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1. JW is a 29-year-old woman who is morbidly obese at 5 feet, 4 inches, and 136 kg. She has type 2 diabetes with hypertension controlled by medications. Her current medications include: glipizide 10 mg orally twice daily, metformin 1 g orally once daily, valsartan 160 mg orally once daily, hydrochlorothiazide 25 mg orally once daily, triphasic hormonal contraceptive product 1 tablet orally once daily, and for arthritic pain, ibuprofen 400 mg orally four times daily. She does not take any nutritional supplements. She states that she is “addicted to sweets” and has a problem with portion control. Considering all of JW's medical conditions, which of the following pharmacologic agents is the best choice for JW to use in a weight-reduction effort?

A. Liraglutide B. Phentermine C. Bupropion/naloxone D. Orlistat

2. JW attempts weight loss without success. She has a consultation with a bariatric surgeon. Which of the following surgical options is the surgeon likely to recommend for JW?

A. Gastroplasty B. Vertical sleeve gastrectomy C. Roux-en-Y gastric bypass D. Gastric balloon.

3. JW is scheduled to undergo bariatric surgery in 4 weeks. Which of these agents needs to be discontinued immediately?

A. Ibuprofen B. Oral contraceptive C. Hydrochlorothiazide D. Flaxseed oil

4. In addition to JW's not taking any nutritional supplements, which of the following medications may be contributing to her poor nutritional status?

A. Oral contraceptives B. Hydrochlorothiazide C. Ibuprofen D. All of the above

5. After surgery, JW is started on all of the required nutritional supplements, lansoprazole 30 mg orally twice daily, oxycodone oral solution 5–10 mg orally every 4 to 6 hours as needed for pain, and ondansetron orally disintegrating tablets 4 mg sublingually every 6 hours for nausea. Her glipizide and valsartan doses were reduced by 50%. The hydrochlorothiazide was discontinued to decrease the risk of which of the following?

A. Increased potassium levels B. Possible rapid weight loss C. Dehydration D. Drug-induced nutritional depletion

6. Two months after the surgery, JW complains to her pharmacist of dizziness upon exercising or quickly standing up. Both her glucose levels and blood pressure readings are consistently low. The recommendation would be to

A. Consider discontinuing glipizide and valsartan B. Reduce physical activity C. Increase salt in the diet D. Increase fluid intake

7. JW is doing well with her weight loss, but she is having trouble tolerating her protein supplement. She is using a whey-based protein shake. This sensitivity eliminates use of which of the following protein sources?

A. Peas B. Soy C. Nuts D. Milk

8. Compared with animal-based proteins, plant-based proteins are usually

A. Complete B. Incomplete C. Easier to digest D. All of the above

9. One year after the surgery, JW presents a prescription at the pharmacy for azithromycin for outpatient treatment of community-acquired pneumonia. Knowing that JW had bariatric surgery, the pharmacist should take which of the following actions?

A. Dispense the prescription for the azithromycin as written. B. Recommend to the prescribing physician an increase in the dose of azithromycin. C. Recommend to the prescribing physician changing azithromycin to doxycycline or clarithromycin. D. Recommend to the prescribing physician use of inpatient parenteral therapy during the azithromycin course.

10. Two years after the surgery, JW develops iron-deficiency anemia. She states that she is taking a multivitamin with 15 mg iron and takes all of her supplements (multivitamins with iron and ascorbic acid first thing in the morning and calcium at lunch) as instructed. She does not understand why her iron levels are low. Which of the following actions is most appropriate for the pharmacist to take?

A. Contact her prescriber about increasing the iron dose B. Contact her prescriber about lowering the iron dose C. Advise JW to separate the iron and ascorbic acid doses by at least 3 hours D. Advise JW to take a calcium dose with multivitamin/iron