The conversion of intravenous (IV) to oral (PO) medication is a cornerstone of modern antimicrobial stewardship and a key pharmacist-driven initiative in the hospital setting. This clinical intervention is far more than a simple change in dosage form; it represents a critical opportunity to improve patient safety, reduce healthcare costs, and enhance patient mobility. As a PharmD student, mastering the principles behind this process is a core competency, explicitly practiced in courses like the Professional Skills Lab 3. A successful IV to PO conversion requires a thorough understanding of drug bioavailability, patient-specific clinical criteria, and the ability to complete therapeutic interchanges based on hospital protocols. This quiz will test your knowledge on identifying appropriate candidates, selecting equivalent oral therapies, and recognizing the significant benefits of transitioning patients from parenteral to enteral medication routes.
1. What is the most important pharmacokinetic parameter to consider when converting an IV medication to its PO equivalent?
- a. Half-life (t1/2)
- b. Volume of distribution (Vd)
- c. Oral bioavailability (F)
- d. Time to peak concentration (Tmax)
Answer: c. Oral bioavailability (F)
2. A patient is receiving IV levofloxacin 750 mg daily and is clinically stable with a functioning GI tract. Given that levofloxacin has high bioavailability (~99%), what is the equivalent oral dose?
- a. 250 mg daily
- b. 500 mg daily
- c. 750 mg daily
- d. 1000 mg daily
Answer: c. 750 mg daily
3. Which of the following is a primary clinical criterion for a patient to be eligible for an IV to PO switch?
- a. The patient must have a central line.
- b. The patient is hemodynamically stable and clinically improving.
- c. The patient’s white blood cell count is still rising.
- d. The patient has been on IV therapy for less than 12 hours.
Answer: b. The patient is hemodynamically stable and clinically improving.
4. Why is oral vancomycin NOT an appropriate switch for a patient receiving IV vancomycin for MRSA bacteremia?
- a. Oral vancomycin is too expensive.
- b. Oral vancomycin has extremely poor absorption and is used for GI infections like C. difficile.
- c. IV vancomycin has a shorter half-life.
- d. The oral and IV formulations are therapeutically interchangeable for all indications.
Answer: b. Oral vancomycin has extremely poor absorption and is used for GI infections like C. difficile.
5. Completing IV to PO therapeutic interchanges based on a protocol is a specific learning objective in which course?
- a. PHA5781 Patient Care 1
- b. PHA5104 Sterile Compounding
- c. PHA5163L Professional Skills Lab 3
- d. PHA5439 Principles of Medicinal Chemistry and Pharmacology I
Answer: c. PHA5163L Professional Skills Lab 3
6. Which of the following is a significant benefit of converting a patient from IV to PO therapy?
- a. Increased risk of phlebitis.
- b. Increased drug cost.
- c. Decreased risk of catheter-related bloodstream infections (CRBSIs).
- d. Longer hospital length of stay.
Answer: c. Decreased risk of catheter-related bloodstream infections (CRBSIs).
7. A patient is NPO (nothing by mouth) for a surgical procedure tomorrow. Is this patient a good candidate for an IV to PO switch today?
- a. Yes, because they are clinically stable.
- b. Yes, if they can swallow pills with a small sip of water.
- c. No, because they have a non-functioning GI tract or cannot tolerate oral intake.
- d. No, because the oral medication is less effective.
Answer: c. No, because they have a non-functioning GI tract or cannot tolerate oral intake.
8. Which of the following antibiotics is known for its excellent (near 100%) oral bioavailability, making it a prime candidate for a 1:1 IV to PO conversion?
- a. Ampicillin
- b. Cefazolin
- c. Linezolid
- d. Gentamicin
Answer: c. Linezolid
9. A “therapeutic interchange” refers to:
- a. Switching a medication from IV to an identical PO formulation.
- b. Dispensing a therapeutically equivalent but chemically different drug in place of the one prescribed, per protocol.
- c. Giving the patient a choice between two different drugs.
- d. Changing the dose of a medication based on lab results.
Answer: b. Dispensing a therapeutically equivalent but chemically different drug in place of the one prescribed, per protocol.
10. A patient is receiving IV metronidazole. This drug is an excellent candidate for an early IV to PO switch because:
- a. It has high oral bioavailability and is well-tolerated.
- b. It is only effective when given intravenously.
- c. It has a very narrow spectrum of activity.
- d. It must be administered with food.
Answer: a. It has high oral bioavailability and is well-tolerated.
11. The presence of a hospital-approved, pharmacist-driven IV to PO conversion protocol is a key component of:
- a. A medication reconciliation program.
- an antimicrobial stewardship program.
- c. A sterile compounding program.
- d. A new drug development program.
Answer: b. an antimicrobial stewardship program.
12. Before switching a patient to an oral antibiotic, the pharmacist must ensure:
- a. The patient has no active infection.
- b. The patient is afebrile and has a normalizing white blood cell count.
- c. The patient’s insurance will not cover the IV formulation.
- d. The oral medication tastes good.
Answer: b. The patient is afebrile and has a normalizing white blood cell count.
13. A patient is receiving IV ampicillin for an infection. The oral bioavailability of ampicillin is approximately 40%. To switch to oral amoxicillin (bioavailability ~90%), the pharmacist would need to:
- a. Use the same milligram dose as the IV ampicillin.
- b. Calculate a therapeutically equivalent dose, which will likely be different from the IV dose.
- c. Refuse the switch as it is not possible.
- d. Switch to oral ampicillin at the same dose.
Answer: b. Calculate a therapeutically equivalent dose, which will likely be different from the IV dose.
14. Which patient condition would be a contraindication to an IV to PO switch, even if the patient is stable?
- a. Uncomplicated urinary tract infection.
- b. Community-acquired pneumonia.
- c. Cellulitis.
- d. Endocarditis or meningitis.
Answer: d. Endocarditis or meningitis.
15. Bioavailability (F) is defined as the:
- a. Rate of drug absorption.
- b. Fraction of an administered dose of unchanged drug that reaches the systemic circulation.
- c. Time it takes for half of the drug to be eliminated.
- d. Amount of drug bound to plasma proteins.
Answer: b. Fraction of an administered dose of unchanged drug that reaches the systemic circulation.
16. An IV drug has a bioavailability (F) of:
- a. 0%
- b. 50%
- c. 100%
- d. It is variable.
Answer: c. 100%
17. “First-pass metabolism” refers to the metabolism of a drug in the ____ before it reaches the systemic circulation, which can significantly lower its oral bioavailability.
- a. Kidneys
- b. Lungs
- c. Liver and gut wall
- d. Spleen
Answer: c. Liver and gut wall
18. A patient has a nasogastric (NG) tube and is unable to swallow pills. The desired oral medication is only available as an enteric-coated tablet. What is the appropriate action?
- a. Crush the tablet and administer it through the NG tube.
- b. Dissolve the tablet in water and administer it.
- c. Inform the provider that the current formulation is not suitable for NG tube administration and recommend an alternative.
- d. Continue IV therapy indefinitely.
Answer: c. Inform the provider that the current formulation is not suitable for NG tube administration and recommend an alternative.
19. Which of the following antibiotic classes generally has excellent bioavailability, making most agents in the class good candidates for IV to PO conversion?
- a. Aminoglycosides
- b. Carbapenems
- c. Fluoroquinolones
- d. First-generation cephalosporins
Answer: c. Fluoroquinolones
20. A patient is receiving IV cefazolin for a skin infection. What would be an appropriate oral therapeutic equivalent to switch to?
- a. PO Cefazolin (not available)
- b. PO Cephalexin
- c. PO Cefepime
- d. PO Ceftaroline
Answer: b. PO Cephalexin
21. A major advantage of increased patient mobility from an IV to PO switch is:
- a. Reduced risk of developing deep vein thrombosis (DVT).
- b. The patient can leave the hospital to get food.
- c. The patient requires less nursing care.
- d. The patient can self-administer their IV medications.
Answer: a. Reduced risk of developing deep vein thrombosis (DVT).
22. Which of the following factors would argue AGAINST an IV to PO switch?
- a. Patient is tolerating a clear liquid diet.
- b. Patient has improving cellulitis.
- c. Patient has severe, persistent vomiting and diarrhea.
- d. Patient has a temperature of 99.5 °F.
Answer: c. Patient has severe, persistent vomiting and diarrhea.
23. The pharmacist’s role in an IV to PO program is to:
- a. Screen patients for eligibility.
- b. Recommend appropriate oral regimens.
- c. Monitor for therapeutic success after the switch.
- d. All of the above.
Answer: d. All of the above.
24. The primary reason aminoglycosides (e.g., gentamicin, tobramycin) are not given orally for systemic infections is:
- a. They taste bad.
- b. They have negligible oral bioavailability.
- c. They are too expensive.
- d. They cause severe GI upset.
Answer: b. They have negligible oral bioavailability.
25. A pharmacist is reviewing a patient on IV ciprofloxacin for a UTI. The patient is now eating, afebrile, and stable. What should the pharmacist recommend?
- a. Continue IV ciprofloxacin for 14 days.
- b. Switch to PO ciprofloxacin 500 mg every 12 hours.
- c. Switch to IV meropenem.
- d. Discontinue all antibiotics.
Answer: b. Switch to PO ciprofloxacin 500 mg every 12 hours.
26. The ability to recommend an oral drug regimen by considering concepts like bioavailability and clearance is a learning objective of which course?
- a. PHA5132 Principles of Drug Therapy Individualization
- b. PHA5703 Pharmacy Law and Ethics
- c. PHA5161L Professional Practice Skills Lab I
- d. PHA5267 Principles of Pharmacoeconomics
Answer: a. PHA5132 Principles of Drug Therapy Individualization
27. Converting from IV to PO therapy can lead to a shorter hospital length of stay.
- a. True
- b. False
Answer: a. True
28. Before recommending a switch to an oral medication, a pharmacist should check the patient’s chart for:
- a. Any history of GI surgeries or malabsorption syndromes.
- b. The patient’s favorite television show.
- c. The patient’s room number.
- d. The name of the admitting clerk.
Answer: a. Any history of GI surgeries or malabsorption syndromes.
29. Which of the following antifungals has excellent bioavailability and is often switched from IV to PO?
- a. Amphotericin B
- b. Caspofungin
- c. Fluconazole
- d. Micafungin
Answer: c. Fluconazole
30. The “IV to PO Conversions” lab session is a component of which course in the PharmD curriculum?
- a. PHA5163L Professional Skills Lab 3
- b. PHA5164L Professional Skills Laboratory 4
- c. PHA5782C Patient Care 2
- d. PHA5878C Patient Care 3
Answer: a. PHA5163L Professional Skills Lab 3
31. When a patient is switched from an IV to PO antibiotic, it is important for the pharmacist to monitor for:
- a. Continued clinical improvement and tolerance of the oral medication.
- b. A new catheter-related infection.
- c. An increase in the patient’s appetite.
- d. The patient’s satisfaction with the hospital food.
Answer: a. Continued clinical improvement and tolerance of the oral medication.
32. The process of assessing the biopharmaceutical properties of drugs is a learning objective in which course?
- a. PHA5176 Drug Delivery Systems
- b. PHA5021C Personal and Professional Development 1
- c. PHA5560 Pathophysiology and Patient Assessment I
- d. PHA5244 Principles of Evidence-Based Practice
Answer: a. PHA5176 Drug Delivery Systems
33. What is a potential issue with switching a patient to an oral antibiotic that must be taken multiple times a day?
- a. It is more effective than once-daily drugs.
- b. It may lead to decreased adherence compared to a once-daily IV dose.
- c. It is always cheaper.
- d. It has fewer side effects.
Answer: b. It may lead to decreased adherence compared to a once-daily IV dose.
34. The pharmacist’s recommendation for an IV to PO switch should be documented in the:
- a. Patient’s billing record.
- b. Pharmacy’s inventory system.
- c. Patient’s Electronic Health Record (EHR).
- d. A personal notebook.
Answer: c. Patient’s Electronic Health Record (EHR).
35. A patient on IV pantoprazole for stress ulcer prophylaxis who is now taking a diet can be switched to:
- a. IV famotidine.
- b. PO pantoprazole.
- c. IV esomeprazole.
- d. NPO status.
Answer: b. PO pantoprazole.
36. A drug with a bioavailability of 50% is given as a 200 mg oral dose. How much of the drug reaches systemic circulation?
- a. 50 mg
- b. 100 mg
- c. 200 mg
- d. 400 mg
Answer: b. 100 mg
37. Which factor is LEAST likely to affect a drug’s oral bioavailability?
- a. First-pass metabolism
- b. Drug formulation (e.g., enteric coating)
- c. The time of day the drug is administered
- d. Presence of food or other drugs in the GI tract
Answer: c. The time of day the drug is administered
38. The development of an IV to PO conversion protocol is an example of a pharmacist contributing to:
- a. The hospital’s marketing plan.
- b. Safe and effective medication use systems.
- c. The daily cafeteria menu.
- d. The surgical schedule.
Answer: b. Safe and effective medication use systems.
39. A patient is on IV ceftriaxone for pneumonia. A potential oral therapeutic interchange could be:
- a. PO Ceftriaxone (not available)
- b. PO Cefpodoxime
- c. PO Vancomycin
- d. PO Gentamicin
Answer: b. PO Cefpodoxime
40. A patient’s ability to tolerate oral intake is a key factor in determining their suitability for an IV to PO switch.
- a. True
- b. False
Answer: a. True
41. The economic benefit of an IV to PO switch includes savings from:
- a. The drug cost itself.
- b. IV tubing and administration supplies.
- c. Pharmacy and nursing time for preparation and administration.
- d. All of the above.
Answer: d. All of the above.
42. Which of the following drugs has low oral bioavailability and is a poor candidate for IV to PO conversion for a systemic infection?
- a. Moxifloxacin
- b. Doxycycline
- c. Acyclovir
- d. Fluconazole
Answer: c. Acyclovir
43. A pharmacist’s daily responsibilities on rounds should include:
- a. Avoiding all communication with physicians.
- b. Identifying patients who are candidates for IV to PO conversion.
- c. Only discussing medications that start with the letter “A”.
- d. Delivering meal trays to patients.
Answer: b. Identifying patients who are candidates for IV to PO conversion.
44. What does it mean for a drug to have a bioavailability (F) of 0.7?
- a. 70% of the oral dose reaches the systemic circulation.
- b. 30% of the oral dose is absorbed.
- c. The drug is 70% effective.
- d. The drug’s half-life is 7 hours.
Answer: a. 70% of the oral dose reaches the systemic circulation.
45. A patient with severe sepsis and hypotension is not a candidate for an IV to PO switch because:
- a. They are likely not sick enough to warrant IV therapy.
- b. They are hemodynamically unstable, and GI absorption may be compromised.
- c. They cannot provide consent.
- d. Their infection is probably viral.
Answer: b. They are hemodynamically unstable, and GI absorption may be compromised.
46. Which of the following is an appropriate reason to continue IV therapy?
- a. The patient prefers getting injections.
- b. The oral formulation is out of stock in the pharmacy.
- c. The infecting organism is only susceptible to an IV-only antibiotic.
- d. The patient is able to eat and drink without issue.
Answer: c. The infecting organism is only susceptible to an IV-only antibiotic.
47. A pharmacist calculates that the equivalent oral dose of a medication is 1200 mg, but the largest available tablet strength is 400 mg. This presents a potential problem of:
- a. Efficacy
- b. Pill burden and adherence
- c. Toxicity
- d. Bioavailability
Answer: b. Pill burden and adherence
48. The primary driver for an IV to PO conversion should always be:
- a. The patient’s clinical status and safety.
- b. The pharmacy’s budget.
- c. The nurse’s preference.
- d. The time of day.
Answer: a. The patient’s clinical status and safety.
49. An understanding of oral dosage forms is a key objective in the Drug Delivery Systems course.
- a. True
- b. False
Answer: a. True
50. The ultimate goal of an IV to PO conversion program is to:
- a. Eliminate the use of all IV medications in the hospital.
- b. Get patients on the most appropriate, safe, and cost-effective route of administration as soon as clinically feasible.
- c. Give pharmacists another task to complete during the day.
- d. Discharge patients before their infection is fully treated.
Answer: b. Get patients on the most appropriate, safe, and cost-effective route of administration as soon as clinically feasible.