A 58-year-old man with newly diagnosed hypertension and type 2 diabetes (eGFR 70 mL/min, urine albumin-to-creatinine ratio elevated) needs first-line antihypertensive therapy. Which class is most appropriate to start?
Clinical Care
Question · Medium
Blood sugar 62: the 15-15 rule
Short
A 64-year-old woman with type 2 diabetes and established atherosclerotic cardiovascular disease has an A1C of 8.2% on metformin. Which add-on agent best reduces cardiovascular risk per current Diabetes Canada guidance?
Blood test used to monitor warfarin therapy, with a usual target of 2.5 and a range of 2.0 to 3.0.
Clinical care
Guess the Term
Chapter 1: Canadian Pharmacy Regulatory Framework & Federal Legislation
1.1 Food and Drugs Act, Regulations, and Health Canada Oversight
Study guide
A patient starting atorvastatin asks which symptom would most warrant contacting a health professional promptly. Which should the pharmacist counsel on?
Question · Easy
Read the clue and guess the term in 6 tries.
Game
A 72-year-old patient with atrial fibrillation, CHADS-65 positive, and an eGFR of 55 mL/min is to start anticoagulation. Which is generally preferred over warfarin for non-valvular AF in Canadian guidance?
Clot that starts in a large leg vessel and can break off and travel to the lungs.
A patient with asthma uses a salbutamol inhaler more than 4 times per week and wakes at night with symptoms twice a month. According to current asthma management, what change is most appropriate?
P-R-I-L: the -pril arena anthem
A 40-year-old woman with an uncomplicated lower urinary tract infection has no allergies and normal renal function. Which is a recommended first-line empiric option in Canada?
Drug class that guidelines recommend at high intensity, with healthy behaviour changes, for every patient with established cardiovascular disease.
1.2 Controlled Drugs and Substances Act (CDSA) & Controlled Substances Regulations (CSR)
A patient is starting sertraline for major depressive disorder. Which counselling point about onset of effect is most accurate?
Swap tiles to line up three of the same term.
Term Match
A 55-year-old man has frequent heartburn for several weeks without alarm features, partially relieved by antacids. Which step is most appropriate before referral?
Chest pain condition that the Canadian Cardiovascular Society grades I to IV by how much ordinary activity provokes it.
A patient on warfarin presents with an INR of 5.5 and no bleeding. The therapeutic range is 2.0 to 3.0. Which action is most appropriate?
Question · Hard
A pregnant patient in her first trimester asks about a safe option for occasional headache. Which analgesic is generally considered the preferred choice?
Inflammatory airway disorder with variable airflow limitation and symptoms such as wheeze, chest tightness and cough.
1.3 NAPRA Drug Scheduling Framework & National Model Standards of Practice
A 68-year-old patient with COPD has frequent exacerbations despite a long-acting bronchodilator. Which therapy addition is most consistent with current COPD management?
Flip two cards at a time to find matching terms.
Term Pairs
A patient newly started on metformin reports nausea and loose stools. Which counselling advice is most appropriate to improve tolerability?
Lung condition confirmed when the post-bronchodilator FEV1/FVC ratio is below 0.70.
A patient with community-acquired pneumonia managed as an outpatient has no comorbidities and no recent antibiotic use. Which empiric regimen is a reasonable first-line choice in Canada?
A patient taking lithium for bipolar disorder starts a new medication and now has tremor, confusion and nausea. Which co-prescribed drug most likely raised lithium levels?
Neurological symptoms from reduced blood flow to the brain, spinal cord or retina that resolve, with no infarct seen on imaging.
Chapter 2: Ethics, Scope of Practice & Safety Culture
2.1 Professional Ethics, Fiduciary Duty & Health Information Privacy
A 45-year-old with stable angina is prescribed sublingual nitroglycerin spray for acute episodes. Which counselling point is correct?
Find five hidden terms in a grid of letters.
Term Search
A patient with type 1 diabetes asks how to manage a low blood glucose of 3.0 mmol/L while conscious and able to swallow. What is the appropriate immediate treatment?
Emergency marked by high blood sugar, ketones and a pH below normal.
A patient is prescribed clarithromycin while already taking simvastatin. What is the main concern with this combination?
A patient with chronic non-cancer pain is being considered for opioid therapy after non-opioid options were inadequate. Which approach reflects safe Canadian opioid prescribing principles?
Condition defined by structural or functional abnormalities of the blood-filtering organs lasting at least three months and affecting health.
2.2 Expanded Scope of Practice: Minor Ailments Prescribing, Renewals & Injections
A patient with hypothyroidism is taking levothyroxine. Which counselling point optimizes absorption?
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A patient on an ACE inhibitor develops a persistent dry cough that is bothersome but not associated with angioedema. What is the most appropriate management?
Drug class spanning natural, semi-synthetic and fully synthetic agents that, for chronic non-cancer pain, should not be forcibly or involuntarily tapered.
A 30-year-old woman with major depressive disorder is breastfeeding and needs an antidepressant. Which SSRI is commonly considered a preferred option during breastfeeding due to low infant exposure?
A patient with gout is started on allopurinol for urate-lowering. Which counselling point is correct about initiating therapy?
Four-category Canadian model that sets how medicines are sold, from prescription-only to open retail sale.
Distribution
2.3 Equity, Diversity, Inclusion, Cultural Safety & Continuous Quality Improvement
A patient taking metronidazole for a bacterial infection asks about alcohol. What should the pharmacist advise?
A patient with stable heart failure with reduced ejection fraction is on an ACE inhibitor and beta-blocker. Which additional class has strong evidence for reducing mortality in HFrEF?
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