Free FPGEE Practice Test Review

Qualifying for and passing the Foreign Pharmacy Graduate Equivalency Exam (FPGEE) can be an arduous and time consuming process. The FPGEE is the mechanism by which pharmacists from other countries, or Americans who have graduated from foreign pharmacy schools, gain approval to become a licensed pharmacist in the United States. This can be frustrating for the person who is applying, as the long delay prevents them from putting into use the skills they spent a lot of time and money acquiring. However, the medical and legal authorities in the US are intent on being thorough and deliberate when it comes to approving foreign pharmacists, in order to ensure that no unqualified pharmacists slip through the cracks because of undue haste.

There are 250 questions on the latest version of the FPGEE. Approximately 40 of those questions will be on basic biomedical sciences, approximately 75 questions will cover pharmaceutical sciences, approximately 55 questions will be on social, behavioral and administrative pharmacy sciences, and approximately 80 questions will be on clinical sciences. The exam is only given twice a year, usually in April and November. There isn't much leeway, either. If someone is approved to take the test in November, but an emergency of some sort comes up and he can't make it, he might or might not get approved to take it the following April. However, if approval is granted, it will be the person's final chance. If he misses that test, he's pretty much done for good when it comes to working as a pharmacist in America, so the stakes are high. The test is also very expensive; as of this writing, the cost is $600 to take it.

One of the best ways of preparing for the FPGEE is by taking the Pre-FPGEE exam. This is a test that is put out by the National Association of Boards of Pharmacy (NABP), which is the same group that develops and administers the FPGEE and the NAPLEX exams. This pre-test is carefully designed to mimic the real exam, although it isn't nearly as extensive, at 66 questions and 85 minutes. A person's results on the pre-test are a very good indicator of how well they will do on the actual exam. Taking it is a great way of discovering weakness and blind spots in one's preparation for the exam that need to be addressed. There is a fee of $50 to take the pre-test, and it can be done from anywhere, as it's given over the internet.

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FPGEE Exam Questions

Patient Name: Bart Smith
Age: 66 Height: 5'10"
Sex: M Weight: 200 lb

Allergies: ibuprofen (stomach upset)

Diagnosis
Primary:
1. Hypothyroidism
2. Renal insufficiency
3. Lower extremity deep vein thrombosis

Chief Complaint: lethargy, weight gain, edema, left leg pain/swelling

Lab/ Diagnostic Tests
Date Test/Result
08/07 TSH 4.3 U/mL
(last week) Serum creatinine 2.2 mg/dL

Medications
Date Name and Strength RouteDirections
07/20 Synthroid 88 mcg PO1 tablet daily

1. Use the Cockcroft-Gault equation and ideal body weight to estimate Bart Smith's creatinine clearance:

a. 27 mL/min
b. 34 mL/min
c. 42 mL/min
d. 62 mL/min
e. 71 mL/min

2. What is the correct dose of enoxaparin (Lovenox) for Bart Smith?
I. 90 mg SC twice daily
II. 140 mg SC once daily
III. None; the patient should receive heparin, due to his renal function

a. I only
b. III only
c. I and II
d. II and III
e. I, II, and III

3. Bart's doctor prescribes warfarin 4 weeks later. Which statement about warfarin therapy is TRUE?

a. Significant drug interactions occur, due to inhibition of R-warfarin metabolism by CYP2D6
b. Acetaminophen does not interact with warfarin
c. The antithrombotic effect of warfarin occurs prior to its anticoagulant effect
d. Warfarin interferes with cyclic interconversion of Vitamin K-dependent coagulation Factors II, VIII, IX, and X
e. Dosing can be guided by patient pharmacogenetics

4. Coag Lab reports Bart Smith's INR is 5.3 but he has no acute bleeding. What would you recommend for management of the INR?
I. Omit 1 or 2 doses of warfarin, then resume warfarin when the INR is within the therapeutic range
II. Reduce warfarin dose by 50% and recheck the INR in 24 hours
III. Administer 10 mg of Vitamin K (phytonadione) by slow IV infusion

a. I only
b. III only
c. I and II
d. II and III
e. I, II, and III

5. Bart Smith requires surgery, so his warfarin is withheld. What is the proper procedure for maintaining appropriate anticoagulation?
I. Stop warfarin 5 days prior to surgery
II. Resume warfarin 12 to 24 hours after surgery
III. If Bart's INR ≥ 1.5 one or two days prior to surgery, administer oral Vitamin K

a. I only
b. III only
c. I and II
d. II and III
e. I, II, and III

Answers and Explanations

1. B: The ideal body weight (IBW) for men is 2.3 (height in inches > 5 feet) + 50 kg. The Cockcroft-Gault GFR = (140 - age) * (weight in kilograms) * (0.85 if female) / (72 * Cr). Using the Cockroft-Gault equation to estimate Bart Smith's creatinine clearance, the answer is 34.1 mL/min.

2. C: No dosing modification is warranted for moderate renal dysfunction (30 - 50 ml/min). Dosage adjustments are recommended for renal function < 30 mL/min. Bart Smith should be monitored for signs and symptoms of bleeding. Heparin could be given, but is unnecessary for this patient's renal function. Enoxaparin is dosed at 1mg/kg SC twice daily or 1.5 mg/kg SC once daily.

3. E: Warfarin is racemic; the S-isomer is about 5 times more potent than the R-isomer. S-warfarin is metabolized primarily by CYP2C9; R-warfarin is metabolized by 1A2 and 3A4. Acetaminophen can augment the anticoagulant effect of warfarin. Doses of 2,000 mg/day or less are unlikely to interact. The anticoagulant effect of warfarin occurs in about 2 days, while the antithrombotic effect occurs in about 6 days. Overlap heparin with warfarin for about 4 days, or until the patient's prothrombin is depleted (t1/2 60-72 hours).Warfarin interferes with cyclic interconversion of Vitamin K-dependent coagulation Factors II, VII, IX, and X. Determination of the patient's VKORC1 and CYP2D6 genetic variants may help guide dosing. However, genetic testing is at the discretion of the attending physician, and is not required to initiate warfarin therapy.

4. A: The World Health Organization states international normalized ratio (INR) is more accurate for managing blood thinners than prothrombin time and partial thromboplastin time (PT and PTT). Normal INR range is 0.9 to 1.2. Therapeutic range for warfarin sodium is 2.0 to 3.0. If the patient's INR is less than 2.0, there is minimal risk of bleeding. If a low-risk patient's INR exceeds therapeutic range, withhold 1 or 2 doses of warfarin. Alternatively, give the patient a low dose of oral Vitamin K (1 mg to 2.5 mg). Resume warfarin therapy when the patient's INR returns to the therapeutic range. If the patient's INR is 3.0 to 4.5, bleeding is likely and higher doses of oral Vitamin K are required. Bart's INR is extremely high (5.3) and he will certainly bleed. Give intravenous Vitamin K for immediate reversal.

5. E: Warfarin could cause the patient to hemorrhage during surgery, or in the post operative recovery period. Stop warfarin for a preoperative patient at least five days prior to surgery, to allow for the normalization of INR. Resume warfarin 12 to 24 hours after surgery, once hemostasis is adequate. Give a small oral dose of Vitamin K (1 to 2 mg) if the patient's INR is greater than or equal to 1.5, one or two days prior to surgery.

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Last Updated: 09/22/2017


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