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2.3.1: Review, dispense, and administer drugs and drug products, considering packaging, labeling, storage, handling, and disposal of medications

RT is a 35-year-old pharmaceutical representative. His territory is the Southeastern United States. He has a past medical history of partial epilepsy and allergic rhinitis. Medications include carbamazepine and cetirizine. RT travels a lot for his job (air and land travel). His seizures have been well controlled until recently. He cannot identify any risk factors for the increase in seizures and states that he has been 100% adherent with his medicine. The past few weeks have been unseasonal as it has been 100° F and very humid. His provider has evaluated RT for treatable causes of his increase in seizures. All labs and evaluation have been within normal limits. RT's carbamazepine level was 8.1 mcg/ml. The provider orders a pharmacotherapy consult for evaluation. Which of the following is a potential reason for the increase in seizure activity for RT?

(A) RT has partial epilepsy and carbamazepine is not effective for partial seizures.

(B) There is a drug interaction between cetirizine and carbamazepine leading to subtherapeutic levels of carbamazepine.

(C) RT has a supratherapeutic carbamazepine level. Supratherapeutic AED levels may cause a seizure.

(D) Storing carbamazepine tablets in humid conditions can cause concretion of the tablets, resulting in poor bioavailability and therapeutic failure.

The correct answer is (D).

Storing carbamazepine tablets in humid conditions can cause concretion of the tablets, resulting in poor bioavailability and therapeutic failure (D).

Carbamazepine is effective for partial epilepsy (A). There is no known drug interaction between carbamazepine and cetirizine that would lead to low carbamazepine levels (B). Additionally, the carbamazepine level is within the expected range. Supratherapeutic levels of AEDs may cause a seizure; however, the carbamazepine therapeutic level is 6-10 mcg/ml (C).

Herpes zoster vaccine should be stored at what temperature?

(A) ?5°F

(B) 6°F to 35°F

(C) 36°F to 46°F

(D) 47°F to 77°F

The correct answer is (A).

The herpes zoster vaccine needs to be kept frozen. Frozen vaccines should be stored in a freezer with a temperature <5°F (A).

Storing the herpes zoster vaccine at temperatures above 5°F can lead to loss of potency (B).

Vaccines that require refrigeration should be stored at temperatures between 36°F and 46°F (C).

The herpes zoster vaccine should be kept frozen. Temperatures between 47°F and 77°F (D) are considered room temperature.

Herpes zoster vaccine should be stored at what temperature?

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