Practice question from NAPLEX-style clinical question (5 choices) testing application-level pharmacy reasoning
A pharmacist receives a prescription for amoxicillin/clavulanate 875/125 mg BID for sinusitis in a patient with documented penicillin allergy (hives 10 years ago). The prescriber is unavailable. Which action best balances patient safety with antimicrobial stewardship? A. Dispense as written; hives from 10 years ago are unlikely to recur B. Substitute azithromycin 500 mg on day 1, then 250 mg daily × 4 days C. Substitute doxycycline 100 mg BID × 7 days D. Dispense with a concurrent prescription for an EpiPen E. Contact the prescriber or covering provider to discuss allergy history and alternatives
Answer
E
Explanation
A documented penicillin allergy with hives suggests IgE-mediated hypersensitivity, which carries risk for anaphylaxis with re-exposure. The pharmacist cannot independently substitute therapy without prescriber consultation, as the severity and certainty of the allergy must be clarified. Options B and C represent therapeutic substitution beyond scope. While many reported penicillin allergies are not true IgE-mediated reactions, the pharmacist must facilitate allergy verification or alternative therapy selection with the prescriber. Dispensing with an EpiPen does not address the underlying problem.