Pharmaceutical Care & Disease Management

A 58-year-old with new essential hypertension (no compelling indications) should start which first-line agent?

A 64-year-old with diabetes and albuminuria needs antihypertensive therapy; preferred first-line?

A 70-year-old with HFrEF (LVEF 30%) is clinically stable. Foundation quadruple therapy includes:

NSTEMI patient on aspirin needs P2Y12 inhibitor; appropriate option at discharge?

A 62-year-old with nonvalvular AF and CHA₂DS₂-VASc = 3; best strategy to reduce stroke?

Community-acquired pneumonia outpatient, no comorbidities; recommended first-line antibiotic?

Uncomplicated cystitis in a healthy woman; which regimen is appropriate?

Sepsis bundle initial fluid resuscitation recommendation is:

A 55-year-old with T2DM, ASCVD, and A1c 8.4% on metformin; add which agent with CV benefit?

For T2DM with CKD and albuminuria, which add-on drug slows renal disease and helps HF?

Moderate-intensity statin is indicated for which patient?

A 48-year-old with persistent asthma needs controller; preferred step-up?

COPD with frequent exacerbations on LAMA; next escalation?

H. pylori positive ulcer; recommended approach?

GERD with alarm features (dysphagia, weight loss); best next step?

Primary hypothyroidism with TSH markedly elevated; initial treatment?

Overt hyperthyroidism due to Graves’ disease; initial pharmacotherapy?

Iron deficiency anemia; best oral iron counseling?

A 67-year-old with gout and frequent flares; urate-lowering goal?

Acute gout flare first-line in patient without contraindications:

Osteoporosis in postmenopausal woman with fragility fracture; first-line agent?

Depression with suicidal ideation—immediate priority?

Major depressive disorder without psychosis; reasonable first-line medication?

Generalized anxiety disorder; nonpharmacologic cornerstone?

Schizophrenia with prominent positive symptoms; initial antipsychotic choice?

Bipolar I acute mania; pharmacologic first-line?

New epilepsy diagnosis focal seizures; reasonable initial monotherapy?

Migraine acute treatment in moderate–severe attacks without CV disease:

Smoking cessation most effective single pharmacotherapy approach?

Obesity management; first-line foundational intervention?

Chronic kidney disease with albuminuria on ACEI; BP not at goal; next preferred add-on?

Hyperkalemia (K⁺ 6.5 with ECG changes); immediate stabilizing therapy?

DKA initial insulin strategy in adults after fluids and potassium correction?

Chronic pain due to knee OA in 68-year-old with CAD/CKD3; best initial pharmacologic option?

A 59-year-old on high-intensity statin has LDL 80 mg/dL and triglycerides 520 mg/dL; next step?

Peptic ulcer disease due to NSAIDs; preferred strategy?

Ulcerative colitis mild–moderate; first-line induction therapy?

A patient with cluster headache abortive therapy:

Osteoarthritis nonpharmacologic cornerstone counseling?

A 45-year-old with primary hypertension and gout; preferred antihypertensive to avoid raising uric acid?

A 66-year-old has high-risk TIA (ABCD2≥4) started within 12 hours; optimal early antiplatelet strategy?

Symptomatic peripheral artery disease with claudication; core nonpharmacologic therapy to improve walking distance?

Cancer-associated DVT without high GI bleed risk; preferred initial oral anticoagulant?

Stable angina with infrequent episodes on optimal background therapy; best abortive agent for acute relief?

NSTEMI patient asks about NSAIDs for knee pain at discharge; pharmacist advice?

A 72-year-old with AF and CHA₂DS₂-VASc 5, CKD stage 3; best anticoagulant choice?

HFrEF (LVEF 25%) on ARNI, β-blocker, MRA; still symptomatic with HR 82 in sinus rhythm; add-on mortality benefit?

HFrEF with persistent tachycardia (sinus, HR ≥70) despite max β-blocker; NYHA II; next option?

Resistant hypertension on ACEI/ARB + CCB + thiazide; next evidence-based add-on?

T2DM on metformin with A1c 8.7%, BMI 36, established ASCVD; add-on with strongest weight loss and CV benefit?

T2DM and CKD with albuminuria (eGFR adequate); foundational add-on to slow kidney decline?

Hypoglycemia unawareness on basal-bolus insulin; key pharmacist counseling?

Suspected community-acquired MRSA purulent cellulitis outpatient; appropriate oral option?

C. difficile infection, initial nonsevere episode; preferred first-line therapy when available?

Acute uncomplicated pyelonephritis outpatient; no allergies; local resistance low; suitable regimen?

Latent TB infection in otherwise healthy adult; recommended regimen?

CAP inpatient non-ICU without MRSA/Pseudomonas risk; regimen?

A 30-year-old with new HIV exposure 36 hours ago; best step?

Recurrent gout flares with CKD4; safest first-line for acute flare?

Long-term urate-lowering therapy titration; key pharmacist strategy?

RA diagnosed; preferred initial DMARD with mortality/morbidity benefit?

Methotrexate key counseling in RA?

SLE patient on hydroxychloroquine; essential safety monitoring?

Osteoporosis on denosumab considering stopping; critical counseling?

Postmenopausal woman with ER+ early breast cancer on aromatase inhibitor; preventive measure?

Migraine prevention with frequent attacks; first-line preventive options?

Cluster headache acute abortive therapy?

Generalized anxiety disorder on SSRI with partial response; evidence-based nonpharm adjunct?

PTSD first-line pharmacotherapy?

Alcohol withdrawal in hospitalized patient with CIWA escalation; cornerstone therapy?

Opioid use disorder maintenance with highest retention and overdose reduction?

Chronic noncancer neuropathic pain; first-line option?

GERD lifestyle counseling with pharmacotherapy?

H. pylori treatment failure after clarithromycin triple therapy; preferred salvage?

CKD anemia with ferritin low and transferrin saturation <20%; first step?

SIADH with mild–moderate hyponatremia; first-line management?

Hypercalcemia of malignancy (Ca 14.5 mg/dL) with confusion; immediate measures?

DKA vs HHS distinguishing feature?

Atrial fibrillation with RVR and HFrEF decompensated; preferred acute rate control?

Long-acting nitrates for chronic angina; key counseling to prevent tolerance?

STEMI with first medical contact at a non–PCI hospital and transfer would exceed 120 minutes; best reperfusion strategy?

Suspected acute ischemic stroke at 2.5 hours from onset; BP 175/100; glucose normal; no contraindications. Next step?

Post-PCI for NSTEMI with drug-eluting stent and low bleeding risk; recommended DAPT duration?

Life-threatening bleed on warfarin with INR 6.5; best reversal?

Major bleeding on apixaban; specific reversal option?

COPD acute exacerbation without pneumonia; evidence-based steroid regimen?

COPD exacerbation antibiotic indication is strongest when:

Asthma step-up for moderate persistent symptoms using SMART:

Uncontrolled HTN on ACEI + CCB + thiazide; next add-on per resistant HTN evidence?

HFrEF on ARNI, β-blocker, MRA still volume overloaded; first-line diuretic strategy?

Hyperkalemia K⁺ 6.8 mmol/L with peaked T waves; after IV calcium, which therapy shifts potassium intracellularly?

Diabetes: metformin + ASCVD with A1c 7.9% and BMI 35; best add-on?

Diabetes with CKD and albuminuria (eGFR adequate); foundational cardio-renal agent?

Type 1 diabetes basal–bolus: practical outpatient correction-insulin rule of thumb?

Hypothyroidism in a healthy 30-year-old; starting levothyroxine dose?

Thyroid storm initial pharmacologic sequence?

Adrenal crisis suspected (hypotension, hyponatremia, hyperkalemia); immediate therapy?

GERD refractory on optimized PPI; alarm absent; next reasonable step?

Peptic ulcer from H. pylori after clarithro triple failure; salvage of choice?

CKD anemia with TSAT 12% and ferritin 40 ng/mL; first step?

Asplenia vaccination priorities include:

On biologic therapy for IBD; vaccine advice?

Oral candidiasis first episode; best initial therapy?

Esophageal candidiasis suspected (odynophagia) in immunocompromised host; preferred treatment?

Infective endocarditis dental prophylaxis is recommended for:

Community-acquired MRSA skin abscess >2 cm; cornerstone therapy?

Clostridioides difficile initial nonsevere infection; preferred drug?

Pyelonephritis outpatient with low FQ resistance; regimen?

HIV PEP after needle-stick within 2 hours; best action?

Osteoporosis with hip fracture history; first-line agent if oral not tolerated?

Denosumab discontinuation planning should include:

BPH with bothersome LUTS and enlarged prostate; combination therapy?

PDE5 inhibitor counseling for ED:

Opioid initiation for chronic pain after failure of nonopioids; key safety step?

Cancer pain with escalating short-acting morphine use; appropriate long-acting conversion?

Depression starting SSRI; counseling on onset and suicidality?

Second-generation antipsychotics monitoring should include:

Lithium maintenance monitoring focuses on:

Alcohol use disorder long-term relapse prevention with best evidence:

Perioperative management of SGLT2 inhibitors to prevent euglycemic DKA:

A 62-year-old with acute leukemia presents febrile (38.7°C) with ANC 300/µL; first-line empiric antibiotic?

A 68-year-old with suspected bacterial meningitis (fever, neck stiffness) needs empiric therapy; best regimen?

Cirrhosis with ascites has PMN 450/µL in paracentesis; optimal initial management?

Confused cirrhotic with elevated ammonia; first-line pharmacotherapy?

Acute variceal upper GI bleed in cirrhosis; immediate pharmacologic bundle?

Acute pancreatitis suspected (epigastric pain, ↑lipase); cornerstone early management?

Upper GI bleed in patient on aspirin for secondary prevention; after endoscopic hemostasis?

Newly diagnosed H. pylori in a region with high clarithromycin resistance; preferred initial regimen?

Fulminant Clostridioides difficile infection with ileus; best antimicrobial plan?

Community-acquired pneumonia treated as outpatient; minimum effective duration if clinically stable?

Diabetic foot infection with suspected osteomyelitis; appropriate empiric IV regimen?

Pregnant patient with pyelonephritis; preferred initial therapy?

Asymptomatic bacteriuria should routinely be treated in which scenario?

Outpatient pelvic inflammatory disease regimen?

Symptomatic bacterial vaginosis; first-line therapy?

Trichomoniasis in a nonpregnant adult; best treatment and counseling?

High-risk patient with confirmed influenza within 48 hours; recommended antiviral?

COVID-19 outpatient with high risk for progression and symptom onset 2 days ago; preferred therapy (no interactions/renal limits)?

Chronic liver disease immunization priorities?

Prior spontaneous bacterial peritonitis; recommended long-term prophylaxis?

Post-ACS discharge “cardiac bundle” typically includes:

Very-high-risk ASCVD with LDL ≥70 mg/dL on maximally tolerated statin; next step?

Statin-associated muscle symptoms (normal CK); pharmacist’s best strategy?

Triglycerides 1100 mg/dL with abdominal pain; immediate pharmacologic approach?

A 55-year-old Black patient with uncomplicated HTN; preferred first-line?

Hypertension with spontaneous hypokalemia and resistant BP; initial evaluation?

Perioperative management for warfarin in low–moderate thrombotic risk (e.g., AF without recent stroke)?

Perioperative handling of apixaban for elective procedure (normal renal function)?

Suspected heparin-induced thrombocytopenia (4T score high); immediate step?

Cancer-associated thrombosis in a patient with active GI malignancy and high GI bleed risk; preferred anticoagulant?

AF with HFrEF (LVEF 30%) and resting HR 105; preferred initial rate-control agent?

AF with stable CAD >12 months after PCI; optimal antithrombotic plan?

Postmenopausal woman on alendronate 5 years, low fracture risk and stable BMD; reasonable plan?

CKD stage 4 with hyperphosphatemia; first-line pharmacotherapy?

Painful diabetic neuropathy interfering with sleep; preferred first-line?

T2DM with persistent albuminuria on ACEI/ARB and SGLT2i; add-on with cardiorenal benefit?

HFrEF guideline-directed β-blockers include:

COPD with persistent symptoms and blood eosinophils ≥300/µL on LABA/LAMA; next escalation?

Suspected obstructive sleep apnea with daytime somnolence and witnessed apneas; cornerstone therapy?

Generalized convulsive status epilepticus in ED; stepwise pharmacotherapy?

A hemodynamically stable patient with acute pulmonary embolism, low bleeding risk, and good follow-up asks about outpatient therapy; preferred initial regimen?

A patient with massive PE and hypotension has no absolute contraindications; best immediate pharmacologic therapy?

Acute proximal DVT in severe renal failure (CrCl <15 mL/min); preferred initial anticoagulant?

A pregnant patient with acute DVT asks about treatment; recommended anticoagulant?

A traveler with prior DVT asks about long-haul flight prevention; best counseling?

Post-MI secondary prevention includes which lipid strategy?

After MI without contraindications, which agent should be started and continued unless limited by side effects?

A Black patient with HFrEF remains symptomatic despite ARNI, β-blocker, MRA, and SGLT2 inhibitor; mortality-reducing add-on?

AF during thyrotoxicosis with palpitations and tremor; preferred initial rate control?

T2DM with A1c 9.8% on metformin; reasonable starting basal insulin dose?

GLP-1 receptor agonist nausea early in therapy; best pharmacist advice?

Transitioning from IV insulin in DKA to subcutaneous basal–bolus; key step?

Metformin safety: which renal function threshold is a contraindication?

Iodinated contrast study is planned; which patients should temporarily hold metformin?

Dog bite with cellulitis risk; first-line outpatient antibiotic?

Nonpurulent cellulitis (no MRSA risk factors) outpatient; preferred therapy?

Erythema migrans after tick exposure; first-line treatment in nonpregnant adult?

Recurrent C. difficile infection after initial cure; evidence-based strategy?

Acute upper GI bleed post-endoscopic hemostasis; acid suppression plan?

Cirrhosis with tense ascites; optimal initial diuretic ratio?

Primary prevention of first variceal bleed in medium–large varices?

IBS with diarrhea predominant (IBS-D) and no red flags; reasonable first-line symptomatic agent?

Severe ulcerative colitis flare inpatient; induction of remission?

Chronic pancreatitis with steatorrhea and weight loss; cornerstone therapy?

CKD anemia with Hgb 8.9 g/dL after iron repletion; next step?

Chronic hyperkalemia on RAAS inhibitor with CKD; pharmacologic option to maintain RAAS therapy?

Metabolic acidosis in CKD with bicarbonate 18 mEq/L; recommended intervention?

Suspected prerenal AKI from dehydration while on ACEI and NSAID; initial management?

Severe symptomatic hyponatremia with seizures; immediate therapy?

COPD with chronic hypoxemia (resting SaO₂ ≤88%); treatment shown to improve survival?

Antimicrobial stewardship principle in improving patient on broad-spectrum therapy with culture results available?