Practice Test 7

A 64-year-old woman (weight 68 kg) presents with new onset muscle aches and weakness 2 weeks after starting simvastatin. She reports dark urine; she previously tolerated pravastatin but it is not on her current plan’s preferred list. Current medications: simvastatin 40 mg by mouth nightly, metformin extended-release 1000 mg by mouth once daily, amlodipine 10 mg by mouth once daily; allergy: none. Labs: creatine kinase 980 U/L (30–170), alanine aminotransferase 32 U/L (7–56), serum creatinine 0.9 mg/dL (0.6–1.3). The plan prefers rosuvastatin or atorvastatin. Which therapeutic alternative is most appropriate for this patient?

A 52-year-old man (weight 86 kg) with type 2 diabetes requests a lower-cost basal insulin option. He has been using insulin glargine (Lantus) 30 units subcutaneously nightly with good control; his plan now prefers a lower-cost insulin glargine biosimilar. Current medications: insulin glargine 30 units nightly, metformin 1000 mg by mouth twice daily, lisinopril 20 mg by mouth once daily; allergies: none. Labs: fasting glucose 118 mg/dL (70–99), hemoglobin A1c 7.1% (goal <7% individualized), serum creatinine 1.1 mg/dL (0.6–1.3). Which biosimilar is equivalent for this patient?