Which of the following is/are false positive tuberculin skin test reactions? [Select All that apply]

a. Infection with non-tuberculosis mycobacteria
b. Cutaneous anergy
c. Previous BCG vaccination
d. Very old TB infection
e. Recent live-virus vaccination

Which of the following is/are false positive tuberculin skin test reactions? [Select All that apply]

a. Infection with non-tuberculosis mycobacteria
b. Cutaneous anergy
c. Previous BCG vaccination
d. Very old TB infection
e. Recent live-virus vaccination

Answer: (a,c). The Mantoux tuberculin skin test (TST) is the standard method of determining whether a person is infected with Mycobacterium tuberculosis. Reliable administration and reading of the TST requires standardization of procedures, training, supervision, and practice.

The TST is performed by injecting 0.1 ml of tuberculin purified protein derivative (PPD) into the inner surface of the forearm. The injection should be made with a tuberculin syringe, with the needle bevel facing upward. The TST is an intradermal injection. When placed correctly, the injection should produce a pale elevation of the skin (a wheal) 6 to 10 mm in diameter.

The skin test reaction should be read between 48 and 72 hours after administration. A patient who does not return within 72 hours will need to be rescheduled for another skin test.

The reaction should be measured in millimeters of the induration (palpable, raised, hardened area or swelling). The reader should not measure erythema (redness). The diameter of the indurated area should be measured across the forearm (perpendicular to the long axis).

Skin test interpretation depends on two factors:

1. Measurement in millimeters of the induration
2. Person's risk of being infected with TB and of progression to disease if infected

What Are False-Positive Reactions?

Some persons may react to the TST even though they are not infected with M. tuberculosis. The causes of these false-positive reactions may include, but are not limited to, the following:

1. Infection with non-tuberculosis mycobacteria
2. Previous BCG vaccination
3. Incorrect method of TST administration
4. Incorrect interpretation of reaction
5. Incorrect bottle of antigen used

What Are False-Negative Reactions?

Some persons may not react to the TST even though they are infected with M. tuberculosis. The reasons for these false-negative reactions may include, but are not limited to, the following:

1. Cutaneous anergy (anergy is the inability to react to skin tests because of a weakened immune system)
2. Recent TB infection (within 8-10 weeks of exposure)
3. Very old TB infection (many years)
4. Very young age (less than 6 months old)
5. Recent live-virus vaccination (e.g., measles and smallpox)
6. Overwhelming TB disease
7. Some viral illnesses (e.g., measles and chicken pox)
8. Incorrect method of TST administration
9. Incorrect interpretation of reaction

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Thiazide diuretics should NOT be used as a first line treatment for hypertension in patient suffering from:

a. Hyperlipidemia
b. Heart failure
c. COPD
d. Gout
e. Peripheral artery disease

Thiazide diuretics should NOT be used as a first line treatment for hypertension in patient suffering from:

a. Hyperlipidemia
b. Heart failure
c. COPD
d. Gout
e. Peripheral artery disease

Answer :(d). Thiazide diuretics may increase the reabsorption of uric acid from renal tubules and may cause hyperuricemia. It should NOT be used as a first line treatment for hypertension in patient suffering from gout.

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Which of the following inhibits CYP 3A4?

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

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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Home ovulation tests usually detect a preovulatory surge in which of the following in the urine?

a. Prolactin
b. Oestrogen
c. Oxytocin
d. Progesterone
e. Luteinizing hormone

Home ovulation tests usually detect a preovulatory surge in which of the following in the urine?

a. Prolactin
b. Oestrogen
c. Oxytocin
d. Progesterone
e. Luteinizing hormone

Answer: (e). An ovulation home test is used by women to help determine the time in the menstrual cycle when getting pregnant is most likely. The test detects a rise in luteinizing hormone (LH) in the urine. A rise in this hormone signals the ovary to release the egg.

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Khedezla is indicated for the treatment of which of the following?...

Khedezla is indicated for the treatment of which of the following?

a. Hypertension
b. Depression
c. Arthritis
d. Type II diabetes
e. Parkinsons

Answer: (b) Depression

The active ingredient found in Khedezla is Desvenlafaxine. Desvenlafaxine (O-desmethylvenlafaxine) is the major active metabolite of the antidepressant Effexor (Venlafaxine), a medication used to treat major depressive disorder.
 
Khedezla contains the serotonin and norepinephrine reuptake inhibitor (SNRI) Desvenlafaxine, which is also contained in Pristiq. Pristiq was approved by the FDA in 2008 and contains Desvenlafaxine as the succinate salt.
 
Khedezla will be available in 50 mg and 100 mg strengths for once daily administration. The recommended dose for Khedezla is 50 mg once daily, with or without food. It should be taken at approximately the same time each day. Tablets must be swallowed whole with fluid and not divided, crushed, chewed, or dissolved.
 
In clinical studies, doses of 50 mg to 400 mg per day were shown to be effective, although no additional benefit was demonstrated at doses greater than 50 mg per day and adverse reactions and discontinuations were more frequent at higher doses.
 
Nausea, dizziness, insomnia, hyperhidrosis (excessive sweating), constipation, drowsiness, decreased appetite, anxiety, and specific male sexual function disorders are commonly reported side effects of the drug.
 

What is the active ingredient found in Paxlovid? [Select ALL THAT APPLY]

a. Viramune
b. Saquinavir
c. Ritonavir
d. Nirmatrelvir
e. Remdesivir

What is the active ingredient found in Paxlovid? [Select ALL THAT APPLY]

a. Viramune
b. Saquinavir
c. Ritonavir
d. Nirmatrelvir
e. Remdesivir

Answer: (c and d). The active ingredient founds in Paxlovid are Nirmatrelvir and Ritonavir. Nirmatrelvir is a SARS-CoV-2 main protease (Mpro) inhibitor, and Ritonavir is an HIV-1 protease inhibitor and CYP3A inhibitor. Nirmatrelvir is available as immediate-release, film-coated tablets. Each tablet contains 150 mg Nirmatrelvir. Ritonavir is available as film-coated tablets. Each tablet contains 100 mg Ritonavir.

The U.S. Food and Drug Administration (FDA) has issued an Emergency Use Authorization (EUA) for the emergency use of the unapproved product Paxlovid for the treatment of mild-to-moderate coronavirus disease 2019 (COVID-19) in adults and pediatric patients (12 years of age and older weighing at least 40 kg) with positive results of direct severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) viral testing, and who are at high risk1 for progression to severe COVID-19, including hospitalization or death.

Paxlovid may only be prescribed for an individual patient by physicians, advanced practice registered nurses, a licensed pharmacist and physician assistants that are licensed or authorized under state law to prescribe drugs in the therapeutic class to which Paxlovid belongs (i.e., ant infectives).

Nirmatrelvir must be co-administered with ritonavir. Failure to correctly co-administer Nirmatrelvir with ritonavir may result in plasma levels of Nirmatrelvir that are insufficient to achieve the desired therapeutic effect.

The dosage for Paxlovid is 300 mg Nirmatrelvir (two 150 mg tablets) with 100 mg ritonavir (one 100 mg tablet) with all three tablets taken together orally twice daily for 5 days. Prescriptions should specify the numeric dose of each active ingredient within Paxlovid. Completion of the full 5-day treatment course and continued isolation in accordance with public health recommendations are important to maximize viral clearance and minimize transmission of SARS-CoV-2.

The 5-day treatment course of Paxlovid should be initiated as soon as possible after a diagnosis of COVID-19 has been made, and within 5 days of symptom onset. Should a patient require hospitalization due to severe or critical COVID-19 after starting treatment with Paxlovid, the patient should complete the full 5-day treatment course per the healthcare provider's discretion.

Paxlovid (both Nirmatrelvir and Ritonavir tablets) can be taken with or without food.

Dysgeusia, diarrhea, hypertension, and myalgia are reported side effects of Paxlovid.

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.