

3. Olumiant (Baricitinib) is not recommended in patients with severe renal impairment.

4. Olumiant (Baricitinib) is not recommended in patients with severe hepatic impairment.

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