If a patient takes 0.5mg of intravenous hydromorphone every 4hrs what would be the equivalent orals total daily dose? Hydromorphone oral to parenteral ratio 7.5:1.5.
A. 15mg
B. 20mg
C. 10mg
D. 5mg
E. 7.5mg
Correct Answer: A
To determine the dose conversion IV to PO, the ratio of PO to IV needs to be determined, this is 7.5 / 1.5 which is 5. This number means that the PO dose is 5 times more than the IV dose to get the same amount of drug into the bloodstream. If the patient is taking 0.5 mg IV then the PO dose would be 0.5 mg multiplied by 5, which is 2.5 mg. Since the patient is taking the medication every 4 hours the patient is receiving 6 doses, 24hrs/4hrs = 6. Since the patient is receiving 2.5 mg every dose and is receiving 6 doses a day, the patient is receiving 15 mg, 2.5 mg multiplied by 6 doses.
Question 62:
Which of the following is/are nominal data?
A. Sex
B. Race
C. Blood Group
D. NYHA stages I-IV
E. Stages of breast cancer
Correct Answer: C
Nominal data is considered unordered categories. Sex answers fall into male or female which is unordered. Race can be multiple answers such as Caucasian, African American, Asian, etc which is unordered. Blood group can only have blood type O, A, B, or AB which is also unordered. Ordered, or ordinal data would have categories that are in some sort of order
You receive an order for 40mg/kg/dose of Amoxicillin every 12 hours. Pt's weight is 18 lbs. You have 250mg/5ml of amoxicillin suspension.
Calculate the total amount in milliliters needed for 10-day supply. Round up your answer to the nearest 1.
A. 14 mls
B. 132 mls
C. 96 mls
D. 86 mls
E. 36 mls
Correct Answer: B
If 40mg of amoxicillin are needed per kg of body weight, then the dose of amoxicillin is 40mg multiplied by the patient's body weight. This patient weighs 18 lbs, based on the conversion of 2.2 lbs = 1 kg, the patient weighs 8.2 kg. 40 mg multiplied by 8.2 kg is equal to 328 mg, this is one dose of amoxicillin. If the amoxicillin comes in 250 mg/5 mL, then it needs to be determined how many mLs it will take to get 328 mg of amoxicillin. In order to do this 328 mg needs to be divided by 250 mg to get a ratio. This comes out to be
1.312. This ratio can be multiplied by the number of mLs it takes to make up 250 mg, which is 5 mLs.
1.312 multiplied by 5 mLs is 6.56 mL, this is how many mLs it will take to have 328 mg. This volume is for 1 single dose of amoxicillin. The patient is receiving 2 doses per day and for a total of 10 days, this means the patient will be receiving 20 doses. 20 doses multiplied by 6.56 mL doses equals the total volume the patient will be receiving, which is 131.2 mL.
Question 65:
What is the Osmolarity of NS with KCL 40 meq/L? (MW of KCl: 74.55 g/mol) (MW of NaCl: 58.44 g/mol)
A. 800 mOsm/L
B. 308 mOm/L
C. 1108 mOsm/L
D. 830 mOsm/L
E. 388 mOsm/L
Correct Answer: E
Question 66:
CJ is a 69-year-old male with a history of diabetes, hypertension and hypercholesterolemia. His fasting lipid profile is TC 530 mg/dL; LDL-C 125; HDL-C 48 mg/dL; and TG 640 mg/dL. His A1c 8.1, calculate creatinine clearance is 65mls/hr, BP 135/80 mm Hg, HR 70 beats /min.
His current medications include metformin 1000mg po bid, lisinopril 20mg daily, sitagliptin 50mg bid and atorvastatin 40mg daily.
What is the best pharmacological agent to initiate on CJ?
A. Increase atorvastatin to 80mg
B. Niacin 500mg twice daily
C. Fenofibrate 162mg daily
D. Gemfibrozil 600mg twice daily
E. Fish oil 500mg twice daily
Correct Answer: C
It is reasonable to add triglyceride-lowering medications such as fibrates or niacin to prevent pancreatitis in those with triglyceride levels >500 mg/dL, which applies to this patient as his TG level is 640 mg/dL . C. is wrong because gemfibrozil should not be initiated in patients on statin therapy because of an increased risk for muscle symptoms and rhabdomyolysis. Fenofibrate may be considered concomitantly with a low-or moderate- intensity statin when triglycerides are above 500 mg/dL,2, however he is on a high intensity statin therapy. For niacin, the IR dose should start at 100 mg TID2 and niacin does not lower triglyceride levels as much as fibrate do.4 Fenofibrates are dose adjusted for renal function lower than 60 mL/min to 54 mg/mL, so this dose is appropriate for this patient because of his renal function being above 60 mL/min. The best option is fenofibrate 162 mg daily, but this needs to be monitored for any symptoms of muscle pain exhibited by the patient, especially as the patient is at a higher risk due to being a diabetic. Fish oil is not a first line agent to treat hypertriglyceridemia.
Number of new cases per population at risk in a given time period is a definition of which of the following?
A. Incidence rate
B. Prevalence rate
C. Mortality rate
D. Odds ratio
E. Confidence Interval
Correct Answer: A
Incidence rate = New reported cases / summed person-years of observation (avg population during time interval). Prevalence = Cases in a population in a given time period / total population at that time Mortality rate = deaths during specified time interval / population size at risk for death.
A patient takes 1gm of Calcium Carbonate salt three times a day. How much elemental calcium, in grams, is he getting in 24hrs? (MW of Ca: 40.078 g/mol, MW of CaCO3: 100.087 g/mol)
A. 3 g
B. 1.8g
C. 1.2g
D. 0.8gm
E. 1.8mg
Correct Answer: C
Question 69:
Results from a Meta-analysis where they looked at frequency of postoperative arterial fibrillation in patients on Ascorbic acid after cardiac surgery found odds ratio, 0.44 (95% CI, 0.32 to 0.61). How can you interpret this data?
A. Ascorbic acid increased frequency of postoperative arterial fibrillation after cardiac surgery by 44%
B. Ascorbic acid decreased frequency of postoperative arterial fibrillation after cardiac surgery by 44%
C. There was no statistically significant difference in frequency of postoperative arterial fibrillation after cardiac surgery
D. Ascorbic acid decreased frequency of postoperative arterial fibrillation after cardiac surgery by 56%
E. None of the above are correct
Correct Answer: D
Odds ratio of 0.44 (44%) means that this group was associated with an event happening 44% of the time, compared to 1 (an event happening 100% of the time if unexposed), therefore 100 - 44 = 56%, which is the reduction caused by the exposure. Exposure is the use of ascorbic acid.
JK is a 67 years old African American man who presents to your clinic for his blood pressure management. His past medical history includes Peptic ulcer disease and hypertension. His two BP readings are 160/98, 159/96 and HR 85. He says he has been adherent to his medication and lifestyle. He currently takes 12.5mg Chlorthalidone and Prilosec 20mg daily.
Which of the following is the best strategy to manage his blood pressure?
A. Increase chlorthalidone to 25mg daily
B. Add Norvasc 2.5 daily
C. Add Lisinopril 5mg daily
D. Add hydrochlorothiazide 25mg daily
E. Add Lisinopril 20mg daily
Correct Answer: B
As the patient is over the age of 60 and he does not have CKD or diabetes, his goal BP should be SBP andlt; 150 mmHg or DBP andlt; 90 mmHg, and he is not currently at this goal with his medication regimen. Options are to maximize the current medication dosage (option A), or to add a second agent. Since calcium channel blockers like Norvasc are recommended as initial treatment options in African Americans, choosing Norvasc over lisinopril would probably be the more effective option.
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