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7
PHARMACY PREP

ANTI-HYPERLIPIDEMIAS

1- A 55-year-old obese man who has been a patient at your pharmacy for many years. He is
receiving atenolol 50mg QD for hypertension, Atorvastatin 20mg QD and glyburide 5mg BID
for blood glucose control. He smoked a pack of cigarettes a day for the last 38 years. His lipid
profile is under controlled. By some reason he started to take herbal product containing niacin
and found problem of muscular pain. This pain was not continuous. What should you
recommend?
a. Contact Doctor and ask him about CK
b. The Pharmacist should be cautious because of his elevated level of CK that is anticipated
c. The pharmacist should be cautious of his anticipated hepatitis
d. Use antidote of Niacin
e. Take Tylenol on prn basis
Ans: A
Tips: Since the level of CK raise ten times the normal level when the patient experience pain.
Reference: Compendium of Pharmaceutical Specialty, Year 2006

2-Which of the following anticholesterol medication may increase his blood sugar levels:
A-Atorvastatin
B-Niacin
C-Simvastatin
D-Fluvastatin
E-All of the above
Ans-B

3-Patient has elevated cholesterol, she saw on internet herbal products to lower her cholesterol,
she calls your pharmacy and ask about it and you are not convinced with the product. What to
tell her?
A. Its better to save her money
B. Discuss with her other herbal products that shown efficacy
C. Tell her to ask her doctor
D. Order the product for her
E. All of the above
Ans-C

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Scenario:
A 58-year-old woman presents you with a prescription for simvastatin (10 mg daily o.n.). She
is also taking atenolol (50 mg daily) having suffered a heart attack last year.
4Are you happy to dispense the simvastatin? J ustify your decision.
A. Yes-there is no interaction with atenolol.
B. There is drug interactions with atenolol
C. Atenolol decrease effect of simvastatin
D. None of the above

5How would you counsel about simvastatin to this patient?
A. Take the simvastatin at night, except
B. Report any muscle pain or weakness immediately: rhabdomyolysis is a rare but
important side effect.
C. She may also initially expect headache, nausea and gastrointestinal pain.
D. It is important that she continues to take the statin long term.
E. Simvastatin take empty stomach
Ans-E

6- A year later, whilst being maintained on simvastatin (20 mg daily ), she presents with a
prescription for erythromycin (250 mg q.d.s.) for sinusitis (she is allergic to penicillin).
How would you respond?
A. There is an increased risk of myopathy when simvastatin is used with erythromycin. , the
prescriber should be contacted and it might be suggested that a non-penicillin/ non-
cephalosporins antibacterial such as doxycycline is used as an alternative.
B. Erythromycin low dose is recommended, while continue using simvastatin 20 mg daily
C. Low simvastatin and low dose of erythromycin can be combined
D. Advise patient to stop taking simvastatin while taking erythromycin
E. Advise patient not to take erythromycin while taking simvastatin
Ans-A
7.. Patient have just started raw diet only few days, taken citrus juice daily. Maintain healthy
life style such diet and exercise. Patient using atorvastatin 20 mg to treat high cholesterol and
recent visit doctor, he increases atorvastatin dose to 40 mg. Patient complains severe dyspepsia
and diarrhea. It may be due to:
a. Because he is on raw food diet
b. Changed lipitor 20 mg to 40 mg
c. Takes citrus juice
d. Exercise
e. Multivitamins
Ans:

8. Uncomplicated chlamydia infection the best choice
a. zithromax*
b. doxyctline
c. cipro
Ans:
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9. Which has more indications among calcium channel blockers (dihydropyridines and non-
dihydropyridines) in Cardio Vascular system disorders?
(A) Nifedipine
(B) Verapamil IR
(C) Verapamil SR
(D) Diltiazem CD
(E) Amlodipine
Answer: (A)
Reference: CPS 2007 Page 409

10. Patient who is pregnant in her 2
nd
trimester uses Colestipol to control her cholesterol level.
The monitoring parameter for this pregnant lady is/are:
I Increase in cholesterol level
II Increase in triglyceride level
III Bleeding tendencies
(A) I only
(B) III only
(C) I and II
(D) II and III
(E) All of the above
Answer: (D)

11. A 75-year old female patient on lansoprazole tablet, and ASA 81mg, admitted to the ICU
experiencing DVT. She was given streptokinase, and her condition was stable and discharged
then from the hospital. Best prophylactic therapy for her is:
(A) Continuous infusion of Heparin +Warfarin
(B) Warfarin
(C) Subcutaneous dalteparin +Warfarin
(D) Subcutaneous dalteparin
(E) Continuous Heparin infusion
Answer: (C)
Reference: Therapeutic Choices 5
th
edition Page 596


12. In the above question, if the patient developed GIT hemorrhage, the doctor should
recommend all of the following EXCEPT:
(A) Vitamin K
(B) Increase lansoprazole dose
(C) Fresh blood infusion
(D) Change dalteparin to heparin
(E) Fresh blood infusion
Answer: (D)


13. Which medication show decreased mortality in CVD:
(A) Nepidipine
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(B) Verapamil
(C) Ramipril
(D) Propranolol
(E) Carvedilol
Answer: (C)