Home' Australian Pharmacist : Australian Pharmacist October 2014 Contents Australian Pharmacist October 2014 I ©Pharmaceutical Society of Australia Ltd.
CONTINUING PROFESSIONAL DEVELOPMENT
KNOWLEDGE IN PRACTICE
The challenge of applying what
you learn to pharmacy practice!
Knowledge in practice is designed to
be difficult and aims to make you apply
information from articles in this month’s
Australian Pharmacist and other suggested
reading to the questions below, just as you
would for a client/patient. This section is not
meant to be easy. There are no simple clear-
cut answers to the questions. The standard
references listed below may be of use when
answering the questions.
1. Sansom LN, ed. Australian pharmaceutical
formulary and handbook, 22nd edn. Canberra:
Pharmaceutical Society of Australia; 2012.
2. Rossi S, ed. Australian medicines handbook.
Adelaide: Australian Medicines Handbook; 2014.
3. National Prescribing Service. At: www.nps.org.au
4. Merck Manual of Diagnosis and Therapy [online].At:
5. Product information – available from various
sources, e.g. MIMS, APP Guide or online on
6. Royal College of Pathologists of Australasia. RCPA
Manual. At: www.rcpamanual.edu.au
7. Therapeutic Guidelines Series. eTG complete
[CDROM]. Melbourne: Therapeutic Guidelines Limited.
Knowledge in practice
TO ANSWER KNOWLEDGE IN
Answers for Knowledge in practice can only be
submitted online through the PSA members-only
area of the PSA website at: www.psa.org.au
PSA members will receive instant feedback on
the correct answers with an explanation of why
the answer is correct. If you do not have member
access details for the PSA website, you can request
them via a link from the login page.
Question 1. Azole drug
John (60 years old) is a regular customer.
He presents with a prescription for
Diflucan (fluconazole) 50 mg once daily
for four weeks. He is suffering from
extensive cutaneous candidiasis which
has not responded to topical azoles.
He has a history of epilepsy, angina,
hypertension, hypercholesterolaemia and
depression, and is currently stabilised on
the following medicines:
• Phenytoin 100 mg 3 times a day
• Glyceryl trinitrate 600 mcg when
• Metoprolol 50 mg twice daily
• Perindopril 5 mg daily
• Hydrochlorothiazide 25 mg daily
• Simvastatin 20 mg daily
• Citalopram 20 mg daily.
Which of the following is LEAST appropriate
to include in a discussion with John’s GP
regarding his antifungal therapy?
a) Citalopram and fluconazole can both
prolong the QT interval and increase the
risk of arrhythmia. Concomitant treatment
will increase the risk of QT prolongation.
John’s ECG should be monitored, and he
may require a temporary reduction in his
dose of citalopram.
b) Fluconazole may increase serum
phenytoin levels and risk of toxicity.
John’s serum phenytoin concentration
should be monitored and he should also
be monitored for signs and symptoms
of phenytoin toxicity. He may require
a temporary reduction in his dose of
c) Fluconazole may increase the serum
concentration of simvastatin, increasing
the risk of myopathy and rhabdomyolysis.
It may be prudent to consider switching
John to an alternative statin (e.g.
d) Hydrochlorothiazide-induced diuresis may
result in an increase in the renal clearance
of fluconazole, reducing its serum
concentration and efficacy. John may
require a higher dose of fluconazole.
Question 2. Treating bipolar
Vanessa (32 years old) has bipolar
disorder, for which she is taking
Quilonum SR (controlled release lithium
carbonate) 450 mg twice daily. She also
takes Microgynon 30 ED (levonorgestrel
150 mcg + ethinyloestradiol 30 mcg).
A week ago, Vanessa’s most recent serum
lithium level was 1.0 mmol/L. Four weeks
ago she developed mild depression
which is becoming progressively
Of the following treatment options,
which would be the MOST appropriate
therapy for Vanessa’s depression?
a) Increase the dose of Quilonum SR
(controlled release lithium carbonate)
to 900 mg in the morning and 450 mg
b) Add citalopram 20 mg daily to her
c) Temporarily cease the Quilonum SR
(controlled release lithium carbonate)
and commence fluoxetine 20 mg daily.
d) Add lamotrigine 25 mg daily to her
Through successful completion of this activity, the
learner will demonstrate their ability to:
• Use readily available information sources to
access and select relevant and up-to-date
clinical and practice based information
• Promote and contribute to the optimal use of
• Address primary healthcare needs of patients.
Competency standards (2010) addressed: 4.2, 6.1,
7.1, 7.2 .
Accreditation number: CAP141010F-G
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