Medication Use Evaluation Practice Test

A health-system pharmacy and therapeutics (P&T) committee implements a formulary restriction removing esomeprazole; a 45-year-old female (weight 70 kg) with GERD and erosive esophagitis has been stable on esomeprazole 40 mg PO daily for 8 months with full adherence and no alarm symptoms. Current labs: SCr 0.8 mg/dL (0.6–1.3), AST 22 U/L (10–40), ALT 24 U/L (7–56); therapeutic goal is continued symptom control with an equivalent formulary agent. Which medication change is most appropriate to improve therapeutic outcomes?

A transitions-of-care pharmacist conducts medication reconciliation for a 64-year-old male (weight 90 kg) discharged after a transient ischemic attack (TIA). Pre-admission meds: aspirin 81 mg PO daily (adherent), simvastatin 20 mg PO nightly (adherent), omeprazole 20 mg PO daily (adherent). Discharge prescriptions include clopidogrel 75 mg PO daily and atorvastatin 80 mg PO daily; the patient states he will “keep taking everything I already have at home,” including simvastatin and aspirin. Labs: AST 26 U/L (10–40), ALT 30 U/L (7–56), SCr 1.1 mg/dL (0.6–1.3). Which medication change is most appropriate to improve therapeutic outcomes?