Practice DI Questions

Self assessment questions on Drug information resources
1. A colleague tells you about a poster on the advantages and disadvantages of the Baxter
IV pump specifically for pediatric patients in the Intensive
Care Unit (ICU). The poster was presented at an annual national pharmacy meeting.
Which one of the following sources would be best to find this poster?
A. IDIS.
B. IPA.
C. MEDLINE.
D. Ovi
2. A physician requests a brief summary of a new anti-depressant, vilazodone. The
pharmacist answering this question has not heard of this drug. Which one of the
following resources is best to consult for this information?
A. MEDLINE, in-process
B. IDIS
C. PubMed
D. IPA
3. A MEDLINE search using the MeSH terms for stroke and aspirin is conducted to find
information on whether every woman over the age of 55 years should take low-dose
aspirin for stroke prevention. In addition to this approach, which search strategy would
best minimize the retrieval of erroneous data?
A. Using the keyword word search of “aspirin
AND stroke”.
B. Using the subheading “therapeutic use”.
C. Limiting the sex to “female”.
D. Restricting the publication type to “review”.
4. Which mobile application for a personal digital assistant (PDA) or smart phone would
most efficiently and effectively identity if simvastatin, benazepril, hydrochlorothiazide,
and omeprazole will interact with clarithromycin?
A. MobileMicromedex.
B. Clinical Pharmacology OnHand.
C. Epocrates.
D. Lexi-Drugs.
5. A pharmacist is researching MEDLINE for the dose of gabapentin for treatment of
spasticity in a 36-year-old woman newly diagnosed with multiple sclerosis. If using the
MEDLINE terms “gabapentin” AND “spasticity,” which one of the following limit
functions would best help narrow results and limit erroneous results?
A. Human.
B. English only.
C. Human and English only.
D. Clinical trials.
6. A medical resident has requested information on a recent news story regarding the
depletion of magnesium by proton pump inhibitors. She requests more information as
to the clinical presentation as well as the incidence of this depletion in patients. Which
one of the following would be the best Internet source to find this information?
A. www.clinicaltrials.gov.
B. www.fda.gov.
C. www.mayoclinic.com.
D. www.clinicalevidence.com
7. A 54-year-old woman has a 10-year history of relapsing, remitting multiple sclerosis. She
has either not tolerated or failed all commercially available drug therapy options. The
patient lives in rural Montana and has limited travel and medical resources. She is
interested in trying to find a clinical trial that she might be eligible for that could provide
some other therapeutic options. Which one of the following Web sites would provide
her with the best options?
A. WebMD.
B. www.clinicaltrials.gov.
C. www.fda.gov.
D. www.controlled-trials.com.
Questions 8–11 pertain to the following case

The Cochrane Library (Cochrane Database of Systematic Reviews) published a
systematic review on the use of supplemental selenium in the prevention of cancer. The
review was published in May of 2011 and included all pertinent clinical trials as of April
5,2011. The review included 49 prospective observational studies and six randomized
controlled trials (RCTs).In epidemiologic data, the review reported a reduced cancer
incidence (odds ratio [OR] of 0.69 (95% confidence interval [CI] 0.53–0.91) and mortality
(OR 0.55, 95% CI 0.36–0.83) with higher selenium exposure. The cancer risk reduction
was more pronounced in men (incidence: OR 0.66, 95% CI 0.42–1.05) than in women
(incidence: OR 0.90, 95% CI 0.45–1.77). The authors of the review stated that no reliable
conclusions can be drawn regarding a causal relationship between low selenium
exposure and an increased risk of cancer. They also summarized that the effect of
selenium supplementation yielded inconsistent results in RCTs, and that to date there is
no convincing evidence that selenium supplements can prevent cancer in men, women,
or children. In addition, the results of the Nutritional Prevention of Cancer Trial (NPCT)
and the Selenium and Vitamin E Cancer Prevention Trial (SELECT) raised concerns about
possible harmful effects of selenium supplements.
8. A 47-year-old man has read recent information that selenium supplementation can
decrease his risk of prostate cancer. His family history of prostate cancer includes his
father, grandfather, and older brother, who all three developed prostate cancer in their
50s. The patient currently has a prostate-specific antigen test with his yearly physical,
which includes a digital rectal examination of the prostate. He takes a daily multivitamin
that contains 55 mcg of selenium. Based on the results of the Cochrane Review, which
one of the following is the best advice for this patient?
A. Continue the daily multivitamin that contains the RDA for selenium.
B. Add an additional selenium supplement to the multivitamin to reach a daily dose of
200 mcg per day.
C. Discontinue the daily multivitamin and increase his daily selenium to 400 mcg per day
with nutritional milkshake supplements.
D. Discontinue the current brand of multivitamin and find a supplement that does not
contain selenium.
9. The conclusions of the Cochrane authors seem inconsistent with the OR reported for
both cancer incidence as well as mortality. What is the best explanation as to why the
reviews indicated that there is no reliable conclusion that can be drawn between
selenium exposure and cancer risk?
A. Odds ratios are an estimate of relative risk and the actual relative risks were not
provided.
B. The RCTs showed inconsistent results compared with the observational study designs;
therefore, a causal relationships could not concluded.
C. The CI showed wide variability and often included a value of one, thereby indicating
that the data are weak
D. The potential for sex bias in the observational studies created inconclusive results.
10. Both the NPCT and SELECT found possible harmful effects of selenium without
additional reductions in cancer. The NPCT evaluated 200 mcg/day in prevention of non-
melanoma skin cancers in light-skinned participants; the SELECT evaluated the use of
selenium 200 mcg/day with or without vitamin E 400 international units/day in more
than 35,000 men older than 55. The SELECT trial cohort included 15% African American
males. These two RCTs illustrate a potential problem related to internal validity
(methodology). Which one of the following was most important to consider when the
Cochrane reviewers were evaluating the data?
A. Variability in dose of selenium.
B. Variability in sample size.
C. Publication bias.
D. Comparability or homogeneity of samples.
11. A student pharmacist is completing an Advance Practice Rotation and has been assigned
the task of seeing if any additional studies have been published on selenium and cancers
since the most recent Cochrane Review has been published. Which one of the following
is the best resource for the student to use?
A. PubMed.
B. UpToDate.
C. Google.
D. www.fda.gov
12. The health care advisory committee to an employee wellness program is contemplating
adding vitamin D serum concentrations to its routine laboratory screening. The cost of
adding this particular test is $12 per employee, which is a significant increase in overall
expenditures. The vice president of human resources is asking the advisory committee
to provide data or national guidelines that show the cost-benefit of this
recommendation. Which one of the following would be the best reference source to
start looking for national guidelines or standards?
A. Google.
B. WebMD.
C. C. www.controlled-trials.com.
D. www.guideline.gov.
13. A patient from the anticoagulation clinic has found a Web site that provides a
comparison between dabigatran and warfarin for atrial fibrillation. The patient insists on
switching to this new therapy because this Web site states that dabigatran is more
effective than warfarin and does not require any blood work. When you inquire about
the source of the information, the patient tells you that it is called “Dean’s Stroke
usings.” The patient has read several other Internet testimonials on treatment with
dabigatran and how it has changed the writer’s life. Which one of the following is the
best advise to give this patient on the use of the Internet for patient information?
A. Discourage them from using blogs and patient testimonials for advice.
B. Caution them on opinion pieces and redirect them to search the web for other sites.
C. Redirect them to WebMD to compare treatments for atrial fibrillation.
D. Redirect them to better sites and provide them with some standard questions to help
determine a high quality site.

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Self assessment questions on Drug information resources

Questions 8–11 pertain to the following case

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