Patients who are on chronic long-term proton pump inhibitor therapy require monitoring for:
1. Iron deficiency anemia, vitamin B12 and calcium deficiency
2.Folate and magnesium deficiency
3.Elevated uric acid levels leading to gout
4. Hypokalemia and hypocalcemia
Patients taking antacids should be educated regarding these drugs, including letting them know that:
1.They may cause constipation or diarrhea.
2. Many are high in sodium.
3. They should separate antacids from other medications by one hour.
4. All of the above
A patient has diarrhea and is wondering if they can take loperamide (Imodium). Loperamide:
1.Can be given to patients of all ages, including infants and children, for viral gastroenteritis
2. Slows gastric motility and reduces fluid and electrolyte loss from diarrhea
3. Is the treatment of choice for the diarrhea associated with E. coli 0157
4. May be used in pregnancy and by lactating women
Methylnaltrexone is used to treat constipation in:
1.Patients with functional constipation
2.Patients with irritable bowel syndrome-associated constipation
3. Children with encopresis
4.Patients with opioid-associated constipation
Many patients self-medicate with antacids. Which patients should be counseled to not take calcium carbonate antacids without discussing it with their provider or a pharmacist first?
1.Patients with kidney stones
2. Pregnant patients
3. Patients with heartburn
A patient presents with complaints of heartburn that is minimally relieved with Tums (calcium carbonate) and is diagnosed as gastroesophageal reflux disease (GERD). An appropriate on-demand therapy would be:
1. Omeprazole (Prilosec) twice a day
2. Ranitidine (Zantac) twice a day
3. Famotidine (Pepcid) once a day
4. Metoclopramide (Reglan) four times a day
Bismuth subsalicylate (Pepto-Bismol) is a common over-the-counter (OTC) remedy for gastrointestinal complaints. Bismuth subsalicylate:
1. May lead to toxicity if taken with ibuprofen
2. Is contraindicated in children with flu-like illness
3.Has no antimicrobial effects against bacterial and viral enteropathogens
4.May cause stools to turn reddish color
A 15-year-old patient presents to the clinic with a 48-hour history of nausea, vomiting, and some diarrhea. She is unable to keep fluids down and her weight is four pounds less than her last recorded weight. Besides intravenous (IV) fluids, the exam warrants the use of an antinausea medication. Which of the following would be the appropriate drug to order?
1. Prochlorperazine (Compazine)
2. Meclizine (Antivert)
3. Promethazine (Phenergan)
4. Ondansetron (Zofran)
A young adult will be traveling to Mexico with her church group over spring break to build houses. She is concerned she may develop traveler’s diarrhea. Advice includes following normal food and water precautions as well as taking:
1. Lopeb. ramide four times a day throughout the trip
2.Bismuth subsalicylate before each meal and at bedtime
3.Prescription diphenoxylate with atropine if she gets diarrhea
4.Calcium carbonate (Tums) four times a day for stomach upset
When prescribing tacrolimus (Protopic) to treat atopic dermatitis patients should be informed that:
1. Tacrolimus is most effective if it is used continuously for four to six months.
2. Tacrolimus should be spread generously over the affected area.
3. The U.S. Food and Drug Administration (FDA) has issued a black box warning about the use of tacrolimus and the development of cancer in animals and humans.
4. The FDA recommends that patients be screened for cancer before prescribing tacrolimus.
Instructions for the use of malathion (Ovide) for head lice include:
1.Use a blow dryer to dry the hair after applying.
2.Use malathion (Ovide) daily for a week until all lice are dead.
3.Rinse the malathion (Ovide) off and shampoo hair after 8 to 12 hours.
4. Use gloves to apply the malathion (Ovide).
A patient is prescribed tazarotene for their psoriasis. Patient education regarding topical tazarotene includes:
1.That tazarotene is applied in a thin film to the psoriasis plaque lesions
2. To apply it liberally to all psoriatic lesions
3. To apply tazarotene to nonaffected areas to prevent breakout
4.That tazarotene may cause hypercalcemia if it is overused
An adolescent female calls the clinic with concerns that her acne is worse one week after starting topical tretinoin. What would be the appropriate care for her?
1. Change her to a different topical acne medication as she is having an adverse reaction to the tretinoin.
2. Switch her to an oral antibiotic to treat her acne.
3. Advise her to apply an oil-based lotion to her face to soothe the redness.
4.Reassure her that the worsening of acne is normal and it should improve with continued use.
First-line therapy for treating topical fungal infections such as tinea corporis (ringworm) or tinea pedis (athlete’s foot) would be:
1. Over-the-counter (OTC) topical azole (clotrimazole, miconazole)
2. Oral terbinafine
3.Oral griseofulvin microsize
4. Nystatin cream or ointment
When prescribing griseofulvin (Grifulvin V) to treat tinea capitis it is critical to instruct the patient or parent to:
1. Mix the griseofulvin with ice cream before administering.
2. Take the griseofulvin until the tinea clears, in approximately four to five weeks.
3. Shampoo with baby shampoo daily while taking the griseofulvin.
4.Take the griseofulvin with a high-fat food.
A patient is a nasal methicillin-resistant staphylococcus aureus (MRSA) carrier. Treatment to eradicate nasal MRSA is mupirocin. Patient education regarding treating nasal MRSA includes:
1.Take the oral medication exactly as prescribed.
2. Insert one-half of the dose in each nostril twice a day.
3. Alternate treating one nare in the morning and the other in the evening.
4.Nasal MRSA eradication requires at least four weeks of therapy, with up to eight weeks needed in some patients.
An adolescent has been prescribed isotretinoin (Accutane) by their dermatologist and is presenting to their primary care provider with symptoms of sadness and depression. The Beck Depression Inventory results indicate they have mild to moderate depression. What would be the best option at this point?
1. Prescribe a select serotonin reuptake inhibitor (SSRI) antidepressant.
2. Refer them to a mental health therapist.
3.Contact their dermatologist about discontinuing the isotretinoin.
4.Reassure them that mood swings are normal and schedule follow up in a week.
When prescribing topical penciclovir (Denavir) for the treatment of herpes labialis (cold sores) patient education would include:
1. Spread penciclovir liberally all over lips and the area surrounding lips.
2. Penciclovir therapy is started at the first sign of a cold sore outbreak.
3. Skin irritation is normal with penciclovir and it should resolve.
4.Penciclovir should be used a minimum of two weeks to prevent recurrence.
Instructions for applying a topical antibiotic or antiviral ointment include:
1.Apply thickly to the infected area, spreading the medication well past the borders of the infection.
2. If the rash worsens, apply a thicker layer of medication to settle down the infection.
3. Wash hands before and after application of topical antimicrobials.
4. Crusted lesions can be scrubbed off with a clean nail brush.
When writing a prescription of permethrin 5% cream (Elimite) for scabies, patient education would include:
1.All members of the household and personal contacts should also be treated.
2. Infants should have permethrin applied from the neck down.
3. The permethrin is washed off after 10 to 20 minutes.
4. Permethrin is flammable and to avoid open flame while the medication is applied.
A patient who used clotrimazole (Lotrimin AF) for athlete’s foot developed a red, itchy rash consistent with a hypersensitivity reaction. They now have athlete’s foot again. What would be a good choice of antifungal?
1. Miconazole (Micatin) powder
2. Ketoconazole (Nizoral) cream
3. Terbinafine (Lamisil) cream
4. Griseofulvin (Grifulvin V) suspension
A child presents with one golden-crusted lesion at the site of an insect bite consistent with impetigo. Their parents have limited finances and request the least expensive treatment. Which medication would be the best choice for treatment?
1. Mupirocin (Bactroban)
2. Bacitracin and polymyxin B (generic double antibiotic ointment)
4.Oral cephalexin (Keflex)
A 6-month-old infant with severe eczema would benefit from topical corticosteroid therapy. Instructions for using topical corticosteroids in children include:
1.Apply liberally to all areas with eczema.
2. Double the frequency of application when the eczema is severe.
3. Apply sparingly to eczema areas.
4. Cover the eczema area with an occlusive dressing after applying a corticosteroid.
An adult male has male pattern baldness on the vertex of his head and has been using Rogaine for two months. He asks how effective minoxidil (Rogaine) is. Minoxidil:
1. Provides a permanent solution to male pattern baldness if used for at least four months
2. Will show results after four months of twice-a-day use
3. May not work for his type of baldness
4. Works better if he also uses hydrocortisone cream daily on his scalp
When choosing a topical corticosteroid cream to treat diaper dermatitis, the ideal medication would be:
1.Intermediate potency corticosteroid ointment (Kenalog)
2.A combination of a corticosteroid and an antifungal (Lotrisone)
3. A low-potency corticosteroid cream applied sparingly (hydrocortisone 1%)
4.A high-potency corticosteroid cream (Diprolene AF)
Mild acne may be initially treated with:
1.Topical combined antibiotic
3. Topical retinoid
4.Over-the-counter (OTC) benzoyl peroxide
The most cost-effective treatment for two or three impetigo lesions on the face is:
1. Mupirocin ointment
2. Retapamulin (Altabax) ointment
3.Topical clindamycin solution
4.Oral amoxicillin/clavulanate (Augmentin)
A young adult female has severe cystic acne and is requesting treatment with Accutane. The appropriate treatment for her would be:
1.Order a pregnancy test and if it is negative prescribe the isotretinoin (Accutane).
2. Prescribe Accutane after educating her on the adverse effects.
3. Recommend she try oral antibiotics (minocycline).
4.Refer her to a dermatologist for treatment.
A patient has been diagnosed with scabies. Education would include:
1. She should leave the scabies treatment cream on for an hour and then wash it off.
2. Scabies may need to be retreated in a week after initial treatment.
3. All members of the household and close personal contacts should be treated.
4. Malathion is flammable and she should take care until the solution dries.
An adolescent football player presents to the clinic with athlete’s foot. Patients with tinea pedis may be treated with:
1. OTC miconazole cream for four weeks
2. Oral ketoconazole for six weeks
3.Mupirocin ointment for two weeks
4.Nystatin cream for two weeks
Severe contact dermatitis caused by poison ivy or poison oak exposure often requires treatment with:
1. Topical antipruritics
2. Oral corticosteroids for 2 to 3 weeks
3. Thickly applied topical intermediate-dose corticosteroids
4. Isolation of the patient to prevent spread of the dermatitis
Topical immunomodulators such as pimecrolimus (Elidel) or tacrolimus (Protopic) are used for:
1. Short-term or intermittent treatment of atopic dermatitis
2.Topical treatment of fungal infections (Candida)
3.Chronic, inflammatory seborrheic dermatitis
4.Recalcitrant nodular acne
Long-term treatment of moderate atopic dermatitis includes:
1. Topical corticosteroids and emollients
2. Topical corticosteroids alone
4.Oral corticosteroids for exacerbations of atopic dermatitis
A child has classic tinea capitis. Treatment for tinea on the scalp is:
1. Miconazole cream thoroughly rubbed in for four weeks
2. Oral griseofulvin for 6 to 8 weeks
3. Ketoconazole shampoo daily for six weeks
4. Ciclopirox cream daily for four weeks
Appropriate initial treatment for psoriasis would be:
1. An immunomodulator (Protopic or Elidel)
2. Wet soaks with Burow’s or Domeboro solution
3. Intermittent therapy with intermediate potency topical corticosteroids
An adolescent presents to the clinic with moderate acne. They have been using OTC benzoyl peroxide at home with minimal improvement. A topical antibiotic (clindamycin) and a topical retinoid adapalene (Differin) are prescribed. Education would include:
1. He should see an improvement in his acne within the first two weeks of treatment.
2. If there is no response in a week, double the daily application of adapalene (Differin).
3. He may see an initial worsening of his acne that will improve in 6 to 8 weeks.
4. Adapalene may cause bleaching of clothing.
Long-term use of PPIs may lead to:
1.Hip fractures in at-risk persons
2.Vitamin B6 deficiency
4.All of the above
An acceptable first-line treatment for peptic ulcer disease with positive Helicobacter pylori (H. pylori) test is:
1.Histamine-2 receptor antagonists for 4 to 8 weeks
2.PPI bid for 12 weeks until healing is complete
3.PPI bid plus clarithromycin plus amoxicillin for 14 days
4.PPI bid and levofloxacin for 14 days
Gastroesophageal reflux disease (GERD) may be aggravated by the following medication that affects lower esophageal sphincter (LES) tone:
The next step in treatment when a patient has been on PPIs twice daily for 12 weeks and not improving is:
1.Add a prokinetic (metoclopramide).
2.Refer the patient for endoscopy.
3.Switch to another PPI.
4.Add a cytoprotective drug.
If a patient with H. pylori-positive peptic ulcer disease fails first-line therapy, the next step would be:
1.A PPI b.i.d. plus metronidazole plus tetracycline plus bismuth subsalicylate for 14 days
2.To test H. pylori for resistance to common treatment regimens
3.A PPI plus clarithromycin plus amoxicillin for 14 days
4.A PPI and levofloxacin for 14 days
Treatment failure in patients with peptic ulcer disease associated with H. pylori may be because of:
2.An ineffective antacid
3.Overuse of PPIs
4.All of the above
Lifestyle changes are the first step in treatment of GERD. Food or drink that may aggravate GERD include:
After H. pylori treatment is completed, the next step in peptic ulcer disease therapy is:
1.Testing for H. pylori eradication with a serum enzyme-linked immunosorbent assay (ELISA) test
2.Endoscopy by a specialist
3.A PPI for 8 to 12 weeks until healing is complete
4.All of the above
A patient with mild GERD is started on _______ first.
2.Histamine-2 receptor antagonists
4.Proton pump inhibitors (PPIs)
Antacids treat GERD by:
1.Increasing lower esophageal tone
2.Increasing gastric pH
3.Inhibiting gastric acid secretion
4.Increasing serum calcium level
If a patient with GERD who is taking a PPI daily is not improving, the plan of care would be:
1.Prokinetic (metoclopramide) for 8 to 12 weeks
2.PPI (omeprazole) twice a day for 4 to 8 weeks
3.Histamine-2 receptor antagonist (ranitidine) for 4 to 8 weeks
4.Cytoprotective drug (misoprostol) for 4 to 8 weeks
Infants with reflux are initially treated with:
1.Histamine-2 receptor antagonist (ranitidine)
3.Antireflux maneuvers (such as elevating the head of the bed)
If a patient with symptoms of GERD states that he has been self-treating at home with over-the-counter (OTC) ranitidine daily, the appropriate treatment would be:
1.Prokinetic (metoclopramide) for 4 to 8 weeks
2.PPI (omeprazole) for 12 weeks
3.Histamine-2 receptor antagonist (ranitidine) for 4 to 8 weeks
4.Cytoprotective drug (misoprostol) for two weeks
Metoclopramide improves GERD symptoms by:
1. Reducing acid secretion
2.Increasing gastric pH
3.Increasing lower esophageal tone
4.Decreasing lower esophageal tone
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