OSCE P2 Oral Exam 2026

Maximum daily dose for non-prescription ibuprofen

1200 mg

Maximum daily dose for non-prescription acetaminophen

4000 mg

Maximum daily dose for non-prescription naproxen

660 mg

Pediatric dosing for ibuprofen

5-10 mg/kg/dose

Frequency of pediatric ibuprofen

every 6-8 hours

Maximum daily dose of pediatric ibuprofen

1200 mg OR 4 doses/day

Pediatric dosing for acetaminophen

10-15 mg/kg/dose

Frequency of pediatric acetaminophen

every 4-6 hours

Maximum daily dose of pediatric acetaminophen

2400 mg

Maximum daily dose of pediatric acetaminophen in neonates (<3 mo)

10-15 mg/kg/dose every 6-8 hours

Dextromethorphan indication

antitussive

Guaifenesin indication

expectorant

Pseudoephedrine indication

decongestant

Phenylephrine indication

decongestant

Diphenhydramine indication

1st generation antihistamine

Doxyalamine indication

1st generation antihistamine

Bulk forming for constipation MOA

absorbs water to soften stool

Examples of bulk forming medications for constipation

psyllium (MetaMucil)

methylcellulose (Citrucel)

(hyper) osmotic for constipation MOA

draws out water into the colon/r*ctum

Examples of (hyper) osmotic medications for constipation

PEG or polyethylene glycol (Miralax)

glycerin suppositories

lactulose

magnesium citrate

Stimulants for constipation MOA

stimulate intestine to secrete water

Examples of stimulant medications for constipation

senna (Senokot)

bisacodyl (Dulcolax)

Emollient/stool softener for constipation MOA

mix aqueous and fatty substances to soften stool

Example of emollient/stool softener for constipation

docusate (Colace)

Secretagogues for constipation MOA

increase intestinal fluid secretion and motility indirectly

Examples of secretagogues for constipation

lubiprostone (Amitiza)

linaclotide (Linzess)

plecanatide (Trulance)

Saline for constipation MOA

draws water into intestines to stimulate movement

Examples of saline for constipation

MOM

Fleet

Lubricant for constipation MOA

coats stool to prevent water absorption

Example of lubricant for constipation

mineral oil

Indication for all NRT

smoking cessation

helps reduces nicotine withdrawal symptoms

Dosing schedule for gum NRT

weeks 1-6: 1 piece every 1-2 hours

weeks 7-9: 1 piece every 2-4 hours

weeks 10-12: 1 piece every 4-8 hours

Doses available for gum NRT

2mg (if smoking >30 mins after waking)

4mg (if smoking <30 mins after waking)

Maximum daily dose for gum NRT

24 pieces/day

Counseling points for gum NRT

Chew and park technique

Avoid food/drinks 15 mins before and during use

Not recommended for TMJ

May experience flatulence, nausea, mouth irritation

Dosing schedule for lozenge NRT

weeks 1-6: 1 lozenge every 1-2 hours

weeks 7-9: 1 lozenge every 2-4 hours

weeks 10-12: 1 lozenge every 4-8 hours

Doses available for lozenge NRT

2mg (if smoking >30 mins after waking)

4mg (if smoking <30 mins after waking)

Maximum daily dose for lozenge NRT

20 lozenges/day

Counseling points for lozenge NRT

Let fully dissolve

Do not chew or swallow whole

Move lozenge around to different parts of the mouth

Do not eat/drink 15 mins before and during use

May experience flatulence, nausea, mouth irritation

Dosing schedule for patch NRT

If >10 cigs/day

• start 21 mg daily for 4-6 weeks

• then 14 mg daily for 2 weeks

• then 7 mg daily for 2 weeks

If <10 cigs/day

• start 14 mg daily for 6 weeks

• then 7 mg daily for 2 weeks

Doses available for patch NRT

7mg, 14mg, 21mg

Counseling points for patch NRT

Apply daily to the upper body (clean, dry, hairless)

Rotate application sites

Remove at bedtime if experiencing sleep disturbances or vivid dreams

Able to swim and bathe with patch on

Do not cut patch

Wash hands after applying

May experience skin irritation

Inactivated vaccines [generic (brand)]

influenza (Fluzone)

COVID-19 (SPIKEVAX)

hepatitis A (Havrix)

hepatitis B (Energix-B)

hep A/B (Twinrix)

HPV (Gardasil9)

pneumococcal (Prevnar 20)

RSV (Abrysvo)

Tdap (Boostrix)

Hib (ActHIB)

polio (Ipol)

MenACWY (MenQuadfi)

MenB (Trumenba)

Shingles (Shinrix)

Live vaccines [generic (brand)]

MMR (Priorix)

varicella (Varivax)

intranasal influenza

Yellow Fever (YF-Vax)

rotavirus (RotaTeq)

dengue

Mpox (Jynneos)

typhoid (Vivotif)

Iron Deficiency Anemia lab findings

ferritin <45 ng/mL

Tsat <20%

Low Hgb, Hct, HCHC, Fe

High TIBC

Iron Deficiency Anemia classification

Microcytic

MCV <80

Iron Deficiency Anemia treatment

ferrous sulfate 325 (65-200mg elemental iron)

• every other day OR MWF for 3-6 months

• 1 hour before meals

ferric gluconate (Ferrlecit) 125mg IV

• over 1 hour

dietary iron

• meat, fish, poultry

• vit C increases absorption

• milk, tea, antacids decrease absorption

blood transfusions

• Hb less than 7

• active bleeding/unstable hemodynamics

Megaloblastic Anemia classification

Macrocytic

MCV >100

Megaloblastic Anemia lab findings

vitamin B12 <200 pg/mL, with normal folate

OR

folate <4 mg/mL, with normal vitamin B12

Megaloblastic Anemia treatment

vitamin B12 deficiency: 1000-2000mcg once daily

• with neurological issues: IM/SQ 1000mcg once daily for 1 week, 1000mcg weekly for 2 weeks, then1000mcg monthly

folic acid deficiency: folic acid 1mg once daily for 4 months OR until underlying causes are corrected

• with absorption issues: IV/IM/SQ folic acid 1mg once daily for 4 months or until underlying causes are corrected

gastric bypass surgery: prevention for life

Anemia in CKD lab findings

CrCL <60 mL/min

Hb <13 in men; <12 in women

(CKD w HD) ferritin <500 and Tsat <30%

(CKD wo HD) ferritin <100 and Tsat <40% OR ferritin >100 and <300 w Tsat <25%

Anemia in CKD treatment

oral iron

• trial 1-3 months for pts not on dialysis

IV iron

• ferric gluconate: 125mg IV three times per week for 8 doses

ESA if HB <9.0-10.0

• CKD w HD

  • IV/SQ: 50-100 units/kg three times per week (IV preferred)

• CKD wo HD

  • IV/SQ: 50-100 units/kg once weekly

1st line treatments for Hepatic Encephalopathy

lactulose

• 20-30g (30-45mL) every 1-2 hours to induce ~2 soft stools/day

• reduce to 20-30g (30-45mL) every 2-4 times daily

• ensure about 2-3 soft stools/day

rifaximin

• 550mg for ppx

• 400mg for tx

Other treatments for Hepatic Encephalopathy

metronidazole (Flagyl): 250mg PO Q6-12h

neomycin: 1g PO TID

• rarely used due to severity of potential adverse effects like ototoxicity and nephrotoxicity

zinc: 600mg PO once daily

polyethylene glycol (similar to action of lactulose)

Examples of SSRIs [generic (brand)]

fluoxetine (Prozac)

sertraline (Zoloft)

escitalopram (Lexapro)

citalopram (Celexa)

paroxetine (Paxil)

Adverse effects of SSRIs

nausea, headache, diarrhea, insomnia, restlessness/nervousness, sexual dysfunction

Contraindications of SSRIs

MAOIs, concurrent linezolid, concurrent IV methylene blue

Black Box Warning for ALL antidepressants

increased suicidal thoughts and behaviors

Examples of SNRIs [generic (brand)]

duloxetine (Cymbalta)

venlafaxine (Effexor)

desvenlafaxine (Pristiq)

levomilnacipran (Fetzima)

milnacipran (Savella)

Adverse effects of SNRIs

nausea, dizziness, sweating, hypertension, orthostatic hypotension

Contraindications of SNRIs

MAOIs

Adverse effects of Bupropion (Wellbutrin)

anxiety, insomnia, nausea, restlessness, seizure risk

DDIs to Bupropion (Wellbutrin)

substrate of CYP2B6, potent CYP2D6 inhibitor

Contraindications of Bupropion (Wellbutrin)

seizures, eating disorder

Adverse effects of Mirtazapine (Remeron)

sedation, weight gain, dizziness, hyperlipidemia, leukopenia

Contraindications of Mirtazapine (Remeron)

MAOIs

MOA of 1st generation antipsychotics

D2 antagonist

Blocks dopamine receptor, reduces excess

Targets D2 receptor in mesolimbic pathway calming hyperdopaminergic activity to treat positive symptoms of schizophrenia

Examples of 1st generation antipsychotics [generic (brand)]

haloperidol (Haldol)

chlorpromazine

thiothixene (Navane)

fluphenazine

MOA of 2nd generation antipsychotics

D2 antagonist and 5HT2A serotonin receptor antagonist

Blocks both dopamine and serotonin, mostly serotonin

Examples of 2nd generation antipsychotics [generic (brand)]

aripiprazole (Abilify)

olanzapine (Zyprexa)

clozapine (Clozaril)

Medications used for AUD [generic (brand)]

naltrexone (Vivitrol)

gabapentin (Neurontin)

acamprosate (Camprol)

disulfiram (Antabuse)

Adverse effects of Naltrexone (Vivitrol)

N/V, anxiety/insomnia, headache, hepatotoxicity, depression/suicidal thoughts

Contraindications of Naltrexone (Vivitrol)

opioid use, withdrawal, positive screen, acute hepatitis, severe liver failure

• must be opioid free for 7-10 days

Adverse effects of Gabapentin (Neurontin)

sedation, fatigue, dizziness, ataxia

respiratory depression when taken along with opioids or CNS depressants

suicidal ideation

Contraindications of Gabapentin (Neurontin)

renal dose adjustment needed, caution in elderly patients, respiratory disease, concurrent opioid/benzo use