A pharmacotherapy specialist is conducting a pharmacokinetic study of a drug. The pharmacokinetic profile of this drug is best described by a one-compartment model with a mean elimination rate constant of 0.173/h. The standard curve for the assay to be used covers the range of 5-40mcg/mL. Samples are collected shortly after single intravenous bolus drug administration, and at 4 and 8 hours after dosing. Preliminary analysis shows that the 4-hour sample concentration is 25 mcg/mL. In this situation, which of the following statements is correct?

• A.Both the initial and 8-hour concentration points are probably outside the range of the standard curve and cannot be reliably measured without diluting the samples.
• B.All plasma concentrations are probably within the range of the standard curve and can be reliably measured.
• C.The initial plasma concentration is probably outside the range of the standard curve' it may be possible to dilute the sample and re-assay.
• D.Both the initial and 8-hour concentration points are probably outside the range of the standard curve but can be reliably quantitated by extrapolating the curve to higher and lower points.

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A 70-year-old man has completed a 14-day course of sulfamethoxazole/trimethoprim for Escherichia coli cystourethritis. The patient has a Foley catheter. A urine culture obtained 24 hours after the last antibiotic dose shows Candida albicans > 10x3 cfu/mL, RBC > 100 cells/hpf, and WBC = 10-20 cells/hpf. The patient is asymptomatic. What is the most appropriate management?

• A.Fluconazole orally daily for 5-10 days
• B.Posaconazole orally daily for 5-10 days
• C.Amphotericin bladder irrigation for 5-10 days
• D.No anti-infective needed

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Which of the following pharmacoeconomic analyses incorporates patient preferences regarding health?

• A.Cost-utility
• B.Cost-benefit
• C.Cost-effectiveness
• D.Cost-minimization

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The Joint Commission requires accredited organizations to encourage which groups to report concerns about safety?

• A.Medical students rotating through organizations
• B.Local specific disease support groups
• C.Patients and families
• D.National special interest groups

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A 60-year-old man who is HIV-positive describes symptoms of erectile dysfunction and requests therapy. Current medications include tenofovir 300 mg orally daily, emtricitabine 200 mg orally daily, atazanavir 300 mg orally daily, and ritonavir 100 mg orally daily. In addition to counseling on preventing HIV transmission, which recommendation is appropriate?

• A.Start sildenafil 25 mg/dose (maximum 25 mg in 48 hours).
• B.Start sildenafil 25 mg/dose (maximum 25 mg in 48 hours) and decrease atazanavir to
  150 mg orally daily.
• C.Start sildenafil 50 mg/dose (maximum 200 mg in 48 hours) and decrease atazanavir to
  150 mg orally daily.
• D.Start sildenafil 50 mg/dose (maximum 200 mg in 48 hours).

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