[ PHLE 2 ] PHARMACISTS LICENSURE EXAMINATION II

PHARMACISTS LICENSURE EXAMINATION Reviewer

Instructions:

Please answer each question to the best of your ability. Each question is multiple choice, and only one answer per question is correct. Select the most appropriate answer from the options provided.

When you have completed all questions, click the "Submit" button at the bottom of the page to see your score. Good luck!

1. A patient with chronic renal insufficiency is prescribed digoxin for heart failure. What is the most important pharmacokinetic consideration when administering digoxin to this patient?

A) Decreased bioavailability in the gastrointestinal tract
B) Decreased renal clearance, leading to a higher risk of toxicity
C) Increased hepatic metabolism, reducing the drug's half-life
D) Altered protein binding, increasing the free fraction of the drug

2. A patient is prescribed warfarin and clopidogrel for the prevention of stroke. What is the most significant drug interaction concern when using these two drugs together?

A) Increased risk of bleeding due to additive effects on platelet aggregation inhibition
B) Reduced efficacy of clopidogrel due to warfarin’s effect on CYP2C19
C) Decreased anticoagulant effect of warfarin due to clopidogrel’s platelet activity
D) Decreased absorption of warfarin due to clopidogrel’s gastrointestinal effects

3. A patient with tuberculosis is being treated with rifampin. Which of the following is a critical drug interaction when rifampin is co-administered with oral contraceptives?

A) Rifampin induces CYP450 enzymes, which increases the metabolism of oral contraceptives, leading to reduced efficacy
B) Rifampin inhibits CYP450 enzymes, decreasing the metabolism of oral contraceptives and increasing the risk of side effects
C) Rifampin reduces the absorption of oral contraceptives from the gastrointestinal tract
D) Rifampin interacts with the estrogen component of oral contraceptives, causing hormonal imbalances

4. A 45-year-old patient is prescribed atenolol for hypertension and is experiencing fatigue. The patient is also on a calcium channel blocker. Which of the following mechanisms could explain this interaction?

A) Both atenolol and the calcium channel blocker are vasodilators, which may result in an additive effect leading to hypotension
B) Atenolol enhances the negative chronotropic effect of the calcium channel blocker, leading to bradycardia
C) The combination of atenolol and the calcium channel blocker leads to excessive myocardial depression, increasing fatigue
D) Atenolol induces the metabolism of the calcium channel blocker, reducing its effect

5. A patient with hyperlipidemia is prescribed atorvastatin. What is the most significant potential side effect of atorvastatin that requires monitoring during therapy?

A) Myopathy and rhabdomyolysis, especially when taken with CYP3A4 inhibitors
B) Hyperkalemia due to potassium retention
C) Gastric ulcers due to inhibition of cyclooxygenase
D) Hypoglycemia from inhibition of hepatic gluconeogenesis

6. A 70-year-old patient with chronic obstructive pulmonary disease (COPD) is prescribed ipratropium bromide. What is the primary pharmacodynamic action of ipratropium in this patient?

A) Muscarinic antagonist that relaxes bronchial smooth muscle and reduces bronchoconstriction
B) Beta-2 adrenergic agonist that promotes bronchodilation
C) Inhibition of leukotriene receptors to reduce inflammation
D) Antihistamine that reduces allergic responses in the airway

7. A patient is prescribed levodopa/carbidopa for Parkinson’s disease. Which of the following is the rationale for combining levodopa with carbidopa in the treatment regimen?

A) Carbidopa inhibits peripheral decarboxylation of levodopa, allowing more levodopa to reach the brain
B) Carbidopa increases the bioavailability of levodopa by enhancing gastrointestinal absorption
C) Carbidopa reduces the incidence of adverse effects such as hallucinations associated with levodopa
D) Carbidopa increases dopamine release in the central nervous system, improving motor control

8. A 60-year-old female patient with osteoporosis is prescribed alendronate. What is the primary mechanism of action of alendronate in the treatment of osteoporosis?

A) Inhibition of osteoclast-mediated bone resorption
B) Enhancement of osteoblast function to increase bone formation
C) Inhibition of collagen synthesis to reduce bone matrix degradation
D) Stimulation of calcitonin secretion to promote calcium deposition in bones

9. A patient is receiving methotrexate for rheumatoid arthritis. Which of the following is a potential serious side effect of methotrexate that requires regular monitoring?

A) Renal toxicity, especially in patients with pre-existing renal impairment
B) Hepatotoxicity, including liver cirrhosis, requiring regular liver function tests
C) Myocardial infarction due to thrombosis
D) Ototoxicity, requiring audiometric evaluation

10. A patient is prescribed metformin for Type 2 diabetes. Which of the following is a rare but serious side effect of metformin that requires immediate discontinuation of therapy?

A) Lactic acidosis, especially in patients with renal impairment or hypoxia
B) Acute pancreatitis
C) Severe hypoglycemia in the absence of insulin
D) Kidney stones, particularly in elderly patients

11. A 75-year-old patient with atrial fibrillation is prescribed apixaban for stroke prevention. Which of the following is the most important consideration when using apixaban in this patient?

A) Renal function should be closely monitored, as apixaban is primarily eliminated by the kidneys
B) The dose should be reduced if the patient is also on a beta-blocker for heart rate control
C) Apixaban should be avoided if the patient is also taking a proton pump inhibitor
D) Apixaban increases the risk of hypertension and should be monitored with blood pressure readings

12. A 50-year-old patient is receiving corticosteroid therapy for an autoimmune disorder. What is a major concern associated with long-term corticosteroid use?

A) Increased risk of osteoporosis and fractures due to decreased calcium absorption and bone resorption
B) Increased risk of hyperkalemia due to potassium retention
C) Decreased risk of infections due to immune system stimulation
D) Increased risk of peptic ulcers due to inhibition of prostaglandin production

13. A 60-year-old female patient presents with symptoms of insomnia and is prescribed zolpidem. Which of the following is a common adverse effect of zolpidem that the pharmacist should educate the patient about?

A) Excessive drowsiness the following day, potentially affecting driving ability
B) Risk of dependence and tolerance with long-term use
C) Increased appetite and weight gain
D) Increased risk of anxiety and nervousness

14. A 68-year-old patient with a history of hypertension and chronic kidney disease (CKD) is prescribed losartan. What is the key benefit of losartan in a patient with CKD?

A) Angiotensin II receptor antagonism reduces proteinuria and protects kidney function
B) Inhibition of calcium channels decreases blood pressure and improves renal perfusion
C) Diuretic effect improves fluid balance in patients with renal insufficiency
D) Beta-adrenergic blockade helps prevent kidney damage from high blood pressure

15. A 40-year-old male patient is taking tramadol for pain relief. What is a potential serious adverse effect of tramadol that warrants caution, especially in patients with a history of substance abuse?

A) Risk of seizures, especially when taken in high doses or in combination with other CNS depressants
B) Risk of hepatotoxicity with long-term use
C) Increased risk of gastrointestinal bleeding, particularly with NSAID co-administration
D) Development of drug tolerance and dependency

16. A patient on antihypertensive therapy presents with dizziness and a dry cough. Which of the following classes of medications is most likely causing these symptoms?

A) Angiotensin-converting enzyme (ACE) inhibitors
B) Calcium channel blockers
C) Diuretics
D) Beta-blockers

17. A 55-year-old patient is prescribed amlodipine for hypertension. What is the main pharmacologic effect of amlodipine in the management of hypertension?

A) Blockade of L-type calcium channels, causing vasodilation and reduced blood pressure
B) Beta-adrenergic blockade, leading to decreased heart rate and blood pressure
C) Inhibition of ACE to reduce angiotensin II and decrease blood pressure
D) Inhibition of sodium reabsorption in the kidneys, reducing blood volume and pressure

18. A 72-year-old patient with glaucoma is prescribed timolol. What is the primary mechanism by which timolol reduces intraocular pressure?

A) Non-selective beta-adrenergic blockade, reducing aqueous humor production
B) Increased outflow of aqueous humor through the trabecular meshwork
C) Stimulation of alpha-2 adrenergic receptors, reducing fluid production
D) Inhibition of carbonic anhydrase, reducing fluid formation

19. A patient is receiving levetiracetam for seizure control. What is the proposed mechanism of action of levetiracetam?

A) Modulation of synaptic vesicle protein 2A (SV2A), which inhibits glutamate release
B) Inhibition of voltage-gated sodium channels to reduce neuronal excitability
C) Enhancement of gamma-aminobutyric acid (GABA) activity at the GABA-A receptor
D) Blockade of N-methyl-D-aspartate (NMDA) receptors in the brain

20. A 70-year-old patient with diabetes is prescribed glipizide. What is the mechanism of action of glipizide in the management of diabetes?

A) Increases insulin secretion by stimulating pancreatic beta-cells
B) Reduces insulin resistance by improving the sensitivity of target tissues
C) Increases hepatic glucose production to improve blood sugar control
D) Inhibits the reabsorption of glucose in the kidneys

21. A 45-year-old male patient with chronic back pain is prescribed gabapentin. What is the primary mechanism of action of gabapentin in the treatment of neuropathic pain?

A) Enhances the release of serotonin in the central nervous system
B) Inhibits excitatory neurotransmitter release through binding to the α2δ subunit of voltage-gated calcium channels
C) Blocks reuptake of norepinephrine and serotonin in the synapse
D) Increases GABAergic transmission by binding to GABA-A receptors

22. A 60-year-old female patient with diabetes mellitus type 2 is started on metformin. What is the most important consideration for this patient before starting metformin therapy?

A) The patient’s liver function needs to be monitored regularly, as metformin is hepatotoxic
B) Renal function must be assessed prior to starting therapy, as metformin is contraindicated in renal impairment
C) The patient should be advised to limit alcohol intake due to the risk of lactic acidosis
D) The patient should avoid high-protein diets, as they can decrease the efficacy of metformin

23. A 25-year-old female patient with mild depression is prescribed sertraline. What is the primary mechanism of action of sertraline?

A) Inhibits the reuptake of norepinephrine and dopamine in the synaptic cleft
B) Selectively inhibits the reuptake of serotonin, increasing serotonin levels in the brain
C) Blocks postsynaptic serotonin receptors to enhance serotonergic transmission
D) Increases norepinephrine release to improve mood and cognitive function

24. A patient is prescribed warfarin for atrial fibrillation. Which of the following factors could increase the risk of bleeding in this patient?

A) A high-fat diet that increases vitamin K absorption
B) Concurrent use of a nonsteroidal anti-inflammatory drug (NSAID) such as ibuprofen
C) Inadequate fluid intake leading to dehydration
D) Use of a potassium-sparing diuretic, such as spironolactone

25. A 50-year-old male patient with chronic obstructive pulmonary disease (COPD) is prescribed salmeterol. What is the primary effect of salmeterol in the management of COPD?

A) Inhibition of acetylcholine release to reduce bronchoconstriction
B) Long-acting beta-agonist (LABA) that relaxes bronchial smooth muscle and improves airflow
C) A leukotriene receptor antagonist that reduces inflammation and bronchospasm
D) An inhaled corticosteroid that decreases airway inflammation

26. A 30-year-old female patient with a history of anxiety and insomnia is prescribed lorazepam. What is the primary concern when using lorazepam long-term in this patient?

A) Risk of renal toxicity and damage with prolonged use
B) Risk of dependence, tolerance, and withdrawal symptoms with long-term use
C) Risk of severe hepatotoxicity, especially in elderly patients
D) Risk of elevated blood pressure due to the drug's sedative effects

27. A 65-year-old male patient with hypertension is prescribed atenolol. What is the expected pharmacologic effect of atenolol in the management of hypertension?

A) Direct vasodilation, reducing peripheral vascular resistance
B) Beta-1 selective blockade, reducing heart rate and cardiac output, thus lowering blood pressure
C) Inhibition of angiotensin-converting enzyme, reducing blood pressure
D) Diuretic effect that reduces blood volume and consequently lowers blood pressure

28. A 40-year-old patient with hyperlipidemia is prescribed atorvastatin. What is the primary mechanism of action of atorvastatin in lowering cholesterol levels?

A) Inhibition of lipoprotein lipase, increasing clearance of triglycerides
B) Inhibition of HMG-CoA reductase, decreasing cholesterol synthesis in the liver
C) Increased bile acid excretion, reducing serum cholesterol
D) Enhancement of LDL receptor activity, increasing LDL clearance from the bloodstream

29. A 55-year-old male patient with type 2 diabetes is prescribed empagliflozin. What is the primary mechanism by which empagliflozin helps control blood glucose levels?

A) Increases insulin secretion by beta cells in the pancreas
B) Inhibits sodium-glucose co-transporter 2 (SGLT2) in the kidneys, increasing glucose excretion in urine
C) Improves insulin sensitivity in muscle and adipose tissues
D) Inhibits glucagon release from the liver, reducing glucose production

30. A patient with a history of gout is prescribed allopurinol. What is the primary action of allopurinol in the treatment of gout?

A) Inhibits the conversion of xanthine to uric acid, reducing serum uric acid levels
B) Reduces the production of uric acid by inhibiting the enzyme xanthine oxidase
C) Increases uric acid excretion by enhancing renal clearance
D) Inhibits the inflammatory response to urate crystals in the joints