CMCaP Prep Course (CMCaP): free quiz

1. Question 1 of 10A patient taking cannabidiol oral solution 5 mg/kg/day by mouth divided twice daily asks how the endocannabinoid system differs from the cannabis product. As the pharmacist reviewing therapy and interaction risks, which explanation is most accurate?
   Choose one answer

   AAnandamide is mainly hydrolyzed by FAAH, 2-AG is mainly hydrolyzed by MAGL, and CB1 and CB2 are principal cannabinoid receptors.BAnandamide and 2-AG are inactive precursors activated by FAAH and MAGL; carbamazepine inhibits cannabidiol metabolism, so reduce cannabidiol.CAnandamide is mainly hydrolyzed by MAGL and 2-AG by FAAH; mild liver abnormalities require no cannabidiol follow-up.DTHC and cannabidiol are the principal endocannabinoids degraded by FAAH, so concomitant valproate requires increasing cannabidiol.
2. Question 2 of 10

   In a pharmacist-run medication review, a fictional adult uses cannabidiol oral solution 10 mg/kg/day PO divided BID for seizures, clobazam 10 mg PO BID, and warfarin 5 mg PO daily. They plan to add a dispensary product labeled THC 2.5 mg/CBD 25 mg PO nightly for sleep. Which pharmacist recommendation best applies THC/CBD pharmacology and interaction risk?

   Choose one answer

   A

   Clarify with the prescriber before use; CBD may increase clobazam-related sedation and affect warfarin exposure, while THC adds CB1-mediated intoxication risk.

   B

   Advise doubling the prescribed CBD dose to reduce the need for THC and improve sleep while continuing the same clobazam and warfarin monitoring.

   C

   Approve the add-on product because CBD is nonintoxicating and has minimal clinically relevant CYP-mediated interaction potential.

   D

   Recommend replacing prescribed CBD with THC 2.5 mg PO nightly because THC has stronger central effects and avoids clobazam interaction concerns.

3. Question 3 of 10

   As the medical cannabis pharmacist, you review a patient using full-spectrum hemp CBD oil 25 mg by mouth twice daily for neuropathic pain. The patient also takes warfarin 5 mg by mouth daily and asks whether the product is safe before an employer urine drug test. Which counseling recommendation is most appropriate?

   Choose one answer

   A

   Switch to dronabinol 2.5 mg by mouth twice daily because pharmaceutical THC is more predictable and less likely to cause a positive THC test.

   B

   Switch to CBD isolate and increase to 50 mg by mouth twice daily because isolate products require double the dose to replace full-spectrum “entourage” effects.

   C

   Clarify with the prescriber, review a current certificate of analysis, and counsel that broad-spectrum or isolate products may reduce but not eliminate THC-testing concerns; monitor INR and sedation after any cannabinoid change.

   D

   Continue the full-spectrum CBD oil at the same dose because a hemp label means the product is THC-free and pharmacologically predictable.

4. Question 4 of 10

   A 58-year-old patient uses THC 2.5 mg/CBD 2.5 mg oral capsules by mouth every evening for neuropathic pain. The patient asks the pharmacist about breakthrough symptoms at midafternoon and is also taking clarithromycin 500 mg by mouth twice daily for 7 days. The prescriber’s cannabis certification is active, but route changes require clinician approval. Which recommendation is most appropriate for the pharmacist to discuss?

   Choose one answer

   ARecommend taking one extra THC 2.5 mg/CBD 2.5 mg oral capsule every 30 minutes as needed until relief occurs.BRecommend switching to THC 5 mg/CBD 5 mg oral gummies every 6 hours as needed while completing clarithromycin.CDiscuss with the certifying clinician whether a low-dose vaporized THC/CBD product may be used as needed for breakthrough symptoms, with impairment precautions.DRecommend THC 2.5 mg/CBD 2.5 mg oromucosal tincture every 5 minutes up to four doses for breakthrough symptoms.
5. Question 5 of 10

   As the medical cannabis pharmacist, you review cannabidiol oral solution 5 mg/kg by mouth twice daily for a fictional adult with seizure disorder. Current medications include clobazam 10 mg by mouth twice daily. The chart shows CYP2C19 poor-metabolizer status. Which recommendation best uses the pharmacogenomic result within pharmacist scope?

   Choose one answer

   AStart cannabidiol only after communicating with the prescriber about increased sedation risk, possible clobazam dose reduction, and close monitoring.BEscalate cannabidiol immediately to 10 mg/kg twice daily because the genotype confirms inadequate exposure at the ordered dose.CStart cannabidiol as ordered and recommend increasing clobazam to 20 mg twice daily because poor CYP2C19 metabolism reduces clobazam activity.DReduce cannabidiol to 2.5 mg/kg once daily solely because CYP2C19 poor-metabolizer status predicts cannabidiol accumulation.
6. Question 6 of 10

   A medical cannabis clinic pharmacist reviews a patient taking warfarin 5 mg by mouth nightly with stable INR 2.4 and clobazam 10 mg by mouth twice daily. The patient asks to start cannabidiol (CBD) oil 25 mg by mouth twice daily for chronic neuropathic pain. Which pharmacist recommendation best manages the CYP-mediated interaction risk?

   Choose one answer

   A

   Recommend switching to inhaled THC 5 mg every 6 hours because inhalation avoids clinically meaningful CYP interactions.

   B

   Clarify with the prescribers before initiation; if used, start CBD at the lowest feasible dose, titrate slowly, check INR early and frequently, and monitor for clobazam-related sedation.

   C

   Start CBD 25 mg twice daily and empirically reduce warfarin by 50% before the next INR check.

   D

   Start CBD 25 mg twice daily and continue routine monthly INR monitoring because CBD is nonintoxicating.

7. Question 7 of 10

   A pharmacist reviews Mina L., a 58-year-old with painful diabetic neuropathy taking pregabalin 150 mg PO twice daily, duloxetine 60 mg PO daily, and warfarin 5 mg PO daily. A clinician asks whether to add medical cannabis oil labeled THC 2.5 mg/CBD 2.5 mg per mL, PO nightly, for pain. Which pharmacist recommendation best reflects evidence appraisal and safety?

   Choose one answer

   ARecommend THC 10 mg PO three times daily and taper pregabalin after 1 week because cannabinoids modify neuropathy progression.BRecommend the same THC/CBD regimen for diabetic neuropathy and knee osteoarthritis because all nociceptive and neuropathic pain syndromes respond similarly.CRecommend clarifying goals with the prescriber, using the lowest feasible THC-containing oral dose as an adjunct, and monitoring pain, function, sedation, falls, and INR.DRecommend CBD 25 mg PO twice daily without extra INR monitoring because CBD has no clinically relevant interaction with warfarin.
8. Question 8 of 10

   A patient with Lennox-Gastaut syndrome is prescribed cannabidiol oral solution 100 mg/mL at 2.5 mg/kg by mouth twice daily. Current antiseizure therapy includes clobazam 10 mg by mouth twice daily and valproate 500 mg by mouth twice daily. As the pharmacist reviewing the order before dispensing, which recommendation best supports safe, evidence-based use?

   Choose one answer

   ADispense the approved cannabidiol product after confirming the neurology plan, counsel about somnolence with clobazam, and arrange baseline and follow-up liver-function monitoring with valproate.BIncrease cannabidiol immediately to 10 mg/kg by mouth twice daily and monitor only for breakthrough seizures because clobazam lowers cannabidiol exposure.CHold cannabidiol until valproate has been discontinued for 2 weeks because concurrent valproate is an absolute contraindication.DSubstitute an over-the-counter hemp-derived CBD oil at 25 mg by mouth twice daily and document patient preference for a lower-cost product.
9. Question 9 of 10

   As the pharmacist reviewing a medical cannabis follow-up, a 38-year-old with PTSD-related insomnia reports using THC/CBD oral solution 2.5 mg/2.5 mg by mouth nightly for 1 week. Current medications include sertraline 100 mg by mouth daily, prazosin 2 mg by mouth nightly, and clonazepam 0.5 mg by mouth at bedtime as needed. The patient says sleep improved for 3 nights and asks to increase to THC 10 mg nightly. Which pharmacist recommendation is most appropriate?

   Choose one answer

   AStop sertraline and use nightly THC/CBD as the primary PTSD sleep treatment after documenting the patient-reported benefit.BContinue the current dose, counsel that evidence for PTSD and anxiety sleep outcomes is uncertain, avoid concurrent clonazepam or alcohol, and monitor next-day cognition, dizziness, and falls.CIncrease to THC 10 mg/CBD 10 mg nightly now because early sleep response predicts durable PTSD benefit.DSwitch to inhaled THC before bedtime because faster onset reduces interaction risk with clonazepam and prazosin.
10. Question 10 of 10

    A pharmacist reviews evidence for a patient taking warfarin 5 mg orally nightly who asks about a 4-week randomized trial of THC 2.5 mg/CBD 2.5 mg oromucosal spray, 1 spray every 6 hours as needed for neuropathic pain. The trial used an active placebo causing dry mouth but no euphoria; pain was self-reported, sample size was 36, and INR was checked weekly. Which appraisal best identifies the main internal-validity threat?

    Choose one answer

    APrefer oral cannabidiol solution 10 mg/kg/day divided twice daily as the comparator because liver-enzyme monitoring would control CYP interaction risk.BReject the efficacy finding solely because 4 weeks is too short; recommend studying THC/CBD spray 1 spray nightly for 12 weeks instead.CDowngrade confidence because THC psychoactive effects may reveal allocation despite the placebo, biasing subjective pain outcomes.DAccept the trial as high certainty because weekly INR monitoring controls the warfarin interaction and the active placebo matched an adverse effect.

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