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Which of the following rating scales is commonly used to evaluate the severity of extrapyramidal symptoms (EPS)? [Select ALL that apply]

a. SAS
b. BARS
c. AIMS
d. ESRS
e. PDS


Which of the following rating scales is commonly used to evaluate the severity of extrapyramidal symptoms (EPS)? [Select ALL that apply]

a. SAS
b. BARS
c. AIMS
d. ESRS
e. PDS

Answer: (a,b,c,d). Extrapyramidal symptoms (EPS) are drug-induced movement disorders that include acute and tardive symptoms.

These symptoms include dystonia (continuous spasms and muscle contractions), akathisia (motor restlessness), Parkinsonism (characteristic symptoms such as rigidity, bradykinesia, and tremor), and tardive dyskinesia (irregular, jerky movements).

Since it is difficult to measure extrapyramidal symptoms, rating scales are commonly used to assess the severity of movement disorders.

The Simpson-Angus Scale (SAS), Barnes Akathisia Rating Scale (BARS), Abnormal Involuntary Movement Scale (AIMS), and Extrapyramidal Symptom Rating Scale (ESRS) are rating scales frequently used for such assessment and are not weighted for diagnostic purposes.

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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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Dificid should be used only to treat infections that are proven or strongly suspected to be caused by:

a. Staphylococcus aureus
b. Streptococcus pyogenes
c. Escherichia coli
d. Haemophilus influenzae
e. Clostridium difficile


Dificid should be used only to treat infections that are proven or strongly suspected to be caused by:

a. Staphylococcus aureus
b. Streptococcus pyogenes
c. Escherichia coli
d. Haemophilus influenzae
e. Clostridium difficile

Answer: (e).

The active ingredient found in Dificid is Fidaxomicin. It is a macrolide antibacterial drug for oral administration. Dificid is a macrolide antibacterial medicine indicated in adults and pediatric patients aged 6 months and older for treatment of Clostridium difficile-associated diarrhea (CDAD).

The recommended adult dose is one 200 mg Dificid tablet orally twice daily for 10 days with or without food. It is available as tablet and oral suspension dosage form.

Anemia, neutropenia, nausea, vomiting and abdominal pain are commonly reported side effects of Dificid.



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Which of the following inhibits CYP 3A4?

a. Omeprazole
b. Lansoprazole
c. Pantoprazole
d. Rabeprazole
e. Esomeprazole


Answer: (a) Below is the list of drugs that inhibit specifically CYP 3A4:

1. Amiodarone
2. Anastrozole
3. Azithromycin
4. Cannabinoids
5. Cimetidine
6. Clarithromycin
7. Clotrimazole
8. Cyclosporine
9. Danazol
10. Delavirdine
11. Dexamethasone
12. Diethyldithiocarbamate
13. Diltiazem
14. Dirithromycin
15. Disulfiram
16. Entacapone (high dose)
17. Erythromycin
18. Ethinyl estradiol
19. Fluconazole
20. Fluoxetine
21. Fluvoxamine
22. Gestodene
23. Grapefruit juice
24. Indinavir
25. Isoniazid
26. Ketoconazole
27. Metronidazole
28. Mibefradil
29. Miconazole
30. Nefazodone
31. Nelfinavir
32. Nevirapine
33. Norfloxacin
34. Norfluoxetine
35. Omeprazole
36. Oxiconazole
37. Paroxetine (weak)
38. Propoxyphene
39. Quinidine
40. Quinine
41. Quinupristin and Dalfopristin
42. Ranitidine
43. Ritonavir
44. Saquinavir
45. Sertindole
46. Sertraline
47. Troglitazone
48. Troleandomycin
49. Valproic acid

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Addyi (Flibanserin) is indicated for the treatment of:

a. PTSD
b. STD
c. HSDD
d. PTD
e. OCD


Addyi (Flibanserin) is indicated for the treatment of:

a. PTSD
b. STD
c. HSDD
d. PTD
e. OCD

Answer: HSDD. The U.S. Food and Drug Administration has approved Addyi (Flibanserin) to treat acquired, generalized hypoactive sexual desire disorder (HSDD) in premenopausal women. Prior to Addyi's approval, there were no FDA-approved treatments for sexual desire disorders in men or women.

HSDD is characterized by low sexual desire that causes marked distress or interpersonal difficulty and is not due to a co-existing medical or psychiatric condition, problems within the relationship, or the effects of a medication or other drug substance.

HSDD is acquired when it develops in a patient who previously had no problems with sexual desire. HSDD is generalized when it occurs regardless of the type of sexual activity, the situation or the sexual partner.

Because of a potentially serious interaction with alcohol, treatment with Addyi will only be available through certified health care professionals and certified pharmacies.

Addyi can cause severely low blood pressure (hypotension) and loss of consciousness (syncope). These risks are increased and more severe when patients drink alcohol or take Addyi with certain medicines (known as moderate or strong CYP3A4 inhibitors) that interfere with the breakdown of Addyi in the body. Because of the alcohol interaction, the use of alcohol is contraindicated while taking Addyi.

Addyi is being approved with a risk evaluation and mitigation strategy (REMS), which includes elements to assure safe use (ETASU). The FDA is requiring this REMS because of the increased risk of severe hypotension and syncope due to the interaction between Addyi and alcohol.

The REMS requires that prescribers be certified with the REMS program by enrolling and completing training. Certified prescribers must counsel patients using a Patient-Provider Agreement Form about the increased risk of severe hypotension and syncope and about the importance of not drinking alcohol during treatment with Addyi.

Additionally, pharmacies must be certified with the REMS program by enrolling and completing training. Certified pharmacies must only dispense Addyi to patients with a prescription from a certified prescriber. Additionally, pharmacists must counsel patients prior to dispensing not to drink alcohol during treatment with Addyi.

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

a. The active ingredient is Dulaglutide.
b. It is indicated for the treatment of migraine.
c. It is a glucagon-like peptide-1 (GLP-1) receptor agonist.
d. Initiate at 0.75 mg subcutaneously once weekly.
e. Contraindicated in patients with a personal or family history of medullary thyroid carcinoma.


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

a. The active ingredient is Dulaglutide.
b. It is indicated for the treatment of migraine.
c. It is a glucagon-like peptide-1 (GLP-1) receptor agonist.
d. Initiate at 0.75 mg subcutaneously once weekly.
e. Contraindicated in patients with a personal or family history of medullary thyroid carcinoma.

Answer: (a,c,d,e)

The active ingredient found in Trulicity is Dulaglutide. It is available as an injection (0.75mg/0.5ml, 1.5mg/0.5ml) administered subcutaneously in the abdomen, thigh, or upper arm.

It is a glucagon-like peptide-1 (GLP-1) receptor agonist indicated:

1. as an adjunct to diet and exercise to improve glycemic control in adults with type 2 diabetes mellitus.

2. to reduce the risk of major adverse cardiovascular events in adults with type 2 diabetes mellitus who have established cardiovascular disease or multiple cardiovascular risk factors.

Dulaglutide activates the GLP-1 receptor, a membrane-bound cell-surface receptor coupled to adenylyl cyclase in pancreatic beta cells. Dulaglutide increases intracellular cyclic AMP (cAMP) in beta cells leading to glucose-dependent insulin release. Dulaglutide also decreases glucagon secretion and slows gastric emptying.

The drug should be administered once weekly. The drug should be initiated at 0.75 mg subcutaneously once weekly. Dose can be increased to 1.5 mg once weekly for additional glycemic control.

If a dose is missed, administer the missed dose as soon as possible if there are at least 3 days (72 hours) until the next scheduled dose.

It is contraindicated in patients with a personal or family history of medullary thyroid carcinoma or in patients with Multiple Endocrine Neoplasia syndrome type 2.

Nausea, diarrhea, vomiting, abdominal pain, and decreased appetite are commonly reported side effects of the drug.


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

I. The active ingredient is Levetiracetam.
II. It is the first FDA approved drug that uses ZipDose technology.
III. It is indicated for the treatment of depression.

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


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

I. The active ingredient is Levetiracetam.
II. It is the first FDA approved drug that uses ZipDose technology.
III. It is indicated for the treatment of depression.

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

Answer: I and II only. Levetiracetam (Spritam) is indicated for the treatment of partial onset seizures, myoclonic seizures and primary generalized tonic-clonic seizures in adults and children with epilepsy.

Spritam utilizes Aprecia's proprietary ZipDose Technology platform, a groundbreaking advance that uses three-dimensional printing (3DP) to produce a porous formulation that rapidly disintegrates with a sip of liquid.1 While 3DP has been used previously to manufacture medical devices, this approval marks the first time a drug product manufactured with this technology has been approved by the FDA.

ZipDose Technology enables the delivery of a high drug load, up to 1,000 mg in a single dose. As a result, Spritam enhances the patient experience - administration of even the largest strengths of Levetiracetam (Spritam) with just a sip of liquid. In addition, with Spritam there is no measuring required as each dose is individually packaged, making it easy to carry this treatment on the go.

The recommended daily dose is 1000 to 3000 mg per day.

Sleepiness, weakness, dizziness, infection, tiredness, acting aggressive, nasal congestion, decreased appetite, and irritability are commonly reported side effects of Levetiracetam (Spritam).

Levetiracetam is also available under the trade names Keppra, Keppra XR, Spritam, Elepsia, Elepsia XR and Roweepra.
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Which of the following is/are considered Diabetes Risk Factor(s)? [Select ALL THAT APPLY].

a. Physical inactivity.
b. Women who delivered a baby greater than 9 lb.
c. First-degree relative with diabetes.
d. High-risk race/ethnicity
e. Hypertension greater or equal to 140/90 mm Hg

A. a
B. b
C. c
D. d
E. e


Which of the following is/are considered Diabetes Risk Factor(s)? [Select ALL THAT APPLY].

a. Physical inactivity.
b. Women who delivered a baby greater than 9 lb.
c. First-degree relative with diabetes.
d. High-risk race/ethnicity
e. Hypertension greater or equal to 140/90 mm Hg

A. a
B. b
C. c
D. d
E. e

Answer (a,b,c,d,e). Diabetes Risk Factors:

1. Physical inactivity.
2. First-degree relative with diabetes.
3. Women who delivered a baby >9 lb or were diagnosed with GDM.
4. High-risk race/ethnicity.
5. A1C greater or equal to 5.7%, Impaired Glucose Tolerance (IGT), or Impaired Fasting Glucose (IFG) on previous testing.
6. Hypertension ( greater or equal to 140/90 mm Hg or on therapy).
7. HDL-C <35 mg/dL plus or minus TG >250 mg/dL.


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According to ADA guidelines, the value of A1C% 10 reflects the mean plasma glucose level:
 
a. 126 mg/dl
b. 183 mg/dl
c. 240 mg/dl
d. 269 mg/dl
e. 298 mg/dl


According to ADA guidelines, the value of A1C% 10 reflects the mean plasma glucose level:

a. 126 mg/dl
b. 183 mg/dl
c. 240 mg/dl
d. 269 mg/dl
e. 298 mg/dl

Answer: (c). 240 mg/dl. Below is the chart that describes the correlation between A1C% and blood glucose concentration in mg/dl.

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Which of the following is commonly known as “Z-Drug”?
 
a. Humira
b. Zyprexa
c. Ambien
d. Axid
e. Unisom


Which of the following is commonly known as “Z-Drug”?
 
a. Humira
b. Zyprexa
c. Ambien
d. Axid
e. Unisom
 
Answer: (c) The Z-drugs, which include Eszopiclone (Lunesta), Zolpidem (Ambien), and Zaleplon (Sonata), are benzodiazepine receptor agonists.  That means they work in a similar way to the benzodiazepine drugs inside the brain.  They are GABA agonists meaning they somewhat mimic the action of gamma-Aminobutyric acid, the inhibitory neurotransmitter and thereby induce sleepiness.
 
These drugs are sometimes referred to as non-benzodiazepine hypnotics or just non-benzodiazepines.  That's a dumb name, if you ask us.  Too unspecific and vague, especially if you are not in the context of sleep medicine.  Further, even within sleep medicine, there are compounds that are non-benzodiazepine hypnotics that would not be considered part of this class: antihistamines and Ramelteon, for instance.

One problem is that the chemists don't have a category that these drugs all fall into which is narrow enough to signify what medical practitioners are talking about.  These drugs are in the categories pyrazolopyrimidines, imidazopyridines or cyclopyrrones, but they are not all in the same category.

Therefore, we prefer the term Z-drugs.  The generic names for these drugs all contain the letter Z, and it is as good a name as any.
 
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