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Using the NARxCHECK, a pharmacist is receiving a scaled score of 650 for a particular patient. Which of the following statements based on this scaled score is TRUE?

a. Very low risk for misuse
b. low risk for misuse
c. moderate risk for misuse
d. High risk for misuse


Using the NARxCHECK, a pharmacist is receiving a scaled score of 650 for a particular patient. Which of the following statements based on this scaled score is TRUE?

a. Very low risk for misuse
b. low risk for misuse
c. moderate risk for misuse
d. High risk for misuse

Answer: High risk for misuse.

NARXCHECK is an automatic prescription drug abuse assessment and management tool for health care providers. Once integrated into the facility's system, NARxCHECK automatically queries the state PMP database to generate a report that includes a score for three different drug classes: narcotics, sedatives, and stimulants.

These three-digit scores (000-999) help practitioners to decide whether or not they need to review a patient history before prescribing additional medications.

The score is easy to read using the following guidelines:

1. Less than 200 = Be confident - low risk for misuse.

2. 200 - 500 = Be curious - moderate risk for misuse.

3. Greater than 500 = Be cautious - higher risk for misuse.

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

I. It is commonly known as RU-486.

II. It is indicated for the medical termination of intrauterine pregnancy through 49 days' pregnancy.

III. The recommended dose is one (200 mg Mifepristone) as a single oral dose.

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


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

I. It is commonly known as RU-486.

II. It is indicated for the medical termination of intrauterine pregnancy through 49 days' pregnancy.

III. The recommended dose is one (200 mg Mifepristone) as a single oral dose.

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

Answer: I and II are true. Mifepristone (Mifeprex) is a synthetic steroid with antiprogestational effects.

Mifepristone (Mifeprex) is indicated for the medical termination of intrauterine pregnancy through 49 days' pregnancy. For purposes of this treatment, pregnancy is dated from the first day of the last menstrual period in a presumed 28 day cycle with ovulation occurring at mid-cycle.

The duration of pregnancy may be determined from menstrual history and by clinical examination. Ultrasonographic scan should be used if the duration of pregnancy is uncertain, or if ectopic pregnancy is suspected.

Any intrauterine device ("IUD") should be removed before treatment with Mifepristone (Mifeprex) begins.

Patients taking Mifepristone (Mifeprex) must take 400 μg of Misoprostol two days after taking Mifepristone (Mifeprex) unless a complete abortion has already been confirmed before that time.

Day One: Mifeprex Administration

Patients must read the MEDICATION GUIDE and read and sign the PATIENT AGREEMENT before Mifeprex is administered.

Three 200 mg tablets (600 mg) of Mifeprex are taken in a single oral dose.

Day Three: Misoprostol Administration

The patient returns to the health care provider two days after ingesting Mifeprex. Unless abortion has occurred and has been confirmed by clinical examination or ultrasonographic scan, the patient takes two 200 μg tablets (400 μg) of misoprostol orally.

During the period immediately following the administration of Misoprostol, the patient may need medication for cramps or gastrointestinal symptoms.

The patient should be given instructions on what to do if significant discomfort, excessive vaginal bleeding or other adverse reactions occur and should be given a phone number to call if she has questions following the administration of the Misoprostol.

In addition, the name and phone number of the physician who will be handling emergencies should be provided to the patient.

Day 14: Post-Treatment Examination

Patients will return for a follow-up visit approximately 14 days after the administration of Mifeprex. This visit is very important to confirm by clinical examination or ultrasonographic scan that a complete termination of pregnancy has occurred.

Pregnancy termination by surgery is recommended in cases when Mifepristone (Mifeprex) and misoprostol fail to cause termination of intrauterine pregnancy
Serious and sometimes fatal infections and bleeding occur very rarely following spontaneous, surgical, and medical abortions, including following Mifepristone (Mifeprex) use.
Ensure that the patient knows whom to call and what to do, including going to an Emergency Room if none of the provided contacts are reachable, if she experiences sustained fever, severe abdominal pain, prolonged heavy bleeding, or syncope, or if she experiences abdominal pain or discomfort or general malaise (including weakness, nausea, vomiting or diarrhea) more than 24 hours after taking Misoprostol.

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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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Which of the following is commonly known as “Purple Pill”?
 
a. Prilosec
b. Tagamet
c. Protonix
d. Axid
e. Nexium


Which of the following is commonly known as “Purple Pill”?
 
a. Prilosec
b. Tagamet
c. Protonix
d. Axid
e. Nexium
 
Answer: (e) Esomeprazole (Nexium). Esomeprazole (Nexium) is the S-Isomer of Omeprazole (Prilosec). It is classified as a Proton Pump Inhibitor (PPI). It is indicated for the treatment of duodenal ulcer, gastric ulcer, Zollinger Ellison Syndrome and GERD. The OTC version of Esomeprazole (Nexium) 24 HR is also commonly known as "Purple Pill".
 
It is supplied in delayed-release capsules and in packets for a delayed-release oral suspension. Each delayed-release capsule contains 20 mg, or 40 mg of Esomeprazole (Nexium). Each packet of Esomeprazole (Nexium) for delayed-release oral suspension contains 2.5 mg, 5 mg, 10 mg, 20 mg, or 40 mg of Esomeprazole (Nexium), in the form of the same enteric-coated granules used in Esomeprazole (Nexium) delayed-release capsules.
 
The recommended dose is 20 to 40 mg once daily for 4 to 8 weeks.
 
Diarrhea, nausea, flatulence, abdominal pain, constipation, and dry mouth are commonly reported side effects of Esomeprazole (Nexium).
 
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Coricidin HBP Night is contraindicated to use in patients suffering from:
 
I.  Hypertension
II. Glaucoma
III. BPH
 
a. I only
b. III only
c. I and II only
d. II and III only
e. All


Coricidin HBP Night is contraindicated to use in patients suffering from:
 
I.  Hypertension
II. Glaucoma
III. BPH
 
a. I only
b. III only
c. I and II only
d. II and III only
e. All
 
Answer: (d) II and III only. All Coricidin HBP (High Blood Pressure) products are free of decongestants and therefore they can safely be used in patients suffering from high blood pressure. The active ingredients found in Coricidin HBP Night are 500mg Acetaminophen, 10mg Dextromethorphan Hydrobromide and 2mg Chlorpheniramine. The active ingredients found in Coricidin HBP Day are 10mg Dextromethorphan Hydrobromide and 200mg Guaifenesin.
 
It is indicated for the symptomatic relief of cold and cough, runny nose and sneezing, and bronchial irritation. Since Coricidin HBP Night contains anti-histamine (Chlorpheniramine), it shall be carefully prescribed to patients suffering from glaucoma or BPH.
 
The recommended dose is 1 tablet every 6 hours, not more than 4 tablets in 24 hours.
 
Nausea, vomiting, sedation, drowsiness, dizziness and blurred vision are commonly reported side effects of the drug.
 
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Which of the following information about Folic acid is NOT TRUE?
 
a. It is indicated for prevention of neural tube defects in pregnancy.
 
b. It is indicated for the treatment of megaloblastic anemia.
 
c. The recommended daily allowance is 400 mg per day.
 
d. It is a water-soluble vitamin that has antidepressant, antiproliferative, anti-teratogenic, gingival and anti-inflammatory effects.
 
e. Erythema, pruritus, urticaria, irritability, nausea, bloating and flatulence are reported side effects of the vitamin.


Which of the following information about Folic acid is NOT TRUE?
 
a. It is indicated for prevention of neural tube defects in pregnancy.
 
b. It is indicated for the treatment of megaloblastic anemia.
 
c. The recommended daily allowance is 400 mg per day.
 
d. It is a water-soluble vitamin that has antidepressant, antiproliferative, anti-teratogenic, gingival and anti-inflammatory effects.
 
e. Erythema, pruritus, urticaria, irritability, nausea, bloating and flatulence are reported side effects of the vitamin.
 
Answer: (c) is NOT TRUE. Folic acid is a water-soluble vitamin that has antidepressant, antiproliferative, anti-teratogenic, gingival and anti-inflammatory effects.  It is indicated for prevention of neural tube defects in pregnancy. It is also indicated for the treatment of megaloblastic anemia. It shall not be used in presence of pernicious and megaloblastic anemia due to Vit B12 deficiency.
 
The recommended daily allowance is 400 mcg (NOT mg) per day. Erythema, pruritus, urticaria, irritability, nausea, bloating and flatulence are reported side effects of the drug.
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A pharmacist receives a new prescription. The prescription reads:
 
Bydureon 2mg SC every day for type II diabetes x 30 days.
Refill: 5 times
 
Which of the following is the most appropriate action by a pharmacist?
 
a. Fill as it is.
b. Question the physician about the indication of the drug.
c. Question the physician about the refill quantity of the drug.
d. Question the physician about the dosage frequency of the drug.
e. Question the physician about the dosage strength of the drug.


A pharmacist receives a new prescription. The prescription reads:
 
Bydureon 2mg SC every day for type II diabetes x 30 days.
Refill: 5 times
 
Which of the following is the most appropriate action by a pharmacist?
 
a. Fill as it is.
b. Question the physician about the indication of the drug.
c. Question the physician about the refill quantity of the drug.
d. Question the physician about the dosage frequency of the drug.
e. Question the physician about the dosage strength of the drug.
 
Answer:(d). The active ingredient found in Bydureon is Exenatide indicated for the treatment of type II diabetes mellitus. It is an incretin mimetic agent. Incretins, such as glucagon-like peptide-1 (GLP-1), enhance glucose-dependent insulin secretion and exhibit other antihyperglycemic actions following their release into the circulation from the gut. Bydureon is a GLP-1 receptor agonist that enhances glucose-dependent insulin secretion by the pancreatic beta-cell, suppresses inappropriately elevated glucagon secretion, and slows gastric emptying.
 
Bydureon is an extended-release formulation of Exenatide, administered as an injection once every 7 days (weekly). It is also available under the trade name Byetta. Byetta is an immediate release solution of Exenatide administered by SC route. Byetta should be initiated at 5 mcg administered twice daily at any time within the 60-minute period before the morning and evening meals (or before the two main meals of the day, approximately 6 hours or more apart).
 
Nausea, vomiting, diarrhea, dyspepsia, injection site reactions, constipation and hypoglycemia are commonly reported side effects of Bydureon.
 
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The active ingredient found in Tavist ND is/are:
 
I. Clemastine
II. Pseudoephedrine
III. Loratadine
 
a. I only
b. III only
c. I and II only
d. II and III only
e. All


The active ingredient found in Tavist ND is/are:
 
I. Clemastine
II. Pseudoephedrine
III. Loratadine
 
a. I only
b. III only
c. I and II only
d. II and III only
e. All

Answer:(b), Loratadine. Normally, the active ingredient found in Tavist is Clemastine. It is indicated for the treatment of seasonal and perennial allergic rhinitis; and chronic idiopathic urticaria. The recommended dose is 1.34 mg orally twice a day. Dosage may be increased as required, but not to exceed 2.68 mg orally 3 times a day.
 
Sedation, sleepiness, dizziness, disturbed coordination, epigastric distress, thickening of bronchial secretions are commonly reported side effects of Clemastine (Tavist).
 
The active ingredient found in Tavist ND is 10 mg Loratadine.
 
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