Pharmacists in Indiana are allowed denying the sale of ephedrine or pseudoephedrine products.

True or False

Pharmacists in Indiana are allowed denying the sale of ephedrine or pseudoephedrine products.

True or False

Answer: True. Pharmacists in Indiana may refuse to sell ephedrine or pseudoephedrine to a purchaser if the pharmacist determines that the drugs are not medically necessary, according to a recently passed law that goes into effect July 1, 2016. The pharmacist is provided with civil immunity for denying the sale, under Senate Bill 80 (SB 80).
 
The law states an individual who has a relationship on record with a pharmacy may purchase pseudoephedrine or ephedrine. However, if the purchaser does not have a relationship on record with the pharmacy, the pharmacist is required to determine whether there is a legitimate medical or pharmaceutical need for the ephedrine or pseudoephedrine.
 
A person who is denied the sale of a pseudoephedrine or ephedrine product may obtain pseudoephedrine or ephedrine pursuant to a prescription. SB 80 also adds ephedrine and pseudoephedrine to the definition of “controlled substance” for purposes of the Indiana Scheduled Prescription Electronic Collection and Tracking program. The Indiana Board of Pharmacy is required to adopt emergency rules that are effective July 1, 2016, under the bill.

Which of the following best describes the Capitation System?
 
a. Risk free income for healthcare service providers.
b. Healthcare provider may get more incentive to provide an extended treatment to a patient.
c. A fixed amount of money per patient per unit of time paid in advance to the physician for the delivery of health care services.
d. A patient gets more benefit if he/she gets services from Healthcare provider receiving reimbursement through capitation.
e. Free prescription benefits to patients.

Which of the following best describes the Capitation System?
 
a. Risk free income for healthcare service providers.
b. Healthcare provider may get more incentive to provide an extended treatment to a patient.
c. A fixed amount of money per patient per unit of time paid in advance to the physician for the delivery of health care services.
d. A patient gets more benefit if he/she gets services from Healthcare provider receiving reimbursement through capitation.
e. Free prescription benefits to patients.

Answer: Capitation payments are used by managed care organizations to control health care costs. Capitation payments control use of health care resources by putting the physician at financial risk for services provided to patients. At the same time, in order to ensure that patients do not receive suboptimal care through under-utilization of health care services, managed care organizations measure rates of resource utilization in physician practices. These reports are made available to the public as a measure of health care quality, and can be linked to financial rewards, such as bonuses.
 
Capitation is a fixed amount of money per patient per unit of time paid in advance to the physician for the delivery of health care services. The actual amount of money paid is determined by the ranges of services that are provided, the number of patients involved, and the period of time during which the services are provided. Capitation rates are developed using local costs and average utilization of services and therefore can vary from one region of the country to another. In many plans, a risk pool is established as a percentage of the capitation payment. Money in this risk pool is withheld from the physician until the end of the fiscal year. If the health plan does well financially, the money is paid to the physician; if the health plan does poorly, the money is kept to pay the deficit expenses.
 
When the primary care provider signs a capitation agreement, a list of specific services that must be provided to patients is included in the contract. The amount of the capitation will be determined in part by the number of services provided and will vary from health plan to health plan, but most capitation payment plans for primary care services include the following:
 
·         Preventive, diagnostic, and treatment services
·         Injections, immunizations, and medications administered in the office
·         Outpatient laboratory tests done either in the office or at a designated laboratory
·         Health education and counseling services performed in the office
·         Routine vision and hearing screening

Slow channel blocking drugs will reduce the movement of which substance into smooth muscle cells? (Select All that apply)

a. Renin
b. Kinin
c. Calcium
d. Sodium
e. Bradykinin

Slow channel blocking drugs will reduce the movement of which substance into smooth muscle cells? (Select All that apply)

a. Renin
b. Kinin
c. Calcium
d. Sodium
e. Bradykinin
 
Answer: (c). Slow channel blockers inhibit the slow inward calcium current, which may prolong conduction and refractoriness in the AV node.

Which of the following information is TRUE ABOUT anaerobic respiration? (Select All that apply)
 
a. Waste products are carbon dioxide and water.
b. It may produce between 36 and 38 ATP molecules.
c. In animals, including humans, the anaerobic cycle produces lactic acid, which causes muscle cramps.
d. The fermentation process in anaerobic respiration is roughly 5 percent as effective as what cells can do when they have access to oxygen.
e. In bacteria, it may produce nitrite, nitrogen gas, hydrogen sulfide, methane and acetic acid.

Which of the following information is TRUE ABOUT anaerobic respiration? (Select All that apply)
 
a. Waste products are carbon dioxide and water.
b. It may produce between 36 and 38 ATP molecules.
c. In animals, including humans, the anaerobic cycle produces lactic acid, which causes muscle cramps.
d. The fermentation process in anaerobic respiration is roughly 5 percent as effective as what cells can do when they have access to oxygen.
e. In bacteria, it may produce nitrite, nitrogen gas, hydrogen sulfide, methane and acetic acid.
 
Answer (c, d and e). "Anaerobic" means without oxygen, and respiration refers to the processes in a cell that convert biochemical energy, such as that found in glucose, into usable energy in the form of ATP. Waste products like carbon dioxide are also produced during this process.

The fermentation process in anaerobic respiration is roughly 5 percent as effective as what cells can do when they have access to oxygen. An aerobic cycle may produce between 36 and 38 ATP molecules, while anaerobic respiration only creates 2 ATP molecules.

Since muscles often run out of oxygen during extreme exertion, anaerobic respiration keeps them running. In animals, including humans, the anaerobic cycle produces lactic acid, which causes muscle cramps. In order for these cramps to stop, oxygen must find its way back into the muscle again so these cells can switch back to aerobic respiration and stop building up lactic acid.

Anaerobic respiration is also common in bacteria that live in environments without oxygen; depending on the bacteria, the products of their respiration include nitrite, nitrogen gas, hydrogen sulfide, methane and acetic acid.

New York Law Mandate Electronic Prescribing Law.

Prescribers in the state of New York must issue electronic prescriptions directly to a pharmacy according to a new law. All prescriptions must be transmitted in electronic format, except for certain limited circumstances, effective March 27, 2016, under the Internet System for Tracking Over-Prescribing (I-STOP) Act. The regulations require prescribers and pharmacists to have a secure system for electronic transmission of the prescription from computer to computer in order to protect the confidentiality of patient information, notes the Office of the Professions (OP) advisory notice. For additional information on the electronic transmittal of prescriptions in New York, visit the OP section of the New York State Education Department website.
 
The New York Times states that New York is the first state to mandate electronic prescribing and enforce penalties, such as fines and imprisonment, for physicians who do not comply. The New York Times also notes that Minnesota has an electronic prescribing law but does not enforce or fine physicians for not complying with the mandate.

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.

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

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.

Source: www.pharmacyexam.com

Which of the following information about Lesinurad is/are TRUE? (Select All that apply).
 
a. Acute liver failure has reported with Lesinurad.
b. Lesinurad should be used in combination with a xanthine oxidase inhibitor.
c. The recommended dose is 200 mg once daily.
d. Lesinurad is a xanthine oxidase inhibitor.
e. Lesinurad is indicated for the treatment of hyperuricemia associated with gout.

Which of the following information about Lesinurad is/are TRUE? (Select All that apply).
 
a. Acute liver failure has reported with Lesinurad.
b. Lesinurad should be used in combination with a xanthine oxidase inhibitor.
c. The recommended dose is 200 mg once daily.
d. Lesinurad is a xanthine oxidase inhibitor.
e. Lesinurad 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.

Source: www.pharmacyexam.com

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).

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.