Clinical review of therapy MCQs With Answer

Introduction:

This Clinical Review of Therapy MCQs with Answers is tailored for M.Pharm students specializing in Clinical Pharmacy Practice. The quiz focuses on real-world therapeutic review concepts such as medication reconciliation, therapeutic drug monitoring, dose adjustment in organ dysfunction, detecting and managing drug–drug interactions, de-prescribing, guideline-based therapy optimization, and outcome assessment. Questions are designed to deepen clinical reasoning, reinforce evidence-based decision making, and improve skills in evaluating appropriateness, safety, and efficacy of pharmacotherapy across common disease states. Each MCQ includes concise options and the correct answer to aid focused self-assessment and to prepare for clinical examinations and practical patient care scenarios.

Q1. When performing a clinical review of therapy for a patient with chronic kidney disease, which parameter is most critical for individualizing dosing of renally-excreted drugs?

• Serum albumin concentration
• Estimated glomerular filtration rate (eGFR)
• Serum liver enzymes
• Serum electrolytes

Correct Answer: Estimated glomerular filtration rate (eGFR)

Q2. During a medication review, which tool is most appropriate for identifying potentially inappropriate medications in older adults?

• Beers Criteria
• Framingham Risk Score
• Child-Pugh Score
• APACHE II

Correct Answer: Beers Criteria

Q3. Which strategy is a primary component of antimicrobial stewardship when reviewing antibiotic therapy?

• Switching from IV to oral therapy when clinically appropriate
• Increasing dose empirically for all infections
• Adding broad-spectrum agents routinely
• Extending therapy duration beyond guidelines

Correct Answer: Switching from IV to oral therapy when clinically appropriate

Q4. In therapeutic drug monitoring, which statement best describes the significance of trough concentration measurement for drugs like vancomycin?

• Trough concentration predicts peak-related efficacy
• Trough concentration correlates with toxicity and efficacy for time-dependent antibiotics
• Trough concentrations are irrelevant for dosing adjustments
• Trough concentration is used only for oral drugs

Correct Answer: Trough concentration correlates with toxicity and efficacy for time-dependent antibiotics

Q5. When reviewing anticoagulant therapy, which patient factor most increases the risk of bleeding and should prompt dose reassessment?

• Young age
• Renal impairment
• High BMI
• History of peptic ulcer disease is irrelevant

Correct Answer: Renal impairment

Q6. Which is the best initial step when you identify a potential drug–drug interaction in a patient’s medication regimen?

• Immediately discontinue both drugs without consultation
• Assess clinical relevance, mechanism, and patient-specific risk, then recommend management
• Switch both drugs to experimental agents
• Ignore it if the patient appears stable

Correct Answer: Assess clinical relevance, mechanism, and patient-specific risk, then recommend management

Q7. During a clinical review, which outcome measure best assesses the clinical benefit of antihypertensive therapy in a population study?

• Change in serum creatinine only
• Reduction in systolic and diastolic blood pressure and reduction in cardiovascular events
• Patient-reported headache frequency alone
• Number of pills prescribed

Correct Answer: Reduction in systolic and diastolic blood pressure and reduction in cardiovascular events

Q8. Which approach is most appropriate for deprescribing benzodiazepines in an elderly patient identified during medication review?

• Immediate cessation to avoid withdrawal
• Gradual dose taper with non-pharmacologic sleep interventions
• Substitute with high-dose opioid therapy
• Increase dose to reduce daytime anxiety

Correct Answer: Gradual dose taper with non-pharmacologic sleep interventions

Q9. In patients with hepatic impairment, which pharmacokinetic change most commonly impacts drug dosing and requires careful therapy review?

• Increased renal clearance for all drugs
• Decreased hepatic metabolism leading to reduced clearance of high-extraction drugs
• Enhanced protein binding uniformly
• No change in first-pass metabolism

Correct Answer: Decreased hepatic metabolism leading to reduced clearance of high-extraction drugs

Q10. While reviewing a diabetic patient’s regimen, which parameter best guides adjustment of long-acting insulin dosing?

• Postprandial glucose only
• Fasting plasma glucose and overall hypoglycemia frequency
• Serum potassium
• Intermittent A1c results without daily glucose

Correct Answer: Fasting plasma glucose and overall hypoglycemia frequency

Q11. Which metric is most useful when assessing the net clinical benefit of anticoagulation in atrial fibrillation during therapy review?

• CHA2DS2-VASc and HAS-BLED scores together to balance stroke prevention and bleeding risk
• Only the patient’s age
• Only the cost of therapy
• Only International Normalized Ratio (INR) regardless of clinical context

Correct Answer: CHA2DS2-VASc and HAS-BLED scores together to balance stroke prevention and bleeding risk

Q12. When evaluating an adverse drug reaction (ADR) during a clinical review, which causality assessment approach is commonly used?

• World Health Organization–Uppsala Monitoring Centre (WHO-UMC) causality categories
• Body mass index calculation
• Estimating pill count only
• Using patient’s income level

Correct Answer: World Health Organization–Uppsala Monitoring Centre (WHO-UMC) causality categories

Q13. For heart failure with reduced ejection fraction, which combination reflects guideline-directed medical therapy to review for optimization?

• Beta-blocker, ACE inhibitor or ARNI, mineralocorticoid receptor antagonist, and SGLT2 inhibitor
• Only loop diuretic and aspirin
• High-dose insulin and metformin
• Antibiotic and proton pump inhibitor

Correct Answer: Beta-blocker, ACE inhibitor or ARNI, mineralocorticoid receptor antagonist, and SGLT2 inhibitor

Q14. Which principle is essential when deciding to perform therapeutic interchange during a clinical review?

• Interchange solely based on brand preference
• Ensure therapeutic equivalence and consider patient-specific factors and formulary policies
• Replace all drugs with generics without assessment
• Never change drug therapy once prescribed

Correct Answer: Ensure therapeutic equivalence and consider patient-specific factors and formulary policies

Q15. In a medication reconciliation process at hospital admission, what is the primary goal?

• To document the last pharmacy visited by the patient
• To obtain and verify the complete and accurate list of current medications to prevent errors
• To prescribe new medications immediately
• To discharge the patient quickly without review

Correct Answer: To obtain and verify the complete and accurate list of current medications to prevent errors

Q16. When reviewing lipid-lowering therapy, which parameter is most important to judge adequacy of secondary prevention in a patient with prior MI?

• LDL-C reduction to guideline target
• Serum sodium concentration
• Body temperature
• Time since last dental visit

Correct Answer: LDL-C reduction to guideline target

Q17. Which calculation is most critical in interpreting the benefit of a preventive therapy in a clinical review?

• Number needed to treat (NNT)
• Glomerular filtration fraction
• Absolute neutrophil count only
• Medication possession ratio without outcome data

Correct Answer: Number needed to treat (NNT)

Q18. During chemotherapy regimen review, which consideration is essential to minimize toxicity while maintaining efficacy?

• Assess renal and hepatic function, performance status, prior toxicities, and dose adjustments based on organ function
• Ignore organ function if the patient is young
• Double the dose to ensure tumor kill
• Stop all supportive care measures

Correct Answer: Assess renal and hepatic function, performance status, prior toxicities, and dose adjustments based on organ function

Q19. Which intervention is most effective during therapy review to reduce polypharmacy-related harm in multimorbid patients?

• Comprehensive medication review with prioritization of therapies, deprescribing when appropriate, and shared decision-making
• Adding supplements for every symptom
• Substituting all prescription drugs with herbal remedies
• Continuing all existing medications indefinitely

Correct Answer: Comprehensive medication review with prioritization of therapies, deprescribing when appropriate, and shared decision-making

Q20. In clinical review of therapy for asthma, which indicator best demonstrates control and guides step-down therapy?

• Frequency of daytime symptoms, nighttime awakenings, rescue inhaler use, and spirometry or peak flow measures
• Only the patient’s height
• Serum cholesterol levels
• Daily calorie intake

Correct Answer: Frequency of daytime symptoms, nighttime awakenings, rescue inhaler use, and spirometry or peak flow measures

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