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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.

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Which of the following glucagon‐like peptide‐1 receptor agonists (GLP‐1 RAs) is administered subcutaneously once daily? [Select ALL THAT APPLY].

a. Byetta
b. Adlyxin
c. Victoza
d. Trulicity
e. Tanzeum


Which of the following glucagon‐like peptide‐1 receptor agonists (GLP‐1 RAs) is administered subcutaneously once daily? [Select ALL THAT APPLY].

a. Byetta
b. Adlyxin
c. Victoza
d. Trulicity
e. Tanzeum

Answer (b,c)



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

a. The active ingredient is Clascoterone.
b. It is an estrogen receptor inhibitor.
c. Indicated for the treatment of acne vulgaris.
d. It should only be used in patients 12 years of age or younger.
e. It is available as topical gel.


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

a. The active ingredient is Clascoterone.
b. It is an estrogen receptor inhibitor.
c. Indicated for the treatment of acne vulgaris.
d. It should only be used in patients 12 years of age or younger.
e. It is available as topical gel.

Answer: (a,c).

The active ingredient found in Winlevi is Clascoterone. It is available as cream. Each gram of Winlevi cream contains 10 mg of Clascoterone. It is an androgen receptor inhibitor indicated for the topical treatment of acne vulgaris in patients 12 years of age and older. Erythema/reddening, pruritus, scaling/dryness, edema, stinging, and burning are commonly reported side effects of Winlevi.

Clascoterone is first-in-class topical androgen receptor inhibitor that tackles the androgen hormone component of acne in both males and females. Androgen receptor inhibitors act by limiting the effects of these hormones on increasing sebum production and inflammation.

Acne is a multifactorial skin condition, affected by four distinct pathways: excess oil (sebum) production, clogged pores (hyperkeratinization), bacteria growth (C. acnes), and inflammation. Topical treatment options that target androgens, which largely drive sebum production and inflammation, presented a significant unmet need in the acne treatment market until now.

Elevated potassium levels (Hyperkalemia) were observed in some patients during the clinical trials.

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What is the principal advantage of Olinvyk, a newly approved opioid pain reliever, over available other opioid analgesics?

a. Cheap
b. Less chance of abuse
c. no dosage adjustments in patients with renal impairment
d. does not cause fatal respiratory depression
e. more patient compliance due to its oral dosage form


What is the principal advantage of Olinvyk, a newly approved opioid pain reliever, over available other opioid analgesics?

a. Cheap
b. Less chance of abuse
c. no dosage adjustments in patients with renal impairment
d. does not cause fatal respiratory depression
e. more patient compliance due to its oral dosage form

Answer: (c). Olinvyk is an opioid agonist that is the first new chemical entity in this IV drug class in decades and offers a differentiated profile that addresses a significant unmet need in the acute pain management landscape. Olinvyk delivers IV opioid efficacy with a rapid 2-5 minute onset of action. In addition, Olinvyk requires no dosage adjustments in patients with renal impairment, a large patient population with significant medical complications.

"Complex patients present unique challenges in the management of their postoperative acute pain, due to the presence of medical comorbidities that can complicate dosing," said Gregory Hammer, M.D., Professor of Anesthesiology, Perioperative and Pain Medicine, and of Pediatrics at Stanford University. "Olinvyk represents a new alternative for clinicians, due to its rapid onset of action, effective pain relief, and unique profile."

The active ingredient found in Olinvyk is Oliceridine. It is available in injection dosage form. Because of the risks of addiction, abuse, and misuse with opioids, even at recommended doses, reserve Olinvyk for use in patients for whom alternative treatment options [e.g., non-opioid analgesics or opioid combination products]:

1. Have not been tolerated, or are not expected to be tolerated
2. Have not provided adequate analgesia, or are not expected to provide adequate analgesia.

The cumulative total daily dose should not exceed 27 mg.

Dosage Administration:

1. Use the lowest effective dosage for the shortest duration consistent with individual patient treatment goals.

2. Individualize dosing based on the severity of pain, patient response, prior analgesic experience, and risk factors for addiction, abuse, and misuse.

3. Initiate treatment with a 1.5 mg dose.

4. For patient controlled analgesia (PCA), recommended demand dose is 0.35 mg, with a 6-minute lock-out. A demand dose of 0.5 mg may be considered.

Serious, life-threatening, or fatal respiratory depression may occur. Monitor for respiratory depression, especially during initiation or following a dose increase.
Concomitant use of Olinvyk with benzodiazepines or other CNS depressants, including alcohol, may result in profound sedation, respiratory depression, coma, and death.
Concomitant use with Serotonergic Drugs may result in serotonin syndrome. Discontinue Olinvyk if serotonin syndrome is suspected.

Nausea, vomiting, dizziness, headache and hypotension are reported side effects of the drug.

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Who developed a Pharmacy Toolkit to help pharmacists engage and educate patients about the safe use, storage, and disposal of pain medicines?

a. CDC
b. CMSA
c. ASHP
d. AAOA
e. FTC


Answer: (d), In collaboration with its pharmacy partners and several state pharmacy associations, Allied Against Opioid Abuse (AAOA) developed a Pharmacy Toolkit to help pharmacists engage and educate patients about the safe use, storage, and disposal of pain medicines.

The AAOA Pharmacy Toolkit includes resources to help pharmacists raise awareness among patients about their rights, risks, and responsibilities associated with prescription opioids.

These resources include: a pharmacy display, patient handout, patient engagement guide, tips for talking with patients and caregivers, prescriber engagement guide, safe storage and disposal training, and social graphics.

To learn more about the Pharmacy Toolkit, please visit:

https://againstopioidabuse.org/

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The FDA has recently approved Xywav for the treatment of cataplexy or excessive daytime sleepiness (EDS) in patients 7 years of age and older with narcolepsy. Another drug Xyrem is available for the same indication in the US. What is a principal advantage of using Xywav over Xyrem?

a. Less side effects
b. Less potential for abuse
c. Low sodium contents
d. More potency
e. Cheaper


The FDA has recently approved Xywav for the treatment of cataplexy or excessive daytime sleepiness (EDS) in patients 7 years of age and older with narcolepsy. Another drug Xyrem is available for the same indication in the US. What is a principal advantage of using Xywav over Xyrem?

a. Less side effects
b. Less potential for abuse
c. Low sodium contents
d. More potency
e. Cheaper

Answer: C

The active ingredients found in Xywav is (calcium, magnesium, potassium, and sodium oxybates) oral solution. It is for the treatment of cataplexy or excessive daytime sleepiness (EDS) in patients 7 years of age and older with narcolepsy.

Xywav is an oxybate product with a unique composition of cations resulting in 92 percent less sodium - or approximately 1,000 to 1,500 mg/night - than sodium oxybate at the recommended dosage range of 6 to 9 grams.

Multiple Xywav dosing options are available for adult and pediatric patients. Prescribers can titrate Xywav into unequal doses taken over the course of the night. When patients start Xywav after sodium oxybate, Xywav treatment is initiated at the same dose and regimen as sodium oxybate (gram for gram) and titrated as needed based on efficacy and tolerability.

Xywav makes it possible for patients to have a lower-sodium oxybate treatment option. This may help patients taking sodium oxybate better align with daily sodium intake recommendations including those by the American Heart Association. Excess sodium intake has been linked with increases in blood pressure, hypertension, stroke, and other cardiovascular disease.

Xyrem (Sodium oxybate) carries warnings about its high sodium content,10 and was previously the only product approved to treat both cataplexy and EDS in patients with narcolepsy 7 years of age and older and designated as a standard of care for the treatment of cataplexy and EDS by the American Academy of Sleep Medicine.
Xywav has a Boxed Warning as a central nervous system depressant, and for its potential for abuse and misuse. Because of the risks of CNS depression and abuse and misuse, Xywav is available only through a restricted program under a REMS called the Xywav and Xyrem REMS Program.

Most common adverse reactions in adults are headache, nausea, dizziness, decreased appetite, parasomnia, diarrhea, hyperhidrosis, anxiety and vomiting.

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Entresto is indicated for the treatment of:

a. Hypertension
b. Heart failure
c. Depression
d. Type II diabetes mellitus
e. Panic disorder


Entresto is indicated for the treatment of:

a. Hypertension
b. Heart failure
c. Depression
d. Type II diabetes mellitus
e. Panic disorder

Answer: b. The active ingredients found in Entresto are Sacubitril and Valsartan. Sacubitril is a neprilysin inhibitor whereas Valsartan is an angiotensin II receptor blocker.

It is available as tablets (24/26 mg, 49/51 mg and 97/103 mg).

It is indicated:

1. to reduce the risk of cardiovascular death and hospitalization for heart failure in patients with chronic heart failure (NYHA Class II-IV) and reduced ejection fraction. It is usually administered in conjunction with other heart failure therapies, in place of an ACE inhibitor or other ARB.

2. for the treatment of symptomatic heart failure with systemic left ventricular systolic dysfunction in pediatric patients aged one year and older.



Hypotension, hyperkalemia, cough, dizziness and renal failure are reported side effects of the drug.

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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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