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1. A 40-year-old transplant recipient who is receiving cyclosporine develops seizures requiring anticonvulsant therapy. Because a drug interaction is likely to occur between cyclosporine and phenytoin, the pharmacotherapy specialist suggests that the resident do which of the following?

A) Decrease the phenytoin dose.
B) Decrease the cyclosporine dose.
C) Increase the cyclosporine dose.
D) Increase the phenytoin dose.

2. A 46-year-old patient begins treatment with allopurinol 300 mg daily following the onset of an acute gout attack due to elevated uric acid.
The patient's other medications are:
* Cyclosporine 800 mg daily
* Prednisone 20 mg daily
* Azathioprine 100 mg daily
* Nifedipine extended release 90 mg daily
Several days later there was an observed decrease in the patient's WBC count. Which drug interaction with allopurinol is most likely to account for this change?

A) Prednisone
B) Nifedipine
C) Cyclosporine
D) Azathioprine

3. A 58-year-old man presents complaining of unsteady gait. Past medical history is significant for diabetes mellitus, gastroparesis, and depression. The patient exhibits a slight shuffling gait, mild limb rigidity, and decreased speed in performing rapid alternating movement. Current daily medications are bupropion, glyburide, metoclopramide, and omeprazole. Which of the following would be the most appropriate initial management for the presenting complaint?

A) Begin ropinirole.
B) Discontinue bupropion.
C) Begin carbidopa/levodopa.
D) Discontinue metoclopramide.

4. A 24-year-old Woman complains of dysuria, hesitancy in urination, and frequent urination for the past 2 days. She has no costovertebral tenderness, fever, or history of UTls. Urinalysis data are:
* pH: 5.5
* WBCS: 15 cells/ul
* RBCS:5 Cells/uL
* Bacteria: Numerous Gram-negative rods
* Negative for protein, glucose, and WBC casts
For this patient, assuming that local resistance rates are low, which of the following would be an empiric cost-effective regimen?

A) Amoxicillin 500 mg three times daily for 7 days
B) Ciprofloxacin 500mg twice daily for 7 days
C) Azithromycin 1 g single dose
D) Sulfamethoxazole/trimethoprim one double-strength tablet twice daily for 3 days

5. A 70-year-old 45-kg patient is admitted to the ICU with a diagnosis of digoxin intoxication. The patient complains of nausea, blurred vision, and fatigue that have been present for 3 days. A cardiac monitor reveals a HR of 42 bpm, an irregular rhythm, and a type second-degree heart block. Current medications include digoxin 0.25 mg and furosemide 40mg for heart failure, both taken daily at 0800. The patient remains adherent to all medications despite nausea, including today's doses. Blood is drawn at 1200 with the following results:
* Potassium: 6.0 mEq/L
* Creatinine: 2.3 mg/dL
* Digoxin: 1.7 ng/mL
Which of the following most appropriately describes the patient's digoxin concentration?

A) A pre-distribution digoxin concentration, which may be misinterpreted
B) Reflects the effect of furosemide on the renal excretion of digoxin
C) A post-distribution digoxin concentration, which indicates significant toxicity
D) A concentration within the desirable range

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