Tacrolimus Patient Counseling Guidelines

Multiple-Choice Question Format 1. Which of the following vaccines is contraindicated in immunocompromised patients? A. Pneumococcal polysaccharide B. Varicella C. Meningococcal conjugate D. Subcutaneous influenza The Varicella vaccine, which is a live attenuated vaccine, is contraindicated in immunocompromised patients because their weakened immune systems may not be able to handle even the weakened form of the virus used in the vaccine, potentially leading to serious complications. The other vaccines listed—Pneumococcal polysaccharide, Meningococcal conjugate, and Subcutaneous influenza (assuming it refers to the inactivated form)—are not live vaccines and are generally considered safe for immunocompromised patients. Multiple-Response Question Format When counseling a patient taking oral tacrolimus, the pharmacist 1. What counseling information should provide the following information: should a pharmacist provide to a ● Avoid live virus vaccinations: Tacrolimus suppresses the patient taking oral tacrolimus? immune system, so live vaccines could potentially cause an (Select ALL that apply.) infection. A. Avoid live virus vaccinations ● Avoid grapefruit and grapefruit juice: Grapefruit can B. Avoid grapefruit and interfere with the metabolism of tacrolimus, leading to grapefruit juice increased drug levels and a higher risk of side effects. C. If a dose is missed, double up ● Medication levels need to be monitored: Tacrolimus has on the next dose a narrow therapeutic index, so blood levels need to be D. Do not drink alcohol while regularly monitored to ensure they remain within the target taking this medication range. E. Medication levels need to be Do not: monitored ● If a dose is missed, do not double up on the next dose: This could lead to toxicity. Instead, the patient should take the missed dose as soon as they remember or skip it if it's almost time for the next dose. ● Avoid alcohol while taking this medication: Alcohol can increase the risk of liver toxicity and other side effects, so it is best avoided. Thus, the correct counseling points are: ● Avoid live virus vaccinations ● Avoid grapefruit and grapefruit juice ● Do not drink alcohol while taking this medication ● Medication levels need to be monitored ● Do not double up on the next dose if a dose is missed. Constructed-Response Format 1. Griseofulvin oral Question To determine how many milliliters of griseofulvin oral suspension should be dispensed, follow these steps: suspension 1. Calculate the total daily dose: The prescribed dose is 250 contains 125 mg/5 mL. A physician prescribed 250 mg bid for 2 weeks for a patient. How many milliliters of griseofulvin should be dispensed in order to fill this prescription? (Answer must be numeric; round the final answer to the nearest WHOLE number.) ● 280 mL of Griseofulvin QUESTION ● 2. ● ● mg twice a day (bid). Total daily dose = 250 mg × 2 = 500 mg Determine the number of milliliters needed per dose: The suspension contains 125 mg/5 mL. To find out how many milliliters are needed for a 250 mg 250𝑚𝑔 dose: Required mL per dose = ( 125𝑚𝑔 ) × 5mL = 10mL 3. Calculate the total amount for 2 weeks: ● The patient needs 10 mL per dose, and there are 2 doses per day. ● Total volume per day = 10 mL × 2 = 20 mL ● The prescription is for 2 weeks (14 days). ● Total volume needed = 20 mL × 14 days = 280 mL Therefore, 280 mL of griseofulvin suspension should be dispensed. ANSWER 1. The metabolic conversion of I to The metabolic conversion of compound I to compound II in the II represents: image involves the change from an aldehyde group (–CHO) in compound I to a carboxylic acid group (–COOH) in compound II. This transformation is typically achieved through an oxidative process where the aldehyde group is oxidized to a carboxylic acid. a. b. c. d. ester hydrolysis amide hydrolysis reductive cleavage oxidative cleavage 2. The flow of blood in the ascending The correct flow of blood from the ascending vena cava (superior VC progresses from the: vena cava) is: a. Right atrium to right ventricle to ● Blood from the superior vena cava flows into the right pulmonary vein to pulmonary atrium. artery ● From the right atrium, it moves into the right ventricle. b. Right atrium to right ventricle ● The right ventricle then pumps the blood into the to pulmonary artery to pulmonary artery, which carries deoxygenated blood to pulmonary vein the lungs. ● After oxygenation in the lungs, the blood returns to the heart via the pulmonary veins to the left atrium (not the right side of the heart). 3. Endometriosis is a condition caused by the deposition of endometrial tissue primarily in the: a. arterial wall b. renal tubule Endometriosis is a condition characterized by the deposition and growth of endometrial tissue (which normally lines the inside of the uterus) outside the uterine cavity. The most common location for this ectopic endometrial tissue is the peritoneal cavity, including areas such as the ovaries, fallopian tubes, and the tissue lining the c. gastric mucosa d. peritoneal cavity pelvis. 4. A pharmacist is to prepare 150 mL of concentrated solution of benzalkonium chloride solution so that a 5-mL aliquot diluted to 500mL yields a 1:7500 solution. To prepare the concentrated solution, how many grams of benzalkonium chloride will be needed? a. b. c. d. 0.067 0.34 2 10 I. Determine the concentration of the final diluted solution: The final solution is 1:7500, meaning 1 part benzalkonium chloride in 7500 parts solution. 1 Concentration= 7500 = 0.0001333 (fractional concentration) II. Calculate the amount of benzalkonium chloride in the final solution: The final solution volume is 500 mL. Amount of benzalkonium chloride in 500mL = 500mL × 0.0001333 = 0.06667 g Determine the concentration of the concentrated solution: You are taking a 5 mL aliquot of the concentrated solution and diluting it to 500 mL to achieve the final concentration. 0.06667 𝑔 Concentration of concentrated solution = 5 𝑚𝐿 = 0.013334 g/mL III. IV. Calculate the total amount of benzalkonium chloride needed for 150 mL of the concentrated solution: Total amount of benzalkonium chloride needed = 0.013334 g/mL × 150 mL = 2.0 g 5. The structure of the brain involved in The structure of the brain primarily responsible for temperature temperature regulation: regulation is the hypothalamus. The hypothalamus plays a critical role in maintaining homeostasis, including the regulation of body a. Hypothalamus temperature, hunger, thirst, and circadian rhythms. b. cerebral cortex c. arbor vitae tract d. spinothalamic tract 6. the complete set of information for an organism is: a. b. c. d. clone genome codon oncogene genetic The complete set of genetic information for an organism is called the genome. The genome includes all of the organism's genes as well as its non-coding sequences of DNA. 7. home ovulation tests can detect, in Home ovulation tests detect the preovulatory surge in luteinizing the urine, a pre-ovulatory surge in: hormone (LH) in the urine. The surge in LH triggers ovulation, making it a key indicator for identifying the most fertile period in a a. Oxytocin woman's menstrual cycle. b. prolactin c. progesterone d. luteinizing hormone 8. Which of the ff is associated with the cytoprotection of the GIT? a. b. c. d. leukotrienes prostaglandins thromboxanes interleukins Prostaglandins are associated with the cytoprotection of the gastrointestinal tract (GIT). They play a crucial role in maintaining the integrity of the gastric mucosa by stimulating mucus and bicarbonate secretion, enhancing mucosal blood flow, and promoting cell regeneration, all of which help protect the stomach lining from acid and other harmful substances. 9. The lipoprotein particle that delivers Note: cholesterol to extrahepatic cells in the LDL – delivers cholesterol to EXTRAhepatic body it the: HDL – delivers cholesterol to hepatic (liver) VLDL – delivers triglyceride to EXTRAhepatic Chylomicron – delivers triglycerides to hepatic (liver) a. chylomicron b. low-density lipoprotein c. high-density lipoprotein d. intermediate-density lipoprotein 10. anaphylatoxins recruit inflammatory Anaphylatoxins recruit inflammatory cells to needed areas following cells to needed areas following the activation of the complement system. The complement activation of which of the ff systems: system is part of the immune system that enhances the ability of antibodies and phagocytic cells to clear pathogens. Anaphylatoxins such as C3a, C4a, and C5a are small peptides released during the a. kinin activation of this system, and they play a key role in promoting b. clotting inflammation by recruiting immune cells like neutrophils and c. fibrinolytic macrophages to sites of infection or injury. d. complement 11. Which of the ff would NOT be true regarding drug distribution in the body? I. Distribution only occurs after absorption of the drug is complete II. A drug that readily distributes into fat will have a relatively large apparent volume of distribution III. A high degree of plasma protein binding results in a relatively low volume of distribution a. I only b. I and II only c. II and III only d. I, II, and III Statement I: "Distribution only occurs after absorption of the drug is complete" is NOT true. Distribution of a drug can begin as soon as the drug enters the bloodstream, even before absorption is complete. Some drugs are distributed simultaneously with absorption. Statement II: "A drug that readily distributes into fat will have a relatively large apparent volume of distribution" is true. Drugs that accumulate in fat tissues tend to have larger volumes of distribution because they spread out into a larger compartment. Statement III: "A high degree of plasma protein binding results in a relatively low volume of distribution" is true. Drugs that are highly bound to plasma proteins tend to remain in the bloodstream and do not readily distribute into tissues, leading to a lower volume of distribution. 12. Which of the ff factors does NOT influence the polymorphic form of the Polymorphism refers to the ability of a substance, such as a drug, to exist in more than one crystal form. drug? a. light b. temperature