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Rolapitant is indicated for the treatment of:

a. Hypertension
b. Diabetes
c. Nausea and vomiting
d. Schizophrenia
e. Rheumatoid arthritis


Rolapitant is indicated for the treatment of:

a. Hypertension
b. Diabetes
c. Nausea and vomiting
d. Schizophrenia
e. Rheumatoid arthritis

Answer: (c). The U.S. Food and Drug Administration approved Rolapitant (Varubi) to prevent delayed phase chemotherapy-induced nausea and vomiting (emesis). Rolapitant (Varubi) is approved in adults in combination with other drugs (antiemetic agents) that prevent nausea and vomiting associated with initial and repeat courses of vomit-inducing (emetogenic and highly emetogenic) cancer chemotherapy.

Rolapitant (Varubi) is a substance P/neurokinin-1 (NK-1) receptor antagonist. Activation of NK-1 receptors plays a central role in nausea and vomiting induced by certain cancer chemotherapies, particularly in the delayed phase. It is available in tablet form.

Rolapitant (Varubi) inhibits the CYP2D6 enzyme, which is responsible for metabolizing certain drugs. Varubi is contraindicated with the use of thioridazine, a drug metabolized by the CYP2D6 enzyme, because use of the two drugs together may increase the amount of thioridazine in the blood and cause an abnormal heart rhythm that can be serious.

The most common side effects in patients treated with Rolapitant (Varubi) include a low white blood cell count (neutropenia), hiccups, decreased appetite and dizziness.

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

I. It is not possible to get homocysteine from the diet.

II. Homocysteine can be recycled back into methionine using vitamin B12-related enzymes.

III. Elevated homocysteine levels have been associated with severe bleeding.

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 Homocysteine?

I. It is not possible to get homocysteine from the diet.

II. Homocysteine can be recycled back into methionine using vitamin B12-related enzymes.

III. Elevated homocysteine levels have been associated with severe bleeding.

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

Answer: I and II only. Homocysteine is an amino acid. Amino acids are the building blocks of proteins. It is not possible to get homocysteine from the diet. It must be made from methionine, another amino acid that is found in meat, fish, and dairy products. Vitamins B6 (pyridoxine), B12 and folic acid are needed to make this reaction occur.

Foods containing methionine are transformed into homocysteine in the bloodstream. Homocysteine is converted in the body to cysteine, with vitamin B6 facilitating this reaction. Homocysteine can also be recycled back into methionine using vitamin B12-related enzymes.

Cysteine is an important protein in the body that has many roles. It is involved in the way proteins within cells are folded, maintain their shape, and link to each other. Cysteine is a source of sulfide and is part of the metabolism of different metals in the body including iron, zinc and copper. Cysteine also acts as an anti-oxidant.

If homocysteine cannot be converted into cysteine or returned to the methionine form, levels of homocysteine in the body increase. Elevated homocysteine levels have been associated with heart attack, stroke, blood clot formation, and perhaps the development of Alzheimer's disease.

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Onfi is available in which of the following dosage forms?

I. Tablet
II. Oral Suspension
III. Capsule

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


Onfi is available in which of the following dosage forms?

I. Tablet
II. Oral Suspension
III. Capsule

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

Answer: (c). The active ingredient found in Onfi is Clobazam. Each Onfi (Clobazam) tablet contains 10 mg or 20 mg of clobazam. It is also available for oral administration as an off-white suspension containing clobazam at a concentration of 2.5 mg/mL.

Onfi (Clobazam) is classified as benzodiazepine. Clobazam potentiates the GABAergic neurotransmission by binding at the benzodiazepine site of the GABAa receptor.

Onfi (Clobazam) is indicated for the adjunctive treatment of seizures associated with Lennox-Gastaut syndrome (LGS) in patients 2 years of age or older.

A daily dose of Onfi (Clobazam) greater than 5 mg should be administered in divided doses twice daily; a 5 mg daily dose can be administered as a single dose.

As with all antiepileptic drugs and benzodiazepines, withdraw Onfi (Clobazam) gradually. The patient should taper by decreasing the total daily dose by 5-10 mg/day on a weekly basis until discontinued.

Somnolence, depression, sedation, withdrawal symptoms, serious dermatological reactions and suicidal behavior and ideation are commonly reported side effects of Onfi (Clobazam).

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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 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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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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