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2011 ACCP Clinical Pharmacy Challenge

Local Competition Exam


The following examination will consist of three (3) segments:
Trivia/Lightning
Participants will have the opportunity to answer up to 15 true-false or multiple-choice questions.
Each item answered correctly will be worth 75 points. The subject content for questions in this
segment will be selected from the following categories:

Pharmacology (including, but not limited to, mechanism of action, side effect profiles,
drug interactions, dosing, approved indications, and monitoring parameters)

Pharmacokinetics/Pharmacodynamics and/or Pharmacogenomics

Clinical Pharmacy History

Biostatistics

Clinical Case
Participants will be presented with a clinical case vignette (250 words or less) and a series of five
one-best-answer questions based on the information in the case text and/or supporting
laboratory, physical examination, and/or medical history information contained therein. Point
values for each question in this category will be assigned on the basis of difficulty (one 100-point
item, two 200-point items, and three 300-point items).

Jeopardy Style
Participants will have an opportunity to answer questions of varying point values
(100, 200, or 300 points) in five predetermined categories and may answer as many as possible
within the allotted time. All items in this segment will be multiple choice. Items in the segment will
be selected from five (5) of the following categories:
Anticoagulation

Asthma/COPD

Biostatistics

Cardiovascular Disorders

Clinical Trial Design

Critical Care

Drug Information

Emergency Medicine

Endocrinology

Geriatrics

GI/Liver/Nutrition

Hematology/Oncology

Infectious Diseases

Nephrology

Pain and Palliative Care

Pediatrics

Pharmacy Informatics

Psychiatry/CNS Disorders

Vaccinations

Womens Health

Follow the instructions given by your local faculty member or proctor for
each segment of the examination.
Do NOT open the examination booklet until instructed to do so.

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2011 ACCP Clinical Pharmacy Challenge


Local Competition Examination
Team/Individual ID ______________________

Total Score ________

For Administrative Use Only

Trivia/Lightning Section
This section consists of 15 items. Each correct answer is worth 75 points. Please circle your
answer for each question.
Question 1
True or False: Part of the blood pressurelowering effect of ACE inhibitors is caused by increased
prostaglandin effects.
1. True
2. False
Question 2
The preferred pharmacologic class for the management of ethanol withdrawal syndrome is:
1.
2.
3.
4.

Barbiturate
Benzodiazepine
-Blocker
Calcium channel blocker

Question 3
Which type of analysis is useful for either developing predictive models or performing survival
analysis?
1.
2.
3.
4.

Correlation
Regression
Meta-analysis
Histograms

Question 4
Which antibiotic is penicillinase-resistant penicillin?
1.
2.
3.
4.

Ampicillin
Piperacillin
Penicillin
Nafcillin

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Question 5
According to the manufacturers label information, which bisphosphonate must be administered at
least 60 minutes before the first food, non-water drink, or any medication of the day?
1.
2.
3.
4.

Alendronate
Ibandronate
Pamidronate
Risedronate

Question 6
Which drug is considered first-line maintenance therapy for a patient with mild persistent asthma?
1.
2.
3.
4.

Albuterol
Fluticasone
Montelukast
Salmeterol

Question 7
Which physiologic/metabolic change in the elderly is most likely to affect serum digoxin
pharmacokinetics?
1.
2.
3.
4.

Decreased serum -glycoprotein


Decreased renal function
Increased stomach pH
Decreased phase II metabolism

Question 8
Which diuretic exerts its primary mechanism of action by inhibiting sodium reabsorption in the
distal tubule?
1.
2.
3.
4.

Amiloride
Spironolactone
Chlorthalidone
Furosemide

Question 9
You wish to survey patients about their preferences regarding the route of administration of
hormonal contraceptives and present the results at a national meeting. True or False: The
institutional review board (IRB) does not need to be informed because this is a survey.
1. True
2. False
Question 10
The Colcrys brand of colchicine is indicated for the treatment of which condition?
1. Fibromyalgia
2. Gout flare

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3. Osteoarthritis
4. Rheumatoid arthritis
Question 11
Male patients taking which one of the following antidepressants should receive counseling
regarding the possibility of its causing the rare, but potentially serious, adverse effect of priapism?
1.
2.
3.
4.

Amoxapine
Desvenlafaxine
Duloxetine
Trazodone

Question 12
True or False:
In a patient with no known drug allergies, trimethoprim/sulfamethoxazole is the drug of choice for
the oral treatment of community-acquired MRSA cellulitis.
1. True
2. False
Question 13
Use of which diabetes medication may result in weight loss?
1.
2.
3.
4.

Glipizide
Insulin glargine
Pioglitazone
Exenatide

Question 14
Which medication is a major inducer of cytochrome P450 3A4?
1.
2.
3.
4.

Clarithromycin
Isoniazid
Ketoconazole
Phenytoin

Question 15
What is the minimum time needed to safely correct a serum sodium concentration from 120
mEq/L to 135 mEq/L (SI 120135 mmol/L)?
1.
2.
3.
4.

15 hours
30 hours
45 hours
60 hours

Team/Individual ID

_____________________________

Trivia Segment Score ________

For Administrative Use Only


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You have reached the end of the


Trivia/Lightning Segment of the exam.
Do NOT proceed to the next segment of
the exam until instructed to do so.

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Clinical Case Segment


This segment consists of a case vignette and five items based on the vignette information.
Case Vignette:
Chief Complaint: Pain, redness, and swelling in the right leg
History of Present Illness: A 42-year-old woman presents to the general medicine clinic with
redness and swelling in her right leg. The symptoms started a few days ago. She denies
shortness of breath, fever, or chest pain. She has no recent history of travel or surgery.
Duplex ultrasound reveals R popliteal deep venous thrombosis (DVT).
Past Medical History: Pulmonary embolism (PE) in 2007, hypertension for 2 years
Current medications: Hydrochlorothiazide 25 mg orally daily, Amlodipine 10 mg orally daily,
calcium plus vitamin D 500 mg/400 IU orally daily
Blood pressure: 128/86 mm Hg
Heart rate: 74 beats/minute
Weight; 78 kg
Height: 65 in. (165.1 cm)
Laboratory values: AST/ALT, PT/PTT/INR within normal range. Urinalysis and stool guaiac
negative
Hemoglobin: 15 g/dL (SI 150 g/L)
Hematocrit: 45% (SI 0.45)
Platelet count: 220 103/L (SI 220 109/L)
Serum creatinine: 1.0 mg/dL (SI 88.4 mol/L)

Proceed to the following page to answer Clinical Case Questions 1-5.

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Clinical Case Segment Questions


Point values for each item are indicated below. Please circle your answer for each item.
Question 1 (100 points)
Which is a therapeutic goal for treatment of this patients DVT with warfarin?
1.
2.
3.
4.

INR 2.5 (range 23)


INR 3.0 (range 2.53.5)
Anti-Xa activity greater than 0.7 IU/mL
Anti-Xa activity less than 0.3 IU/mL

Question 2 (200 points)


What is the appropriate duration of warfarin therapy for this patient?
1.
2.
3.
4.

1 month
36 months
612 months
Long term

Question 3 (200 points)


Which regimen represents an appropriate treatment plan for this patients acute DVT in the
outpatient setting?
1.
2.
3.
4.

Enoxaparin 30 mg subcutaneously every 12 hours


Enoxaparin 80 mg subcutaneously every 12 hours
Enoxaparin 120 mg subcutaneously every 12 hours
Enoxaparin 150 mg subcutaneously every 24 hours

Question 4 (300 points)


In which situation would extended (36 months) treatment with a LMWH be recommended for
treating this patients acute DVT before transitioning to warfarin therapy?
1.
2.
3.
4.

History of an acute major PE together with the current acute DVT


Coexisting breast cancer at the time of diagnosis of this acute DVT
Age of 72 years at the time of this acute DVT
Extended LMWH is warranted now due to history of recurrent venous thromboembolism

Question 5 (300 points)


While taking warfarin, the patient is given a diagnosis of hyperthyroidism, and treatment with
methimazole is initiated. Which one of the following best describes the expected dose adjustment
necessary to maintain a therapeutic INR and the mechanism for the effect?
1. Decreased warfarin requirements caused by inhibition of warfarin hepatic metabolism
2. Decreased warfarin requirements caused by increased metabolism of vitamin Kdependent
clotting factors
3. Increased warfarin requirements caused by decreased metabolism of vitamin Kdependent
clotting factors
4. Increased warfarin requirements caused by enhanced warfarin hepatic metabolism

Team/Individual ID

_____________________________

Case Segment Score ________

For Administrative Use Only


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You have reached the end of the Clinical


Case Segment.
Do NOT proceed to the next segment of
the exam until instructed to do so.

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Jeopardy Segment
This segment will consist of 15 items in five predetermined categories. Point values for each item
are indicated below. Please circle your answer for each item.

Cardiovascular Disorders
Item 1 (100 points)
What is the LDL cholesterol goal for a 52-year-old man with a history of hypertension, a 40 packyear history of smoking, gastroesophageal reflux disease, and abdominal aortic aneurysm?
1.
2.
3.
4.

Less than 160 mg/dL (SI 4.1 mmol/L)


Less than 130 mg/dL (SI 3.4 mmol/L)
Less than 100 mg/dL (SI 2.6 mmol/L)
Less than 70 mg/dL (SI 1.8 mmol/L)

Item 2 (200 points)


Which is a correct oral ACE inhibitor target dose for treating chronic heart failure in a patient after
myocardial infarction?
1.
2.
3.
4.

Enalapril 5 mg twice daily


Ramipril 10 mg once daily
Lisinopril 5 mg once daily
Trandolapril 1 mg once daily

Item 3 (300 points)


A 46-year-old man has a history of hypertension and chronic stable angina. His current
medications are atenolol 50 mg daily, atorvastatin 10 mg daily, lisinopril 20 mg daily, and aspirin
81 mg daily. His blood pressure is 130/80 mm Hg, and his heart rate is 56 beats/minute. He
presents to the clinic today with chest pain that occurs once or twice weekly. These symptoms are
relieved by the use of sublingual nitroglycerin. What is the next appropriate addition or change to
his regimen to decrease the frequency of angina symptoms?
1.
2.
3.
4.

Add isosorbide mononitrate sustained release 30 mg orally daily.


Add verapamil sustained release 180 mg orally daily.
Increase lisinopril to 40 mg orally daily.
Increase atenolol to 100 mg orally daily.

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Critical Care
Item 1 (100 points)
Which opioid is most potent as a single dose if all are given in the same milligram amount to a
critically ill patient?
1.
2.
3.
4.

Morphine
Oxycodone
Meperidine
Fentanyl

Item 2 (200 points)


The potential for dobutamine to decrease blood pressure in the critically ill patient is associated
with which mechanism?
1.
2.
3.
4.

Stimulation of 2-receptors causing vasodilation


Stimulation of 1-receptors causing vasodilation
Inhibition of 2-receptors causing bradycardia
Inhibition of 1-receptors causing bradycardia

Item 3 (300 points)


Acute delirium is a common contributor to agitation in the critically ill patient. Which medication is
currently recommended as the treatment of choice for the management of acute delirium in the
critically ill patient?
1.
2.
3.
4.

Propofol
Dexmedetomidine
Haloperidol
Midazolam

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Hematology/Oncology

Item 1 (100 points)


The most appropriate intravenous fluid to treat a patient with hypercalcemia of malignancy is:
1.
2.
3.
4.

Dextrose 5% in water
Lactated Ringers solution
Mannitol 25%
Normal saline

Item 2 (200 points)


Which statement regarding rituximab is TRUE?
1.
2.
3.
4.

It is a recombinant humanized monoclonal antibody against CD52 + cells.


Treatment with this drug requires patients to receive PCP prophylaxis.
It is a recombinant chimeric monoclonal antibody against CD20 + cells.
It is considered first-line treatment of multiple myeloma.

Item 3 (300 points)


Which medication could be recommended for the management of hot flushes in a premenopausal
woman with breast cancer being treated with tamoxifen?
1.
2.
3.
4.

Lorazepam
Fluoxetine
Soy protein
Conjugated estrogens and medroxyprogesterone

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Infectious Diseases
Item 1 (100 points)
Which of the following organisms is known as an atypical respiratory tract pathogen?
1.
2.
3.
4.

Legionella pneumophila
Moraxella catarrhalis
Haemophilus influenzae
Streptococcus pneumoniae

Item 2 (200 points)


Which serum concentration target is appropriate when using gentamicin in combination with
penicillin G for a patient with viridans streptococcal endocarditis?
1.
2.
3.
4.

Trough of 35 mcg/mL (SI 6.310.5 mol/mL)


Trough of 1520 mcg/mL (SI 31.441.8 mol/mL)
Peak of 35 mcg/mL (SI 6.310.5 mol/mL)
Peak of 812 mcg/mL (SI 16.725.1 mol/mL)

Item 3 (300 points)


Which virologic/serologic profile is consistent with a patient being immune to hepatitis B because
of prior hepatitis B vaccination?
1.
2.
3.
4.

HBsAg positive, anti-HBc positive, anti-HBs negative


HBsAg negative, anti-HBc positive, anti-HBs positive
HBsAg negative, anti-HBc negative, anti-HBs positive
HBsAg negative, anti-HBc negative, anti-HBs negative

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Pediatrics
Item 1 (100 points)
An 8-year-old girl (Wt = 25 kg) is admitted to the hospital for an asthma exacerbation and
pneumonia. Her temperature is currently 39.5C. What is the most appropriate single dose of
acetaminophen for this patient?
1.
2.
3.
4.

160 mg
325 mg
500 mg
650 mg

Item 2 (200 points)


A 9-month-old boy is brought by his parents to the emergency department after he has an
apparent seizure. On examination, you note that he is a fussy infant in no visible distress, febrile
to 104F (40C), with rhinorrhea and upper respiratory congestion. His medical history includes
term gestation and no previous episodes of seizures. Family history is positive for coronary heart
disease and asthma. Which intervention should be recommended?
1. Administer acetaminophen, start an intravenous infusion for fluids, and sponge him with tepid
water.
2. Administer acetaminophen, encourage oral fluids, and sponge him with tepid water.
3. Administer acetaminophen and start an intravenous infusion for fluids, and load with phenytoin
to prevent further seizures.
4. Administer acetaminophen, encourage oral fluids, and load with phenytoin to prevent further
seizures.

Item 3 (300 points)


Which treatment should be initiated in a 20-month-old child who presents to the emergency
department with a 3-day history of fever, rhinorrhea, a "barky" cough, an oxygen saturation of
98%, and inspiratory stridor?
1.
2.
3.
4.

Humidified oxygen
Racemic epinephrine
Fluticasone
Cefuroxime

Team/Individual ID

_____________________________

Jeopardy Segment Score ________

For Administrative Use Only

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