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SECTION 4-7 PRACTICE QUESTIONS

A pharmacist is performing a medication therapy management (MTM) session on a patient who's diagnosed with hypertension, dyslipidemia, MI, and depression. Which of the following medications is most likely to cause a dry cough in this patient?

A. Lipitor

B. Lisinopril

C. Hydrochlorothiazide

D. Toprol XL

E. Nitroglycerine

B. Lipitor

ACE inhibitors block the degradation of bradykinin, which is thought to contribute to decreasing the blood pressure but also the common side effect of dry cough. Although ARBs can also cause cough, there's a higher incidence of dry cough with ACE inhibitors than ARBs.

MD is a 45-year-old female, who comes in your pharmacy with a new prescription for Biaxin. Patient wants to know if she can take a supplement named St. John's Wort for her depression. While checking patient's medication history, you notice that the patient is diagnosed with hypertension, hypercholesterolemia, and diabetes. Below is his medications list:

  • Simvastatin 10 mg PO daily

  • Prinivil 20 mg PO daily

  • Metformin 500 mg PO BID

  • Omega-3 fatty acids

  • Yaz 28

After you advised the patient about the potential drug interaction with St. John's Wort, using your clinical judgment, will you dispense Biaxin and what is your rationale?

A. Yes, dispense the medication. There is no reason for you to believe that Biaxin is not safe to be dispensed

B. Yes, dispense the medication. Biaxin does not have a major interaction with other drugs, but it is a minor P-glycoprotein inhibitor, which shouldn't affect other drugs substantially

C. No, do not dispense the medication. Concomitant use of Biaxin and simvastatin is contraindicated, because Biaxin is a major CYP3A4 inhibitor that can substantially decrease the metabolism of simvastatin, that can lead to severe rhabdomyolysis

D. No, do not dispense the medication. Biaxin is a major CYP3A4 inducer and can substantially decrease the concentration of simvastatin, which can lead to sub-therapeutic effect of simvastatin

E. Yes, dispense the medication. The patient needs the extra cholesterol lowering effect

C. No, do not dispense the medication. Concomitant use of Biaxin and simvastatin is contraindicated, because Biaxin is a major CYP3A4 inhibitor that can substantially decrease the metabolism of simvastatin, that can lead to severe rhabdomyolysis

Concomitant use of Biaxin (clarithromycin) and simvastatin is contraindicated. Biaxin is a major CYP3A4 inhibitor that can substantially decrease the metabolism of simvastatin, that lead to an ...

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